In this current environment of rapid therapeutic development and evolving physician—and patient—needs, new challenges for pharmaceutical education are emerging. Dr. Jerome Lisk, board certified neurologist and Dr. Shawn Sen, double-boarded neonatal cardiologist, discuss the impact of this changing landscape on their learning, practice, and needs as they relate to mechanism of action (MOA) and mechanism of disease (MOD).

“When the reps used to come in, they would bring us materials that we could see. Now, when they're doing Zoom calls, there's no materials, everything's verbal. So we can't see anything when we're talking about mechanism of action. It's all audio. There's no verbal. There's no visual aids at all. So that's one thing they're lacking.”

- Jerome Lisk, MD, FAAN, Board certified neurologist with a fellowship in movement disorders

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Panelists

Jerome Lisk, MD, FAAN

Board certified neurologist with a fellowship in movement disorders

Shawn Sen, MD

Assistant Professor of Pediatrics, Northwestern University Feinberg School of Medicine, double-boarded neonatal cardiologist

Melyssa Nocar

Senior Vice President, Marketing at Level Ex, 15+ years leading marketing and communications for Fortune 500 healthcare clients

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Melyssa Nocar: [00:06] Hello and welcome to our Pharma Trends discussion, powered by CASCADES™, Level Ex's mechanism of action solution. My name is Melyssa Nocar, Senior Vice President, Marketing at Level Ex. I am honored to be joined today by Dr. Jerome Lisk, board certified neurologist with a fellowship in movement disorders, and Dr. Shawn Sen, Assistant Professor of Pediatrics, Northwestern University Feinberg School of Medicine, and a double board certified neonatal cardiologist. Today we will cover trends surrounding education for newly approved pharmaceutical therapies, and ways that pharmaceutical companies can provide added value and support to physicians for improved disease management and patient care. Let's start with a few thought-provoking statistics.

A recent survey found that only 10% of healthcare professionals (HCPs) say they want to return to pre-COVID norms for in-person meetings.1 How has COVID impacted your learning methods, especially with regard to mechanism of action, mechanism of disease, and other pharmaceutical education, and the nature of your interactions with pharmaceutical medical sales liaisons and sales representatives? Also, what newly developed habits are, in your opinion, here to stay? Dr. Lisk, let's start with your thoughts.

Dr. Jerome Lisk: [01:16] Thanks for having me, first of all. COVID has really impacted the pharmaceutical industry being able to reach physicians because a lot of pharmaceutical representatives have not been able to come back to the office to be able to show us their learning materials. I believe that the pharmaceutical companies are going towards more graphics and things that they could send us so that when we can't do in-person meetings, they can still teach us. What I think is here to stay: Zoom. It has impacted all of our lives, especially the medical community. We're doing more Zoom meetings with pharmaceutical reps, and they're really trying to use more visual aids.

Dr. Shawn Sen: [02:08] Thanks, Melyssa. It's great to be here, and I really appreciate the opportunity. I totally agree with Dr. Lisk. The pandemic created a big shift in medical education—even just working in an academic setting. With the absence of traditional platforms, we've come up with different ways to continue medical education through innovative avenues: case-based learning, flipped classroom methods where we're providing reading material before the interactive sessions, and telemedicine platforms such as Zoom. It has redefined the whole concept of e-learning. Using those modalities to teach and continue that in a virtual setting has pushed the boundaries of our learning.

Melyssa Nocar: [02:59] Yes. One challenge that we know was around long before COVID is the realm of health literacy. According to the National Association for Adult Literacy study, published by the Health and Human Services Office of Disease Prevention and Health Promotion, only 12% of US adults have proficient health literacy.2 Additionally, several studies have proven the connection between limited health literacy and decreased understanding of appropriate medication use.3 That means an alarming percentage of American adults struggle to comprehend medication guides, and many admit to not reading them at all.4 What is it about mechanism of action or mechanism of disease content that hinders its widespread fluency? When explaining MOA and MOD to your patients, what is challenging about conveying it? On the flip side, what is effective? 

Dr. Jerome Lisk: [03:56] I would tell you that with neurology, the overwhelming majority of my patients don't even know what the neurological disorder is. When we talk about Parkinson's disorder, all of my patients think that every Parkinson's disorder is Parkinson's disease. Not only them, but the ER and primary care physicians as well. First of all, you have to explain that there is Parkinson's disease, multiple system atrophy, Lewy Body Dementia, and so on. You have to explain the disease first, and then you have to explain the mechanism of action. Once you've already explained the disease, a lot of times patients are overwhelmed, so you have to break this up into bits. One visit, we'll talk about the disease process. The next visit, we'll talk about mechanism of action. I have found that there are companies like Health Monitor that will have the screens you put in the room that really will show things more graphically. Companies like Acorda, a company that has a medication called Inbrija, have these little boxes with videos that show patients the mechanism of action. Patients really respond well to visual demonstration of mechanism of action.

Melyssa Nocar: [05:14]  Dr. Sen, what are you seeing in cardiology?

Dr. Shawn Sen: [05:16] I completely agree with Dr. Lisk. Even just taking a step back, when you think about it, mechanism of disease is complex. We spend four years of medical school learning an incredible amount of information, medical terms, pathophysiology, the origin of words and their meaning. I joke around about this, but I'll tell my wife, "Oh, this baby had multiple rhabdomyomas in the tricuspid valve inlet." And she'll say, "Rabbits located where?" Understanding treatment modalities and medication use, with increase in medication compliance and understanding disease processes, all will help push healthcare literacy. From a cardiac standpoint, I continually draw out anatomy and some of the medications that we use. To be able to have a video interface, or even just some of the novel ways that we use technology these days, can really minimize the extra time that can be spent and try to improve that understanding.

Melyssa Nocar: [06:33] Yes, definitely. Level Ex has a long track record of creating interactive mechanism of action and mechanism of disease that draws medical professionals into the action at a molecular, cellular, and physiological level. Our newest solution coming soon, CASCADES, is a toolbox of interactive learning experiences to explore and deepen healthcare professionals' understanding of MOA and MOD. Given that analyses show the current pipeline increasingly focusing on more innovative mechanisms,5 we see this solution becoming more important in the years to come. This shift also signals an increase in drug discovery and development for rare diseases.6 I'm going to ask you a two part question here. Dr. Lisk, we'll start with you. You've done a lot of work in Parkinson's disease. What developments do you think may be, or you hope will be, in the pipeline to help patients suffering with this disease?

Dr. Jerome Lisk: [07:38] There's a couple of different mechanisms that we're looking at right now. One is alpha-synuclein molecules that can actually precipitate out the abnormal protein called alpha-synuclein that's involved with a lot of different disorders, especially Parkinson's disease. If we could pull that out of the spinal fluid—that abnormal protein that builds up, and that we believe is the basis of disease—then that is something that companies have been looking at for a few years now.

Dr. Jerome Lisk: [08:15] Also, as you know, gene therapy and stem cell therapy are huge. There was a drug called GnRH that grew back nerves in the putamen, the part of the brain that's basically around the brainstem there, and was able to grow back some of these cells that produce dopamine in Parkinson's patients, but unfortunately that drug had a couple of bad side effects, so it was pulled out of research. Those are the three main things that I'm hopeful for in the future that we're making good strides and progress with.

Melyssa Nocar: [08:52] Dr. Sen, what pharmaceutical innovations are you most excited about and why?

Dr. Shawn Sen: [09:00] Melyssa, that's a great question. I take care of babies that are very small, and some of these babies are almost four months premature. Many times their organs, especially their lungs, are still very premature. One medicine that we use often is a medicine called surfactant, it helps to keep the lungs open. The way we administer it can be challenging. It's almost a syrup type of consistency. It's an older drug. The holy grail in neonatology has been finding a way for us to administer this aerosolized or nebulized. There have been trials, and I believe it's currently in a phase one trial, but that's probably what I'm most excited about: being able to come up with new drug delivery systems. Even then, when you think about it, it isn't easy. Understanding the mechanism of action, how it integrates with other molecules, and understanding the efficacy of the drug—all of that plays a big factor in its success.

Melyssa Nocar: [10:03] Thank you both for this great discussion. This is where we get a little playful. We want to have a little fun with our final question. If you could be any protein, signaling molecule, or receptor in an MOA sequence, what would you be and why? 

Dr. Jerome Lisk: [10:32] I would be GABA. GABA is the number one inhibitory transmitter in the brain. Right now, with this pandemic, and the politics, and everything going on across the world, I think we all just need to calm down. So I'm going to calm everyone down with GABA, the inhibitory. I'm going to inhibit the anger. I'm going to inhibit the rhetoric. I'm going to inhibit the lies—everything negative.

Dr. Shawn Sen: [11:08] That's a tough one. I am a believer of the mantra to be mindful of your actions and how you impact others. One medicine that we use commonly is a cardiac glycoside, Digoxin, or Digitalis. It naturally comes from a foxglove plant. We use it in pediatrics. I've always found it interesting because it never actually acts on the receptor. It acts on another receptor, which influences the other receptor. When you think about how the heart contracts, it needs calcium inside the tissue, so it actually doesn't even affect the sodium calcium channels. It attacks the sodium potassium pumps, and it indirectly impacts it. I've always thought that was a unique molecule and mechanism of action.

Melyssa Nocar: [12:05] I didn't realize this was going to be such a soul session. I appreciate those responses. I can't wait to share these insights with the team and in upcoming conversations with our pharmaceutical partners. Thank you for taking the time to speak with me today, both of you. It was an absolute pleasure.

To our viewers, thanks for tuning in. As you were thinking about potential impacts of these trends and considerations for your business objectives, we would love to hear from you. For those participating in Digital Pharma East, Level Ex would welcome the opportunity to continue the discussion with you at the event. Please reach out if you're interested in meeting up with us. As always, for more information or to request a demo, visit us at levelex.com.

For more information or to request a demo, please visit https://www.levelex.com/partnerships/pharma

References

  1. Reinventing Relevance: New Models for Pharma Engagement with Healthcare Providers in a COVID-19 World, Accenture Healthcare Provider Survey May 2020

  2. America’s Health Literacy:Why We Need Accessible Health Information

  3. Literacy and misunderstanding prescription drug labels

  4. A critical review of FDA-approved medication guides

  5. Drug discovery effectiveness from the standpoint of therapeutic mechanisms and indications

  6. Drug discovery effectiveness from the standpoint of therapeutic mechanisms and indications

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