Physician perspectives: Dr Mike Thompson
Our latest physician to share his or her perspectives on how pharma can better engage with physicians and the effects of social media and e-patients is Dr Mike Thompson.
Dr Thompson has an extensive background in hematology and oncology, and is most passionate about clinical trials. We find out his thoughts on the fact that adult cancer trials only have an accrual rate of between 2-7%, compared to more than 60% in children cancer clinical trials. Dr Thompson shares his thoughts on how this issue can best be overcome.
We also speak to Dr Thompson about the rise in social media and find out how much this has affected his way of working as a physician in the United States. Read the full interview summary below to see what he says…
HB: Hello Dr Thompson thanks for speaking with me today. Please can you tell us a bit about your medical background?
MT: I am a hematologist / oncologist in Waukesha, Wisconsin. I have a background in molecular biology, pharmacogenetics, hematologic cancer, and clinical trials. After completing my Hematology / Oncology fellowship training at the University of Texas M. D. Anderson Cancer Center, I moved back to the Midwest. I have served as the Medical Director of Cancer Research at my institution and been involved with the NCI Community Cancer Centers Program (NCCCP) Clinical Trials committees including the Early Phase Working Group. More recently I have developed an interest in health IT and have served on the American Society of Clinical Oncology (ASCO) Integrated Media / Technology (IMT) / Education Committee. I am active in social media and have worked with groups such as Doximity, HealthTap, and Best Doctors on the use of patient and physician social networks.
“…only 2-7% of adult cancer patients participate in clinical trials.”
HB: Your LinkedIn profile states that you are passionate about clinical trials and that only 2-7% adults take part in cancer clinical trials. How important is it to raise further awareness and education of clinical trials in order to increase patient participation?
MT: According to a study from Robin Zon, MD and colleagues published in 2008 (with references from 1990-1999) only 2-7% of adult cancer patients participate in clinical trials1. At the National Comprehensive Cancer Network (NCCN) sites (n=17), clinical trial accrual is 10-24% (to therapeutic trials)2. For community sites, the American College of Surgeons Commission on Cancer (COC) “exemplary” accrual has been 8%3. A 2015 goal (see p.57) is an accrual level of 2-4% for minimum requirements and 6-8% for “commendation”4. A recent analysis of a large CCOP database showed that only about 1/3 of clinical trial accruals in that group were to new therapeutic drugs. So, at many centers only 1/3 of 3% equals 1% of adults are enrolled on early drug trials. In other words, 99% of adult cancer patients are not on studies to test new drugs to potentially help them as individuals or contribute to generalizable oncology knowledge to help all of society. This leads to slow drug development, increased drug costs and unneeded barriers to improving clinical care. This compares with accrual rates of ~60% in pediatric oncology5. As a society, we have decided that the current standard of care is not good enough for our kids with cancer. This hasn’t been true for adults for a variety of reasons.
It is of critical importance to discuss these issues and engage and educate physicians, pharma, and the public. According to HINTS (Health Information Trends Survey, hints.cancer.gov), 34% of Americans have not heard of a clinical trial. The National Cancer Institute Myeloma Steering Committee Accrual Working Group (NCI-MYSC AWG) identified 10 barriers to accrual for NCI sponsored multiple myeloma clinical trials, which is likely generalizable to other cancer types6. One barrier was education, which that group suggested could be overcome by multiple means including educating patients and providers about the significance of new clinical trials using social media. The NCI has multiple twitter feeds (@NCIBulletin, @NCITrialsatNIH, @theNCI, etc), as do some of the clinical trial cooperative groups (@ALLIANCE_org, @SWOG). These and other social media mechanisms may help with one accrual barrier.
“…34% of Americans have not heard of a clinical trial.”
HB: What do you think about the AllTrials data transparency campaign and the news that pharma companies such as GSK and regulatory bodies such as UK’s NICE are getting involved?
MT: The AllTrials concept includes registering clinical trials (eg, at ClinicalTrials.gov), reporting the results even if negative (difficult historically to accomplish and without much academic benefit, but improving), and providing methodology is commendable. I’m not sure how feasible doing that retrospectively will be. Certainly the clinical trial landscape is changing in many ways for pharma, but also for patients, institutions, and the government. Interestingly, Sir Ian Chalmers brought this concept up in JAMA in “Underreporting research is scientific misconduct” in 1990. Social and institutional changes can take a while. While hearing more about reporting negative studies, I saw a new Open Access, peer-reviewed, online journal (PeerJ) that accepts negative studies that are methodologically sound and I have now joined the editorial board.
HB: As a regular tweeter, how do you think social media has changed the engagement between patients, pharma and physician over the recent years?
MT: I think patients are more engaged. The e-patient has emerged and is far more willing to find information independent of his or her physician7. I am not sure that social media has done much to change pharma-physician interactions really. Most pharma is only slowly getting into social media. Many are afraid. Some have done it poorly – such as blatant advertising at ASCO annual meetings for instance. Some pharma have figured out that dedicating time and energy to social media teams and providing useful information as a collaborative member of social media networks is a valuable resource allocation.
HB: Has social media changed your way of working as a physician?
MT: Clinically, I often find information faster than my colleagues by using social media. This is useful when patients see a news headline. I usually know about a new research finding days to weeks before it comes out in the general media. I greatly enjoy continuing medical education (CME) at national meetings and at didactic courses, but the informal daily doses of small feedings of CME via social media supply my appetite for new knowledge.
“I am not sure that social media has done much to change pharma-physician interactions really.”
Academically, I have gained greatly by networking with collaborators using social media. This has resulted in invitations to give presentations, publish, develop projects, and of course be interviewed by pharmaphorum.
HB: In what ways do you think that pharma could better engage with physicians?
MT: We live in a post “detail person” world. Data is ubiquitous, but experience and wisdom is less common and highly valuable. I don’t need someone to recite the product insert on a new drug. However, I can benefit from hearing from the people that used the drug in studies and have real world experience beyond the long legalistic label. Moving beyond “selling” drugs to collaborating in knowledge delivery and providing authentic contextualization of therapy can help people connect. Physicians can help pharma determine the clinical need for future drugs and help save wasted resources by critiquing proposed clinical trials. This is currently done in advisory panels, but there is potential to ask questions by micro-crowd sourcing to groups of physicians, patients, and patient advocates to potentially accomplish the same goals. However, given time limitations this depends on participant willingness and possible regulatory and institutional disinterest in promoting such collaborations. While some thought leaders are involved in social media, many don’t see the utility. I think this is changing over time.
HB: And finally, what do you believe the future holds for pharma, in terms of social media and data transparency?
MT: I recently saw this tweet:
“Good goal. MT @ASCO: This year’s #ASCO13 Annual Meeting theme is “Building Bridges to Conquer Cancer.” ow.ly/hWLUK via @genentech”
ASCO President Dr. Swaim’s use of “Building Bridges to Conquer Cancer” is an apt rallying theme for a number of reasons – translational research to clinical care, bridging the global oncology community, bridging values, etc8. It may not have been intended for pharma and public / physician interaction, but it could be. We have set up and perpetuated silos between physicians and pharma. We need basic science research, translational research, and clinical trials with new drugs supplied by pharma and then developed and distributed by pharma. Building bridges with social media, collaboration, and data transparency should aim for the ultimate goal of improving patient care.
1. JCO link – http://jco.ascopubs.org/content/26/15/2562.full.pdf+html
6. ASH 2012 Abstract 3165 https://ash.confex.com/ash/2012/webprogram/Paper49565.html
7. ASCO Connection – “Participatory Medicine in Oncology” http://connection.asco.org/Commentary/Article/id/3062/Participatory-Medicine-in-Oncology.aspx
About the interviewee:
Michael A. Thompson, MD, PhD is a haematologist / oncologist at ProHealth Care in Waukesha, Wisconsin.
Dr Thompson received his Bachelor of Science (BS) degree in Molecular Biology from the University of Wisconsin – Madison, his Medical Degree (MD) from Mayo Medical School, Rochester, MN, and PhD in Molecular Pharmacology and Experimental Therapeutics from the Mayo Graduate School. He completed his Internal Medicine Residency at the Mayo Clinic College of Medicine. He obtained his Hematology / Oncology Fellowship training at the University of Texas M. D. Anderson Cancer Center in Houston, TX. He is board certified in Internal Medicine, Medical Oncology, and Hematology.
He currently serves on the ASCO Integrated Media / Technology / Education Committee and is in the ASCO Leadership Development Program. He is active in social media with national presentations and publications on the topic of the use of social media in oncology. He has advised groups such as Doximity, HealthTap, and Best Doctors on the use of patient and physician social networks.
Dr Thompson has studied and published in the area of hematologic malignancies – myeloma, lymphoma, leukemia, and other cancers. He has a strong interest in clinical research in hematologic cancers as well as in new drug development and early phase clinical trials in a variety of other tumor types.
How can cancer clinical trial recruitment improve?