Bonus Episode: Dr. Wael Barsoum (Part 2)

Clay Hausmann: Hi, everyone. Clay Hausmann, your host here, back with a bonus episode. Now this is new for us, and the reason why we're doing it is because we had our first healthcare provider on the podcast recently, Dr. Wael Barsoum. I encourage you all to go listen to that episode. It was great, with so many different interesting insights. But that's why we're doing a bonus episode. Because he had so many interesting things to say, we couldn't fit it all in one episode. So in this bonus episode, he's going to share even more interesting perspectives about how life science organizations can bump their grade up to an A, in the way they communicate with HCPs. You talked about the importance of very targeted objective data, but it was also combined with a human relationship or a human delivery or human connection point, not only with the rep, but also with some of your peer set that you started talking to. And this is a tipping point that's a big discussion in the industry, about whether the sales force on the pharmaceutical and medical device side will decrease significantly, because now we have all these digital channels, and HCPs are becoming more comfortable with those channels. But, that combination of the human element, with the data or the technology, all of those working in harmony, we've felt for a long time at my company, that they all play their role. And so I guess my question to you is that, can you envision, or have you experienced that sort of situation through a digital channel, where you don't have that human interaction back and forth, you don't have the relationship that you play off of, but you're still getting objective targeted data, but you're getting it through a more impersonal channel, but it's more efficient, most likely, and it's on your own terms and your own scheduling and you can look for it? How have you seen that evolve with regard to digital channels, versus the rep relationship that's been in place for so long?

Dr. Wael Barsoum: There's no doubt that the rep relationship, for those of us that have been around long enough, is still important. And candidly, I mean, it's important, because over time, you build a level of trust with other people, right? It's just like being in an operating room with the same scrub tech and the same circulating nurse every day. You get comfortable with them. You know where their left hand is going to hand you the next instrument, where their right hand's going to be while they're handing you that, so you become comfortable with folks. I don't ever want to minimize the value or the importance of folks that are doing that work, because candidly, they're really smart. They work extremely hard. And they're, in many cases, as committed as the clinician taking care of the patient, right? When I'm doing an open hip fracture at three o'clock in the morning, thank God I haven't done one in a long time, but when I did, the rep was standing right there too. They got up. They got out of bed. They showed up. They did it for the patient just like I did, right? And, that rep might have gotten paid 60 bucks to show up for that case. But they were still there, because they knew that it was a higher calling, right? They felt it just like I did as a physician, that it was my job to be there and the right thing to do. Clearly, that relationship and that level of trust is important. I think that, over time, what we're seeing is, as we're moving into more and more of a digital age, that those relationships and the value of those relationships is probably higher with folks that have been in healthcare longer. And, younger folks who are actually learning healthcare through digital textbooks, they're learning anatomy, not necessarily through cutting up a cadaver, but by wearing augmented reality glasses and entering a heart chamber and looking around and seeing valves. Life changes, right? I mean, healthcare evolves. So, moving to more digital platforms, digital channels is, without a doubt, the right thing. But I do think, Clay, that having human contact in somebody that you can ask questions, not maybe they don't have to be there in person, but that accessibility to somebody when you need them is important. It's no different than if you're calling your bank. If it's a simple question, I just need to know my balance, it's great, right? You can do that in two seconds. It'll give you your balance and you're done. But if you think that your identity's been stolen, you need a human being on the other side to help you with that. So, like everything in healthcare, there are going to be kind of gradience of, what am I comfortable getting from a digital channel that's objective and data- driven and convincing, versus what do I really need to have an interaction with a human being about, because I'm not quite comfortable where this is going?

Clay Hausmann: Well, and I imagine also, this is where there's a distinction between the relationship with the medical device rep or the pharmaceutical rep, because the medical device rep is much more, it's a more consultative relationship, I would imagine. As you say, they may be in there with you at three in the morning, in that way that a pharmaceutical rep wouldn't play that role, as much of a partner role that you would rely upon. Would you say that that is accurate?

Dr. Wael Barsoum: Yeah. I have to be honest with you. I haven't had a lot of experience recently with pharmaceutical reps, just because I'm an orthopedic surgeon, right? Most of what I prescribe is generic stuff. I mean, it's pretty simple. But certainly I can tell you, when I think back to my training, I had close relationships with pharmaceutical reps that were educational, that clearly helped me to understand some of the physiology of certain drugs and how they worked and why one might be better than the other. I mean, when I was finishing my residency, that's when COX- 2 inhibitors came out, Vioxx and Celebrex and some of those drugs, and understanding, drawing back to the way the kidney worked and the loop of Henle, and why does a COX- 2 inhibitor, why is it more protective to the kidney than a non- COX- 2 inhibitors? I mean, it was kind of interesting to understand that and to learn that, and maybe even to have some of my basic science knowledge kind of confirmed through the understanding of the physiology of a drug. So look, I would say, you're probably right. I mean, for me, certainly, working with the medical device reps is very different than working with a pharmaceutical rep. But I would also tell you that it probably doesn't change my premise, that for certain things, I need to talk to a rep, or I need that level of knowledge from somebody that I can talk to, versus, here's something that I can just read about online, or I can watch a video about.

Clay Hausmann: Certain things you can consume. Other things you need to interact with somebody and get some consultation, yeah. So, you mentioned earlier the grade going up, and I'm sure people who are listening are pleased to hear it's gone from a D- to a B +, but of course, people would want an A. So, what gets it from a B + to an A, for you, in terms of how you're supported?

Dr. Wael Barsoum: I think more of an ability to customize, and then respect that customization. That's kind of the key. And look, I want to be clear. I have a tremendous amount of respect for folks that are in the sales field, both in medical device and in pharmaceuticals. I mean, like I said, and I really mean it, these super dedicated people that are committed and smart and really know their stuff, so I just want to be clear about that, but there are points where you're kind of done being sold. Either you're in or you're out. And if the decision is you're out, okay, then let's stop with the emails. Let's stop with the text messages or the phone calls or the invitations to meetings. And again, I'm not saying it in a disrespectful way, but that's probably the key to getting to an A. And I think the other part to getting to an A is, in the pharmaceutical world, I think it's better in that, the data that the pharmaceutical companies show is generally level one data. Because to get a drug approved through the FDA eventually, you have to do prospective randomized, double- blinded studies. In the medical device world, in many cases, you don't have to do that. You can get things cleared through different pathways that don't necessarily require level one studies. So, I think the next step to getting to an A is, if you really think that your product is truly differentiated and should supplant the present gold standard product, if you want me to be convinced of that, then show me level one data. When I ran our new product committee at the Cleveland Clinic, when we would be looking at bringing new products into our operating rooms, for example, our methodology was very simple. You can't go from product A to product B and get paid more for it, just because of healthcare inflation, and because it's the newest one that came out on the market today. If you want to get paid more for it, then you had to show level one data that showed that it was better than product A. If it wasn't better, then we would pay the same as product A. We weren't going to pay a premium for it, unless it was clear, objective data that it was better than the predecessor. And I think that ability to prove definitively that a new product is better than its predecessor, I think is the key. So, just as I would use that as my criteria for using a new product in an operating room, I think that probably ought to be the same criteria that is used to sell a product.

Clay Hausmann: I think some of your themes that you've brought up here really resonate with me around obviously leading with objective high- quality data, recognizing that the role of different channels are influenced by the depth or sensitivity of the information that's being presented. That's it for this special bonus episode of Contextual Intelligence. We hope you enjoyed it. And if you haven't already, our full conversation with Dr. Barsoum is definitely worth a listen. You can find all our episodes on Apple Podcast, Stitcher, Spotify, or wherever you get your podcasts. And please leave us a review or a comment or a question, or all of the above. That'll do it for 2021. We have some amazing guests coming up next year, so please join us in the new year for more Contextual Intelligence.