4 Practical uses for a Wiki in Pharma

You’ve lived and experienced the nightmares associated with document management and collaboration in an enterprise environment. E-mails follow multi-branched and reply all paths. Spreadsheets and Word documents get passed around and everyone asks – “do I have the latest version?” Or what about the times when you need a new job posting on your corporate site or to perform an urgent update to content. Do these problems sound like your organizations? Even worse do you have a over burdened process that governs what you need to do to make simple changes?

Enter the wiki: collaboration software that solves all these problems yet, unlike many traditional content management systems, remains simple enough for non-technical employees to use.
Although wikis have been around for a decade, they're just starting to take off in business. Like the Web did when it first caught hold in the corporate world, wikis will likely go through a period of wild growth, fierce competition, and inappropriate usage. Proceed with caution. Any “crazy” technology will cause undue distress amongst your management team. Baby steps are usually best for “crazy” technologies. Likewise as you all know making the business case is just as important. That said, I’ve outlined 4 practical (or crazy) uses for Wiki’s below that will help align a powerful collaboration tool with emerging business needs for the pharmaceutical industry.

• Create an internal communication portal: Prior to wikis, an expensive enterprise application would have been required for sophisticated information management. But because most wikis are based on open-source code, they're free for companies who opt for an open-source distribution, or relatively cheap for companies willing to pay for their implementation and support. That said portals are implemented very often in pharma companies. For example marketing teams are asked to develop a communication website specific to a particular brand that will help align all internal messages regarding one or multiple indications. Typically when marketing types are asked to create web sites, they have to rely on the chance that someone in a group knows how to make a web site, or that some sort of training is available or even worse spend several thousand dollars to get a static website from an interactive agency. The wiki eliminates all three obstacles, because it provides a ready to use site with a simple user interface, ability to easily add pages, and simple navigation structure. Imagine a wiki that would allow the marketing people to concentrate more on strategy and content development, instead of trying to learn how to put font tags around a section of text. The simplicity of the wiki syntax, or language for formatting text, inserting images and creating links, means your employees spend less time trying to figure out how to make the site do what they want. Easy and empowering
  
• Develop a peer reviewed paper: Publish or perish. That’s the tenant that many researchers live by. Publishing is the main vehicle to advertise the positive (and negative) effects of a particular drug, however often times the peer review process is tainted with inefficiencies and lack of a true peer review. A wiki makes it easy for researchers to write, revise and submit a manuscript, since all three activities can take place in the wiki. Imagine a researcher that is provided access to a wiki page to develop an outline. First the researcher will begin by tracking their background research and bibliography. This allows the fellow researchers, to see what they’re using, help them if they’re off track, suggest other resources/searches, or even get ideas based on what others find useful. Next, the researcher can draft the paper in the wiki, taking advantage of the wiki’s automatic revision history that saves a before & after version of the document each time s/he makes changes (sound like EDMS). This allows the peers to see the evolution of the paper over time, and continually comment on it providing transparency. When the researcher completes the final draft, admins and/or agencies can ready all elements of the manuscript for submission to a journal and/or congress. Efficient and transparent.
  
• Simplify the maintenance of processes: Just about every pharma/biotech company I’ve worked with has an emphasis on process, however they face 2 challenges in their change management efforts of a process: a) getting buy-in from all who use the process and b) effectively implementing changes and distributing a consistent communication stream to all involved. Imagine a wiki where processes are published for the entire organization. Say the process for reporting expenses is slightly inaccurate and Judy from accounting makes a recommended correction. The process excellence folks see the error and republish the change. Now the challenge, disseminating the change effectively. Imagine then all users who have been trained on the process are distributed an alert and notified to refresh themselves on the revision. This collaboration happens automatically without any human intervention. Impactful and lean.
  
• Track emerging regulatory trends: The need to track emerging pharmaceutical trends, especially regulatory ones is a need that pharma companies pay millions for in subscription based services every year, while their most important resource – their people – already have this information in small doses. Built together in a collaborative workspace such as a wiki, a pharma company can be nimble in addressing emerging trends. For example in the news as of late was a re-hash of the PHRMA ethical guidelines. Imagine an internal wiki where a researcher places a notice about the amendment that he/she read on a blog. A medical writer who recently attended a conference posts a slide kit that was posted by a leading opinion leader in the regulatory space. All this in a centralized location where users can sign of real time alerts to get the data. Powerful communication without having to pay for it.
  
  Stay tuned for my next post – Why a Wiki wouldn’t work for you…
  
  About the author –Hassan Mahmud is a Principal of WEKGroup, LLC a project and management consultancy specializing in forward thinking and technology adoption within the pharmaceutical industry. He is an early adopter of lean process management and has implemented Wikis at leading pharmaceutical and professional service organizations. For more information on Mahmud and WEKGroup’s services, you can visit them online.

Internet Killed the Pharma Sales Star

Well it doesn’t exactly roll off your tongue like the iconic hit, Video Killed the Radio Star by the Buggles, but the title is perhaps foreshadowing to the inevitable…the reduction of pharmaceutical sales rep and their role in the drug marketing process.

The infamous Accell report (“Through Our Customers Eyes”) find many revelations in regards to pharmaceutical sales and marketing. There is lots of data in the report, but my key takeaways include –

• Between 1995 and 2000 the number of pharmaceutical sales reps almost doubled, yet the sales generated were not nearly proportional to the increase in reps


• About 10 years ago, adding a rep to the sales force yielded 750,000 visits per year. By 2000, the number dropped to just 17 visits per year. Today, more than 90,000 drug reps compete for the attention of 768,500 doctors.


• For every 100 visits, only 8 reps succeed in speaking to a physician and being remembered.
  

What gives? Did drug companies loose sight of the value that solid pharma reps provide to the physicians? Is the proportion of reps to physicians at its saturation point? Do the physicians simply no longer trust a typical rep? I believe it to be a combination of the later and the three major reasons why eDetailing is on the forefront of many product manager’s minds and also of execs with companies such as Pfizer, Seprocor and GSK who have slashed their sales forces. Bob Dylan said it best…Times are a Changing.

Against the backdrop of the Accell report, electronic detailing (eDetailing) has emerged as an increasingly popular alternative, with 31% of physicians participating in eDetailing according to Forrester Research. For more on eDetailing see (en.wikipedia.org/wiki/E-Detailing).

So will eDetailing kill the pharma star? In my opinion most likely - in due time of course. Like many industries, methodologies and processes, the internet and technology have revolutionized how people do things. Traditional drug detailing is no different. Today’s physicians have less time, are embracing technology and want to talk science. Studies indicate that physicians do not listen or care for pharmaceutical reps. The most impactful value proposition that a rep provides is samples.

There are research firms out there that walk a fine line on this issue suggesting that both eDetailing and traditional detailing can co-exist in harmony by allowing the reps to focus on details for “willing” physicians and leave eDetailing for the hard to reach folks. That doesn’t make a whole lot of sense to me. Why not use the eDetailing machine to detail all physicians in a consistent, ethical and regulated manner yielding better educated physicians who can make the right therapeutic decisions. There’s also the potential of adding eSampling to this whole mix! On the flipside there is something to be said about relationship building between the rep and a physician for the pharma company, but as a consumer that’s exactly what I’d like to not happen.

Let’s face it, regardless of how unbiased a rep is, it’s in his/her best interest to spin the data and facts in favor of the company that they work for. If Joe Rep is counting on a huge bonus around the holidays to pay for his wife’s new Tag watch, Joe Rep is going to say and do what he has to, to establish credibility with the physician to net more prescriptions. You may want to take a look at a recent New York Time article (Dr. Drug Rep). The article is an example of the types of behavior that has shed severe scrutiny on pharma sales reps and the traditional marketing process.

Pharma companies are smart…really smart and are facing other promotional issues such as ghost writing, CME, and patent expiration for small molecules. Add the pressure of cost cutting and mergers and you get a perfect storm begging for a clearing. Enter eDetailing. It’s not the answer to all of pharma’s problems, but just may help them sing a different tune and revolutionize medical promotion by enhancing reach and message quality, while performing details with the highest integrity. Perhaps that tune would be Honesty (Billy Joel), or I could be completely wrong and we’ll all be singing Dream On (Aerosmith).

Imagine - The Real Ghostbusters!

Ghostwriting is a topic that plagues the pharmaceutical and biotech industries. See my previous post entitled “Ghosts in the Machine” (http://wekfiles.blogspot.com/2007/10/ghosts-in-machine.html). The ghost writing issue has been debated to death without firm resolution. I promised in a previous post that I had a solution to help with the ghost writing dilemma…well here is one solution. Sorry medical writing firms and publication planners, though many of you are good friends, I don’t believe a long-term solution can be developed with multiple competing interests.

In my opinion the issue really boils down to people. People can be influenced very easily, especially if there is $$$ in the mix. In contrast systems cannot.

I’ve spoken to many publication planners and medical writers about this very topic. Full disclosure, everyone I’ve spoken to, thinks its nuts and there is no way an automated system could ever replace a human being in such a complex set of processes. I think Larry Ellison said it best, “When you innovate, you've got to be prepared for everyone telling you you're nuts.” I’ll also cite the radiation technology industry. 10 years ago, aside from the visionaries no one thought that XRays could be read by a machine….well today they are. Not only are they screens read, they are analyzed and emailed to the physicians who can tend to patients while the processing is occurring. Nuts? Maybe, but who else is going to dream this stuff up?

The idea…

I’d hope Larry Ellison would endorse this one…

There are volumes of data and warehouses of publicly available data on the Internet (e.g. PubMed.com, ClinicalTrials.gov). What medical (ghost) writers will typically do in a nutshell is troll the online data stores, confirm citations, garner permissions from publishers, create an outline, and draft the paper, format it to guidelines - rinse, repeat. This process of back and forth typically takes 30 weeks.

Often times not only are the data freely available but are also consumable by XML technologies. Enter Web 2.0. These XML technologies are commonly used to distribute or get information from disparate sources (e.g. Froogle, weather and news updates). Imagine a tool that pulls information from online medical repositories, based on parameters (search criteria) a user enters through a website. The website in the backend compiles online data intelligently, rendering at the very least an automatically generated set of references and perhaps an outline for the publication. Let’s take it one step further and give the application the ability generate data that is deemed regulatory “safe” and within online and traditional publisher guidelines. Futuristic? Yes. Crazy ? - You decide, but the technology exists today to get what I just outlined done. Of course there are caveats and much alignment needs to be performed to make something like this happen…but wouldn’t information that is disseminated more quickly, more transparently and more completely from sources that cannot be influenced help an industry that is accused of hiring professional writing talent to spin a drug’s messages in the medical literature? I think so.

Who loses? Well of course the ghostwriters. But do they have to lose? Couldn’t they change their business to adapt? Publication planners don’t want to become the Polaroid of the pharmaceutical industry. Take a lesson from Kodak. Moving from traditional writing role to service oriented architecture may give medical writing firms the nimbleness to change with technology as opposed to change with the law.

Why the trend towards biologics?

When sanofi-Aventis sold its share of Exubera to Pfizer for $1.3 billion in 2005, they must have known what they were doing. Exubera which offers diabetes patients an alternative to injected insulin via inhalation of powdered form of the insulin has been made light of due to its resemblance to a marijuana bong. While comical, I don’t think that’s why Pfizer has canceled it’s agreement to market and distribute the drug. I imagine it has something to do with its lack luster performance this year of $12 million dollars and if I can venture a guess the unknown efficacy profile. Regardless of Exubera’s poor performance pulling a compound off the market that does not possess a poor safety profile is unprecedented. Abbott and NovoNordisk beware.
Form your opinion and say what you will about Exubera, one point is clear…even the big boys are focusing on developing biologics as opposed to traditional compounds. Certain analysts have called the failure of Exubera the largest failure in pharmaceutical history. Pfizer is no dummy, why would they risk so much on a biologic?

They wanna be like Mike
Michael Jordan was arguably the greatest NBA player of all time. Baseball is another story. MJ established a brand that provides automatic patent protection because of what he did and how he did it Do you think his performances will ever be duplicated or his compensations for that matter? You couldn’t just take any old players silhouette and put it on a sneaker that was not Nike. Who would buy it? Let me rephrase…who would want it? Biotech companies are similar to MJ, where they have innovative products to which the process for creating and duplicating them is way too complicated for generic manufacturers.

The biotechnology industry has always felt a need to break free of patterns set by traditional pharmaceutical firms since most products run into patent expiration after 8-10 years. Now the industry is trying to avoid the usual fate big drug companies suffer (aka MJ scoring 50 on them) when their top-selling drugs lose patent protection. Currently there are no laws to allow manufacturers to create generics for biologic drugs and a debate is percolating regarding this issue (stay tuned).

They’re trying to do the right thing…
Pharmaceutical organizations are so often accused of doing just enough for patients even though there mission statements are patient focused. Often comedians and analysts compare big pharma to drug dealers…stating that there is “more money in treatment as opposed to the cure”. Biologics allow a company to focus on the root causes of a disease, as opposed to flare ups and indications created by a disease. So what of the pundits? Of course pharma and biotech companies are trying to make money…it’s a business, however they are trying to also help physicians to effectively treat diseases which have been untouchable by traditional therapeutics. So can we all hold hands on this issue? Probably not…the treatment costs for biologic drugs are 10, 15 or even 20x greater than non-biologic drugs. Who’s gonna take care of those bills?

Times are a changing…
It’s hard to change on a dime especially when you are instituting change within a large drug organization. Different organizations such as Lilly have taken a path of creating in house biotech innovations centers while others such as sanof-Aventis have went on purchasing sprees gobbling up biotech left and right. Regardless of the strategy the time for biotech is now and traditional methodologies for sales representatives are changing due to marketplace demands. Did someone say e-Detailing?

Physicians are inundated day in and day out with messages, education, health care reform etc etc. The bandwidth for a physician is diminishing; therefore the traditional pharmaceutical sales rep faces challenges to keep a physician’s attention. (Side Bar: Honey please take note of this section). Physicians look primarily to increase their knowledge with continuing medical education (CME) and they often get this through highly knowledgeable biotech representatives. There is a rep of the future which is more knowledgeable and more scientific than today’s rep. That’s the rep that physicians will speak to because they get better educated not only a drug’s mechanism, but more importantly they gain information on disease state and emerging research trends which the may not have picked up in the literature.
Other reasons or comments? Please post.