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  • Episode 29: Medical Societies and Pharma: Unleashing Blockbuster Launches Through Partnerships and Medical Education

Medical Societies and Pharma: Unleashing Blockbuster Launches Through Partnerships and Medical Education

with Neal Kovach, Global Chief Commercial Officer at the American College of Cardiology

  • 56.000 members of ACC worldwide, and why are they a critical component of the healthcare ecosystem globally?
  • Alignment or Conflict? Unveiling the link between medical societies and pharma companies
  • Entresto Launch: Lessons learned from educating the market and guideline integration
  • Power Triad: How can Societies, Pharma, and Technology revolutionize medicine launches

To answer these questions, Bozidar is joined by Neal Kovach, Global Chief Commercial Officer at the American College of Cardiology.

Topics Covered in this Episode

  • [ 01:42 ] - To understand medical societies, you need to consider what they do and why they exist, not who they represent. They are a critical component of anything in healthcare, working everyday to help the people on the front line create a healthier world for their patients.
  • [ 05:15 ] - Pharmaceutical companies invest billions of dollars in innovation, helping to reduce disease across the world. Medical societies exist in order to ensure that practitioners have the time and tools they need to make consistent, equitable, well informed decisions about their patients’ care. Both organizations are looking to answer the question of what can be done differently to create better outcomes for patients.
  • [ 10:00 ] - Medical societies approach innovation by taking time to utilize the right evidence base and publish robust and rigorous guidelines that can be utilized when an innovation is released. However, with the example of Entresto, there wasn’t an investment made in order to ensure doctors truly understood the burden of heart failure. The knowledge base and market in the space were not built in order to let the drug be successful.
  • [ 18:35 ] - There needs to be a triad of partnerships between pharmaceutical companies, medical societies, and technology organizations. In order to affect change logistically, you need to consider the technology networks that are leveraging novel solutions, seamlessly informing clinicians on how to approach and close the gaps in their day-to-day practice.
  • [ 31:30 ] - Pharmaceutical companies and medical societies both need to be approaching things with a global first mindset. If we don’t think of things from a global first mindset, we will end up with subscale, inadequately integrated solutions.

If you want to learn more about leading a successful pharma marketing campaign in the US, tune in to this episode of Pharma Launch Secrets, a Podcast by Evermed.

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About the Podcast

Pharma Launch Secrets” is a podcast by Evermed and hosted by CEO Bozidar Jovicevic, where we host direct, actionable conversations with world-leading pharma launch experts and help you stay up-to-date with the latest trends and strategies to help you launch your product successfully.

Episode Transcript

Bozidar: Hello, and welcome to the new episode of the Pharma Launch Secrets podcast. I'm joined today by Neal Kovach, an experienced nonprofit leader with a strong belief in the power of cross-sector partnerships to improve the world. Neal is currently the Global Chief Commercial Officer at the American College of Cardiology, a large, well-known, nonprofit medical association. He leads strategic partnerships, revenue growth strategy and the global corporate relations and innovation teams. I hope I got all that right. And then I pronounced your first name and last name. Neal, welcome.

Neal: Thank you. Good to be here.

Bozidar: I am excited about our conversation today because medical societies and pharma companies have always been working together for many, many years, many decades and evolving together with doctors. And also another reason is that you're the first guest that I'm discussing this topic with. So I'm really curious about the conversation and how pharma executives who are thinking of preparing a launch of the product should think about how to work with medical societies, because many of them are. Sometimes, I found, a little bit afraid to even think about the topic. So someone else on the team will do that. So to start with that and maybe set the foundation and tone for what we're going to discuss today. In your view, what is the primary role of medical societies in the overall healthcare ecosystem, and how do they interact with pharmaceutical companies?

Neal: Yeah. So when I think about medical societies, I think a lot of times people think about who we are, right? We represent ACC, Cardiologists, cardiovascular care team members. But to understand medical societies, you really got to think about what we do and why we exist. Right. So ACC, even if we had no members of the organization we would exist to achieve the mission of the organization. And that's why we come to work every day. And that's why our members join the organization. Right. So our mission is to transform cardiovascular care and improve heart health at ACC, we're trying to create a world where cardiovascular disease is not the number one killer of men and women in every country on earth. Right. And medical societies all across different medical therapeutic areas, primary care. They're all focused on the mission of trying to change health care delivery and create healthier lives for people. And then how they do that and who we are is we're medical specialty societies that have members. So at ACC, we have 56,000 members worldwide. Right. We represent 90% of practicing cardiologists in the United States. Cardiovascular care team members, administrators, nurses, the whole team. Right. And so, medical societies are really critical component of anything you're doing in healthcare, because we represent the people on the front Lines, and we're working every day to help those people to create a healthier world for the patients that they're treating. So I think you can't really change anything sustainably within the healthcare ecosystem without proactively thinking about how can the medical societies that are creating the standards in the field, that are representing the leaders in the field and that are led by the people that are really driving change in the field. Part of the solutions that are going to create a healthier world. So I love working for a medical society. I have my whole career. And I think there's a huge opportunity and I know we'll dive into this today to really try to be transformational on how private sector and nonprofit organizations like ACC are working together. Because I think there's a huge amount of shared goals that we have and we've got to do something differently if we're going to change the equation for the direction. The healthcare system is going in the United States and around the world.

Bozidar: No, thanks for that. And just to share, when I would be thinking about society, sometimes I would think of them as almost like guardians of scientific information and with the highest level of trust in any specialty where standards are set. And we're really that, as you said, working towards that mission where education drives outcomes. So I don't know if that term is anywhere used, but I was always thinking like that when I was also on the pharma side.

Neal: The guardians of the medical galaxy. 

Bozidar: Maybe. Okay, all right. That's also cool.

Neal: No. I agree with you, though, Bozi. I mean, medical societies are the organizations that clinicians go to when they're treating their next patient, and they want to know what to do because every patient has their own circumstance, right? And hopefully when you're sitting down there as a clinician, you've got the tools and resources and education and training that you need to do what's right in that particular circumstance. But we're always that group that people come to when they're making those decisions, when they're preparing to see their patients. 

Bozidar: 100%. 

Neal: Your analogy is good, yeah. 

Bozidar: My mother would immediately agree. She's an ophthalmologist experienced one. And I asked her recently, so are you using this product? And she's like, no. And I said, why not? She said, my society doesn't recommend it right now. And that was it. So after 35 years of experience in Ophthalmology, that was the answer. Okay, I totally get it. So speaking of pharma and society, so what are the common goals that both pharma and societies have and where do they diverge? And we can share some of the what's true and what are some of the misconceptions as you answer the question that we really great to hear.

Neal: I don't think that there is very much that diverges when it comes to the goals of pharmaceutical companies and medical societies. Right? I mean, pharmaceutical companies invest billions of dollars in incredible innovation, helping to create a world where people can be free of disease in the future that are not today. Right. The things that need to happen in order to achieve those goals are quite aligned with what medical societies do, right? ACC exist to make sure that every time somebody sits down with the patient that they're seeing that they, as I said, have the tools that they need, but more importantly, that they're making consistents, equitable, well-informed decisions based upon the standards and guidelines and evidence that exist. And we know that we're really far away from that becoming a reality. If you look at the day-to-day circumstances and the evidence of what treatment standards should be and what they are and things like when new medical guidelines come out and how long it takes them to be adopted, we know that it's generally 20 years between a guideline coming out and that being fully adopted into medical practice. And obviously there's a huge divergence there in the investment that a pharmaceutical company puts into creating an innovative therapy that's life changing for people and the commercial equation that takes place if it's going to take 20 years for that to be adopted. Right? And I think that intersection is where the collaboration that's really impactful happens between medical societies and pharma. Because if we don't create circumstances in daily practice where people are making more consistent, more well-informed decisions about what their patients need, then we're going to be stuck in this cycle of frustration for clinicians and patients and industry and everybody because nobody is satisfied with the standard that we're meeting today. I think there's a big alignment in terms of the things we want to do. The critical question and the challenge is what are we going to do differently to create better outcomes for patients? Because I think we're all feeling like we're beating our heads against the wall a little bit and we've got to think about doing things, differently.

Bozidar: All right, so let's talk about it just a little bit on this topic to kind of examples and share a little bit from my side for pharma. So one side we have a nonprofit organization, medical society that has very mission-driven and I found that also people that work at medical societies also are united around this very meaningful impactful causes. They really want to feel that meaning and nonprofits are great place for that because they're about collaboration and a big mission. So they're nonprofit organizations, the most trusted organizations in medicine and driving education, many other things education forward to improve patient outcomes. On the other side, you have commercial entity pharma that every CEO goes to Wall Street every quarter-by-quarter. What are the results? So they have pressure, of course, to deliver on revenues and deliver value for shareholders. And the core of what they do, the value that they create in the marketplace is innovative medicines which correlates to market being able to pay for it. Right. And so I almost felt that part that unites both types of organization is that they're driving improvements in medicine together. Right. And where it gets a little bit tricky is because there is a pressure for CEOs and for pharma companies to deliver on revenues and they may want things to get faster in the guidelines, or you don't need five outcome studies in order to be included in the guidelines. And, you know, in cardiovascular, specifically with those big outcome studies, So they would want to be faster because they felt this pressure. And I feel like societies are there to kind of balance that out and really be objectively looking at the data. So I always felt that this was a healthy tension, almost like a little bit of a checks and balances, right. So that we find some middle. Just curious, how do you think about that? And what I just described is what you see. And last thing I'll say, I remember Entresto. So I was at Novartis at the time. I actually worked on Entresto and it was called LCZ. And I remember it had great results. And it was a brainchild of my boss at the time who's heading cardiovascular development there. And I remember the results are so good and the drug had the name given to it faster than planned, and then it entered the market. However, the adoption of the market, because it also went to primary care physicians, so it becomes new standard of heart failure on top of standard care. And then the adoption of guidelines took much longer, to your point, exactly as you say. And I was always thinking, it's really interesting how these two or three systems work together in order to find the right balance. So I just wanted to ask you whether that kind of thinking or as an example makes sense. I'm on the right track with that? 

Neal: Yeah, I think you've highlighted two distinct, but also highly interconnected issues. One is the pace of innovation and new therapies that come out and then how those get integrated into guidelines. And the second is how guidelines get implemented, as you're saying. Right. Trust comes in on a donkey and out on a freight train. Right. And for a medical specialty society, taking the time to do things right and to have the right evidence base and to put the guidelines out in a way so they're really rigorous and robust. And also so that we build the tools and resources so they can be utilized when they come out. That's important. But we've put a huge amount of effort in to getting guidelines out more rapidly and also updating them more rapidly, because that's the frustration as you come out with a guideline. You can't wait five years for another guideline. They've got to be updated on an annual basis, and they've got to be iterative and updated annually as new evidence comes out. So we're committed to doing that. We're doing that. All of the new guidelines that we put out are using that methodology. Is it going to meet the expectations of every pharmaceutical executive that ever exists? No. But is it a lot better than it has been in the past? No doubt about it. Right. And there's been huge enthusiasm about that. But that's not going to solve the issue that you raised around Entresto, and it's not going to solve the issues that I was raising earlier about clinical practice. So I think there's two things here. One, from a pharmaceutical perspective, if you look at that Entresto example, things moved quickly there. But the question really is, was the investment made to build the market and heart failure so that when Entresto got into the market, doctors were thinking and understanding about the burden of heart failure, that heart failure has a worse prognosis than cancer does? When somebody is diagnosed with heart failure, is it top of mind for clinicians when they're sitting down with their patients about what the evidence is today and what they need to know and what's the titration that needs to take place? I think there was a lot more that everybody that was involved then from a medical specialty society side, and certainly from a pharmaceutical perspective, says, we didn't build the knowledge-base and the market in that space to allow the drug to be successful even after the evidence and the guidelines were updated. We're all working, and certainly companies like Novartis are working. And you look at their whole reorganization now, it's sort of built around solving this problem for, let's make sure that there's awareness in the marketplace before the drug exists. Right. So that's an obligation that pharmaceutical companies have to be investing in organizations like ACC and others all across the spectrum with primary care and specialty to make sure we're educating doctors and training doctors years before a product hits the marketplace. One other thing I would say is we've got to put programs in place that give tools and resources to people that are easier for them to use because patients are so complex and they have so much multimorbidity. And the error that pharmaceutical companies make and that ACC makes the same thing is thinking we're going to solve some individual problem and not solve the delivery system and the information system for medical knowledge in a way that people are getting the information that they need, when they need it, how they want to receive it, so that they can make the right decision.

Bozidar: I'm actually glad I mentioned that as an example because I wanted to ask you about the opportunities to work together, and I think interest, given that its launches happened quite some time ago and now actually the drug became established. And I remember there was a gap of a couple of years where there was changes of strategy I was ignoring at the time, but change of strategy in order to kind of rework the launch again. And then it worked and now it's a big drug. It's a $4 billion something drug and it's pretty much everyone in cardiology. A lot of primary care doctors see it as standard. We're now 2023 with some learnings from the example I mentioned. How should pharma companies think about the opportunities to educate clinicians prior to launch and doing the launch? What are some of the best practices and the best channels to do it together with medical societies? 

Neal: I think you deed to approach things at a high level from a therapeutic area perspective. Let's take an example like cholesterol control, right? The reality is today, for somebody who has a heart attack, a huge proportion of them are not even getting a lipid value taken twelve months after they have a heart attack, and they're not on a basic statin twelve months after they have a heart attack. So we're so far from creating an ecosystem where people are driving their LDLs to below 70, if there are secondary prevention, like the new guidelines recommend, right? That we've got to really be creating alarm bells in the field to say, hey, we have a crisis of cardiovascular disease driven by a lack of urgency in how we're treating the risk factors that are driving cardiovascular morbidity and mortality. And as a clinician, you have an obligation to be optimizing the health outcomes for your patient and understanding using the tools and resources that exist, what their risk is and how you can improve their long-term outcomes. And obviously, clinicians are committed to doing that. But the problem is we've had so much innovation in cardiology and in healthcare, right, in terms of new therapies, new devices, new technology, but nothing has changed. The experience of a person walking into a doctor's office and then the technology infrastructure that a doctor is operating with as they're walking into their clinic every day. Right. The gap in change between the incredible innovation that now exists in the field and how much innovation has actually taken place in the day-to-day practice of a clinician is huge, right? And we have to solve that problem using technology. You've got to be understanding the health status of your patient longitudinally, and not just every six months when they sit down in your office using technology. And you've got to be consuming education and training as a clinician longitudinally on a daily basis so that you can stay up to speed with the huge myriad of things that you have to understand as a clinician as evidence is constantly evolving. So I think technology has a huge role to play in the delivery of clinical practice on a day-to-day basis and also in how we can make the most of a busy clinician's time that's more burnt out than ever to give them the tools and resources that they need to make informed decisions. And I think that's why Evermed is a company that exists, right place, right time, in terms of what you do and how you approach things and why partnerships between ACC and Evermed are so critical to solving that training component. That is such a huge gap still today.

Bozidar: As you were sharing that example of beyond the pill or beyond the drug, also challenges that exist. I was actually leading at some of my last row in pharma. I was leading digital therapeutics. So I was looking at that problem every day and looking at the companies who solve it, asking myself, should pharma solve this problem or should partner? And all kinds of things. And it always reminded me one of my best friends, international cardiologist, and at some point he started building his own practices, like twelve practices now in New Jersey, which is across the River. We both live on the west side of the city. And I was telling him, I remember four or five years ago this technology and that technology and can do this and monitoring. He always looks at me like, I would highly suggest you come over to some of my practices and take a look a little bit of where the patients are, where's their state, the challenges that they have. There's a huge gap when I hear you speak about the technology and what I deal with every day. And I worked at Sinai, I work in smaller practices. I work in Midsize Hook Community hospitals. It was very interesting. It just reminded me of those conversations. And yes, technology is moving faster than human beings, mostly in our behavior. And now, especially with GPT, those kind of gap between how fast we can move and how fast technology moves is going to be even more shown. I'm glad you mentioned the LDL example. Hey, I just realized I have very high LDL, so do something about it. Last week and two, I'm thinking, okay, so let's say I'm a pharma executive and now I have LDL lowering drug and it's one year from launch, maybe one year and a half. And usually what I've seen in pharma companies always a little bit late with prelaunch because they're waiting for phase three to read out and then there is only twelve months left until the market. So there is always not enough time to prepare launch. So how do I think about what do I do now with ACC cardiology societies? Now that I've shown that I have results in primary, secondary prevention? Where do I start? Should I talk to the society executives? Should I form a team around it? Should I first think of conferences or think of year long engagement? Let's say that I'm new in this area. I haven't been traditionally a company. This is a big player in cardiology.

Neal: I think that increasingly the key sort of triad of partnerships that needs to exist is between pharmaceutical companies that make innovative therapies medical societies that create the standards in the field and represent the leaders and frontline practicing clinicians on a day-to-day basis and then technology organizations that are really changing how care is delivered, leveraging technology. And so as we're thinking about how to affect change holistically whether you're talking about hypertension or LDL or titration of heart failure, therapies or anticoagulation for AF, anything in Cardiology, we're thinking about what are the technology networks that exist nationwide that are leveraging novel solutions for informing clinicians in seamless ways that don't create work for them. About the gaps in day-to-day practice that they have and how they can close those gaps. And then we're building our tools and resources and intelligence and guidelines and guidance documents and pathways and training and clinician patient tools, all of that at the point of care using those technology companies. So I think that's the model of change for the future because it's the only way we're not going to pilot our way out of this frustrating scenario that we're in. We've got to get to some really scaled solutions where we've got the right evidence at scale at the point of care using technology. And I think that the three parties are really critical for getting there. You've got to have the innovative therapies and you've got to have the standards that are being set and the tools and resources that are being developed. But you've got to have it integrated at the point of care in a way that's really seamless for somebody who's busy in a day-to-day practice. And I think that's where the focus has got to be. If you're a pharmaceutical executive, how do you form those partnerships? So you have the knowledge and then you have the dissemination mechanism, so it's actually going to be utilized.

Bozidar: So are there any examples that you can share? We don't need to name the companies, but where things were done right. And we mentioned Entresto and the challenge that community was not ready, the awareness of the issues in heart failure, which has kind of been treated the similar way, chronic heart failure for many years. So doctors were not ready for understanding the really gaps and then adopting this therapy. So that took some time. So that's an example of market readiness education purely focused on pharma, not even being ready to think about technology at that point, because person doing that is like, okay, I can't even solve now the problem of awareness of my drug, let alone integrated technology. So companies are doing it better than other companies that you see across the board. What are they doing differently right now in 2023, preparing the launch?

Neal: Yeah. So I think it's about creating all of the different types of tools and resources that you need to be successful, right? So you've got to have the clinician education. You've got to have patient education, you've got to have clinician and patient resources. So when the clinician is sitting down with a patient, they've got something that they can use to solve the problems that that patient is facing. And then you've got to have implementation programs that are establishing a baseline of what the reality is today in terms of the clinical care continuum, setting goals for what those should be based upon the evidence that exists, and then tracking on an ongoing basis how you're changing the reality of adherence to guidelines on a daily basis. And those are the best partnerships we've seen, where the tools are developed in a holistic fashion so that everybody has what they need to be successful, who's part of the care team, including the patient and their caregiver, and then leveraging technology. We are training people differently at home during their busy clinical practice, while they're traveling, right. They can get the training that they need when they want to receive it, how they want to receive it, and it's concise and it's got the information they need. And then we're pulling through it in daily practice with the practice tools that they need integrated into the EMR at the point of care, so that you're pulling through. You know what to do through the knowledge that you're creating and conveying to the doctor. But then you're giving it to them in terms of a tool, at the point of care, in a way that they can use it seamlessly.

Bozidar: When you say tool, what do you mean by tool? Can you just give examples so audience can understand?

Neal: We've worked hard through the technology partnerships. We have to have dashboards developed by ACC that leverages the risk calculators and the different tools and resources we have, so that when you sit down with a patient, you can see the gap that exists, and then increasingly you can see what's the outcome change for that patient going to be if you pull different levers for optimizing their care in a better fashion. So there's a lot of different really innovative technology companies that are rolling out solutions like this. We work with a few different companies. We work with Paradigm Life Sciences is one group that has a huge outpatient network of practices that we work closely with. We work with a really cool company called HealthPals. That's one of the companies that builds dashboards like that, but there's many others that we work with. For us, it's about what's the problem we're trying to solve, where are the clinicians and patients we're trying to reach, and then what's the network we need to reach into and what's the technology we need to leverage to get there. And we built it in a customized way so it has the best impact.

Bozidar: Yeah, I mean, those are powerful. Just I had an example last week, so went for an annual. I had a physician assistant, they'll look at everything and LDL 160, but then they plug in the calculator that you just mentioned. Plug in the calculator, looked at all the data and said, look based on what I see here, your risk of having a cardiovascular event turning 46 is here is 1.5%. Even though is high with LDL, with everything else taking into consideration, I wouldn't suggest right now, starting with statin, that's the overall recommendation. And he stood behind that because he also had a very powerful tool powered by outcome trials and data to say something like that. And I thought, wow, this is actually I knew about those tools and everything, but it's really powerful that at many different levels in healthcare, you actually can, with a quite high level of certainty, make a recommendation that that was the right decision to be made. And just having those tools in the right place, right time, think is key. And then in terms of some specific tactical ways that Pharma can drive education, let's say again I'm launching LDL. Maybe there's a new mode of action or maybe a new administration route. Conference is the first thing that comes to my mind to Pharma marketeer. Like, there is a conference, I need a booth, I need to have a lecture, I need to engage, et cetera. What are some of the other things that you say Pharma executives could think about? Are there any specific partnerships they could think about through the network that societies have and all the tools that you mentioned and your existing partnerships on technology side and also engaging doctors throughout the year with any channels that societies have. So how should they technically think a little bit about this?

Neal: I mean, I think it has to be an omnichannel approach where you're meeting people holistically throughout the year in person through major conferences like ACC, right. Got 20,000 people gathered, leaders in cardiology, a huge momentum and focus around doing something differently in the field of cardiology during the three days of a conference, right? But then people are going back into their daily busy lives and they're burnt out and they're worried about a million different things inside and outside of their professional life. So we've got to be supporting solutions that meet the needs of doctors just like we meet the needs of consumers in any other space that we think about. Right. So doctors don't have different expectations for how technology should integrate with their daily life. And I think that's their expectation when it comes to education and training. Right. They think that they should have education in the easiest way possible, focused on the things that they want to learn about. And then I think what's really cool about what Evermed does is the algorithms inform doctors about things that they might not have thought of being interested in, but they're really interested in learning based upon the huge depth of information we have. And that's why partnerships like ACC and Evermed is so amazing, because we have this depth of information. We know everything about what every clinician is engaging with on all the ACC assets. Right? But we're. A medical specialty society. We're incredibly good at creating standards in cardiology and providing high quality education. We are incredibly bad at being a leading technology company because that's not who we are and it's not why we exist. And we're subscale even as a big medical society. So the technology and the algorithms and the insights and the information that you have combined with our ability to develop knowledge, that's the recipe that doctors, nurses, administrators, physicians, assistants, everybody's expecting, right? And so I think we need to hold ourselves to the same standard that any consumer facing technology company would in terms of the tools and resources we're providing to clinicians.

Bozidar: Yeah, I'm glad you mentioned that, because one of the big trends also when it comes to how doctors consume information, and one of the reasons why Evermed and ACC partnered is a trend of convenience and ability to access. Information in short bursts of time, five to 15 minutes throughout the year, in between conferences on the go, in between two patient visits in the afternoon, et cetera. And said, that kind of Netflix, Spotify, YouTube, reality we live in and where technology fits into our busy lives. And I'm really a big believer that societies that figure out how to engage members all year long and deliver that massive amount of education that they have in a way that is digestible and it really helps Doctor find the next piece of critical information or gap that exists in knowledge are going to also create massive opportunities for innovators in the field. Whether it's pharma companies or tech companies who have new innovative products who are for profit. Organizations who want to be in front of those doctors in the same way they want to be during the conference in front of the doctor, but do it 365 days a year. But even more efficient way, because algorithms understand very well in the personalized level what people want or where they may be ready to receive the information, whether it's sponsored or not sponsored. So 100% believing that future. So be interesting to have this conversation a couple of years from now to see how fast it happens. I have zero doubt that it's already happening, that it will happen. The question is how fast will become a mainstream. And I want to applaud really ACC for taking a leadership and innovator role in this and for something that I truly believe in just a very few years it will be a standard.

Neal: Yeah, I agree. And the other thing, Bozi to keep in mind is the expectations of younger clinicians, right? Younger clinicians coming into practice. We know that first of all, they want to be part of organizations that are doing inspirational work, but we know that work life balance is critical to their perspective. That this idea that you're going to work yourself to death, 24/7 and be happy with your career is just not something that inspires people going into the field of cardiology today. It's also we have a big focus on diversifying the field of cardiology, and you've got to create balance for people in the field if we're going to achieve that goal. And so it's table stakes for a 32 year old cardiologist coming out of interventional cardiology training that's got a young family that is driven as hell, but has no time for anything that's just table stakes to give them snippets of information that they're interested in, informed by algorithms. Like, it would be ridiculous for them to think about doing things any other way, right? It's so disruptive because this is not how it's been done. But if you put it in the context of a young person coming into the field of healthcare today, it also seems so obvious that it's the way that things need to be.

Bozidar: Yeah. I read somewhere that digital natives are more than 70% of the physicians right now in the US. Meaning that as they were growing up, everything was digital. They all use digital tools. So that's really interesting. And then many of them don't see, for example, Reps anymore. In the US, the latest numbers are 50% to 70%, don't even see reps anymore. So they really self-educate through content, through technology, through algorithms. I started to use that term lately self-educating through content. Because it just really explains what was being done and how all of us kind of accept new products in our lives, even as consumers, is really self-educated through content and then talk to a human being, potentially, who knows a little bit more on the topic on the sales side or something. Now, I know that a big area of your focus is global and making sure that reduction in death from cardiovascular causes focused on in the US. But globally with their whole myriad of challenges. Right. So I wanted to ask, in the context of pharma launches and US versus global, any guidance that you have for pharma companies how to think of that?

Neal: Yeah, I just think it's incredibly critical for pharmaceutical companies and medical specialty societies both to be approaching things with a global first mindset when it comes to their strategy. People are more and more similar all around the world. There's incredible innovation and incredible work happening in New York City and in Kigali, Rwanda, right. And everywhere in between. And we've got to be creating networks and building solutions that meet the needs of clinicians in any of these circumstance. If you look at cardiovascular disease, the unfortunate scenario is, after decades of decline in the United States, it's on the rise again. Right. And if you look at the social determinants of health and the discrepancies in inequities in care, it's projected to increase drastically and not decrease. Now, so we're at a seminal moment in the United States where inequities in care are going to drive a drastic increase in cardiovascular morbidity and mortality. And that's the same problem being faced all around the world in low and middle income countries where now, for decades, we've seen a drastic increase in cardiovascular disease. Health systems are hugely ill equipped to meet that challenge. There's a global goal at WHO. I was just in the United Nations at a hearing around this two days ago. 30% reduction in premature mortality from non-communicable diseases by 2030, 7 years from now. The goal was set in 2011. We've made no progress. Right? And so the onus is on all of us, across all sectors, NGOs, academia, private sector, governments to be coming together and finding new ways to collaborate. And if we're going to do that, we've got to build solutions globally. So I know the US is a big market. I got my MBA, I get how numbers work. But I still believe that if pharma companies are not thinking about things in a global first mindset and figuring out how a solution and a strategy is going to work in the US And China. And in Brazil, as in Saudi Arabia and in South Africa. From inception, all you're going to do is get to a point of frustration where you've got subscale, inadequately integrated solutions. And maybe even more importantly, you're not surfacing the things that are happening all around the world to solve problems for your company because you're so focused in just one country. So that's our approach at ACC. And I think pharma companies have to take that approach. And I've got to say, I see it moving the opposite direction sometimes because of the commercial pressure on these companies to deliver and because of the size of the market. But I think people are thinking small if they're thinking that they're going to solve the commercial problems of their organizations by focusing on just the biggest markets or most developed markets in the world. You want to hit your quarterly earnings now and in the future, and you've got to be investing with a global mindset if you're going to do that.

Bozidar: Yeah, you just mentioned some of the restructurings and then yeah, I've seen focus on the US. Because it's 45% of the overall, like, 1.2 trillion of prescription market, 45% is US. There's a lot of focus there. All right, so this is a great conversation, and what I like to do with my guests is ask them a few rapid fire questions. Short questions, short answers about themselves so the listeners get to know you, Neal, just a little bit better. So the first question is, what's your favorite industry buzzword in 2023?

Neal: Got to be Synergy, right? Everybody says we've got to have synergy and the efforts that we're driving between all of the people that are working in healthcare. And I just think, what the hell does that mean? You've got to really unpack these things and figure out how we're actually going to build things from the ground up differently. A lot of talk about synergy as you dive into what somebody means when they say that you often are left disappointed.

Bozidar: Yeah, I often ask when I hear a more abstract word, I ask people what do they mean by that, because usually ten people have ten different interpretations and is there any book over the past twelve months that you came across that you really like?

Neal: How to Build a Unicorn, is that what it's called? The innovation book just about being market solution focused from the ground up when you're building a product and that you've got to really think about how it's going to be utilized in the marketplace, including the commercial model that you're going to utilize as you're starting to build the product rather than building the product and then figuring out that out afterwise. That's a big thing for medical societies, obviously for profit organizations, you've got to have the end consumer, what their environment is, what their commercial capacity is, how your product is going to fit into their daily life upfront and not build things and figure that out afterwards. So that's a good one, I thought.

Bozidar: Got you. And then who in the world of pharma or medical societies would you most like to take for lunch?

Neal: There's this guy, I can't pronounce his last name right, but he's Cardiologist SC who has this Verve Therapeutics that's this one shot gene editing, cholesterol treatment genetics. I have family members impacted by cancer. And when you work in cardiology and then you spend years interacting on a day-to-day basis with how oncology treatment works, you're left really astounded by how, from day one people are like, well, did you do the genetic sequence to figure out what the circumstance is before we tailor a treatment strategy here? And then in cardiology they're like what is the genome? What does that have to do with cardiology? It's like these are the top killers. And now you see all of this innovation happening around genomics and cardiology and I think the innovations that we've seen and the pathways that we've seen be effective in oncology and these other areas, we're going to see that same bang for your buck in cardiology as we start to do things differently.

Bozidar: Yeah, that's very cool. As I said, high LDL results, I started to dig deeper. I went into medical education, I went to ACC, anywhere. So trying to understand Lipoprotein (a) and the gene that impacts it and all the other tests I need to do because I wanted to have a little bit more precision treatment if needed. So glad you mentioned it. So I totally understand. And then what's the one sentence advice you would give to anyone entering the world of medical societies, right now?

Neal: We have got to do things differently in terms of how we're thinking about partnerships for medical specialty societies. The way things have been done are not making a difference. I think we need to lean hard on technology companies that are committed to impacting clinical practice in a meaningful way and then show that you can use technology to change the paradigm of how people are getting treatment. This idea that we're going to continue existing in this world where we submit for grants and a portal and then get it and then produce some education and put it on the website, or produce some tools and then hope that people will utilize them in their daily practice, that's just ridiculous, right? I mean, we've got to be showing that technology is capable of creating urgency around risk factors in treatment for cardiovascular disease or any other therapeutic area. Right. So I think anybody going and working for a medical specialty society should be as focused on educating themselves from a technology perspective as they are in their area of professional focus and whether it's clinical or business or anything else.

Bozidar: Great. And lastly, where can people find you online?

Neal: You can find me on LinkedIn. That's the best place to find me. Try to stay updated, update people about what we're thinking, what's going on, what's happening at ACC? I went to India in January and I was astounded to put out there, hey, does anybody know some disruptive digital health companies in India within the network? And I met like 25 companies as a result of putting it out there. I'm a big nobody, right? But it just shows that the network and interest of people out there is there if you put it out there and get a conversation started. So, yeah, that's the best place to find me and engage with me. 

Bozidar: Give me some ideas how to use my LinkedIn. Well, thank you. It's been a great conversation and useful for listeners thinking of launching pharma products on how to work with medical societies. So thank you, Neal, for joining. 

Neal: Great. Thank you so much.

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