The following reflection on personal impact and growth was originally published in the June 2024 issue of HOPA News. To discover even more articles in that issue and beyond, visit the HOPA News archive.
Authors
- Megan Langer, PharmD, BCOP, Medical Science Liaison, Medical Affairs Hematology - Myeloid, Bristol Myers Squibb
- Jake Hanlin, PharmD, BCPS, BCOP, Medical Science Liaison, Medical Affairs Hematology - Myeloid, Bristol Myers Squibb
Megan Langer, PharmD, BCOP
For most of the 11 years I spent in clinical practice, I only superficially understood the purpose of medical science liaisons (MSLs). I knew that this was an industry role focused on clinical data, but never considered that I could, or even should, work with MSLs in my clinical practice. When complicated or new clinical scenarios arose, such as a request from a physician for an off-label use of a therapy, my approach was typically to figure it out myself, or if I were lucky enough to have a student or resident, I would engage them to assist. I would spend precious, patient-care time digging through literature or asking for help on online special interest groups, trying to find justification to support the request. A massive shift occurred late in my practice, when I was tasked with bringing a novel monoclonal antibody to my institution via the pharmacy and therapeutics committee, which included subsequent electronic medical record (EMR) order set development and creation of institutional standard operating procedure. On top of my clinical duties and precepting, this was a heavy lift. The multi-faceted project was time- and labor-intensive, as the agent was riddled with black box warnings and a risk-evaluation and mitigation strategy (REMS) requirement. It was operationally highly burdensome to the pharmacy, the nursing staff, the patient, and the EMR. I spent countless hours researching, emailing, and troubleshooting.
I eventually spoke with the sales representative who offered to connect me with the MSL, who served as the scientific resource to help ensure that the drug was used effectively and could provide relevant clinical data. The MSL proved to be instrumental in the timely implementation of all facets of this project. She was continuously available to address my questions, thoroughly review the associated clinical data, and liaise to connect me with partners at her company, such as access and reimbursement specialists and clinical development teams. Additionally, she was able to connect me with experts at other institutions where the agent was already operationalized to share best practices, reflections on failures, and ideas for optimization. I became the institutional point for this drug, and once our site was comfortable and experienced, I educated our satellite sites as well. The drug company invited me to participate in pharmacist advisory boards, where I was empowered to share my own experiences with experts across the United States. In these forums, the pharmacists were able to vocalize barriers for use, strategies for managing toxicities, and express unmet needs for patients. Personally, I expanded my professional network and learned new strategies to apply to the care of my patients. I learned that clinical pharmacist input to pharmaceutical companies serves as a valuable, if not vital, mechanism to enhance patient care.
When the next clinical challenge arose, I was quick to seek out the associated MSL and request resources, allowing me to implement institutional drug policy and procedures and to develop EMR order sets more efficiently. From this point forward, when an MSL reached out to meet about a relevant drug, I prioritized time for them. The meetings were fruitful for me and my learning, as well as for my entire department, as I was able to share my learnings with the team. Typically, it was difficult for members of our team to travel to and attend live educational conferences, so these meetings were a simple means to review new data, allowed active engagement, and left me with new resources. I learned about up-and-coming therapies, updated data on approved products, and clinical trial opportunities for patients. I grew as a clinical specialist and became a more well-rounded resource for my team and my patients.
Jake Hanlin, PharmD, BCPS, BCOP
When I was a hospital/clinical pharmacist, one of my first meetings with an MSL was planned out several weeks in advance. We agreed to meet in the hospital cafeteria, and I completely forgot about it until I received a reminder email about an hour prior to the meeting. Of course this was right after we had finished rounding and I had two discharging patients to counsel and several other follow up items. I kept the meeting but could not stop thinking about all the tasks I had to get back to as the MSL relayed intricate details of a drug that I had never used, in a disease state that I rarely cared for. I gained little from the interaction that went well over the allotted 30 minutes, and it reaffirmed my convictions to decline any future meetings with anyone.
It was not until a few colleagues had left their clinical positions to work in the pharmaceutical industry that I began to better appreciate what the role of medical affairs entailed. With trusted friends working in the pharmaceutical industry, I saw the many advantages to having a strong relationship with an MSL. There were times when a question would arise during rounds that typically would have required post-rounds research; however, because the medication was covered by my MSL friend, I was able to reach out to them during rounds and often have a response quickly.
I began to see how the MSL could be a particularly useful tool if you know how and when to use him/her. As I reflect on my initial negative experience, I realize there were several things that I, as an oncology pharmacist, could have done to make that meeting more productive for me. First, I could have asked more questions long before that meeting. Had I realized that the MSL covered a therapeutic area (or a therapy) that I had little experience or interest in, I could have respectfully declined the meeting. If the MSL covered a therapy that I had been interested in, but perhaps wasn't something that I was familiar with, I should have been open with the MSL (and confident enough to admit that I don't know everything) and asked them to provide more background information to ensure the meeting was beneficial. Next, like most pharmacists, I have a healthy amount of trust issues, so rather than simply trusting the MSL explicitly, I could have requested references or visual materials. Additional data would have allowed me to further digest and interpret the information for myself at my own pace. Lastly, I should have shared with the MSL that I was under a lot of stress and that it would have been beneficial to me to shorten (or even reschedule) the meeting. This is not an uncommon or unreasonable request from front-line healthcare workers. A good MSL will be prepared for this and can condense their message to fit your needs and, if necessary, schedule a follow-up meeting.
Consider these additional tips prior to your next MSL meeting to ensure it is beneficial and can provide value to you and your practice.
Megan and Jake's Tips for Working with MSLs
- Share your preferences. You can communicate with MSLs face-to-face (on-site, off-site, at conferences, etc.), via teleconference, over the phone, text, or email at any time. Be open and honest with your time constraints; meetings can be as short or long as you want them to be.
- Know which drugs (including pipeline) your MSL supports. Check the company website or simply ask the MSL.
- Request a focused agenda, communicate your needs, and ask specific questions. Your time is important, so request efficiency of your MSL. This will allow the MSL to gather resources and bring you the specific information, or additional personnel, that you need.
- Be honest with your data analysis and feedback. An MSL's goal is to serve as an unbiased conduit between healthcare providers and their company's Medical Affairs team. By providing your expert opinion, genuine critique, and thoughtful analysis, you are helping patients and helping to identify areas where further research is needed.
- Invite your teammates, residents, or students to the meeting. Group meetings allow for enhanced engagement, wider distribution of knowledge, and greater impact on patient care.
- Designate an industry liaison on your team. They can take the lead on these meetings and disseminate information to the team.
- Create a tool that serves as a quick reference for easily contacting the appropriate MSL for your needs. A suggested format is below:
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