Why Most Clinical Data Never Changes Patient Care

The way I transformed my understanding is it means that this patient will live with this treatment, not just receive it. And I think that really changes your perspective when you design that from the mindset of there's a patient that's living with this treatment day to day, everything changes. Welcome to Transforming Medical Communications, a podcast by medcom's experts. We share medical communications insights and advice from the best and brightest in the industry to find out what they're doing to push our industry forward. Here's your host, Wesley Portegheese. Welcome to Transforming Medical Communications, the podcast where we explore bold ideas that shape the future of medical affairs. In oncology. The problem isn't really the lack of data, it's the opposite. Physicians are navigating and overwhelming volume of clinical trials, treatment pathways, biomarkers, and therapy management considerations. So the real challenge isn't really just understanding the data. It is also, how do we now apply that data in the clinic? Well, today's guest has spent his career thinking about exactly that. I'm joined by ILI Al Hashimi, Director of Global Medical affairs in Thoracic Oncology at Pfizer. In this episode, we'll explore how medical affairs can move beyond presenting data and start translating evidence into practical guidance, helping physicians, pharmacists, and care teams understand not just what the data says, but what it means for patients in real life. Eli, welcome to the show. Thanks, Osley. Hi, everyone. Thanks for having me on the show. It's my pleasure. Well, why don't we start with the reality that physicians face today? Right. What would you say is the biggest challenge physicians have when it is about translating clinical trial results into their everyday treatment decisions? I think when we talk about clinical trials, we have to understand where they live. They live in a very clean, controlled universe. And the clinic, it's totally the opposite of that. The trial tries to answer the question of does this drug work? The clinic ask a different question. Will this work for this patient? A Tuesday afternoon after I'm running behind because you got delayed. These are two different questions, and I think being aware of them can really help us to find what's the best way on how to integrate the clinical trial into clinical practice. So how would you define the gap between how we as an industry present the data, but then how it's actually being used in practice? When we look at the data, let's say it's presented at a major congress, there is an inherent assumption that clinicians may have unlimited time or maybe unlimited brain space to really interpret the data and think about implementation in Reality, this type of data are being used almost like a quick decision tool to support how I can use that to benefit my patients. You know, think about it, that clinicians, they need this type of data on how I can solve this problem with that limited time and brain space available just because of the situation that they live in or the reality of their clinic that they sit in. Mm. So it's kind of answering the so what Question. Right, so here's the data, possibly. Great. So what? That's what you're saying? Exactly. It's the so what? And also how it could be implemented within the clinic itself. Does it have a life in clinic and what does that look like? So, so what? And what now? Right, Exactly. Exactly. Now, you know, of course there are several different channels where we, you know, between air quotes, presents data. Right. Like you mentioned. One, the conferences, we have our field medical. We have publications, posters, oral presentations, all of that. Now, what can we possibly do with those channels? Right. What can we do in those channels to make the data more clinic friendly? I think that's a really great term, clinic friendly, because that's the intent of medical affairs and how to humanize the data to make it clinic friendly. So the way I define clinic friendly is means the data can be aware and understand the environment it's entering, the clinic itself, test, respect the time, the workflow, who's using it, whether it's the physician, the nurse practitioner, even the pharmacist. This is not just about simplifying the science itself. It's ensuring that the science can actually survive that environment, but also preserve the scientific integrity of the data itself while it's surviving that environment itself. Yeah, and I like what you just said around that it depends on who we're talking about. Right. And their clinic friendliness may differ because they have a different role in the ecosystem of healthcare. And it is something that, you know, we see close by as well. We often help our clients defining their, like, target audiences, or I guess like communication audiences would be a better word. Right. On the medical affairs side of things, because, like, there still is this concept that we're kind of having a one size fits all style to communications. And even if we think about the different audiences, in reality, we're not really producing content that is that much modulated or tailored for those audiences. And we're constantly trying to remind the industry on like, hey, listen, we really need to see this perspective through their lens, not through our lens. And that is a very hard thing to do. Right. To step in the shoes of your audience. You know, what would, in your mind, be a way that people can do that? More like, how would you possibly understand what your audience is dealing with? It's a really interesting point that you bring. So from my personal experience, I was faced by that. I didn't understand a clinical perspective from a busy oncologist perspective. So the best way to do is to partner with a clinician. And personally, what I've done is I shadowed some clinicians in their practice just to observe patient flow. And what I realized is the way we can engage clinicians or the healthcare team, it usually comes in these little short bursts. It's between patients, sometimes on a phone, or sometimes they think about a slot that they saw at a meeting of some sort of. So being aware of the environment and how the physician or the healthcare team perceive that data can really help us become better communicators, understanding kind of the challenges and the limitations of that setting itself. That is beautiful. I love to see people shadowing physicians. I think that's an amazing thing to do, and I wish more people in the industry would get a chance to do that. Yeah, exactly. And I think it also humanizes medical affairs, too, that the main objective is our stakeholder in this case would be the patient. And we're trying to work together collaboratively as a team to make sure that the patient is looked after and they can receive the best treatment available. So working and partnering with the clinicians, I think, has been actually really fun from my experience. Yeah, absolutely. And I think it creates such a clear view on how that reality actually looks like compared with what we think. And it's very normal that we are kind of biased in a way. Right. In where we think how that looks like versus what the reality is. The discussion I've had with many people is we are on the industry side. So in other words, it's all about our drug, our therapy area, our data. And we work on that at least 40 hours a week. Right. Often 60. And of course, we're very excited about it. If you look through the lens of a physician, that is not what it is all day about all day and all week. Right. It might be actually a small percentage of their time that they need and want to interact about that as well. So it's really like, the trick is, how do we find the time and the right, like, methodology as well to communicate with them? So when you did that shadowing, how did you see the physicians engage with data or information about therapies that maybe surprised you or. That was a good takeaway. So let's talk about the environment. For a shadow, there was an academic environment, which is, I think could be very distinct from a community environment where there's a lot more pressure on the clinician. So I think understanding that environment is really helpful to kind of tailor how you best communicate. So within the academic setting that I was in, I saw the physician doing a lot of preparation, ahead of their clinic time, where they looked at the data and they were responsible to teach the residents, the nurse practitioner, especially if there's a new treatment or a clinical trial. So it's actually the engagement to these folks come in these little intense bursts of data and it's a very short amount of time that you have to engage with. So the lesson that I learned from that is I have to be very clear, very to the point and help the physician place where the data could sit in their practice and what that patient may look like based on the clinical trial and then have a conversation. It just having that clarity so important in communication and you do it with purpose. You know, I'm speaking with you because I want to talk to you about the specific data, get your impression, get your perspective on the reality of your practice based on this data. Yeah, that makes a lot of sense. And the call out to community physicians is an interesting one too. Right. And that has been a really hot topic actually lately because like we start really understanding better that a lot of our key opinion leaders and academics, you know, they're the ones that can go to the big conferences, they're the ones that get MSL visits, and then we have our community physicians that might not be able to do either of those. And as a result, the challenge to actually get that information to them in a meaningful manner is even harder. So when we spoke recently, you gave me some examples of things you have done to address that and I would love for you to share that with our audience here. Yeah, absolutely. So one of the things that we worked on is taking the results of the clinical trial and making it more clinic friendly. So we had to partner with clinicians globally on how we can bring therapy management from a clinical trial perspective, bring their own real life or real world experience in managing these medications and put it as a guidance to communicate this. We chose to use the peer reviewed route in the setting for the reason that we want to maintain the academic integrity of this and really to capture the impressions and the clinical opinions in a peer reviewed way. We thought that would be the best way to document this. And the intent of this is to be very clear that this has a place in an academic setting or. Or a community setting. By using visuals and timelines and even side effect timeframes, it helps the physicians or the healthcare team if they have a short amount of time to take a glance at it, and acts as a refresher on what to do if these side effects surface. Yeah. So you kind of baked this into the publication, right? Yeah, exactly. So this is all captured within the publication itself. Yeah, I think that's really amazing. It's sometimes these very powerful things are so simple. Right. And I'm wondering, like, if other people would want to do something similar. You have any takeaways for them? I'm sure there must have been like, at least a few hurdles to get there. What are some good steps for someone that is listening to this podcast and things like, this is great. Like, I would love to do that for our audience and they would really benefit from it. Like, what are the different steps? What are things to look out for? One of the learnings from this exercise, how quickly medicine transformed from the trial to the time when we did this exercise was only a couple of years from therapy management. There was a transformation from therapy management perspective. So the other aspect that we wanted to include is make it as clinically up to date as possible, being mindful of the limitation of the clinical trial. So it was actually a cool conundrum to be in on how we can transform that. Because, you know, part of medicine is the constant transformation and updates that you have from a guideline perspective, or even on how to manage some of these side effects. Like, for example, if there's a new treatment to manage side effect X that was not part of the trial protocol, how would you safely implement it and describe it from a clinical perspective? So that was actually a really cool way to do this. So we started off with absorbing the reality of the trial, where we moved on what has been update, and we kind of reverse engineered that into this guidance. And the intent of this is to provide a framework on how to manage these side effects. And this is a developing story and I think the beauty of it is it's always going to be updated whenever we have new data on how to manage these side effects. Yeah, that's beautiful. And just for anyone listening to this, to kind of imagine a little bit how this looked like this was basically, I guess a therapy management flowchart is maybe the best way to put it that you could just stick on the wall, right? Yeah, exactly. The way we wanted to do it is we wanted to be very visual. We included timelines framework, quick reference tools that could be potentially placed on a clinic wall if compliant. We have to be mindful of compliance that this is a quick reference and the peer reviewed routes really protects the scientific integrity of it. So it limits the bias that could come in from the different sources. So does that mean that the authors of the publication kind of co developed this therapy management diagram with you? Exactly. So the authors had full control of what to include and how to design this. When we worked with the physicians, we told them, think of your resident, think of your medical student. This is what your task is. Make it as friendly as possible so that any of your healthcare professional team members can actually implement it and they can take a glance at it, look at it and then understand what they need to do. Yeah, that's beautiful. And I guess in medical affairs generally we're all talking about impact making an impact. So I would love to hear if you got any feedback what the adoption was. Have you encountered this actually being on the wall in a clinic? So overall, this is something that was well taken by physicians. They see it as a really good transformation from the clinical trial data to actual real practice. And actually we did get asked the question of even to simplify it further, the intent of this and what the insight that we got from this is, these good tools can really protect their clinical judgment and they can spend more time in their brain power. They can focus on the different side effects on patient preparation rather than getting stuck into the details of, you know, Remembering what Slide 15 showed on trial X of this type of safety data. It makes it more real life and I think as time goes by, I'm hoping, I would love to see it on someone's clinic one day. I know it's being used in at least a couple of centers on their electronic health record system, which is to me, in this day and age in technology, that is the equivalent of the electronic clinical. Yeah, absolutely. That's great. I'm really curious about this. So hope you don't mind me asking, but how did you collect the feedback? Like what channels? How does this come back to you? Because I love it when you know, you have like a feedback loop that actually works and you can adapt your strategy so, you know, getting this feedback and request, like, hey, can we simplify this further? That is so valuable. How did you make sure that you got that feedback and what were the channels to collect it? So from my perspective, the best person to do this would be your field medical or field colleagues, really. So any field colleague that can speak about this tool Compliantly were in scope to get feedback and provide feedback on how to simplify that. So that's kind of the main channel to get this. The other channel would be direct conversations with some physicians that are not part of this panel and get their honest feedback and asking questions that really are relevant. For example, do you see yourself using this in your clinic? Would your nurse practitioner use this? Do you think that your pharmacist would benefit from something like this? What is missing from it? What would be something that we can work on it together that would make this even better and safer for the implementation of this type of medication into your practice? Is metcoms evolving faster than your team can keep up? You're not alone and you don't have to navigate it alone. Wesley Portiges, host of Transforming Medical Communications, is offering a limited Number of free 30 minute consultancy sessions for medical affairs professionals. Whether it's medical communications, field medical or medical affairs training, these sessions provide an opportunity to address your real world challenges, pressure test ideas and walk away with practical strategic insight for your team. No fluff, just strategy. Follow the on screen link or in the show notes to book your free session. Now, you mentioned compliance a few times. How did you navigate that? Actually, especially now I'm thinking about like asking for feedback. How do you deal with like the proactive versus reactive conversation compliantly. So compliance, the way I look at it, it's there to protect both the innovation that comes from pharma, but also to protect the information that we can disclose to the external stakeholder. This way it minimizes that risk. And the risk in this case is to recommend something that could potentially cause harm in any way. So the best way to navigate it is very clearly these are the objectives, this is what we're trying to do. When we talk about compliance in this sense, it's the clinical guardrails and we talk to the physicians and we have an honest conversations. You know, we're sitting on the same side of the table. This is what we're trying to do on our side from a pharma perspective is we're dealing with side effects. So reporting these side effects appropriately and you know, if you hear something that you have not heard before, then you try to address that. But I think the main point here is going back with, we're trying to put the most important external stakeholder here, which is the patient, and work together on how we can do it that way. Once you create that alignment, then it was really logical on how to manage the different steps we have to do to make sure. That this is delivered in a very clinic friendly way, but also compliant way. Yeah, that's really cool. I love this story. I think it's one of the most practical applications I've seen where you can actually also then measure between air quotes the impact of it. So that's great. I want to pivot a little bit and talk about the patient perspective and patient involvement in medical affairs. And it's often mentioned. Sometimes it feels a little bit more symbolic. What does it mean to you to integrate the patient perspective into these efforts? So my interpretation, or even sometimes from the clinical trial, it's very dry in terms of, you know, you have an X number of patients receiving it. The way I transformed my understanding is it means that this patient will live with this treatment, not just receive it. And I think that really changes your perspective when you design that from the mindset of there's a patient that's living with this treatment day to day, everything changes. How we talk about these side effects changes, how we talk about the timelines, changes. Patient preparation comes as a point that sometimes it's missed in clinical trials. But I think that's the beauty of medical affairs. Once you realize it, then you can really weigh in and lean into it. Hmm. I kind of see a parallel with the beginning of our conversation. Right. About walking in the shoes of your audience. And when you were talking about this, what came to mind was, do we have a systemic lack of empathy? Right. If you think about it. And of course, unintentional. Right, unintentional lack of systemic empathy. Because we are focused on the data, the numbers, the science, which is of course all crucial. But ultimately these are human beings. Would you agree with that? And if so, what do we do about it? It's a good point. I will transform it. It's not a lack of empathy, but I think our focus is so much on the clinical outcomes. Like, for example, do we have pfs, do we have os? Do we have a safety profile that is manageable from that perspective? And maybe there's an assumption that's made that clinicians are designed to manage this. So there's also another aspect to consider, that sometimes pharma is two to three steps away from the patient. So maybe you don't interact with them as much, at least from medical affairs. So there's kind of a perfect storm that the patient perspective could be hidden. But what I'm trying to say is it's hidden in plain sight, though, because it's right there. So you can't just ignore it. You have to bring it to the conversation and bring it as part of your discussions. Because at the end of the day, the patients would have to live with it day to day, and the physician themselves or the healthcare team would have to deal with it on the clinic days or when they have their clinic visits. It's interesting. And to share a little bit of a personal anecdote here, you know, I have a friend who's unfortunately suffering from cancer and going through that experience. And I worked in medical communications for over two decades. So I'm also one of these people that constantly talks about data and science and all of those things. Right. And now it hits really close to home. And I'm having conversations with my friend and trying to help. And it's just so clear that it's so hard for people to actually figure out what is going on. And I know, you know, the physicians do their best and they inform patients as good as they can. Pharma also has resources for patients, but it's still like, you know, it kind of still feels that there's a far cry from where we could be. And it's just like a hard challenge. And the main thing is that, of course, like with my profession, I could easily help because it's easy for me to figure out what the background information is and where you can get more information. And where could you go with some of your problems or which, maybe even which multidisciplinary team member would you need to talk to for certain topics? And it's just often actually those kind of basics that are pretty hard to find and understand for people, and they feel lost, and it's kind of sad. And I'm really thinking, like, we should figure out, like, how we can do more to help the physicians communicate to their patients as well. And I'm not saying they're doing a bad job. I'm just saying clearly there's a need for more. Right. I'm wondering, the things we have discussed here today, where do you feel there's still, like, a gap? Where do you feel there's things that we could actually do? Let me approach this, and I'll use the example of that publication. So we designed a publication that is for physicians and similar to your friend. I was actually faced with a similar conversation at one of my clinic visits, and a patient said something to the physician, and it felt like that the patient was not prepared for the treatment or they didn't understand it. And when I was talking to the physician, he said something that I would never forget. He said, place yourself in their shoes and think about their whole world is now upside down with their diagnosis. They don't even know where to start. And now we're layering on medical appointments and all of the things that comes with it. Some personal challenges that comes in with it. And it really made me pause. Sometimes we do operate as let's make sure that we're being very data driven, very accurate, very scientific, and that's great. But the question is, are we able to communicate that in a patient friendly way? So this actually drove the same guideline that we have published. We partnered with actual patients and we translated that guideline to a patient friendly way in a peer reviewed way using the patient voices. So we still kept the same clinical panel. So the clinical guide rail is always there. So we are compliant, but we brought in the patient perspective so they can tell us things that they focus on is a little different from what the physician focuses on. And when we did that exercise, it was a light bulb moment. It helped me realize that patient preparation and providing physicians and healthcare team with tools to prepare the patients is such more meaningful way to approach this. Because at the end of the day, you give a treatment to a patient, but the reality doesn't become the PFS or the os. It's more about therapy, management. That's what they live with day to day from a clinical perspective and the patient perspective. So my advice in this case is you have to think about all these stakeholders, you have to think about the physician, you have to think about the healthcare team, you have to think about the setting, but you also have to think about the patient and you have to create that parallel narratives that you're trying to achieve from a science perspective. So you can speak to these stakeholders within their own language, in a language that they understand and they can implement. Yeah, exactly. In their language. Right. And I think that's just one of the hardest things to do and it's great, you know, to work together with other actual patients because they will understand best and it might be close to impossible for someone else to understand it as good. Right now I would like to talk a little bit more about field medical as well, because also there from my end, we give a lot of storytelling trainings to MSLs. And in the beginning, you know, people were a little bit suspicious of it. It's like, well, is it commercial? You know, it sounds kind of commercial. What does this exactly mean? Does this have a place in medical affairs? And what we've been telling is that like this is has a lot to do with that humanizing Information, right. Humanizing data. Because ultimately when you put the data into perspective and in, into context, it just makes so much more sense. And I've actually had several QLs on this particular podcast and asked them about this. It's like, hey, listen, how do you think about MSL physics and how does that help you? And they were actually confirming and validating this concept where it's like, well, it was great to hear the data, but I kind of want to understand what it means, right? I want to understand what it means to me, my treatment decisions and what it means for my patients. Most importantly yet, I think in a lot of MSL conversations, we focus on the data and the data only. And I'm just wondering, like, how could we evolve those discussions beyond the data heavy presentations? So I started my career in field medical and this is kind of the things that helped me unlock a better communication with the physician. So from field medical, I think we get excited, we have exciting data. It could be practice changing and we get stuck into that realm. And what comes down to communicating that to the patient, or rather the physician or the healthcare team, they're thinking about, where does this data fit, how many patients will it impact me, what kind of resources I need to implement it? So making sure that field medical or the MSL are asking really clear questions that, you know, hit home is really important. They are the data translators. So the job of field medical or the MSL is truly to uncover what you're struggling with, not to think about. Do you think this is just meaningful for your practice? It's more about, let's not talk about the presentation more, let's talk more about. Do you see this as an issue when you implement it with your patients? Do you think that your patients would be amenable to this type of therapy management? Do you need more resources for managing this? What would that look like? So asking the questions that would more resonate with the physician that, you know, I've had a case last week about this case. Exactly. And then you're asking the right questions. That's what make an MSL more of a partner rather than a person that just regurgitate Haskell data or a Congress data. So basically there are two layers, right? One is ask questions, period. The second one is like ask questions that go beyond the data. And I really liked the examples you just gave. Any others you would like to share? I think because after the data reads out, therapy management becomes the forefront. A lot of these conversations because when the physician is about to implement this new innovative medicine, they're not going to see results maybe right away, but they'll see maybe the side effects or the adverse events more. So asking questions. For example, what's been the hardest thing about managing your patients? Do you see that the clinical trial data kind of deviates from what you're seeing in real life? What does that look like? What do you think the cause of it? Asking the questions that would make their practice better and go back to the point of can we free up some of that brain space so they can protect their clinical judgment rather than spending a lot of times on trying to dig out and figuring out these things. And I think this is how we can transform medical affairs to be more of an active partner with clinicians, rather than just a data review of what was released at a recent Congress or a recent publication. Yeah, absolutely. Now, I know a lot of MSLs and I know for sure that this is not for a lack of intent. Right. But I think there's opportunity to enable them better to have these conversations this way. How can we help our MSL teams? How can we help our field medical teams getting better at this? One way I found it to be helpful is first of all, prepare them to be data experts. Once they are data experts, they don't need narratives on how to talk about the data. If you're an expert in anything, then your recall is a lot better. So preparation of the MSL or anyone in field medical is really, really important. And then after that, equip them with a framework. So you get a lot of these. Think of your phone calls and someone is just reading a script, you lose interest immediately. But if you give them a framework about some of the challenges, how to ask questions, the framework to be a partner to protect the clinician's time, to ensure that the patient communicating through the physician understand the reality of this data and what it means, and doing all of that without losing the. The scientific integrity of what the data shows, because there's always limitations to that. So this is, I think, where the MSLs can really shine and where they have a nice role so that innovation becomes more of a partner that comes from pharma to the clinicians and the healthcare team, rather than just a review from recent data. I like that concept, especially what you said at the beginning. Like, once you are an expert in something, you create kind of some remaining mental bandwidth that you don't need anymore because you're not like on the edge of your chair trying to keep up and remember what the data is. Right. You can do that by heart, basically. Blindfolded. And as a result, there is capacity left that you can now use for other skills and capabilities. I really like that. That's an interesting way of thinking about it. Unfortunately, we're already heading to the end of our episode today. But before we disconnect, I want to ask you, like, imagine you have a magic wand, right, and you could make a change in the industry. What would it be? What would you encourage your colleagues to do? I would tell them you need to be able to sit in different positions. So one day you're sitting with the physician, one day you're sitting with the clinical development team, one day you are sitting with the patient. Understand the uncertainty that each different stakeholder faces can really be helpful. And you do this before you get that approval or before that data disclosure because it makes you a better communicator about the data, about the placement, about the preparation that you need to do for that asset that's coming in, or even sometimes a data update, let's say an asset's already there on how you can transform how it's managed. Don't forget about therapy management and don't make the assumption that a lot of resources means more clarity from the physician and from the patient. Always check how it's being implemented. If you don't do all these steps, then there's a possibility that you will be missing something or making a wrong assumption. That is amazing. Well, I think that was a really powerful reminder that data alone doesn't really change the clinical process practice, but translation of that really does. So, Eli, thank you so much for being here today. This was a really inspiring conversation. Actually got some new ideas myself while we were talking. Let's stay in touch and thanks for sharing your insights here. Thanks for having me on the show, Wesley. Looking forward to our conversations. Was my pleasure. Transforming Medical Communications is brought to you by Medcom's Experts. To find out more about Medcom's Experts and how we create some of the most cutting edge medical communications programs anywhere in the world, visit www.medcoms-experts.com and then make sure to search for Transforming Medical Communications in Apple Podcasts, Spotify and Google Podcasts or anywhere else podcasts are found. Make sure to click subscribe so you don't miss any future episodes. On behalf of the team here at Medcoms Experts, thanks for listening.