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Cost issues, complex drugs drive industry's use of technical experts.
Ask 20 medical liaisons from different pharmaceutical companies to describe their jobs and you'll get 20 distinct answers. Even their titles differ from company to company - they may be clinical specialists, scientific affairs liaisons or medical information specialists.
The purpose of medical liaisons is to augment a company's marketing and image-building efforts, even though they don't directly promote products in the way a typical field rep does, according to Bryna A. C. Elder, director of strategic studies for Scott-Levin, a Newtown, PA-based health care consulting firm.
"They don't do marketing per se, but they do supplement what reps do with relationship marketing," Elder said. "It's a way of reaching thought leaders who might not open their doors to reps and relate to them on a higher level. Their message is 'scrubbed clean' of the promotional aspects and more focused on the clinical 'whys' and 'wherefores' involved with a particular product or class."
According to a study by Scott-Levin, the responsibilities of medical liaisons are varied. They may:
• Set up continuing medical education programs or on-site training programs.
• Organize focus groups or symposia for any given group of specialists.
• Call on thought leaders or members of the medical research community.
• Provide searches of medical literature for influential doctors.
• Set up clinical trials, especially phase IV post-launch trials.
Medical liaisons usually focus their attention on medical opinion leaders, with whom they may develop relationships before any particular product actually comes to market. They often share best practices with experts and help them rework their clinical pathways. In many cases, medical liaisons do not report to the sales department, but to medical affairs.
Though the job varies from company to company, drug firms are fairly consistent in their desire to hire professionals with more clinical and scientific knowledge than the typical sales rep. Medical liaisons are likely to be senior salespeople, nurses, registered pharmacists, Pharm.D.s and even physicians.
"They have to be able to talk the language, build rapport and come across as though they are not selling a product," Elder said. "They have to have more savvy and disease-state knowledge than the average rep has."
Of the top 40 sales forces that Scott-Levin tracks, about one-quarter have separate medical liaison forces, Elder says. But other industry experts believe the number is significantly higher, and that nearly every major pharmaceutical company has these professionals on staff. Scott-Levin's number may be low because companies might be including their medical liaison forces in their total sales force figures.
While most medical liaison forces number under 100 professionals, some companies have considerably more. For example, Scott-Levin reports that Merck has two teams of liaisons totaling more than 300 - one group that focuses on research, and one group that has education responsibilities. Other companies divide their medical liaisons by therapeutic category, such as the former Astra Pharmaceuticals, which had two specialized forces to support its gastrointestinal and cardiovascular drugs, Elder said.
Historically, medical liaisons grew out of pharmaceutical companies' medical affairs departments, where they worked in-house to help organize clinical trials and provide technical support to the field, according to Craig Wheeler, vice president of the Boston Consulting Group, Boston. With their vast technical competence, these professionals were the ideal people to answer all the tough questions about drugs, including off-label uses.
"Basically, they could answer the off-label questions that the sales force couldn't answer," Wheeler said.
However, the growth of these medical liaison forces should not be interpreted as a sign that drug companies are trying to skirt Food and Drug Administration guidelines.
Customers' increased economic pressures - plus the fact that therapeutic categories are crowded with complex drugs - make it necessary for companies to have experts on hand who can answer the medical community's questions about topics such as clinical pathways and drug interactions for a drug's approved and off-label uses.
Managed care organizations demand clinical information, and FDA guidelines limit the kind of information account managers can share. Medical liaisons, however, can give managed care customers the information they want, the way they want it - in a non-promotional way.
Glaxo Wellcome Inc., Research Triangle Park, NC, currently has a number of medical science liaisons based in six regional hubs across the country who do just that. Most are Pharm.D.s whose role is to provide on-site clinical data to managed care customers while remaining uninvolved in the actual selling process, which is conducted by account managers.
"They don't talk price, they talk science," said Dan Long, group director of strategic operations for managed health care at Glaxo Wellcome. "These are people who know their therapeutic areas and all the medications, not just Glaxo Wellcome drugs."
The degree to which a company's medical liaisons partner with its field force depends on how integrated the company's approach is to sales and marketing.
The Medical Imaging Division of DuPont Pharmaceuticals, Billerica, MA, has 25 field-based clinical specialists in North America, most of whom are experts in nuclear medicine and nuclear cardiology, to support its medical imaging products, according to Brad Pounds, associate director of medical affairs.
"Because of their expertise, they are used as both clinical and technical resources for our external customers, as well as our internal sales and marketing staff," Pounds said.
Each clinical specialist is assigned a group of reps. "The clinical specialists have a pretty big toolbox, used to collaborate with and support the field sales organization," Pounds said.
For example, a clinical specialist in Los Angeles may work with five other sales reps to develop medical education programs, continuing medical education events and in-service meetings. The clinical specialist is also responsible for maintaining contact with regional and local thought leaders.
At Pharmacia & Upjohn - a Bridgewater, NJ-based company with a long history of using medical liaisons (see sidebar) - sales reps and medical sciences liaisons partner in a variety of ways, explained J. Scott Mohrland, Ph.D., vice president of scientific, professional and government operations at Pharmacia & Upjohn.
"For example, a representative may identify an emerging, future medical opinion leader with whom a medical sciences liaison can begin a developmental relationship," Mohrland said. Also, a physician might share an idea with a sales representative about one of the company's products.
"When the sales representative communicates this to the medical sciences liaison working in that area, he or she can then follow-up on the idea," Mohrland says. "This can lead to benefits not just for the company and the medical community, but, most importantly, for the safe and effective use of our product by patients." PR