November 21, 2024
Welcome to Perspectives, Leerink Partner’s signature podcast, where we share our insights and interview leaders across the industry to get their perspective on how they’re driving innovation. We’ll also be digging into the backstory to learn more about what has most influenced their success. Be sure to check out all episodes by Leerink Partners.
Diane Vieira: Hi, I’m Diane Vieira and I lead marketing and communications at Leerink Partners. I am very excited today to dive into the fun world of pharmacoeconomics, say that fast five times, with Mel Whittington, Head of the Leerink Center for Pharmacoeconomics. She has an incredible story, which started in small town, Illinois, and today, where she is an expert in health economics and cost effectiveness analysis. Mel, welcome. So excited to have you here today.
Mel Whittington: Thank you, Diane.
Diane Vieira: Let’s take it back, like all the way back to the beginning. Can you tell us what sparked this journey for you?
Mel Whittington: So, it goes all the way back to small town, Illinois. I was born and raised in a teeny, little town called Macomb, Illinois. You’ve probably never heard of this quaint little town, but it’s my roots. And I always planned on being the town’s pediatrician. I have no idea why, but that was always the plan, I suppose. I suppose I liked kids, loved math and science, and liked a challenge. So, I went to college to study biology. And be a pre-med student. And the summer before my senior year, I spent time with an organization called Global Medical Brigades, and they set up medical clinics in remote areas. And so, I spent the summer in Panama, in a remote area of Panama, offering free medical care. And my eyes were really opened to the importance of access to healthcare services and treatment. And actually, way more than the clinical encounters I had while I was there, I was left wanting to know more about access to care, systems research, and health policy. I remember being on my flight back home and preparing to apply for medical school and having these doubts and these questions of like, “what is health policy? What is access to care? And do I actually want to be a clinician?” and so instead of going straight to med school. I decided I would get a master’s degree in health sciences first to learn about health policy and systems research, but then eventually go to med school with the thinking that this training in health policy would make me a better pediatrician. But it took about, I don’t know, two lectures into my degree to be entranced with statistics and using data to inform decisions. So, I never went to med school. I ended up getting a PhD in health services research. And after my PhD, I started a research faculty position at the University of Colorado, where a large portion of my time was spent conducting cost effectiveness analyses for pharmaceuticals through a contract with the Institute for Clinical and Economic Review. And the Institute for Clinical and Economic Review, it’s an organization in the United States that, as its name suggests assesses the clinical and economic value of new treatments. And so, I worked as an external collaborator of ICER’s for about five years through my academic appointment at the University of Colorado. And then I left academia and joined the team at ICER to become their director of health economics, as I was really drawn to the impact and the speed of the work. However, about 18 months ago, I left my position at ICER and started a senior fellowship at the Center for the Evaluation of Value and Risk in Health at Tufts Medical Center with Peter Newman and his team. And I started consulting. And the reason why I left ICER and went to back to an academic type position was there was a lot of chatter about two things. The importance of the societal perspective in cost effectiveness analysis and the need for cost effectiveness analysis to include genericization. So, when I say the societal perspective, cost effectiveness analysis typically only focused on health system costs, patient survival, and patient quality of life. But a lot of people were discussing this wider societal benefit of healthcare treatments that are not typically included in cost effectiveness analysis. And things like that could be patient productivity, caregiver time, health equity, all of which were historically not captured in cost effectiveness analysis. So that was one thing that was kind of brewing that had me interested in digging in more. The other was for the need for cost effectiveness analysis to include genericization. Maybe as a surprise, it’s common practice in cost effectiveness analysis to keep a drug price constant over the time horizon. So, say you’re on a drug for 30 years and its launch price is $30,000. The cost effectiveness analysis would keep that annual price of $30,000 over the entire time frame and wouldn’t incorporate any expected genericization that would happen, you know, 13, 14, 15 years later. So, I was working on that methods development work at Seaver and through consulting. And now I’m thrilled to be able to start implementing those methods at the Leerink Center for Pharmacoeconomics.
Diane Vieira: That’s very cool. And we’ll get to the Leerink Center for Pharmacoeconomics a little later. But when I asked you to humor me for a minute, I have to ask for those of us that are new to the field and maybe our brain power isn’t at your level, what exactly is pharmacoeconomics?
Mel Whittington: It’s essentially a branch of economics that examines the costs and consequences of pharmaceuticals. So, it’s kind of like pharmaceutical economics. A common method of pharmacoeconomics is cost effectiveness analysis. That might be a little bit more digestible, thinking about the costs and the effects of drugs. My mom hates the name Pharmacoeconomics. She gets really, really bothered that it’s not “pharmaeconomics.” She doesn’t like the “co” in there. But after a while, I think it rolls off the tongue. But I do think the word “pharmacoeconomics” is evidence that we as a field could really benefit from some communications training to make sure our messages resonate with non pharmacoeconomists.
Diane Vieira: I love that. And I think you’re right. The term “pharmacoeconomics” could use a little PR work for sure. But I myself, now that I’ve been introduced to it, have learned to start practicing that and getting a little bit better at that word, a little bit difficult and challenging first time out. I’d love to kind of hear more about what drew you to this field. Was it some sort of an evolution? Was there a specific moment when you knew that this was the path for you? Like what was that draw?
Mel Whittington: So, when I started my PhD, I had never heard of pharmacoeconomics, but one of my early classes was an introduction to health economics. At the course there was, in the course there was a guest lecturer who came in to talk about pharmacoeconomics. And in a lecture, he pulled up a cost effectiveness analysis model in Microsoft Excel, and I was absolutely fascinated with it. And for probably the vast majority of people on this planet who have never seen a cost effectiveness model, there’s a lot of tabs, there’s a lot of formulas, there’s a lot of inputs, there’s a lot of math, there’s a lot of probabilities. And then it kind of synthesizes all of this evidence, extrapolates it, and gives you some new nuggets of information. And so, I loved how it could be built in Excel, a program everyone has access to, and then it used math and existing data. I also thought it’d be a good way for me to do a dissertation without primary data collection so I could graduate sooner and get a real job because grad school is quite the chore. I did the graduate student version of a cold call, and I went to the guest lecturer’s office hours, and then actually ended up becoming his research assistant. throughout my entire PhD. And so if there are any other pharmacoeconomists listening, that guest lecturer was Dr. John Campbell, who’s now the chief scientific officer of the National Pharmaceutical Council. And I’m fortunate to still collaborate with him to this day. It’s a pretty small field.
Diane Vieira: I certainly don’t doubt that for sure. I mean, that does sound like the perfect blend of science analysis and real-world impact. So, I can see how you’re drawn to that. And it seems the Excel model really was the lightbulb moment. I, an Excel enthusiast myself, love that, uh, who would have thought an Excel spreadsheet could be so powerful. But on a serious note, you’re now bringing all of the passion to CPE, and we can feel it, right? So, we couldn’t be more excited for it, but we’d love to know, like, what are some of the most exciting developments that you’re seeing in pharmacoeconomics right now?
Mel Whittington: There was a lot of chatter about cost effectiveness analysis needing to incorporate societal outcomes and future expected price changes. What’s really exciting is now the methods have been developed to do so, so we no longer only have to talk about it. But we are actually at the time now where we can execute them. So, I think we will see the field start examining the impacts of a drug on the broader society rather than on the health system. So, when we’re evaluating pharmaceuticals, not only will health system costs, patient survival, patient quality of life be considered, but also the importance of patient productivity, time spent caregiving, equity, uncertainty, and so many other things that treatments can provide an individual and society. So that’s number one, big development is emphasis on societal outcomes. The second one is I think we’ll see much more appreciation and understanding that the vast majority of expensive branded drugs will eventually become cheap generics or biosimilars. And the importance of capturing that in cost effectiveness analysis. So that’s number two. So societal perspective and the future genericization will really change how cost effectiveness analyses are conducted. One other thing, I would really like to see our field be less reliant on a formula and rolling everything into a cost effectiveness estimate because not everything that counts can be counted. And I think there’s real power and passion in stories. Whether those are stories about patients, stories about new drugs, stories about the development process, that when we wrap everything into a cost effectiveness estimate, I think we lose out on the story and the passion.
Diane Vieira: So true. Not everything is tangible, and sometimes the deeper impact is much more valuable. It’s incredible to see that the field is evolving, to consider these wider impacts of these therapies, super important. And knowing that kind of switching gears to CPE and like, what are your main goals there with the center?
Mel Whittington: At the Center for Pharmacoeconomics, we want to be the storytellers of innovation. We want to be the people to give the platform to hear the stories around new innovations, to hear the stories around the development process and to hear stories from patients and other stakeholders in the industry. We really want to facilitate that storytelling. We hope to do that in a few different ways. First, to tell the stories around new innovations, new pharmaceuticals. We will be releasing reports that assess and communicate the societal impact of new healthcare treatments. So, we can celebrate what novel medicines provide society and their benefit that will persist long after their high launch price. We also want to tell stories about the development process, and to do this, we are releasing these weekly digest emails, kind of like a newsletter, that talks about how healthcare innovation occurs and the importance of preserving the research and development ecosystem, and then to tell stories from patients. And other stakeholders in the industry, we’d also love to have more podcasts and hear the stories of patients, investors, innovators, and give that platform to share those stories with a larger audience. And so, I think pharmacoeconomics has become far too formulaic. We need more stories. We need more passion. And at the Leerink Center for Pharmacoeconomics, we want to bring that. We want to work with investors, innovators, patients, really the entire healthcare industry. To tell the story and importance of innovation, to demonstrate the value of innovation, and to humanize the field and the people within it.
Diane Vieira: I’m going to address the big purple elephant in the room because as you know, there are always critics when new approaches or affiliations are introduced. So how would you address or engage with someone who might question your work and it being affiliated with an investment bank?
Mel Whittington: I think everyone should always consider the funding sources and potential biases of something. So, I certainly appreciate the critique. What we are doing at the Leerink Center for Pharmacoeconomics, I’ve wanted to do for a long time, and I’ve been trying to figure out the best place to do it. I did consider releasing these commentaries and analyses from the comfort of my own home as a side gig for no pay outside of some other paying job. I really did consider that. But would those commentaries and analyses ever get anywhere? Would anyone see them? Would I have a team to collaborate with and to learn from? Whereas now, at MEDACorp, within the Leerink Center for Pharmacoeconomics, I have access to an amazing communications team, quick access to 20,000 key opinion leaders, and an extensive network of investors and innovators who I can quickly learn from. And so, I can be transparent about my biases right now. I can tell you that I am pro innovation but I’m not pro innovation because I work for the Leerink Center for Pharmacoeconomics, which is a division within MEDACorp, which is affiliated with Leerink Partners. I’m pro innovation because I’m a patient. I have two children, I have a husband, I have parents, in laws, siblings, nephews. I want the world to be a better, healthier place for them. And if they do get sick, which they all have, and sadly they all will, I need there to be a treatment that they can get.
Diane Vieira: Very powerful perspective, Mel, and appreciate you being so open about that. I mean, a very, very good point. You’ve shared so much to this point about the evolving field and your dedication to it. But I do kind of have a question, like why now to make this big pivot in your career and why not years ago or stay with doing the work that you had been doing up until now?
Mel Whittington: I wouldn’t necessarily call it a pivot. I’ve continued to learn from others and have been open to revising the status quo. I’ve taken feedback and been honest about limitations of conventional cost effectiveness analysis and its approaches. And so, I’ve spent time developing and testing and learning new methods. So, I would consider this more of an evolution rather than a pivot. Now, in saying that, there were a lot of things that have motivated this change. For one, the field was changing, right? I’ve already talked about this growing interest in societal perspective and incorporating genericization. The field was certainly evolving. But a few other moments were monumental in encouraging my evolution. One was, I conducted a cost effectiveness analysis for a drug that was found to be not cost effective at any price. But the drug was safe and effective and improved a devastating condition. And so, this stuck with me and demonstrated to me that the conventional cost effectiveness analysis approach has some issues and we need to expand that to evolve it to make it better. And then on a more personal note, a bunch of my loved ones got really sick. My sister was diagnosed with stage four cancer six weeks after giving birth. My mother-in-law was diagnosed with glioblastoma at the end of last year, around 11 months ago. And I realized the first thing you look for when you or a loved one gets sick is a pharmaceutical. And in my sister’s case, chemotherapy was successful. She’s in remission. We are counting down the years, months, minutes to when she’s five years cancer free, and that will be one hell of a party. And with every six-month scan, our, the tightness in our chest loosens a little bit. But in my mother in law’s case, we haven’t found a treatment that can do that. Obviously, the impact on her health has been devastating, if anybody knows anything about glioblastoma, but the impact far exceeds her health. She went from working full time to not working. She went from being 100 percent independent to needing full time support. And so, I’ve seen the societal impact of the condition and the need for a treatment to not only impact her health, but also some of those societal impacts. Watching a loved one battle a terrible cancer with sadly not much innovation available has made me committed to learn and preserve the research and development ecosystem.
Diane Vieira: Phew! Mel, I wasn’t expecting our podcast to get so deep. Thank you for sharing that. I can’t even imagine how hard that all must be on you and your family. I mean, thank you for sharing that deeply personal story. It really brings to light why the work that CPE is doing is so important. But also, why you’re so passionate about educating people on this topic, because it’s not an Excel spreadsheet. It isn’t about formulas. It’s about people’s lives. It’s about families and it’s about future generations. And I think we all have examples in our own lives about how we’ve been affected or someone we love has been affected by something that a prescription drug has helped for. And having these innovators really be applauded and celebrated so that they can continue their work. Is probably one of the most important things that we can do. So, I’m excited for all of the work that you’re doing and that others in the field are doing to advocate for these same things. And we’re just about at time, but I have a question that we always typically close with, which is knowing all of the people you’ve been surrounded with and your journey through your career. What has been the best piece of advice that you’ve ever been given?
Mel Whittington: Yeah, I think it’s never to take yourself too seriously. And I was guilty of that at the beginning of my career. I tried to be very rigid and not let my personality come through. And I’ve noticed when I’ve given up on that, when I’ve just let, be true to my authentic self, let my personality come through in my work, that it can be a wonderful experience. So, I, to this day, try not to take myself too seriously.
Diane Vieira: I very much appreciate that, and I couldn’t agree more. I think sometimes we underestimate how much all of what we do is built on relationships and trust and really being able to connect with people. And it’s hard to do that when everything is so cleansed and kept at 30,000 feet. So couldn’t agree with you more on that one. One final question. And oddly, I’ve been wondering this myself. Do you have some secret love for Metallica that we do not know about?
Mel Whittington: If anyone’s read our Center for Pharmacoeconomic Weekly Digest email. It’s titled, Diary of a Health Economist, and if you’ve read it, you know why she’s asking me this. And I have to confess, I’m a total fraud. I’m actually not a major Metallica mega fan, um, but I am a big fan of a theme and wanted some underlying theme to our newsletter. So, it does happen to be all of the section titles of our newsletter are named after Metallica songs. But that’s not because I’m a fan, how it came to be. Was, I was on a road trip with my husband, my two kids, and my two Bernese Mountain dogs. And I was trying to get everyone to brainstorm with me fun sections for our Center Weekly Digest email. And we live in Kansas City. If you couldn’t already gather, I was a Midwesterner by me saying we go on weekend road trips with the whole family and the dogs. But we love the New Heights podcast. And my husband was saying I should have, you know, reoccurring sections in the newsletter like they have. They have sections like “New News” and “Getting Out of the House.” I came up with “Sad but True” for a section header in the newsletter. I came up with that on my own, but I couldn’t think of anything else. So, I started googling and found out, unbeknownst to me at the time, that “Sad But True” is a Metallica song. And then I stumbled on an exhaustive list of all of their songs, which they have so many, and there was just so much to work with. And so, the newsletter practically wrote itself. And then, you know, I proceeded to play the Metallica songs during a road trip and that didn’t last very long. So, I am not a major Metallica fan, but I am a fan of a theme. And my husband has told me he’s going to get me a Metallica graphic tee.
Diane Vieira: I love that. Great story. And probably because I’m also type A, I love a good theme myself. It’s all about being organized. And before we say goodbye, can you tell listeners, how can they keep up with the center of pharmacoeconomics and all the cool stuff that you’re doing? Is there an easy way?
Mel Whittington: Yeah. If you’re interested in what we do, if you want to receive our content, or if you have suggestions for us, all you have to do is email cpe@medacorp.com and we’ll get you on our email list.
Diane Vieira: Love it. Well, Mel, thank you so much for the time today and the enlightening, inspiring conversation. I cannot wait to see what CPE does next and how it’s going to help shape the future of healthcare. Thanks.
Mel Whittington: Oh, thank you, Diane. It was a pleasure.
Thank you for listening to this episode of our Perspectives podcast. If you are interested in participating in future podcasts or would like to learn more about Leerink Partners, please email us at info@leerink.com
