Personalized medicine has been one of healthcare’s most anticipated and least understood treatment paradigms. Physicians remain optimistic regarding its future, however the 52 doctors surveyed differed in their views in its implications for therapeutic research and development (R&D). Patients, by contrast, were viewed as increasingly interested in embracing the therapy.

Physicians were asked in which therapeutic areas do they feel the use of personalized medicine—for example, the use of genetic testing to tailor drug therapy to an individual—would be most prevalent. Of the doctors surveyed, nearly 58 percent said oncology/hematology, followed closely by cardiology (48 percent), allergy and immunology (38.5 percent), endocrinology (32 percent), and rheumatology (nearly 29 percent). In contrast, doctors felt the therapy would be least common in orthopedic surgery and obstetrics/gynecology.

Clinicians disagreed, however, on whether financial incentives are strong enough to encourage widespread collaboration between developers, payers, consumers, and pharma. When asked, “How will the adoption of personalized medicine affect the priorities and processes for pharma/biotech R&D?” physicians’ anonymous responses ranged from, “More opportunity for profit will drive new genetic testing,” to “No effect.” (It should be noted that a greater percentage of doctors did feel that opportunities for profit and for developing new drugs would increase.)

The Cost of Adoption
Much like a new consumer technology or ‘green’ product, the limits to widespread adoption are directly affected by the costs to the patient or payer. This is backed up by the Lehrman/Bloomberg survey, in which nearly 81 percent of respondents felt the adoption rate was directly affected by the willingness of the patient or payer to pay. And even when personalized medicine is adopted, 79 percent of physicians feel it would be only narrowly embraced.

These numbers are based on several factors, not least of which is the collaboration between diagnostics companies, drug makers (including pharma companies and biotech firms), patients, and physicians, the combination of which is where survey respondents think the big push will come from. Several clinicians believed that therapeutic companies would continue to target known genetic situations where biomarkers are linked to disease. Others believed that the entire R&D paradigm would change to link effective therapy to individual patient genetic profiles. The biggest detriment to adoption seemed to fall on whether the right incentives are in place to foster collaboration between the therapeutic and diagnostic companies toward developing personalized medicine therapies—are the financial incentives strong enough to encourage the collaboration needed?

Overall, what is garnered from the Lehrman/Bloomberg survey on The Future of Personalized Medicine is that diagnostic and therapeutic companies will have to partner to champion wider adoption rates. It is this participation that will help to alleviate payer and patient concerns over paying for additional screenings as well as higher targeted therapy costs.

SK&A released the results of its latest physician survey, and it turns out that most docs are happy to meet with sales reps as long as they make an appointment in advance.

In fact, 98 percent of offices that allow sales reps to make office calls see 20 reps per week.

“That’s how many reps step through the door,” said Jack Schember, director of marketing, SK&A. “And by that we mean reps that were allowed in to drop off promotional materials, drug samples for signature, attempt to see the physician, or have an appointment for a meeting.”

Schember admits that SK&A has no benchmark to compare the data against, as this is the first time that company has asked the question as part of its Physician Access Survey, which surveyed more than 200,000 medical offices.

There is no data on how many of these sales calls are repeat visits from the same rep, or what companies they represent.

Of the physicians interviewed, 49.6 percent said that they require an appointment to meet with a rep. That’s up from 38.5 percent in 2008. Doctors in smaller practices appear to be the most likely to demand appointments, but they are also more likely to meet with reps, because they own the practice.

On the other hand, “doctors in larger practices are requiring appointments because their policies are governed by corporate owners, such as medical groups and health systems,” Schember said. “In some cases, pharma reps have to apply through the corporate owner for clearance to visit a single office.”

Physicians in specialties such as diagnostic radiology, pathology, and neuroradiology are the most likely to deny all access to reps, while diabetes specialists are the most likely to meet with a rep. Just make sure to schedule an appointment ahead of time.

“The difference is that I think smaller companies take more risks in Phase I and II,” said Anthony DiTonno, CEO of NeurogesX. “They make mistakes like big ones, but in our case, we were lucky enough to have a package of Phase III trials approved in Europe, where authorities view neuropathic pain differently than the US does. One of the interesting things is the difference between the regulatory pathways.”

Since neuropathic pain is very different than acute traumatic pain, it’s not something primary physicians see often. Thus, the sales team will target a very specialized group of physicians who treat nerve signal disorders. “Our approach is to capture roughly the 15,000 to 25,000 physicians out there who spend their day treating this, which includes calling on physicians in pain centers and hospitals,” said DiTonno.

Initially, the company plans to put 30 to 35 people in the field, and ramp that number up based on sales. The plan basically overlays physicians’ prescriptions by zip code. For example, in zip code 00000 there are X amount of prescriptions generated for Product A by a specific type of physician. DiTonno notes that by doing it this way, “you get to more intelligently deploy your sales force.”

So what happens if NeurogesX doesn’t receive get approved? According to DiTonno, that depends on the audience. He cautions, however, that one thing is most important for small pharma to remember: Put yourself in a position to be successful by doing all the planning you can while being extremely conservative with resources.

“Be really strict as you can be in deploying your human and financial resources. In early 2007, we decided that any activity not directly related to approval didn’t begin. We didn’t start any new clinical developments.”

In light of the economic meltdown, and the tough times that all of pharma has experienced, DiTonno emphasized that cash is king, and a kingmaker must manage it efficiently. “It’s a balance between planning for success while making sure that in the event there is a delay or a hiccup, you have the cash available to get you through whatever that hiccup may be.”