In an exclusive interview at the eyeforpharma Barcelona Summit 2016, GSK's Danie Du Plessis speaks out about patient-centricity and the growing role of medical affairs in the pharma industry.
In your speech today, you mentioned that the concept of patient-centrality has not changed, but that expectations around it have; could you elaborate on that and explain GSK’s activities in this area?
When I joined the industry 23 years ago, I think the majority of MNCs mentioned the patient in their vision or mission. This is therefore not a new concept, but what the entire pharma industry was doing at the time was zooming in on the prescriber with a view to generating as many prescriptions as possible.
Because patients are today much more informed, because societal expectations are changing and because awareness of bad pharmaceutical practices has grown; what was acceptable 20 years ago is no longer appropriate to the current context. This is not only true for the pharma industry, but for many industries. For example, there was a time when it was okay to smoke on an aeroplane, now nobody would even dream of it!
Previously, it was enough just to care about the patient. Now people are asking, “What does that mean? Tell me tangibly what you are doing.” And because patients are better informed, they are challenging their healthcare providers and asking, “Why are you prescribing this product? I read an article that the industry is paying people to promote their stuff; don’t you think there’s a conflict of interest?” Instances of malpractice may not be widespread, but you only need a few isolated cases and a tabloid journalist seeking out a scandal to erode that trust between the industry and patients. Overcoming public scepticism is therefore one of the challenges that the pharma industry faces.
GSK, for its part is resolutely committed to changing this perception of conflicts of interest and to fostering transparency. To counteract it some of the negative opinions people might have of pharma companies, we’ve decided to reconfigure our business model with incentives for the sales force that are not based on prescriptions. As a company we believe that the industry has an important role to play in education and therefore we are committed to making money available for independent medical education that is fair, balanced and objective, as well as for helping practitioners attend international meetings.
One of the most tangible changes we’ve implemented is to transform the practice of paying KOLs to speak on our behalf about disease and products. That will be done internally unless somebody wants to speak for free because they really believe in the product or disease. Different capabilities are required compared to the past. People now need to get up and talk about disease and treatment modalities in a way that is effective and is actually helping to educate.
You’re in charge of medical affairs at GSK, an area that has grown in influence as pharma has moved from emphasising sales and marketing to placing greater focus on market access and the associated big issues of today comprising risk-benefit profiling, cost-containment and financial sustainability.
Absolutely, the role of medical is incredibly important for a variety of reasons. More collaboration needs to occur between the medical and commercial sides of the business because our core activity is in generating positive health outcomes. The medical department needs to help bring the science to life and help with that transformation of the science into sales. They can do this by talking through the clinical benefits and making sure that we deliver the right context in different settings, whether through presentations, responding to medical information requests, in sales aid or detailed aid, it has to have that fair balance and look at both benefit and risk.
I think the challenge going forward for the industry is that if we want to make sure we have the right patient using our product, we need to have the data that points out who this right patient is. We need to make sure, as multinationals, that we have clear data, the science, and the information that this is the right patient and therefore demonstrates that a particular patient needs to get a particular product. There is therefore an ongoing responsibility from an R&D perspective.
GSK’s Danie Du Plessis and Focus Reports’ Louis Haynes at eyeforpharma Barcelona
It seems as though the medical affairs department has risen in status from a support function to a leadership function?
Definitely, for me it’s now become a co-leadership function. Medical affairs should not be taking over the business because their expertise doesn’t sit there. The medical affairs personnel do, however, need to take the opportunity and show they can lead, and if they can’t, then we need to help them acquire that capability. On the commercial side, they need to allow medical affairs to do this. We must earn internal trust first. People are not just going to put you in a co-leadership role if they don’t trust you. It is a journey of transformation for that side of the business. If the medical affairs staff don’t take that journey then the opportunity is going to pass them by.
So what are your main priorities looking forward?
My main priority is getting the capability to the right level, but also the mind-set. If the mind-set isn’t right, people won’t embrace the opportunity and work on their capability. Because our industry is so highly regulated and because people want to do the right thing; they don’t want to get in trouble and are quite risk-averse. From a business perspective that may sometimes be too much. We want medics to understand that, within reason, it’s acceptable not to always stick to the most conservative interpretation of everything. What is important is the collaboration between commercial and medical. Commercial sometimes needs to pull us away from being too risk-averse and medical sometimes needs to pull commercial back from being too risky. Together we’ll do the right thing for both the business and patients.
You have raised the issue of gaps in patient support, for example the gap between people being discharged from hospital and going back to work. In terms of sustainability; do you think the private sector has a role to play in providing solutions?
This notion of partnership and collaboration is really important and as an industry there are still many opportunities and options. There is room for improvement in the collaboration between different pharmaceutical companies, with regulators, with patients and patient groups, with the media, and with academia.
The detail of that is challenging, especially as different countries have different regulations and healthcare system rules governing what is and isn’t allowed in terms of how close you get to the patient and how to empower the patient. However, there is huge room for improvement for companies like GSK to truly understand the issues from a patient perspective and ask how we can actually help to make things better. In some cases, we may not be able to because it might just be a function of the disease, in other cases the question may be about how to speed up the recovery process. The issue could also be education; we talk a lot about educating healthcare professionals but maybe we have a role in patient education. There can be a whole host of clinical reasons why recovery may take longer and as an industry we need to get into that.
There have been a number of company programmes around improving adherence to treatment. However, a lot of this consisted of telling the patient to continue taking their medication, A: because it’s good for them and B: because it’s good for us from a business perspective. I don’t have an issue with that, but preventing disease is good as well. Adherence to chronic medication is a form of prevention as far as I’m concerned. We do need to focus more on this, but also ask what else we can do to recover from that acute- chronic situation. It will be different for different diseases and in some cases we may not be able to do it, but it is an area that is not even being explored today.
