Think Tank Extra With KOL Roundtable Exclusive Online Content

In addition to reaching out to manufacturers and agencies for our Think Tank, we asked three Key Opinion Leaders in different therapeutic areas to weigh in on the changes that loom for KOL and industry collaborations.

SHAIVAL KAPADIA MD, FACS,:  is the Co-Director at Bon Secours Heart and Vascular Institute. As a cardiovascular specialist, his role as a KOL has included broadening lipid management discussions and advancing heart failure therapies.

SELENE G. PAREKH MD, MBA,:  is an Associate Professor at Duke University, Department of Orthopedic Surgery. He has been intimately involved with the product development for minimally invasive surgery, novel technologies using amniotic tissue and juvenile tissue to address certain orthopedic issues, and the refinement of hardware, plates, and screws used for ankle replacements.

JAI G. PAREKH MD, MBA, FAAO,:  is a managing partner at Brar-Parekh Eye Associates, NJ, and Chief of Cornea & External Diseases & Medical Director of the Research Institute at St. Joseph’s HealthCare System, NJ. He is also a Clinical Associate Professor of Ophthalmology on the Cornea Service at the New York Eye & Ear Infirmary, NY.

PM360: Is there any way pharma could better utilize KOLs?

Dr. Selene Parekh: KOLs are being underutilized and kept at arm’s length to the detriment of the orthopedic industry in the U.S. They do interact, but it’s in a highly-regulated manner, and I think you will see industry and orthopedics lose focus. Innovation will decrease to the disadvantage of the patients, because KOLs are just not involved often enough.
Dr. Jai Parekh: Well, marketing is one way. How you bring the drug to market is another. It’s really about education, marketing, helping them get the message out to their sales force—what doctors want to hear. There’s a big disconnect right now between sales reps and doctors. And if a rep is going to come in for five minutes, it’s got to be a very quantifiable and a very high impact interface. I’ve been asked by numerous entities within the industry to help shape that conversation. What makes an effective conversation? Where is our best ROI? Should we invest in this indication? Questions like that have come up a lot more in the last four or five years because the money is now dried up and the overhead management is so important.

PM360: How have the increased restrictions from the Sunshine Act, your own institution’s policies towards interactions and other issues changed the KOL relationship?

Dr. Shaival Kapadia: When I would give lectures 10 years ago, you didn’t have to speak strictly from the slide deck. You could ad lib a bit. Now it’s really propaganda—it’s really unsatisfying. The pendulum has swung so far the other way that the message that’s out there really is of little benefit to the recipient physicians. I think if KOLs can come in a lot sooner and help massage the message it would be far more beneficial. Let’s put it this way: Right now, the value add of what pharma is doing has limited effectiveness because I think people get turned off. There has to be a paradigm shift, and the pendulum needs to swing somewhat center again.
Dr. Selene: Well, the Sunshine Act has hit orthopedics very hard and, again, I think it’s been to the detriment of the involvement of surgeons. I’d hate to see this kind of regulation end up being rolled out to the other subspecialties of medicine, and it’s heading that way. I think the quality of care of medicine will decline over the ensuing decades if things don’t change.
Dr. Jai: I think it’s actually getting better. People are much more forthright with what they’re doing and what their agreements are. In ophthalmology, at all the meetings that first slide will say, “I’m a researcher, consultant, or speaker for the following list of companies.” Anything that’s about fair and balanced and transparency, I’m all for.

PM360: How is online technology helping to shape or change the KOL relationship?

Dr. Shaival: The concept of a virtual advisory board is great, and getting involved in development, marketing, and branding way earlier is going to be important. Exactly what kind of media would be the most optimal, I’m not sure. I think that’s going to evolve over time.
Dr. Selene: We haven’t really figured out how to use the online presence yet, and we don’t have the perfect platform to deliver virtual advisory boards or webinars as effectively as we can. Right now, I’m seeing webinars being used more for marketing activities and not necessarily as education. As the academic societies jump on board and start doing more webinars, you’ll start seeing more and newer educational content being delivered. Obviously, the online vehicle will be the way to do that, but I just don’t think we’re there yet.
Dr. Jai: At ophthalmology companies, I have seen an immense growth in webinars and virtual advisory boards over the last two years, and they’re being done very well because the technology’s gotten much better. And as long as the lawyers and regulations allow it, I definitely foresee more podcasting.

PM360: You already touched on how the industry relationship has changed in the last few years. Do you anticipate it changing even more in the future?

Dr. Selene: More physicians will have an online presence and I’m not just talking about having a static website for your office. I’m talking about having an interactive place where patients can message board, and you can interact with patients globally.
Over the next decade you’re going to start seeing more branding of individual physicians. KOLs will do something very unique by going direct-to-consumer, and they’re going to start marketing their uniqueness, their skill set, their outcomes, their expertise, and patients are then going to follow those physicians to get those procedures done. That’s going to change the way people view KOLs.
Dr. Shaival: The landscape that is coming is the concept of a virtual medical community and network between physicians, not only in a peer-to-peer way but also in a physician/patient relationship. It will be some sort of social media type of thing, where this branding concept that Selene mentioned could really take off. And pharma could really have a role in that space by offering detailing, both in a direct-to- consumer and also to the physician.
I also wonder if there’s a role for pharma, although this is probably fairly iffy because of HIPAA and privacy issues, where medications are prescribed in an electronic medical record environment. You could have pop-ups and links that would be educational from a physician standpoint in terms of appropriateness of a medication for a specific condition, or contraindications or other considerations.
Dr. Jai: I have a feeling there’s going to be more KOLs out there. I’m seeing more and more companies these days really having more focus groups, more KOLs, and now the average KOL, instead of doing 100 hours of KOL work a year may be only doing 25 hours a year. So then it becomes much more transparent and better for the industry, because now they’re getting the opinion of many doctors versus only one or two.
The only problems you get into is if it’s like Lipitor and Crestor; they’re in the same drug class but they’re two opposing camps, two different companies. That would be the only source of cynicism for the consumer and/or the colleagues out there when KOLs speak for both companies.
Dr. Shaival: The way to get around that is to really focus on disease management rather than product-specific. And if you really focus on disease management, then your messaging becomes that much more credible.
Dr. Selene: But I’ll tell you, for orthopedics and other specialties, I think there’s going to be a challenge to do that, because disease management may not necessarily fit very well as a paradigm for those subspecialties. I think it becomes hard for the KOL to be specific towards one technique or technology, but then also be focused and fair and balanced. So I think there are challenges for KOLs as we move towards disease management. However, if you can maintain being fair and balanced while potentially having some strong opinions, I think that’s fine.

KOL Roundtable Exclusive Online Content

PM360: Have any of you ever been approached by a pharma company to help develop marketing materials?

Dr. Jai: I have been approached, within the last 18 months, to help with marketing for a couple different disease entities sponsored by well-known and emerging companies in ophthalmology; it’s a lot of fun, because there is significant hubris, yet challenges, in marketing where it is traditionally believed that if the consumer will get it, the doctors will get it. However, it doesn’t always work that way and sometimes you need to infuse some emotional and practical intelligence into marketing pieces. For instance, as physicians we have a lot to offer based on what we’ve seen or heard when we go to meetings or take care of our patients. Lately, I’m seeing more and more participation on our side in marketing campaigns as well as sales campaigns. This includes offering help on what to focus on, how to handle “off-label” indications and generally how to get the message out there.

PM360: As KOLs, what do you want to get out of these collaborations with pharma?  

Dr. Shaival: The platform of information delivery for pharma is changing dramatically because of the access issues in offices. So, in terms of delivering information to physicians and the community we have to think outside the box. This includes looking at more focus groups, webinars and different media to deliver information (such as eDetailing). But I think the face-to-face—particularly in the office setting, the lunch setting, and the dinner programs—are fast dwindling.

I also worry about safety issues and appropriateness issues. So for me, the most attractable aspect of working with pharma are the opportunities to really counsel primary care and cardiology physicians in the appropriate patient profiles, when to prescribe the drugs, when not to, what are the pitfalls, etc.

Dr. Selene: It’s a little bit different with the heavy device hardware fields. For me, the opportunity to be a KOL is more from the perspective that the process from the initial concept to the product being available on the market is much shorter with devices than it is with pharma. This gives surgeons the opportunity to think outside the box, implement ideas, and create products that can quickly become game-changers in the operating room or in the care of patients. That’s a huge satisfaction, to be able to see an idea come to fruition through the partnership with industry.

Dr. Jai: Well, first of all, medicine is fun. Whether I’m going to get remunerated $500 an hour or $1.50 an hour, at this stage of my life, I rarely say no to a consulting situation in my specialty because it’s allowing me the ability to enjoy my profession in a different way. I like to be in the forefront and helping dictate the delivery of healthcare in a macro-fashion. Otherwise, the monotony of taking care of the same kind of patient with dry eye, glaucoma and cataracts can be quite boring. So this affords me the ability to do that.

A lot of my colleagues, right now, are leaving full-time academic medicine and are moving over into the private sector side with an academic affiliation; the academic institutions are clamping down tremendously on participation by their physicians as KOLs with different companies. We all want to be a part of innovation, and academics aside, it keeps you at the frontier of new medicines and technology.

PM360: How do companies build long-lasting relationships with KOLs?

Dr. Shaival: A lot of it depends on the product, but it also depends on the person that’s developing that relationship, and that’s a unique skill set. In order to partner with a physician (and their busy schedule) the pharma or device rep needs to understand the fund of knowledge of that physician, where they’re coming from, and really partner with him at the right level. Far too often I see reps detailing at a very fundamental, basic level that is fairly insulting.

Dr. Selene: First off, now there’s an opportunity to partner with multiple companies. (And it makes you more valuable of a KOL when you’re partnering with multiple companies.) However, the question is: How do you decide on what companies to work with? Sometimes those relationships evolve from the surgeon approaching different companies that have technologies that are aligned with some ideas he/she may have or other (less frequent) times it is the company that approaches you because of your reputation.

Dr. Shaival: I would just like to add that pharma’s goal is to have physicians write more prescriptions, which is understandable. My role as a KOL, however, is to guide a more customized tailored approach to disease management rather than “one size fits all.” Personalized medicine is around the corner with the advances in pharmacogenomics. This approach offers a far greater opportunity to impact care and outcomes while minimizing adverse effects.


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