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Eye to eye

Battles between marketing and R&D departments could be a thing of the past if `medical marketers' take the middle ground

The discovery, development and distribution of medical agents used to treat, cure or prevent diseases are, by and large, undertaken by for-profit organisations. The revenues generated from the sales of those agents provide incentives to the developers to invest in further research for new medicines.

In this model, research and development (R&D) and marketing emerge as two of the most crucial functions to ensure that the cycle runs smoothly. Why is it, then, that in the pharmaceutical industry these two functions have such a difficult time interacting and understanding each other?

The typical R&D employee usually has a markedly different background from their counterpart in marketing, so what is fascinating to one is often of superficial interest to the other. Their worlds are sharply disconnected, not just because of differing interest, and the specialist jargon that makes the language of one incomprehensible to the other, but also because of organisational issues. All of these factors can serve to elicit silo mentalities and self-fulfilling prejudices about each respective function.

This scenario can lead to R&D losing sight of market needs and concentrating on researching and developing compounds that, while scientifically fascinating, nobody wants. In turn, marketers can lose sight of the need to understand the science behind the compounds, focusing instead on developing gimmicks and marketing messages that physicians increasingly come to despise.

In the past, the dissociation between the two functions was of little significance. Both the business model and the external environment allowed R&D to focus on discovery and development and then, when the new drug gained registration, hand it over to marketing.

In those days, the concept of evidence-based medicine was just a notion entertained by a handful of epidemiologists; regulations on the marketing and selling of pharmaceutical agents being restricted almost exclusively to safety issues. Traditionally, marketing had a great degree of freedom in terms of message development and marketing techniques. For the most part, pharmaceuticals were sold less on their scientific and innovative merits and more through established relationships with prescribers, who received loyalty rewards for prescribing the products.

In short, all marketing needed from R&D was confirmation that the drug was safe and had some degree of efficacy; creative messaging and sales techniques would do the rest.

Harsh realities
Those days are gone. Evidence-based medicine has now evolved to a point where few self-respecting physicians would accept any claim without it being backed by some evidence.

Evidence, increasingly, is being defined as outcome measures of morbidity and mortality, which entail huge clinical trials of around five years, run at enormous cost and risk to the pharmaceutial companies.

Regulators have also stepped up the pressure and there are now few countries where a sales rep can make claims on a drug which are not described explicitly on that drug's label. Codes of conduct regarding marketing and sales practices have also become stricter following media exposure of golfing trips, lap-dancing escapades and even outright bribery sponsored by some companies. To top it all, governments and other payers, increasingly, are questioning the price tags attached to new drugs.

In this changed world, where the word `innovation' has lost its marketing connotations and become the yardstick by which a drug is judged, the need for close collaboration between R&D and marketing has never been greater. That close collaboration, however, will rarely happen by itself. As in a chemical reaction, a catalyst is needed to bring it about; enter the 'medical marketer'.

Some companies now realise the importance of the medical marketer as the bridge between marketing and R&D and have established dedicated medical affairs departments where the medical marketers take on specific R&D and marketing tasks. Within these departments, they are responsible for clinical trial design (particularly for late phase III and IV), for publication planning, medical education activities and key opinion leader management. The organisational dilemma of where to place medical affairs (marketing or R&D) remains, however the competencies are more clearly defined and the collaboration between R&D and marketing is made to happen through this group.

Ex-physicians
Those best equipped to perform this new role are medical practitioners. Yet this group of people often view the industry as putting profits before patients and in engaging in marketing practices best suited to used car salesmen. As somebody exposed to an ever-increasing army of slickly dressed, detail-carrying sales representatives, the typical medical practitioner can quite easily hold a negative image of the pharmaceutical industry; a necessary evil, as a physician colleague used to put it.

Physicians, traditionally, have been the exclusive customer and focal point of a pharmaceutical company. They have enjoyed both prestige and economic advantages by practising medicine. Indeed, it was always very unusual to see any physician, apart from clinical pharmacologists, working for a pharmaceutical company. The few that did were usually regarded as either professional failures or greedy individuals, more intent on filling their pockets than in helping to alleviate patients' suffering.

Yet, the past few years have witnessed a small but steady flow of medical doctors into the industry. So what has changed?

To begin with, in many developed countries the role of practising physician no longer carries the social prestige that it once did. My son, the doctor is still a matter of family pride and achievement, but the reality is that the job is often underpaid and overly demanding.

The access to medical knowledge through the internet and other media has diminished the aura of omnipotence of the physician, and patients increasingly now demand specific forms of treatment, or will openly question medical decisions.

Malpractice lawsuits have also spiralled out of control in many places, with both monetary and psychological implications for the affected physicians (and their colleagues). Moreover, while doctors are trained exhaustively to diagnose and treat diseases, there is little time in the medical curricula for learning people management skills.

Many young physicians become frustrated at the way they are treated by senior doctors and professors, and consider their working environment to be a 'dead-end street'. It is no surprise, then, that many physicians (primarily young ones, but increasingly also older ones) choose to `jump over the desk'.

As is the case with every such decision, there are a number of factors to consider, as shown in figure 1 (here).

The good 'all-rounder'
Of those physicians who make the decision to join the industry, there is a group that has certain characteristics which set them apart. They are extrovert, very good at networking, like to work in teams, have a strong scientific background but also have interests outside medicine and science, and have a particular curiosity about the business world. But where should these people end up within a pharmaceutical company?

Medical marketers do not fit entirely the profile of the typical R&D employee, nor do they fit the typical profile of a marketer. Human Resources departments in various companies are still trying to figure out the organisational implications of placing these physicians in R&D or marketing.

The majority are placed in marketing, usually as medical advisers for a product or a therapy area, and they are expected to challenge R&D on trial designs, development of claims, allocation of patients to trials and other such issues.

Some are placed in R&D, and are expected to form part of the culture of resisting marketing's attempts to `corrupt' the scientific integrity of the trials and the claims that derive from them. In either case, the medical marketer usually ends up feeling like a thin rope in a never-ending tug-of-war.

Reaping the rewards
By contrast, those pharma companies that have appointed former physicians as medical marketers and located them in dedicated medical affairs departments are seeing a number of advantages to this approach, besides that of ensuring that there is a dialogue between marketing and R&D.

Firstly, it provides medical marketers with a clear career path. A medical adviser reporting not to a marketing manager but to a medical manager in medical affairs, who in turn reports to a medical director or VP, is not forced to choose between `pure' marketing or an R&D job to move up the corporate ladder.

Secondly, it provides the pharmaceutical company with a credible external partner to the medical profession as the medical marketer speaks the same language, and shares the same experiences, as the physician. Thirdly, it speeds up the completion of tasks, as there is no more ambiguity about whether a particular task should be placed in marketing or R&D.

The landscape in which pharmaceutical companies are working is changing rapidly: increased regulations and price pressures; fewer opportunities for sales reps to meet with physicians; and, an ever-growing demand for increased transparency.

The price paid by pharma companies that do not ensure a smooth collaboration between marketing and R&D can therefore be high. Resulting problems include:

  • financial costs - because of low market penetration of drugs developed to serve no clinical need, or positioned without any understanding of their true therapeutic potential;

  • reputational costs - the perception that the company does not understand the market it operates in, and from unlawful marketing practices, such as off-label promotion;

  • opportunity costs - from the company's inability to decide which project to invest in or by its misguided decisions to invest in the wrong projects;

  • personnel costs - resulting from increased turnover in both functions as the blame for failure is spread around.

In order to secure preferential access to physicians, some companies have introduced the role of `medical liaison'; effectively medical marketers in the field, away from the central office. Some have likened this approach to the `super rep' figure, able to both engage in scientific conversation and to communicate the messages ascribed to a certain product.

Will medical marketers, by the very definition of the role, be constrained to choose between R&D and marketing? Their skills can certainly be used in other areas of the organisation, such as corporate communications, and areas where transparency and high ethical standards in the running of the company's operations are paramount.

Sales can also benefit from having medical marketers among their staff, since they have been customers of the industry and can provide highly useful insight and feedback to the representatives making the calls.

Conflict and misunderstandings between departments will continue, as they are staffed by people with different backgrounds, expectations, ambitions and interests. However, functions that can bridge the divide, such as medical affairs, and those who have proper understanding and experience of those differences, are the way to keep conflict to a minimum.

After all, it's not about what you stick your nose into, but being able to tell what something smells like.

The author
Dr Danilo Verge is director of Medical Affairs, CDC/Medical Affairs Europe, at Novo Nordisk Region Europe. He can be contacted via: dver@novonordisk.com

2nd September 2008

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