Are Your MSLs The Real Deal?
An MSL must ooze authenticity. Science depends on it.
The British philosopher Bertrand Russell once said, “The world is full of magical things patiently waiting for our wits to grow sharper.”
It is not hard to imagine Russell, a humanist who devoted his life to the sanctity of truth, lamenting our current slide towards populism and fake news propaganda.
Indeed, at a time when objective truth is under attack, defending the principles of scientific inquiry seem more pertinent than ever.
For pharma, this is where the Medical Science Liaison (MSL) steps in.
“MSLs are essentially a critical vehicle for fruitful and two-way scientific exchange,” says Maria Rivas, SVP, Global Medical Affairs, EMD Serono.
To advance scientific research and learning, MSLs must first and foremost project authenticity when engaging with KOLs and other key stakeholders.
The importance of authenticity increases as the industry develops new innovations and pools of knowledge, says Rivas. An MSL must be a trusted partner to be at the forefront of these conversations.
Show me what you got
Of course, authenticity is not a God-given right. You must earn it.
First step is to recruit the right talent, says Rivas. Strong scientific acumen is essential. “We are increasingly looking at a very sophisticated cohort of professionals, often with PhD's and doctorates in pharmacy, or individuals with a pharmacy degree that are very experienced in a particular therapeutic area. They cannot be generalists — these individuals have to come in with a background that is pertinent to the disease where the company is particularly focused.”
Alongside acumen comes agility, she adds. An MSL must understand the scientific literature and stay constantly updated with the latest developments.
For Kirk Shepard, SVP, Global Medical Affairs Oncology, Eisai, MSLs must have their feet planted firmly in data. They must be able to crunch the numbers but also possess that “scientific rigor and excitement of wanting to explore data and that comes somewhat uniquely because you don't find a lot of people like that who really love to dive into data.”
An MSL must then be able to distill the data in a way that resonates with the different stakeholders. This is where social traits become very desirable, says Shepard. “We're looking for people who like people, who like to be around them and can talk to them; that's very important because we want the MSLs to engage the stakeholders and not just feel as if they are regurgitating the data.”
Rivas agrees.“It is not about any kind of self-serving agenda but rather it's about creating that collegiality and peer to peer environment and for that you need to be extremely adept as a communicator.”
The ability to listen should underpin this exchange. “By listening you can provide much more tailored, relevant information and actually advance the dialogue further than just one-way dumping information on the audience.”
No ‘I’ in team
Eisai puts its MSLs through months of rigorous training to sharpen their data skills, says Shepard. “We train them to look at the data, study it, and test them on it to make sure they know what we call ‘certification’. We also have training in how to present the data and how to ask the proper questions as far as the data in the science and we've named the Scientific Challenge; the process that we have developed that enables them to do this better.”
Although MSLs are typically self-driven learners, companies should make their lives easier by “facilitating access to the latest scientific information including our latest cutting-edge innovation internally in the company,” says Rivas.
In addition to the technical grounding, training on how to be an effective communicator and listener is also essential, she says. Helping MSLs to tailor their approach to different stakeholders may result in meaningful scientific collaborations.
Eisai has developed a feedback loop to enable MSLs to share best practice with each other through aglobal MSL network. This is a group of MSLs that meet up once a month to discuss how they are doing, what has worked and what hasn’t, what their issues are, etc.
Companies also usually provide regulatory training to ensure MSLs never veer into promotional territory — a key element of authenticity.
Walking this tightrope is one of the biggest challenges, says Shepard, although the hiring and development of good talent lessens the risk. There is always the risk that MSLs could become too enamored by the company itself and overzealous in promoting the drug. “We are always telling people, ‘Look, we're here for the patient. We think we have a good drug. Your job is to objectively present that and not cherry pick what makes our drugs look good.’
“We're very big, as most companies are, in if somebody asks a question, we're going to answer it, but we are going to send them the balanced data of how we got there.”
Rivas believes risk can be managed “by selecting scientific talent and establishing appropriate scientific exchange objectives for the MSL staff”.
The authenticity ark
To stay focused on what is important about the product, MSLs and their Medical and R&D colleagues are encouraged to help craft the clinical narrative, says Shepard. This is a concerted effort that spans the company; colleagues from clinical development, medical and market access come together to craft an overarching narrative for a given product.
“All these partners come together and say, 'What is the essence of what we need to say about this product?’ And with that clinical narrative it keeps MSLs authentic and to the point as far as what needs to be said about the product.”
Eisai also links its Q&As for all its products to the overarching narrative, that way MSLs will know with some certainty that the answer to specific questions about a given product will be consistent with the company message, they will know that the “best minds of our company have put together the answer to this question”.
How long is a piece of string?
There are no real quantitative metrics for measuring MSL effectiveness, says Rivas.
The best way to measure the value that an MSL brings to an engagement is by conducting a qualitative survey, she says.
“We ask them [the stakeholders] questions such as, ‘Did this individual communicate information that you felt was balanced, was scientifically credible?Would you recommend this source and this liaison to other colleagues or experts and then ultimately does the information that we provide actually help the expert in some fashion to understand a patient care challenge or even make better or rather informed decisions on overall patient care?’”
Shepard agrees. In his past work, his team has developed a tool that functions like a net promotor score, where doctors are asked to rate an MSL according to a fixed scale. It is used to gauge the general effectiveness of an MSL. The next stage probes deeper. The team will then ask the doctor in question if they would be permitted to speak on the phone, to get a deeper insight into the interaction.
Find your own feet
There are good reasons why MSLs are not subject to quantitative metrics. To this date, no reliable, validated and widely used quantitative ratings have been developed for MSLs, and it is not appropriate to use product sales as a measure of their effectiveness. They also do not want to be micromanaged. A part of their credibility and authenticity stems from their intellectual independence to communicate from the data what is best for the patient and their independence from commercial influences
An MSL should have the right scientific acumen but also “learning agility and emotional intelligence” to be able to go back and reflect on how an interaction went. What they felt worked and what was amiss. And think about how they could improve the interaction next time, says Rivas.
For Shepard, experience reveals more about authenticity than numbers. “The most important part of our certification is when a manager or other people ride with them to see how well they really know the data and interact with a KOL.”
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