The Power of MSL Authenticity

Paul Meade and Mark Schoeman describe the determining factor driving effective relationships between medical science liaisons and key opinion leaders.

In a recent series of surveys across multiple therapeutic areas, we uncovered a rather startling statistic: 36 percent of key opinion leaders (KOLs) are not strong supporters of the companies with whom they engage on a regular basis-that's a little over one in three who are unlikely to recommend that company’s products or services, or recommend their MSL to their colleagues. As the lead relationship-builders with KOLs, medical science liaisons (MSLs) deserve credit when KOLs are supportive, as well as accountability when they are not.

As we searched the underlying data to pinpoint the foundation of the detractor or non-supportive opinions, we saw a pattern emerge. Those KOLs who had net negative opinions about companies and their products most often also found little value in their relationships with MSLs. In fact, several MSLs were regarded by their KOLs as no more than "sales representatives in lab coats"-a jarring reference that articulates the blurring line that traditionally separates commercial representatives from medical liaisons. In a word, the MSLs lacked authenticity.

When we think of the term “authentic,” words like genuine, sincere, reliable, and trustworthy come to mind. The word is derived from the Latin authenticus, meaning “coming from the author; genuine, original.” Thus, when KOLs find MSLs to be lacking authenticity, they are doubting their integrity and trustworthiness.

The data shows that to effectively drive mutually beneficial relationships with KOLs, MSLs must focus on placing the patient first when discussing any scientific information, even when that information may be detrimental-at least temporarily-to the KOL’s perception of the company’s product(s). When the MSL puts the patient first, the mutual exchange with the KOL is much more congruent with achieving the optimal outcome for that patient.

The Medical Science Liaison: defining the role

The MSL is a highly skilled and highly educated consulting professional who represents manufacturers in the healthcare space, such as pharmaceutical and biotechnology companies, medical device makers, and even diagnostic concerns. MSLs representing these companies usually interact with thought leaders and other healthcare providers, to offer information about clinical studies, health education, and a variety of other important services.

The MSL role, introduced at Pfizer legacy company, Upjohn Pharmaceuticals, turned 50 years old in 2017. During the last five decades, the role of the MSL has evolved to include a range of services for healthcare providers, such as helping to coordinate advisory board meetings, acting as a conduit for investigator-initiated trials (IITs), and more. However, having open access to these thought leaders in healthcare has become increasingly challenging for most MSLs, primarily due to time constraints felt by these healthcare providers and blanket institutional restrictions limiting access by any industry representatives.

For many thought leaders and healthcare providers, the line separating a sales representative from a manufacturer and an MSL from that same company has blurred over the years. While MSLs are strictly prohibited from “selling” on behalf of their companies, there is a fine line between providing clinical information on a company’s product to encourage use and an overt sales call to promote product use. As such, concerns have arisen over objectivity, credibility, and authenticity of MSLs.

Indeed, the same person signs the paycheck for the sales representative and the MSL, so clearly both parties act as representatives for the company’s interests. However, the role of the MSL is quite distinct from that of the sales representative, even if that demarcation is perceived as being somewhat blurred by healthcare providers. Thus, if the MSL is to rise above suspicions of being biased or lacking in objectivity, it is critical that the MSL achieves authenticity with the healthcare provider. So how does one establish an “authentic relationship”? Or better still, how does one achieve authenticity?

As described earlier when thinking about authenticity, what comes to mind are phrases like “genuine,” “sincere,” and “trustworthy.” As opposed to the scientific acumen expected of MSLs, the “soft” skills that define authenticity and can be difficult to measure. What has been traditionally measured by companies with regard to MSL key performance indicators are visits/meetings, duration of interaction, scientific literature left behind, follow-ups on requests, responsiveness, and reachability. These measures are often performed by self-reporting from the MSLs or field visits by MSL managers. On occasion, companies will seek some feedback from the healthcare provider as to the performance of their MSLs.

But why not instead glean the value of MSL authentic interactions directly from the KOL?

KOL feedback: what is important?

Our company conducted a series of blinded surveys across multiple therapeutic areas and geographies with over 3,000 thought leaders in the healthcare field. These surveys sought to determine which attributes and services were deemed important by the providers and which MSLs were performing the best against these priorities. Three general categories of expectations emerged: 1) science and clinical knowledge, 2) being professional and reliable, and 3) being authentic (as defined by certain criteria, such as being truthful and respectful, being fair and balanced when presenting information (even about the competition), being considered a “trusted advisor” to the thought leader, and showing a genuine concern for the provider-and more importantly, for his/her patients.

When an MSL is screened and interviewed before hiring, the selection criteria are often quite stringent, from level of education and experience in the healthcare field to interpersonal and organizational skills. Once selected, the on-boarding training program is rigorous and extensive-often several months in duration-before the MSL is ready to interact with thought leaders. A critical part of the training program is in the science and clinical area to ensure meaningful discussions with the healthcare providers. Another key training focus is on professional skills, such as being organized, dependable, resourceful, responsive, etc. But measures of authenticity are, on the whole, expected to be an integral part of an MSL’s built-in skill set.

The results from the KOL surveys showed that, for the most part, performance of MSLs was high in two areas: 1) science and clinical knowledge and 2) professionalism and reliability. Given the rigors of hiring and training of MSLs, these results were not unexpected in these surveys. However, as shown in table 1, performance in the area of authenticity was lower than expected, given the importance of this area to the survey respondents. It is important to keep in mind that gauging authenticity is somewhat subjective and is often “in the eye of the beholder.” Thus, a low score given to MSLs in this area is often the perception of the healthcare provider. Since most thought leaders rated authenticity high on the importance scale, low perceived performance by MSLs is a cause for concern. And remember, as in many other aspects of life, perception becomes one’s reality.

MSL performance: What is the KOL experience?

Using the Net Promoter Score (NPS) methodology, table 2 shows that the global aggregate score by over 3,000 thought leaders was 0%, which means that promoters minus the detractors netted a score of zero. The results from the surveys indicated 36% were promoters, 28% were passives (neutral), and 36% were detractors. Of importance to note is that the perception of the MSL and the company he/she represents are inextricably intertwined, so the reputation of the MSL and/or the company can influence the perception of authenticity by the healthcare provider. Across a range of 84 companies (table 3), an NPS below zero indicates a below average performance, an NPS of zero to 20% indicates average performance, and a score above 20% indicates elevated or high performance by the MSL. Table 4 shows an example of a high performing company with regards to their MSLs' interactions with thought leaders. As can be seen in this table, this company had a NPS of 25%, with 30% being in the neutral or passive range. One alarming fact from these surveys is that across 84 companies, a third of thought leaders will not recommend MSLs to their colleagues. How can this willingness to recommend be improved by MSLs?

As part of the thought leader surveys, there were open-ended questions asking what some of the barriers were to being more willing to recommend MSLs. The most frequently mentioned comment pertained to the MSL trying to “sell” his/her products too hard and without adequate balance. This theme played out through related comments about “lack of objectivity,” “overly criticizing the competition,” and “not showing a genuine concern” for the thought leaders or their patients. Many of the negative comments could be clustered under the authenticity category. Several thought leaders vehemently echoed the sentiment, “Always put the patient first.” By putting the needs of the patient first, an MSL will be in greater harmony with the healthcare provider than if he/she is perceived as only trying to promote the company’s products.

What does authenticity mean for an MSL? Table 5 shows five key areas to consider, as expressed by the thought leaders who responded in the research:

1.Always put the patient first.

By giving precedence to the patient’s interest in interactions with the healthcare provider, the MSL will be perceived as a partner in the management of health and wellness. By showing a genuine concern for the welfare of patients and discussing how various treatment options can achieve a favorable outcome for all concerned, the MSL demonstrates not only empathy but sincerity, as well.

2. Be knowledgeable, truthful, and respectful.

The MSL must be informed and honest. The MSL must also show respect for the time constraints and restrictions placed on healthcare providers, in addition to the challenges placed on thought leaders.

3. Be proactive and responsive.

Many healthcare providers reported that they spend long hours in treating patients, frequently extending well beyond the typical workday or even workweek. Too often, when they need find themselves in need of information to solve a problem, their assigned MSL is unreachable during "off hours." And while it may be unreasonable to expect an MSL to be “on-call” 24/7, with the option of using “virtual” interactions in such circumstances, the MSL could be better prepared to respond to the needs of providers.

4. Be fair and balanced, even about the competition.

The MSL must be devoid of any bias when discussing both his/her company’s products and competitors' products

5. Become a trusted advisor to the healthcare provider.

Ultimately, when a provider can depend on the MSL to be responsive, proactive, resourceful, knowledgeable, empathetic and objective, the MSL can become a trusted advisor.

As stated by one thought leader in response to the question on improving the value of the MSL interaction, he said, “The best MSLs know the interests of the physician and work to form a collegial relationship.”

While the role of the MSL has evolved over the past 50 years, there is still room for improvement. The changing landscape of healthcare requires that MSLs adapt to those changes and to the challenges that healthcare providers face daily in delivering care to patients. Consequently, measuring the performance of the MSL must build on traditional methods by including the analysis of critical feedback obtained directly from the healthcare providers that MSLs interact with on an on-going basis-and to provide the greatest value to those thought leaders, the MSLs must always strive for authenticity.

And as we define authenticity, we must remember that passive non-promotion of products is a bare minimum behavior to meet compliance and ethics standards. MSLs, however, will never become trusted advisors to KOLs by simply not doing something. They must be proactive, willing to share balanced information, and meet adversity head-on. These are standards common to any profession where success is defined by relationship-building, and MSLs must not only adhere to industry and regulatory standards, but also be authentic in how they treat KOLs.

Paul Meade is founder of Thought Leader Select, a research and consulting firm offering solutions to optimize industry engagement with individual and institutional stakeholders. Mark Schoeman heads Thought Leader Select’s innovation lab for qualitative insights in healthcare, Clear Point Health.