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Introduction: The History of the MSL

Many know that the origin of the Medical Science Liaison (MSL) came out of Upjohn. What is not largely known, however, is the drug that started the MSL movement: it was tolbutamide (Orinase^®). According to the text, A Century of Caring: The Upjohn Story by Robert Carlisle, the first ever MSL program was initiated by marketing to establish rapport and provide educational awareness to doctors before they were able to write prescriptions, during medical school. In 1967, the program was started and seeded by sales professionals that had, “intense interest in science, [had] high social skills, and recognize[d] that they [were] no longer detailing products”.¹

The MSLs began calling on medical schools and thus, a movement was born. Upjohn had been mostly unknown to medical students, but after just 6 years of the MSL program, “Upjohn was one of the best-known”¹ companies to medical students. The entire onus of the MSL was to provide education in the form of monographs, access to internal researchers, and assistance for external educational programs. The program was conceptualized and developed a mission to provide appropriate use of oral diabetic drugs, which at the time was a novel approach to diabetes.¹

Today, there are thousands of MSLs across the country, in hundreds of disease states and therapeutic areas. As will be explored further in this book, MSL job descriptions, professional backgrounds, and job motivators can vary widely from company to company. This text will discuss who the MSL is, what the MSL does, and where the role might be headed in the future. The approach we are taking with the book is to look at the product life cycle of the MSL, so to speak. We begin with a professional with a long history in the world of pharmaceuticals, Dr. Stan Bernard. We not only ask him about the past history of the MSL world, but we also explore his ideas on what the future may hold for the profession at the end of this book.

The Past and Future of MSLs: Interview with Stan Bernard, MD, MBA

Stan Bernard, MD, MBA is President of Bernard Associates (www.BernardAssociatesLLC.com), a pharmaceutical and health care industry management consulting firm offering strategic planning, marketing, medical marketing, competitive simulations/planning, and business development services. Dr. Bernard is nationally-recognized as a consultant, speaker, and author. He has published over 50 book chapters and articles on pharmaceutical and health care topics. Dr. Bernard is a former Senior Fellow at The Wharton School of Business where he initiated and taught in the “Pharmaceutical Management” course for fourteen years.

Previously, Dr. Bernard served as a Consulting Principal at A.T. Kearney and held several executive positions at Bristol-Myers Squibb Pharmaceutical Company. He served as U.S. Product Manager for the launch of the cholesterol-lowering drug Pravachol^®, Bristol-Myers Squibb’s most successful pharmaceutical product. He served as Associate Medical Director, where he co-founded the first doctor-only Medical Science Liaison (MSL) group in the U.S.. Dr. Bernard also served as U.S. Managed Care Medical Director, the first person to hold such a position in the pharmaceutical industry, and as U.S. Director-Pharmacoeconomics. He also worked in Worldwide Business Development and U.S. Medical Operations. Dr. Bernard received his M.B.A. in marketing and health care management from the Wharton School of Business. He received his Medical Degree from Baylor College of Medicine. Dr. Bernard can be reached via email at: SBernardMD@BernardAssociatesLLC.com and via phone at: (908) 234-2704.

History

As you know, Upjohn started the MSL function in the late 1960’s. However, the first MSLs came from sales. Subsequently, other programs moved to professionals with a science background.² Can you share your experience on what generated that switch, and how the scientist MSL began?

In 1988, Jan Leschly was the President of E.R. Squibb. A pharmacist by training and an experienced businessman, Jan believed that individuals with combined backgrounds in business and science would represent the next wave of professionals in the pharmaceutical industry and provide Squibb with a competitive advantage. Toward this end, Jan envisioned a sales force composed exclusively of business-oriented doctors.

In 1989, Squibb hired David Best, an MD/MBA from the advertising industry, to turn Jan’s vision into reality. David recruited me from Squibb’s Worldwide Division to help him create and implement the first doctor-only, regionally-based field force. Together we hired, trained, and managed a total of 12 doctors, predominantly physicians. We called this concept “Medical Services Managers” or MSMs to distinguish it from competitors’ medical science liaisons (“MSLs”). At that time, MSLs were typically top sales representatives without advanced scientific degrees who called on doctors to communicate scientific information and address more complex product questions.

From the outset, MSMs were designed to be different from MSLs and other sales representatives. As doctors, MSMs could relate to and interact with key opinion leaders and other doctors as “peers”. They shared a comparable level of scientific training, experiences, and knowledge with their physician customers. This enabled MSMs to earn the respect and time of physicians. In fact, BMS marketers found that MSMs were spending dramatically more time with physicians than sales representatives.

The roles of MSMs also differed dramatically from those of MSLs. We trained MSMs to handle several novel tasks, such as the management of regional and local opinion leaders, including speaker training; identification and placement of Phase IIIB and IV clinical trials; facilitation of physician dinner meetings; spearheading the pre-launch of new products; and training of sales representatives on disease states and product information. Like a special military force, the roles of MSMs expanded over time as senior Bristol-Myers Squibb (“BMS”) executives recognized their extensive capabilities and impact.

It was not long before competitors took notice and began to develop their own versions of the MSM program. The MSM program became the foundation for a number of regionally-based, scientifically-trained medical professional programs across the industry. Probably the most satisfying aspect for me is the number of “MSM Alumni” who have ‘graduated’ from the program and moved on to executive leadership roles in other companies. While the MSM name has changed back to MSL, the concept of MSLs with scientific training and advanced degrees endures.

Has the MSL changed in terms of work since the first science based MSL teams vs. today?

I think there have been dramatic changes in the roles of science-based MSLs reflecting industry-wide changes. The most significant changes have been regulatory: stricter regulations on pharmaceutical product promotion have virtually eliminated the MSL placement of clinical trials and grants and the facilitation of dinner meetings, for example. Therefore, these MSL roles have been reduced in order to comply with those regulations.

Conversely, three other industry factors have changed to enhance the roles of the MSL: the decreasing numbers and importance of the sales representatives; the increasing complexity of science; and increasing pharmaceutical competition. The declining role and impact of the sales representative means that the MSL interaction and communications with physicians and other stakeholders are more important. The complexity of science has resulted in a greater need for scientifically-educated MSLs to help translate these new technologies and discoveries. New biologicals and biotechnologies, complicated biochemical pathways, targeted therapies, drug safety, and pharmacogenomics are all critical areas that pharmaceutical stakeholders need to understand.

Competition between companies and among products has intensified over the years. Most major pharmaceutical companies need to have a strong MSL group just to be competitive. There is now greater product competition with more in-class and across-class therapeutic agents, generics, over the counter medications (OTCs), and alternative therapies. Because of increasing limitations on promotions, MSLs are playing a larger role in the overall promotional mix for product marketers.

Dr. Bernard’s comments on the future of the MSL are contained in the final chapter of this book.