As with any effective forward looking collaboration in the healthcare space, input from key physician leaders and experts in the field are needed, leading to think-tanks drumming up and driving initiatives. At Medtronic, one form of collaboration is called a Scientific Advisory Board (SAB), and it is where thoughts and discussions about the future of health care and health care technologies come together. In this interview, Dr. Turco talks about the SAB in Medtronic’s APV business, how to evaluate scientific advisory board membership, and how to design meetings in such a way that “ideas” turn into action.

After over four years as Covidien’s chief medical officer, Dr. Mark Turco joined Medtronic in the role of Medical Director for its Aortic & Peripheral Vascular business (APV). The APV business includes the Aortic, endoVenous and Peripheral franchises, and is a joint sector between Covidien and Medtronic. Together, the companies merged, joining their knowledge and resources in an effort to advance medical technologies and solutions for hospitals, health systems and health care providers, so that they can then render high-quality care to patients around the globe. Here, doctor Turco talks to VEIN Magazine Medical Director Dr. Steve Elias.

Steve: What is the intent of a SAB for Medtronic’s APV business?

Mark: One of the fundamental purposes of our SAB meetings is to help Medtronic’s APV business leaders collaborate with key physician leaders around the globe to deliver the very best health care solutions to patients and providers. Physicians provide critical expert advice regarding: medical and/or strategic perspectives on subjects such as market research or development; new product development; clinical trial design; health care policy, etc. Those physicians who are best fit are those who like to look at the field in a strategic way. It is critical to have physician input to help understand the unmet needs of physicians and patients. Collaboration is key.

Steve: Who do you look to for guidance when choosing who should sit on a SAB?

Mark: When looking and researching new SAB members, we may go back to highly regarded senior physician leaders and ask for recommendations or look to folks who are well-published in the field, present at symposia, and are generally considered experts. Truly broad-based backgrounds and experience are critical— geographies, practice type, and specialty type. The treatment of vascular disease requires a broad-based, system-wide approach, so the best mix for us to gain insight is to have a diverse group. Our business likes to then break the SAB group down into smaller breakouts to allow for a deeper dive into specific device-related topics where feedback is key.

Steve: Is it a requirement that a SAB member use Medtronic’s products?

Mark: No. While it may be helpful to have experience with our devices and technologies, within our SAB boards in the APV business, the focus is not commercial. In fact, we limit the attendance and involvement of sales and marketing, and make it much more of a strategic board. Membership for this particular type of board fits the criteria that I laid out a few minutes ago, rather than those who are using specific products. This is especially true when you are considering future generations of devices or breakthrough technologies where nobody has any experience yet.

Steve: Right. You want to keep it at a higher level, at a level that is really going to allow you to think about things going forward. As you said, it’s the strategic aspect of it that’s more important than the, “Can we sell a lot of products from this.”

Mark: Absolutely. I would even go a step further. What I would like to try to do with our advisory boards is actually give folks a mix of some individuals that may not have a lot of familiarity with our technology, so that there can be varied perspectives brought into the discussion. Diversity is key to obtaining good output.

Steve: From a legal aspect, what are some of the protective mechanisms? Also, what are the hurdles you see now that have been put in place that maybe don’t allow a free exchange of ideas as we used to be able to have?

Mark: Each medical device company, and pharma company for that matter, have to uphold their company and industry code of conduct policies that apply here. We work hard to make sure we are transparent and align with Medtronic’s guiding principles. For example, agendas are reviewed in advance to ensure compliance.

Steve: Have you had any physicians that you have asked to be on the strategic advisory board that just said, “No, I don’t even want to be associated with the industry, that people will think I’m being paid and coerced by industry?”

Mark: That’s an interesting question. We’ve had one or two small instances where a physician may not be able to participate based on codes of conduct or regulations from their employers or institutions. Alternatively, some physicians express concern about the public reporting of their compensation which now is visible as a result of Sunshine laws. This to me is a very critical issue, because it is very important to preserve the ability to have an open dialogue and collaboration between physician leaders in the medical device space. It is the collaboration which leads to finding solutions.

To your point, the requirement for public reporting is becoming more of a sensitive issue with the enactment of the Sunshine Act, but it’s something that we need to navigate.

Steve: When people are meeting, and when you’re at the strategic advisory board meetings, what considerations need to be made based on the personality of the group?

Mark: When we make a selection, it’s in some ways like bringing together a big family. Even within big families, you can be at a Thanksgiving dinner and have some discussions that are not the most comfortable. I like the idea of the different specialties challenging each other. As long it’s done in a scientific, evidence-based way, and that it’s very much collegial. It’s that challenging back and forth that ultimately leads us to the best solutions. Sure, there are times where you may have a topic and certain specialties disagree with each other around how that particular situation should be managed. Again, as long as there is a collegiality around dealing with the individuals, I really appreciate the type of dialogue that occurs.

I’ve never had boards where physicians have come to a meeting and then not come back the next day or the next meeting because their feelings have been hurt. This issue of silos and turf battles and so forth, in my mind, are really starting to get broken down. This is a great thing for the medical field. It’s a great thing for patients, because it is the type of collaboration that’s ultimately going to advance care.

Lastly, I would say, in my experience, I have had many more positive comments with regards to having a board filled with multi specialties, in that they feel that they can learn from their colleagues. The interventional cardiologist can learn from some of the vascular specialists, and vice versa. It can be a learning experience for everyone involved, as well as providing the medical device space with the strategic knowledge that we need to move the field further.

Steve: Do you guys consciously, beforehand, discuss how you are going to make sure you engage all of the people that you’ve chosen, or do you just kind of see how it goes? What steps do you take to ensure the less vocal members have a voice?

Mark: It’s very important that every member of the board contribute. We evaluate the level of participation of our members and if over time individuals don’t engage, they may be excused from the SAB. It takes a number of weeks for us to put our agenda together and have the topics that we need and the topics to fit with our board membership.

As we set up the agendas, we do mold the them towards the personality and makeup of our board so that we can get optimal engagement of all board members. Additionally, you pointed out that some physicians may not do well in larger groups.

To combat that, we will have breakout sessions, which enable those who are more comfortable in a smaller group setting to demonstrate their expertise. The agenda is clearly defined by our board makeup and the need for strategic and scientific input to our business. It is very important for us to have engagement of all the docs.

Steve: What happens if a board member is not ultimately the right fit?

Mark: It’s critical that there is a good family structure within an advisory board. We do want everyone to contribute to that board. After several meetings, if we find an individual is not really best suited for that particular type of board, we will speak to that physician individually and see if we have other unmet needs for collaboration where that person’s strengths might be a better fit.

Not everybody likes to sit in a room with 15 or 20 of their peers and discuss these kinds of strategic topics. They may be better suited for more one-on-one type of interactions with our research and development folks, or our business development folks, or our marketing individuals. It’s a simple conversation, and usually most physicians agree very much at the end of the day, and it really does not become an issue of personalities and so forth.

Steve: I’m assuming there is some debriefing that goes on amongst members and industry members of the board, whether it’s all of them or a select few, to say, “Okay, what went really well during this meeting? What do we need to change?” It’s kind of a critique of the people that participated. Do you have a formal debriefing?

Mark: At the end of a meeting, internally we will almost immediately sit down and debrief around what went well and what didn’t go well. We then formally put together a report on the outputs of the meeting.

I think the other important aspect of boards is that it’s a two-way street. We want our physician members of the board to leave feeling good about the time that they’ve spent away from their practice, away from their patients, away from their families, and really want them to leave with a feeling that they’ve learned something, and that they have participated in the advancement within their particular field.

Steve: What are the things that can’t be discussed? What kind of things do you discourage being discussed, and what are the things that may be totally forbidden?”

Mark: There is actually very little that cannot be discussed along the lines of scientific developments and progress and strategies for the future. All of our materials concerning the use of current products are reviewed by our legal teams, our compliance teams, and our regulatory teams. The agenda is vetted prior to the meetings. The only thing that we try to stick to is our agenda, and the agenda is around the science, the technology, the therapy, and the education.

We want to have a balance. We can speak in a limited fashion about off-label utilization in this type of setting, especially where we’re speaking about trying to look at new opportunities and futuristic therapies, expanding current device indications, or gaining new clinical evidence. But the purpose of the meeting cannot be around topics of off-label utilization.

We limit the number of sales and marketing individuals that attend any one particular meeting.

Steve: Even if they’re there, I notice some of them are kind of outside the center ring, so to speak, of discussion. They’re more observers rather than active participants.

Mark: That’s correct. Our meeting, in particular, is run by the functional leaders that are going to take the information that is obtained and apply that to their strategic mission and plan.

Steve: Do you have anything else that you think you want to touch on, Mark, at all? If there is something in particular that I just didn’t come up with, that you think would be important for the readers of Vein Magazine who are both physicians and industry.

Mark: One of the things that is important is that some of our boards do move beyond physician membership— for example, health care administrators and service line administrators—that can maybe add an economic perspective to our discussions around what we’re speaking about. There may be selected meetings where we do try to bring in a hospital administrator or a member who can bring some economic value to what we’re discussing.