Christina Bennett Freelance Writer GEN
A Pharmaceutical Pricing Primer, Presented via a Series of Well-Crafted Tweets
Behind the glow of a computer screen, primary care physician and policy researcher Walid Gellad, M.D., M.P.H., drafts emails, grant proposals, journal articles—and tweets.
Earlier this year, he wrote an op-ed for the Wall Street Journal in which he drew readers closer to his world: The Veterans Affairs (VA) hospital system, where he is a part-time primary care physician. The fact that he spends so much time at the VA gives him a different vantage point than most as it relates to the drug pricing issue—a quality made clear in the aforementioned article as well as throughout much of his work. He also penned a controversial perspective for the New England Journal of Medicine, explaining the nuances of accelerated approval of expensive drugs. And he reminded others in a post on the Health Affairs Blog that health reform is needed for long-term care too.
All the while, Dr. Gellad keeps pace in the traditional publishing sphere. He authored about a dozen research studies this year alone on various healthcare policy issues, the latest aimed at informing policy surrounding the opioid epidemic. And this physician-academic hybrid has a knack for tweeting.
“Most of my week is spent sitting at a desk in front of a computer typing,” Dr. Gellad tells GEN, chuckling softly. He works at the University of Pittsburgh, where he has been a faculty member for nearly a decade. Currently, he is associate professor of medicine and the director of the Center for Pharmaceutical Policy and Prescribing at the University of Pittsburgh.
Another generous portion of his time is spent in meetings. “That’s what occupies my day. It’s a lot about writing and talking to people.” He jokes, “Does that sound exciting?”
All joking aside, Dr. Gellad says he enjoys how he spends the majority of his time. “That’s how you do the research—in meetings and at your computer.”
The remaining time—one day a week—he spends seeing patients at the VA Pittsburgh Healthcare System.
Music and Medicine
Rewind two decades, and you’d find a young Gellad composing music, not research articles, emails, or smart, 280-character summaries. Having grown up playing piano and being around music all his life, he chose to study music during his undergraduate years at Swarthmore College, a private liberal arts college in Pennsylvania.
“You didn’t have to be a biology major to go to medical school, so I studied music and did all of the pre-med requirements at the same time,” he says. He saw it as his chance to do something different, before medical school.
He says he was “hooked” when he took a music theory class at the start of college. “There’s this amazing structure to music, this underlying almost mathematical explanation for why the music sounds the way it does. That’s what was really fascinating to me.”
“During this whole time it was absolutely clear what I was going do after college, and that was go to medical school,” he says. “I was never going to be a musician. I knew I wasn’t at the level where I could be a musician professionally, but the issues around music theory just fascinated me.”
“Where I went to college, I think at least half of the music majors ended up going to medical school, so for me it was not that unusual. But it certainly is not typical, and something I’m really happy I did,” he says.
At the University of Maryland School of Medicine, he deviated slightly: He took a year off to serve as an AmeriCorps volunteer in Brooklyn, NY.
“I’d always been interested in public health in general, but that was a firsthand experience,” he says about his time as an AmeriCorps volunteer. He recalls doing a lot of health education work in a Brooklyn community and being face-to-face with the ways health is affected by forces outside of the healthcare system. “That was pretty impactful. That really solidified my interest in wanting to do something related to public health, or policy in general.”
After medical school, he trained at Brigham and Women’s hospital in Boston, MA, where he found role models who showed him how he could be both a primary care physician and be involved in research and policy. He also completed a master’s in public health and a fellowship in health research services.
Stuck in the Middle
“I’ve been interested in this issue of prescription drug costs since I started,” Dr. Gellad says. During his residency, the first paper he published as lead author examined how the new prescription drug benefit for seniors (Medicare Part D) could affect vulnerable seniors. When the article was published, Medicare Part D had just gone into effect. He says the issue of prescription drug costs has been pervasive throughout his research. However, interjecting his voice into the drug pricing debate has been a challenge.
“The middle-of-the-road people, they get no air time,” he says. “Everyone is competing for air time, and it’s not necessarily that exciting to just be in the middle sometimes. That’s a challenge for people who want to solve the problem.”
He adds, “That’s part of why Twitter is actually very useful. It evens the playing field a little bit and also provides direct access to others.”
A Voice on Twitter
Dr. Gellad joined Twitter in April of 2014 and says the social media site has served as a way to meet people, develop ideas, learn each side of an issue, keep up with the latest news—and have your opinion heard. Eric Topol, M.D., also an influential voice on Twitter, has echoed similar sentiments about the platform in the past.
“It’s a highly valued part of my day,” Dr. Gellad says. “It’s a really good way to understand the whole playing field.”
“He has a very important voice that reaches a different audience because of his activity on Twitter,” says colleague Chester Good, M.D., M.P.H., chair of the Medical Advisory Panel for Pharmacy Benefits Management for the Department of Veterans Affairs. Drs. Good and Gellad coauthor articles together often. Dr. Good adds, “I’m an older guy, and I stick to traditional means of publishing, but [Dr. Gellad has] figured out the social media angle.”
One relationship Dr. Gellad has fostered through social media is that with Twitter sensation Vinay Prasad, M.D., M.P.H., hematologist-oncologist and assistant professor of medicine at the Oregon Health and Sciences University. Dr. Prasad is known among tweeps for his snappy, fearless remarks on hot-button healthcare issues. Dr. Prasad recalls virtually connecting with Dr. Gellad a few years ago through Twitter. Since then, they have met in person and collaborated at times. (In 2016, Drs. Prasad, Gellad, and Topol were all named in a list of people—dubbed #biotwitter—who were found to be quickest to share biotech-related links on trending topics in the industry.)
“I really enjoy the kinds of things he’s putting out there,” says Dr. Prasad, referring to Dr. Gellad’s tweets. “What he does exceptionally well is he can engage in dialogue with people on either side of the issue, and do so in a very constructive [way], even while he’s being very firm and pushing. He doesn’t do what a lot of people do on social media, which is, he doesn’t alienate people. He never uses an ad hominem attack.”
Although well-mannered on Twitter, Dr. Gellad has not been sheltered from attacks on his character.
“When you talk a lot about pricing on Twitter, inevitably you’re going to get into conversations with one side or the other that feels very strongly about these issues,” Dr. Gellad says. He rattles off a few attacks thrown at him: He wants children to die. He doesn’t care about developing cures for rare diseases. He thinks spending money on drugs for people who have genetic conditions is not worth it, that the money should be spent elsewhere.
None of the various accusations are true, he says, “and that rhetoric doesn’t help the conversation.”
When verbally lashed on Twitter, Dr. Gellad says he doesn’t take it personally, noting that others deal with it much more than him. He says it gives you a sense of how strongly people feel about certain issues. He recalls only one instance in which he decided to block someone on Twitter. He explains, “It wasn’t productive conversation. It was just yelling falsehoods all the time.”
Dr. Gellad explains that the whole point of health services research is to identify topics about the healthcare system that people might not know about and then use the research to make decisions about how the healthcare system should work. Several years ago, he did exactly that. Boldly, he asked: Is it a conflict of interest for people running academic medical centers to also run pharmaceutical companies as directors on their boards?
“It’s an issue that hadn’t been addressed in any research,” he recalls. The point wasn’t to say yes or no, he says, but to raise the question. He coauthored two studies on this topic, one in 2014 and the other in 2015. “Those two pieces were really interesting to write. They were really eye-opening.”
“We’re still working on some of that work, but again, those kinds of papers do not get you funded. They do not get you elected to the Institute of Medicine. They do not get policy change necessarily. They get everyone mad at you,” he says.
The underlying goal of all of his research is to find ways to make prescription drug use more rational, he says. He explains that even if you can’t get the price of drugs down, you can be rational in what you prescribe, when you prescribe, and to whom you prescribe.
In the aforementioned NEJM perspective, Dr. Gellad brought an uncomfortable question to the forefront of people’s mind in his discussion of FDA’s Accelerated Approval of expensive prescription drugs for rare diseases. The reason this was of interest to Dr. Gellad was because by nature of accelerated approval, drugs traveling through an expedited pathway often have less evidence (at the trial level) of clinical efficacy than do drugs approved through the traditional pathway. Yet, drugs following an accelerated pathway are increasingly carrying high price tags.
“The question is, at what level should everyone else pay for that?” he asks rhetorically. “Obviously, it’s a different issue if this is you or your family member versus if you’re a taxpayer or policy maker.”
Close colleague Everette James, J.D., M.B.A., director of the University of Pittsburgh’s Health Policy Institute, has been working with Dr. Gellad for the past six years. He describes Dr. Gellad as a “truth seeker.” He says there is a “small handful of clinicians” who have the passion to do the research Dr. Gellad does.
Cutting through the Noise
When asked what he hopes to accomplish, Dr. Gellad pauses.
“That’s a hard one,” he says thoughtfully. “It’s a conversation I have in my head all the time because it’s hard to figure out what the right impact is. It’s a little bit unrealistic to say you’re going to solve the problem, at least in pricing.”
He hopes, at least in the short term, to “cut through the noise” and help the public understand the reality of the situation, rather than the talking points. That’s what academics are supposed to do, he says—provide perspective and an unbiased opinion to the public.
“I’ve been at the university a long time, and every so often there’s someone that comes along and you know they’re destined for great things,” says Dr. Good. “The sky is the limit [for Dr. Gellad]. He really is very talented, and he’s driven and interested in being an important voice. I think those qualities and characteristics will move him forward.”