Day 3 (blog)
**correction : Letter A in the medicine
license codes means is scheduled poisons (controlled medicines), while OTCs use
letter X, which fall under non-scheduled poisons (not controlled).**
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| Let's brush up the knowledge we learnt on Day 2! |
Later in the afternoon, we will tag along
with Medical Affairs associates to visit doctors at hospitals. We will be
observing how MSL associates discuss with the professionals on the latest
findings in clinical studies. Hence, we will need to read up on the journal
papers, if not we’ll be “blur blur” also!
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| Breakfast+ Journal paper |
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| Left: Rebecca (another IPEP student from University of Bath!) :D |
While we are busily dissecting our journal
paper (last minute homework!!) in the morning, Ms. Mei Wen came in to explain
to us more about the medical science liason (MSL) job. The MSL team works
together (liases, hence liason) with all other departments, such as sales &
marketing, regulatory and pharmacovigillance. The team also engages with Key
Opinion Leaders (KOLs), discussing with them not only the scientific advantages
of new drugs but also the disadvantages as this will give a more comprehensive
understanding to make professional prescribing decisions.
The job of MSLs differ from sales
representatives is because sales reps deal mostly with on-label information of
the product (what is written on the Package Inserts), whereas MSLs are in a
better position to discuss information regarding off-label information (such as
off-label indications, whereby the doctor may wish to use the drug for treating
diseases outside its licensed scope, but is licensed in other countries) or
recent updates of clinical data, such as efficacy, tolerability and safety
profiles. The MSL also have sales
meeting every mid of the year with the sales reps to check on how the sales are
progressing and to supplement the sales team on medical knowledge.
MSL associates also reviews promotional
materials designed by the sales & marketing department, such as the thin
booklets of specific products, to check for inaccurate information and
adherence to the PhAMA code.
Apart from the roles explained in previous posts,
MSL staffs also looks out for “misleading” claims by promotional advertisements
of their own company as well as other companies, whether its posters, leaflets,
or magazines etc. This is not to deliberately find loopholes in competitor
companies, but more of protecting the patients (us!) from being misleaded by
such exaggerated claims (normally people won’t bother to check the validity of
such data from the mini little references printed at the bottom of
advertisements).
MSL associates also organize CME events
(like educational talks) from time to time, sometimes 2-3 per month, and
sometimes in different states or even countries! This job is suitable for those
who like to travel! MSL associates also liaise with IDM (integrated disease
management) specialists to set up patient programs. These include counseling to
patients via telephone by external counsellors. Integrated disease management (IDM) is a disease control approach that uses all available management strategies to maintain disease pressures below an economic injury threshold. Its indirectly meaning the set up of other facilities on top of usage of therapeutic drugs to reduce the negative impacts of diseases on the society.
After that, we were also taught how to look
up on some drugs registered on the NPCB list. From there, the details of each
medicinal product, from its active ingredient down to its manufacturer address
and country, can be obtained. Go product search and try it yourself! Click me!
In the afternoon, we learnt how to dissect
the journal papers. A few extra tips on top of what Dr. Lim has taught us:
After reading the title and the abstract, google up any unfamiliar terms and
understand them first before reading other sections. Cut down huge chunks of
texts into different portions, so you know from paragraph # to paragraph # is
talking about efficacy, or about safety profiles etc. Note the confidence
intervals of statistical tests (95% confidence interval) as well as P values.
Use these in future journal summary assignments (or in the working world, they
call it clinical paper appraisal). Note the sample numbers (n), which is also
important for readers to pick up. Test results are not so important as at the
end, it’s the statistical interpretations that matters, so no need to quote all
the numbers and figures actually. **DISCLAIMER: These tips are solely the opinions
of the mentors in the company and may vary from the actual criteria set by the
university assignment marking system**
During the visit to the hospital, we got to
observe how the MSL associates discuss with doctors about the latest findings
(including the paper we had to appraise!).
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| Sime Darby Medical Centre: Waiting area |
We found out that each doctor has
their own preference on which product to prescribe for the same disease, not
only depending on the patient’s health background, but also depending on their
goals of treatment, taking into account the pros and cons of each product. For
example, some may prefer to give a lower dose to patients new to the prescribed
drug, and titrate it up if it’s not efficacious enough, while others may prefer
to give the standard dose on the first prescription, although with more
prominent side effects, will reduce the occurrence of other side effects when
the concentration in the body is below the therapeutic window.
It brings us to a little scientific
discussion we had with our mentor about contraceptive pills. There exist two
kinds of oral contraceptive regimen for the combined oral contraception (COC)
pills, namely 21/7 and 24/4. The first number is number of active pills, and
second number is number of placebo pills (no problem if not taken). 21/7 gives
a longer break from taking active pills, but menstruation proceeds for 7 days
long. 24/4 gives a shorter menstrual period (4 days), but will have a higher
chance of compliance problem, i.e. the patient may miss taking the 22nd,
23rd or 24th pill, especially if she’s already used to
taking 21/7 pills. Besides that, 24/4 pills generally have lower
strength of synthetic oestrogen compared to 21/7 pills. This is also important
as the synthetic oestrogen increases risk of blood clot in some women, which
then deep vein thrombosis occurs. Other milder effects such as weight changes
and acne problems are also due to this oestrogen component. It may sound like
24/4 are lot safer, but some women may need the higher strength for suppression
of ovulation to occur. Therefore, it is really up to the professional judgment
of practitioners in their prescribing practice.
How about using progestrogen-only pills
(POP)? Generally the oestrogen component acts more on suppressing FSH and the
progesterone on suppressing LH, so probably there is less efficacy but we have
to dig up more clinical papers to find out. We would be doctors ourselves if we
knew that much!
my turn to makan XD
One last sharing from our mentor today.
Sales reps in pharmaceutical companies, also known as product specialists (as
they have to master a few selected products at their fingertips), are not
considered low rank or the “door-to-door salesman”. Generally in reputable big
companies, customers already have sales accounts with the company, so what
sales reps really have to do here is to maintain these accounts, follow up on
customers and update them on any new details. It’s not like direct-selling
whereby you have to find new customers, and be “thick skin”, sometimes annoying
your friends to buy your products. As medicinal products are sold to doctors,
professionals etc. using scientific facts (and not by exaggerated claims, or
“lunch treats”), you will be able to promote your products using science! If
the product is good, the doctors themselves will know it, so no worries, you
don’t have to try to please them, but yes you do carry the company’s image, so
just be honest and transparent in your dealings. In fact, many pharmacists
choose to enter sales first as it is the best platform to understand not only
the products being sold, but also how the organization runs as a whole. It is
also the best position to ask for a transfer to other departments, really!
Today, we ended our day at Coffee Bean!
Stay tuned!
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