Collaboration At Every Level of Medical Communications

Rob: Medical affairs brings together many teams with different areas of expertise, but too often those teams work in silos. So why do silos form?

This is In Plain Cite, a podcast exploring the biggest questions and trends facing medical publication and communication professionals. I'm your host, Rob Matheis, President and CEO of ISMPP.

Today, I'm joined by Kirk Shepard, a longtime medical affairs leader and co-founder of MAPS, the Medical Affairs Professional Society. In our conversation, we're gonna discuss how we strengthen collaboration at every level and strategically prepare teams to work together as they integrate new technological changes.

We also talk about the increasingly important role medical publication and communication professionals will play in creating that culture of collaboration. Let's get into it.

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Rob: You know, I'm thinking about, you know, what we've been talking about for years and, you know, in the early MAPS days around, coming together and really thinking about the value of medical affairs.

I tend to think about the value of scientific and publication, professionals, of course. When I'm thinking about medical affairs overall, we do tend to see a lot of silos. We do tend to see people not coming together, and at a time when we're trying to bring them together and demonstrate value, it becomes a real challenge.

So what are some of your thoughts around what's causing this?

Kirk: Yeah. I mean, we struggled a little bit in the beginning, with the use of the word silos.

A lot of people really don't know what it means, and essentially it's a business department or a team that operates independently and avoids sharing information or resources or goals with other departments in the same company.

So you've gotta ask, well, why does that happen? There's a number of reasons. We've asked people about it. One, in some ways, my job is easier if I stay in a silo. I don't have to interact with anybody.

Rob: That may be true.

Kirk: Two, I have my own goals. All right? I don't have to worry about other people's goals. I just do what I have to do with narrowly defined, and I move on.

And three, sometimes they're political. You know, by moving across different silos or departments, you're sharing things that aren't a part of everybody's character. I think also the fact that a lot of leaders have not realized how important it is for collaboration, and so they allow the silos to form. And I think this has to start at the top, Rob. You know, it has to be a leader who knows the value of collaboration, sets the culture for that, and then goes forward with metrics and rewards, goals that reward people for mutual, you know, goals that they have for their bonuses or whatever. And right now, there are a lot of goals, you know, that are individually placed in departments and not across the board.

Rob: Yeah. It's a great point. You know, we think about medical affairs, and it's made up of, generally speaking, multiple departments, you know, your field medical, your medical information. But at the end of the day, while they're integrated, they do compete for shared resources in many of the current models.

And so that situation really does require leadership aspects to make sure that we are incented to work together. So now you mentioned the word culture before, and I wanna come back to that because I thought that was a really important comment. Um, how important do you think the culture is in making sure that these integrations happen across medical affairs?

Kirk: It's so important, And we also say, you know, the culture eats strategy for breakfast, you know?

If you don't have the culture to support your strategy, you're going nowhere. In the same way here, collaboration is a strategy that your people are working together. And so if you don't sound like that from the top, if you don't put in place rewards for that, it's gonna go nowhere.

Rob: No, I agree with you. So now let's say we have a well-functioning medical affairs organization and, and we see good integrations with all the different teams. What does that look like from your perspective? Like, how will we know it when we find it?

Kirk: Yeah. I mean, there's quite a few signs. I mean, one is what we've just talked about. We've talked about that the leaders are speaking, uh, about collaboration, and that you see then the culture forming, the people then believe in it. Next thing is you've got to measure it in some way, just like everything else, so that when you are forming collaboration, people will say, "Well, how do you know this works?"

You've got to look at your measures of both quality and time and satisfaction of jobs as far as is that improving as we move forward with these collaborations. Also three, you, you don't want to boil the ocean from the beginning. It may be that your collaboration starts with a couple of departments or teams to show other ones as a demonstration project of how it works.

For instance, a very natural one, of course, is publication, scientific communications, medical communications, maybe the MSLs, and bring those two together first. So in other words, it may be like a Legos building. You're building it slowly from the bottom and you're showing people how it does work and it leads to good results.

Rob: All good points. You know, so our listeners, they're primarily publication and medical communication professionals, and some of them may be there thinking, "Well, this is great, but my VP, this is not what's on his agenda or her agenda."

Is there something that someone in the trenches, like one of our listeners can do in their organization that can help to improve this culture, to raise awareness that the collaboration and lack of silos is so important?

Kirk: Yeah, I think if they believe in collaborations and wanna move forward with it, and you have someone at the top who doesn't believe in that, I think the way to do it is by frequent communications and alignment with a number of your partners. So in other words, if you have frequent communications, prioritize perhaps your partners by what's the most important that I can hook together with, second, third. And then to show them that you are forming common goals and working together, and then I would see it spreading from there. And that's the way I've seen, and that's the way we used to do medical affairs where I was before. We would go around with our deck, of course, an abbreviated one, and show them what we're about.

How can we work better as partners? Is everything perfect? Well, no one ever mentions yes, oh, it's, it's perfect. But let's then look at these areas of unmet need within our companies, within our teams, and let's do this together. Let's make it a collaborative effort. So many people go around when they have ideas and wanna be in charge right away.

They say, "This is my idea," or they give that feeling of that. I always told my people, "You don't own anything. Share. Share the glory, share the work, prove it, and then move on." And we did that at one company with just digital when it was first introduced. There was a lot of confusion about, you know, the digital world, but medical drove that a lot, and it was done by partnership, and trustworthy partnership.

We had a person who was in charge of it who was a previous MSL, somewhat quiet, but brilliant, and she went around and developed trust, so in the end, when we developed an AI tool for insights, every company in the world accepted it. You don't find that too often, 'cause you eventually get to a wall saying, "Well, we didn't invent that," or, "We've been working on this. We don't wanna be a part of that." 

But she developed trust throughout the world, and it, from the bottom up, built this empire, so to speak, and shared the glory with all the others.

Rob: Yeah, I think that's, that's really important. That trust allows, allows for some credibility, and it allows people to be a part of the process. If they're brought along for it, it's easier to build it, and then certainly the implementation all, all works better when you have those, those pieces moving,

Um, and I like this conversation a lot too, because, you know, right now our profession, publication and medical communication professionals, there's a bit of anxiety. You know, people are concerned about artificial intelligence and what it's gonna do with their roles. And I'm always listening when I'm chatting with listeners for, like, where's another area we can bring value?

And so if someone is listening to this recording, they may be thinking, "Well, I can maybe raise the flag for better integration, even if I'm a small voice, if I'm low in the totem pole." or maybe you're higher on the totem pole and you're a director or VP, whatever it may be. There's an opportunity for you to be the voice, within your profession, to try to bring these different people together to the same table.

Kirk: Well, you know my feelings on that as far as the importance of publication, medical communication, scientific communication. Because the reason why that's important, people have, I think, often thought of scientific communications, publications as isolated to medical or R&D, but it's not.

It's the epicenter of the truth of the data, and everything should emanate from there. You know, you shouldn't have commercial or sales going off and forming their own messages around whoever they're talking to, maybe on the outside, a consultant or whatever. It should come from the inside, carefully designed by all your partners.

To me, that sits within the current publication, scientific communications and medical communications. I've seen it done, 

Everything had to come from there because that was the truth.

Rob: Yeah. No, I think that's great. And it does-- That points out another area of value for our profession because, you know, at the end of the day, all these things can change with technology, you know, AI can um, change the way we do our jobs. But going back to what you said just a moment or two ago, around being the source of truth, I think is gonna become critically important, especially as we have machine readability of publications and third-party resources to come out.

That center of truth and the guardian of that center of truth is really, really important moving forward.

Kirk: Yeah, that's another element we've discussed at MAPS. Number of partners, "Well, how are we gonna do this? Who's responsible for it?" Internally, not too bad. Externally, that's a whole 'nother world. Who's gonna do that? Who's gonna be responsible for talking to influence leaders who are propagating false information?

Who is going to be someone who questions certain reports? And I think this is gonna be more and more a part of pharma, is to be a part of that conversation, and that takes some guts. So in others, you gotta have people, and again, I'd see them coming from the current publications, medical communications, scientific communications, because they are grounded in the truth.

That's all they work with is the data and communicating it. And so when that comes out, we have our internal model, we're developing our scientific communication platform, our narratives, but then we're always looking to the outside to say, "Who is distorting this?

So to me, I think you're right, Rob. This is gonna become a more of an important role, and I see it, of course, not just sitting within publication of scientific communications and medical communications, but like everything else, it's a seamless integration of partners who are currently within pharma.

'Cause you'll need compliance, you'll need legal with it. you know. But I see them, I see this is one place of leadership, I think. With AI, we can identify those areas of erroneous communication on the outside faster and more accurately.

Rob: Yeah, it really does get to the heart of, you know, as the chairs shuffle in medical affairs and as medical affairs teams change, everybody's looking to see where their seat's gonna land, you know, and what are they gonna contribute, what are they going to do?

It can create anxiety, it can create fear, for sure. I, you know, I work with publication professionals who are like, "Well, AI can write my strategic plan. It can write my first draft," and so on. We can debate that all day long in another talk. But at the end of the day, they're left saying, "Well, do I have a job now because AI can do all these different things?"

And the answer is yes, because somebody still needs to make sure it's done well. Somebody has to create the workflows. Somebody has to work in the ecosystem. 

And I love what you're saying because it really does give optimistic hope for those within the medical affairs space, and particularly within scientific communications, to think, "God, there's gonna be a lot of value I can bring in the future.

I just need to find and define it for myself."

So changing gears a little bit, we deep dived into scientific communications, which I think is good, but I wanna bring it back out a little bit for our listeners and talk a little bit about medical affairs in the future. And, you know, I guess, as an expert in medical affairs and a leader in the area for many, many years, how do you think medical affairs teams can be designed in the future if you could build one from scratch?

Like, what would you do differently moving forward?

Kirk: First of all, the, the medical organization that I would design if I was given full reign, and in some cases, one company I was, I mean, in the, in the interview I was able to say, "This is the way I think it should be," and they did echo a lot of that. But it has to report in high. So in other words, that's usually the CEO or the C-suite.

The problem is, if you have medical reporting into R&D, which was traditionally I think the way it's been done, still maybe have the highest percentage, it all depends on your R&D head if they understand what medical can do. And I've seen both sides of it. I've seen where people didn't understand it, and so you were suppressed, and you were suppressed to levels not even getting to the CEO or the other officers.

And I've seen people the opposite, who were wonderful and supported it. And then of course it was able to get to a strategic level, where your ideas and your information are important. So that to me is really important. They are a person who should be involved with the strategy, and become even more so because, first of all, they have the components of education. In most cases they've had clinical experience, they know the clinical data, they know pharma, they know the regulations. That can really contribute a lot to where we take our current clinical or non-clinical data. So very, very important that that voice is heard up on top. 

And it mildly irritates me when people talk about medical affairs as the bridge. The bridge between R&D and commercial, whoever else they wanna say. You know, to me, a bridge is passive, okay? People are walking all over you to get to the other side, okay? Medical is far more than that. They are at the table giving strategic information. And when we trained our people, we said, "Be proactive, put your voice on a strategic level, and give the information from what you know." So what else would I design? Well, they know sometimes it could be said from clinical or other people. Well, we know that too. You know, we do studies and we're out there interfacing. The really valuable leverage that they have, and this is what I'd really design in the future, is an analytic center for insights.

Insights are coming together to be accurate, almost like data from clinical trials. And if you have enough insights coming in, and you have AI attached to that where it can be interpreted as far as maybe even your clinical data or what's happening outside- no one else can do that.

And from that, that's where AI helps us the most. AI also helped us, of course, with the interaction with, you know, the different KOLs. But to leverage insights and to be able to do this quickly now. In the past, you know, insights for medical, I know this is before your time, Rob, but they went in a big box.

You know, a bunch of paper insights written out, and you try to analyze and whatever. Now, within a couple of days, you can have an interpretation of insights coming from all over the world, and sentiment. In other words, saying what this physician about what you're saying compared to last month.

So the important thing with AI is it offers us not only quality, but speed. The need for speed in insights. I hear more people saying, "Yes, we meet with our CEO every quarter." No. If you meet with them every quarter, that insight has lost all its effect. It's like a PK of an IV drug. It's going out fast.

And so we emphasize rapid, quick insight reporting so that it really did have an effect on the strategic decisions. Insight should be a strategic signal, and that's the way actually we should be judged in medical affairs. One of the things we'd be judged on, along with the MSLs, how many strategic signals did you bring in?

How did it change things within the company?

So that's two areas there that I would really work on as far as my current medical department. And the other thing is more of a general one. I would make it as seamless as possible. I want these partners working together, clinical development, medical. We should be together at phase one or pre-clinical.

It's not like, okay, throw it over the wall, we're getting close to launch. All these people should be as seamless as possible as an engine. And so that's the vision I have. I'm not gonna get into the details. We don't have time for that. I don't wanna bore people, but those are the main tenets that I would design a clinical medical department.

Rob: No, I think they're really, very important. And what I like about every aspect of what you're designing is that in each of these different areas, we're still putting the people first. We're still putting the roles first. We're talking about it, and every time you mention it, you simply mentioned AI as a tool, as a resource to increase speed, to increase the level of insights that we can get.

But certainly didn't say it was gonna take out a department, right? It was gonna just enhance the way we can work together. So the other piece I like about it too is, you brought strategy into it, and I think, you know, if I'm thinking about strategy in 2030, 2035, it may be a bit different, but I wondered if you had thoughts as to how strategy could look different in the next twenty-five, thirty years.

Kirk: I mean, I think strategy is changing right now and it's gonna be bigger in the future. One, our strategies for our products or assets, as some people call them, are becoming narrower and narrower. I look at oncology, and this is true in other areas too, is that your patient populations are getting to be very focused because of gene therapy, because of...

I mean, you know, we can get certain kinds of cancer now into, you know, dozens of different diseases, and this is the effort as far as strategy's gotta be ready for. It isn't like a mega strategy that will handle everybody with hypertension or whatever. So this is going to change. And I think also because of that deep dive focus into these areas, a lot of these things we've talked about, I would be centering them around a therapeutic area.

And I know a lot of people do that now. We've done it for a while. But having general departments to handle numerous things I think is gonna be a mistake in the future because our healthcare professionals are gonna expect depth from us. Um, and that's why the MSLs, field medical teams, have become so much more important.

They are really an equal partner with who they are seeing as far as the science and the data and what's important for them to know as far as the insights. I'm not saying sales are gonna go away. Sales to me are very valuable in a different way, but I think that visit is going to change a lot.

So, you know, during COVID when everybody was freaking out that we couldn't get the MSLs or the salespeople in front of people, I didn't see it as a disaster. I saw it as this is the big experiment to see can we do the same thing virtually? Darn it, we did it. Not that it's 100% virtual, but it's a mix now that you can get to people more often, more quickly, and they can get to you.

Rob: Yeah. All, all very important. So this podcast is being recorded at a time when many of our members are finding that they are being organized the way you just described. You know, coming out of functional areas and going into more therapeutic area-focused contributions.

And I think that, to me, speaks to yet another opportunity for us to bring value within, within the profession, right? So that the tenets of being a publication professional, um, the roles around authorship and transparency and ethics, that flame needs to be carried. So as we reorganize and reshuffle medical affairs departments in the future, I think what I hear you saying is the role of the publication professional, uh, medical communication professional becomes even more important.

Kirk: Oh, so much more. I mean, still the foundation of all data is a published in a reputable peer-reviewed journal, and I don't think that should change. But the expectation of getting that data in a quick fashion, this is where our scientific communications people, our publication people can help with that.

And what's appropriate? You know, should we put it online? Can you put a certain amount online and give the rest later at the conference? That whole interaction. But the expectation is we get this data to people much faster.

Rob: Yeah. No, and I think it's, as we were saying before, at a time when, a lot of our members or a lot of our listeners are running around saying, "Gosh, Rob, AI can generate all this stuff. What is-- Where am I gonna sit?" And, the truth is, what you're saying makes total sense. It's about really thinking, where is the data going? How is evidence getting out there? What is the source of truth? Who's the guardian of that? 

So, I love the conversation because it keeps redefining an important role for publication medical communication professionals now and into the future, which, I think is a really important message for our listeners to have.

So, I mean, we've had a great conversation, Kirk. I've really enjoyed it. Is there anything in closing that you want our listeners to take away who are sitting largely, in agency-based or industry-based publication and communication firms? What would you say to them in closing?

Kirk: Yeah, I mean, the importance of this area and these roles and how they're gonna change not only in what they're doing, but also the impact that they have within the company is something that I would see coming. I mean, to me, it's all about communication. You've got the data, you've got a good drug, but if you don't communicate it correctly, accurately, then you've got a problem.

So what... I would only say maybe as a more of a practical thing to all of them, communicate frequently with your partners. Even if you set up something, you know, like once a month just to go in and see how they're doing. Maybe prioritize the importance of these partners and start communicating how you guys can make an impact together on this.

Because there's power in more and more people, in masses. So with that, looking at your processes, don't let AI control you. We had what was called a process improvement team. We looked first at where's the breakdown in process, whatever, and then how can we add digital at the time? But now we're doing the same thing with AI. Where do we need this to help us, as far as a tool? And you put that together with your partners at the company so it becomes a strategy. And then again, form those collaborative goals.

That kind of binds you to somebody, you know? Yeah.

Rob: Excellent. Real good advice for our listeners. I really appreciate the conversation and, and you joining us here today, Kirk. It's been a great discussion.

Kirk: Thank you. Thank you very much for the opportunity, Rob.

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