1. ®
Physician
Voices
2016
WHITEPAPER
5 Key Physician Insights
Pharma Needs to Know

2. As Healthcasts celebrates 15 years as a physician education company, we thought
we would mark this milestone by taking the pulse of the ever-shifting landscape in
which physicians interact with the pharmaceutical industry. While the past 15 years
have been marked by ongoing debate – and occasional controversy – over pharma’s
supposed influence on health professionals’ prescribing decisions, the fact remains
that physicians and industry need each other in their shared quest to advance public
health. However, the question is, how do physicians truly perceive pharma, and
what can pharma do to better serve physicians’ (and patients’) needs?
That question strikes at the heart of how Healthcasts approaches the marketplace.
To educate physicians properly, we need meaningful intelligence on what doctors
want to know. We then must marry that knowledge to what marketers want to
communicate. In short, Healthcasts seeks to create a trusted environment in which
dialogue grows organically between thought leaders, practicing physicians, and
pharmaceutical marketers.

3. This year we set out to learn specifically what
the pharma industry can do to help physicians
advance patient care. Starting in February,
we conducted an extensive series of video
interviews with key opinion leaders (KOLs)
from several specialty areas. Highlights from
the video interviews can be accessed at
http://healthcasts.com/physicianvoices.
Additionally, in an effort to quantify the intel-
ligence gathered from those experts, we
fielded the Physician Voices 2016 survey in
May, collecting insights from 342 Healthcasts
member physicians across a range of specialties
that included oncology, cardiology, neurology,
endocrinology, and primary care.
This whitepaper presents key insights from
the Physician Voices 2016 survey, based on
responses from Healthcasts member physicians
who are on the front lines of patient care. It
also includes pertinent excerpts from the KOL
video interview series. As summarized on
the following pages, our KOLs and survey
respondents weighed in on a range of topics,
including:
+ How physicians and pharma can act as true
partners in patient care – and how much
physicians actually value these partnerships
+ How payors and regulators constrain
physicians’ ability to make independent
decisions on behalf of their patients
+ What types of information physicians value
beyond what sales reps typically provide
+ How personal interaction and on-demand
access to online information can complement
each other
+ How best to customize information according
to individual physicians’ needs
Physician Voices
2016
Physician Voices May 2016: n=342. On average, our survey respondents have been practicing for 20 years, see nearly 350 patients per month, and predominantly (58%) work in partnership or group
practices (compared to 21% in private or solo practice, 15% who are hospital-based, 3% in a staff model maintenance organization such as an HMO, and 3% who responded “other”). The total pool of
respondents report spending 14% of their time in a teaching capacity versus a clinical setting.

4. How Do Physicians
Perceive the
Pharma Industry?
“
The pendulum needs to swing in the other direction because
[pharma] needs us to give them guidance by thinking about
new devices, new drugs, and new patient populations, and
we need them to really address the issues that are pressing
with regard to some of the epidemics such as heart disease,
diabetes, hypertension, and increased [incidence of] disease
in young individuals.
”In 2016, the marketing practices of “Big Pharma”
are attracting heightened scrutiny, largely due
to the pricing models of companies such as
Valeant and Turing Pharmaceuticals. While those
companies’ practices are not necessarily typical
of the larger industry, the widespread and often
lurid media coverage of drug pricing has eroded
much of the public’s trust in pharma. And yet,
according to our survey respondents and KOLs,
despite the recent turmoil, physicians still see
the industry as their true partners in patient care,
and they want to enhance their relationships
with pharma.
In fact, 30% of Healthcasts member physicians
told us that the information they receive from
industry to inform their treatment decisions is
more useful than it was five years ago. Some
of those that said the information is more
useful commented that today’s increasingly
data-driven environment necessitates more of an
informational approach, and that the growing
number of treatment options – particularly for
rare conditions – calls for an expanding body
of evidence-based information, especially as
mechanisms of action and dosing schedules
become more complex. One oncologist appre-
ciated “receiving more detail on the clinical trials
related to the chemo agents now, compared
to past years.” Other physicians noted that
improvements in web-based technologies have
increased the volume and frequency of more
advanced and specific clinical trial data. As
another oncologist put it, “The clinical trial data
is now available online, whereas you used to
have to wait for the meeting or the mail to get the
information.”
In many cases, physicians are clamoring for more
interaction with pharma. “When I was training
25 years ago, we had a great relationship [with
industry]. We often learned a great deal from
the reps because they would bring in data that
was fresh and new,” recalled Malissa Wood, MD,
during her Healthcasts video interview. “Because
of a few bad apples, there was a heightened
concern for conflicts of interest with the pharma-
ceutical industry, leading to a very restrictive
relationship with physicians and nurses. The
pendulum needs to swing in the other direction
because [pharma] needs us to give them
guidance by thinking about new devices, new
drugs, and new patient populations, and we
need them to really address the issues that are
pressing with regard to some of the epidemics
such as heart disease, diabetes, hypertension,
and increased [incidence of] disease in young
individuals,” noted Dr. Wood, who is co-director
of the Corrigan Women’s Heart Health Program
at Massachusetts General Hospital and assistant
professor of medicine at Harvard Medical
School.
All of the KOLs we interviewed hold high-level
teaching positions at academic medical centers
that have largely banned detailing by pharma
sales reps. Some KOLs lament the loss of those
relationships. “We miss that role in our academic
centers of having the pharmaceutical team
partners,” commented Matthew Powell, MD,
director of the Division of Gynecologic Oncology
at Washington University School of Medicine.
“It’s very difficult to have any interaction with
pharma anymore. There isn’t enough of it,”
echoed Barbara Goff, MD, professor and director
of the Gynecologic Oncology Division at the
University of Washington. “We, to some extent,
limit our ability to learn from pharma, but
pharma has a lot to teach us.”

5. Constraints on
Physicians’
Decision-Making
While our Healthcasts physician members and
KOLs generally expressed interest in partnering
with pharma in a meaningful way, many feel their
decision-making power has been constrained
by payors and regulators. Thirty-nine percent of
our Physician Voices 2016 survey respondents
indicated that it has become more difficult to make
an independent, individualized treatment decision
for their patients, compared to five years ago.
When asked to specify the factors that impact their
treatment decisions, 35% of our physician members
(including 42% of PCPs and 33% of specialists) said
insurance companies exert the greatest influence
because their reimbursement policies mandate use
of certain therapies. “Managed care dictates what
we use regardless of the message,” commented one
PCP in the survey.

6. “Drug reps can only tell us what
the FDA allows them to tell.
”
The
TOP
CONSTRAINT
on physician
decision making
is insurance
companies.
The FDA emerged as the second-most cited factor, due to the agency’s approval of
drugs for narrow indications or specific lines of therapy. Such restrictions “make
it impossible to get any more info than what is already on the package insert,”
commented one oncologist. Additionally, our member physicians expressed
frustration with communication barriers thrown up by FDA regulations. “Drug reps
can only tell us what the FDA allows them to tell,” noted an endocrinologist. “Every
word is vetted through the FDA,” echoed a PCP respondent, who mused that
physicians “used to have some crosstalk between providers via the reps.”
Compared to insurers and the FDA, pharma received less blame for physicians’
feelings of marginalization. Only 10% of our physician members cited pharma
companies as a constraint for not releasing all of the clinical trial information
they need to make good treatment decisions. Somewhat surprisingly, a similar
percentage of physicians (10% of all respondents) mentioned direct-to-consumer
(DTC) advertising for its impact on treatment decision-making.
For many physicians, payor-imposed restrictions not only limit what they
can prescribe, but can also inhibit their ability to obtain educational infor-
mation at medical meetings, as noted during some of the KOL video interviews.
“Reimbursement in many parts of the country has gone down so much that a lot of
[physicians] can’t afford to come to meetings,” commented Peter Toth, MD, PhD,
director of preventive cardiology at CGH Medical Center in Sterling, IL, and clinical
professor of medicine at the University of Illinois College of Medicine and Michigan
State University College of Osteopathic Medicine.
The constraints on physicians’ treatment decision-making make it especially
important for pharma to forge and maintain mutually beneficial relationships with
doctors. If pharma companies position themselves as physicians’ allies in their
struggles with payors and the FDA, physicians may feel more empowered to make
independent decisions on behalf of their patients.

7. Specific responses to this question about
physicians’ needs are especially revealing:
+ One oncologist requested information on drug
prices, particularly on “how to obtain drugs
when patients can’t afford [them].”
+ Another oncologist asked for “early clinical
trial data presented at meetings NOT part of
FDA guidelines.”
+ An endocrinologist expressed interest in
“educational material about disease state
that fosters improving patients’ knowledge
and improved decision-making as team
participant.”
+ “It is helpful to know how the product is being
used by other providers who are in similar
practices,” commented a PCP.
+ Several oncologists said they sought infor-
mation on off-label use.
+ One oncologist suggested, “Ad boards
moderated by key opinion leaders are always
the best.”
Such responses suggest that pharma companies
should re-think how best to provide the kind of
information physicians find most useful in this
day and age, and how to continue the “conver-
sation” beyond the rep visit. “What we really
need are information specialists who can come in
and really be a source of good, applicable infor-
mation,” said Dr. Toth in one of his Healthcasts
video interviews.
For some physicians, impatience with detailing
may stem from pharma companies’ focus
on promoting newly approved drugs. Many
physicians are interested in older therapies,
which often lack field force support. A vast
majority – 93% – of our member physicians felt
that it was important (39% said very important)
to have information on older therapies, especially
to educate younger physicians who were not
practicing when these older drugs were first
approved. Long-term data compiled from years
of usage of older therapies would also benefit
physicians’ practice. However, 44% indicated
that it is difficult to learn about older drugs in
the current environment, and 5% said this is
very difficult.
“We tend to get much more information about
new drugs than we do about older drugs,”
commented Dr. Powell. It would appear, then,
that as much as physicians appreciate visits from
pharma reps, their practices would benefit from
more specialized information and more commu-
nication about a breadth of therapies, both old
and new.
93% of HCPs feel it’s important to
have information on older therapies.
49% of HCPs think it’s difficult to
learn about older drugs today.
What Physicians
Need Beyond the
Rep Visit
The tightly regulated landscape for pharma/
physician interaction does not appear to give
doctors the type, volume, and depth of infor-
mation that they want and need. Even when
pharma reps are allowed access to medical
practices and treatment facilities, physicians
are often left with unanswered questions. This
is even more apparent among specialists, such
as oncologists, for whom the stakes are higher
when making treatment decisions. When asked
what they still need after having seen a sales
rep, Healthcasts member physicians cited more
in-depth information pertaining to clinical data,
the treatment experience, and insights from other
providers.
49%
93%

8. “ WHAT WE REALLY NEED
ARE INFORMATION
SPECIALISTS WHO CAN
COME IN AND REALLY
BE A SOURCE OF GOOD,
APPLICABLE INFORMATION.
“ WHAT WE REALLY NEED
ARE INFORMATION
SPECIALISTS WHO CAN
COME IN AND REALLY
BE A SOURCE OF GOOD,
APPLICABLE INFORMATION.
”

9. Supporting In-Person
HCP Interaction
Our research clearly demonstrates the need for both in-person and digital interaction for different
types of education, as evidenced by responses to the question, “What is your favorite way to receive
information from the pharma industry and why?”:
+ In-person interaction “enables a didactic dialogue and questions can be answered immediately.
While other sources are easily accessible online, in-person discussions allow for interactive infor-
mation sharing.”
+ Dinner speaker programs provide the opportunity to “network with colleagues and discuss their
opinions, as well as those of the speaker.”
+ Email “is more efficient and can be read as time allows. I can read those during non-clinical hours
and not be interrupted during time devoted to patients.”
+ Online information can be accessed “at my convenience – not in the middle of a busy office day.”
The survey results also revealed some interesting findings in terms of preferences for non-digital
access to information, as illustrated in Figure 1. Specialists were more likely than PCPs to say they
look for more in-depth information as provided through medical journals and KOLs. On the other
hand, PCPs, especially those under 44 years of age, tend to seek input from colleagues within their
practice/local area for information, whereas older PCPs and specialists (i.e., over 45) rely more on
sales reps and MSLs than their younger colleagues.
There appears to be no substitute for live presentations by KOLs on specific topics as a trusted source
of information. Two-thirds (67%) of our physician members cited live KOL speaking engagements as
the most useful vehicle for learning about new treatment approaches. However, live events have their
drawbacks, foremost of which are time and money.
Many physicians are unable to attend live events, and thus may represent missed educational oppor-
tunities for pharma. Indeed, “A lot of physicians now are relying on media and the internet to obtain
HOW DO YOU PREFER TO GET INFORMATION
TO MAKE TREATMENT DECISIONS?
(100 PT. ALLOCATION)
Internet/digital
Colleagues within your practice/local area
Medical journals
KOLs that present at conferences
Pharma company sales reps/MSLs
Figure 1.
11
13
18
26
31
100
90
80
70
60
50
40
30
20
10
0
44 and under PCP 44 and under
Specialists
45 and over
Specialists
Total45 and over PCP
26
13
27
24
11
21
14 15
12
19 19
18
26 24
16
14 14
33
27 28

10. “
There are really important creative
ways [pharma] can communicate
with the physician audience using
the current technology.
”The physicians’ varied preferences underscore the importance of customizing infor-
mation to their individual needs. “Most people don’t have enough resources in
terms of time to be able to navigate through all of the new information,” said Ara
Dikranian, MD, a rheumatology KOL affiliated with the San Diego Arthritis Medical
Clinic. “The approach to presenting information to physicians has to be tailored and
individualized. The customizability of information from pharma is really key.”
“In the current era, it’s not clear that [physicians are] getting the value they want
in terms of education and communication, and so increasingly I think you want to
micro-target,” echoed Dr. Kathiresan. “The more relevant [the information] is to me,
the more likely I am to engage.”
information from remote sources because a lot of them can’t afford
to come to meetings,” noted Dr. Toth.
“As a busy clinician, who is not only treating patients but also
academically active, I find it nearly impossible to get out to
meetings where I am not speaking,” commented Jeffrey Gudin,
MD, director of Pain and Palliative Care at Englewood Hospital
and Medical Center in Englewood, NJ. “Physicians [today] are
able to educate themselves on their own time at home. To have a
three- to four-minute snippet to see what is going on in the world
of medicine is just remarkable.”
For many physicians, on-demand access to web-based
technologies complements their need for interpersonal contact.
The emergence of new technologies has actually made it easier
for physicians to get the information they need. In fact, 50% of
Healthcasts member physicians said it is easier or much easier to
obtain information to inform treatment decisions today, compared
to five years ago. That is largely due to the growing use of digital
sources. When asked how they like to get information to make
treatment decisions, on average, both PCPs and specialists
expressed a preference for digital means of communication.
“The world is changing,” observed Sekar Kathiresan, MD, director
of preventive cardiology at Massachusetts General Hospital and
Associate Member of the Broad Institute’s Program in Medical and
Population Genetics at Harvard Medical School. “There are really
important creative ways [pharma] can communicate with the
physician audience using the current technology.”
When asked about specific ways to learn about treatment
approaches through innovative digital means, our member
physicians cited their top 5 preferred vehicles:
1. Short online surveys to test their knowledge of different
therapies, clinical data or patient cases
2. Short online presentations or outlines of clinical data that can be
accessed at any time
3. An online platform to look up specific information on drugs
4. Online topical videos of KOLs that can be watched any time
5. Printed Q&A materials from a KOL

11. “The best interactions are
open, they're transparent,
they're driven by what
patients need, actually
brokered through doctors'
knowledge, and [there is]
no harm if industry is willing
to support that.
”
Maintaining an
Open, Transparent,
and Constructive
Dialogue
Our research tells us that physicians are looking
for a meaningful dialogue with pharma. That
is readily apparent in the responses to the
Physician Voices 2016 survey as well as in the
KOL video interviews. “The best interactions are
open, they’re transparent, they’re driven by what
patients need, actually brokered through doctors’
knowledge, and [there is] no harm if industry is
willing to support that,” stated Peter Goadsby,
MD, PhD, DSc, professor of neurology at Kings
College, London, and director of the Headache
Center at the University of California, San
Francisco. In his video interview, Dr. Goadsby
emphasized the importance of including
patients in these discussions: “Bring everyone
together and you can use everyone’s expertise
and resources to make things bigger. [When]
everyone is at the table, everyone benefits.”
“Physicians are asking questions about
mechanism and how and why, when maybe we
should be asking, 'what’s better for my patient?'
and rethinking the prescriptive process,”
commented Paul Ridker, MD, senior physician
at Brigham and Women’s Hospital and Eugene
Braunwald Professor of Medicine and Director of
the Center for Cardiovascular Disease Prevention
at Harvard Medical School. “[Pharma]
companies need to figure out a way to say, ‘but
the patient is living longer,’ and remind us that’s
our core issue.”
Finally, the importance of a constructive dialogue
cannot be over-emphasized. Indeed, public
health and patient well-being depend upon a free
flow of incisive information between physicians
and pharma. In her Healthcasts video interview,
Dr. Wood summed up this vital issue quite
succinctly:
"It needs to be a two-way street, with better
communication from us to the [pharma] industry
and from industry back," concluded Dr. Wood.
“If we can create that bidirectional flow of infor-
mation in a non-conflicted way, we’ll really be
able to move medicine forward.”
About Healthcasts
Healthcasts is the leading educational resource for physicians with an exclusive, verified network of
practicing members that spans over 30 clinical specialty areas. Since its inception in 2001, Healthcasts
has been leveraging research and member feedback to provide relevant, personalized educational
content from more than 50 medical conferences, insights from Key Opinion Leaders, and CME
programming through partnerships with leading educational institutions. Healthcasts programming
is available digitally, on-demand on all devices for an optimized, cross-channel experience.
To learn how your brand can leverage the new rules of HCP engagement on Healthcasts, visit us at
healthcasts.com/digitalpromotions or call us at 866-275-7861 ext 2040.

12. ®