Digital Health is gaining momentum on all fronts, from transforming drug discovery, managing supply chains to enabling remote clinical trials and development of digital biomarkers.

Divya Mishra, our next pathbreaker, Medical Director APAC (Hematology/Oncology) at ICON plc, provides medical strategy and technical inputs into the design and appropriateness of clinical trials for all cancer types.

Divya talks to Shyam Krishnamurthy from The Interview Portal about transitioning from a career in medical practice to leading and coordinating clinical research in oncology, for the development of innovative treatments and therapies.

For students, be ready to learn and unlearn as you discover new career paths that are aligned with your interests and aspirations !

Divya, can you tell us what your growing up years were like?

Born to a family of academicians, I grew up in the city of Kanpur. My father was a Professor of Physics in Kanpur University and Mother was a lecturer of English and Principal of a Girls’ Inter-college. We were 5 siblings, and three of them were elder to me: each with a unique strength and aptitude such that there was never a dull moment at home and always abundant support and guidance to me. I went to an English medium convent school and then to a public school during my 14 years of school education. I was an obedient and introverted child and would often sit around my mother checking school notebooks of her students, feeling happy about learning from their mistakes. I loved helping out in household chores and learning to cook with my grandmother. I also remember rides to the village on the motorcycle my father drove and enjoying games with village children, eating homemade butter and pulling pails of water from the well, the night outs, sleeping on warm thatched beds laid when the whole family visited the village home. Thus, my initial years were full of fun, play and quite an exposure to celebrations and community festivities and diverse interactions.

What did you do for graduation / post-graduation?

I became a medical doctor, having qualified competitive examinations at the State and National level. I did my MBBS and MD (Radiation Oncology/Radio-Therapy) from Government Medical Colleges in Jhansi and Allahabad respectively in Uttar Pradesh in India. Much later, I also completed a two-year Diploma in Family Medicine from CMC Vellore, Tamil Nadu and a one-year Fellowship in Palliative Medicine from Institute of Palliative Medicine in Calicut, Kerala in hybrid/blended learning mode.  

What were some of the influences that led you to such an offbeat, unconventional and unusual career

At various points of my early life, my parents, siblings, teachers and role models like Mother Teresa and Florence Nightingale, were key influencers for my inclinations and world view. 

I remember a few turning points in my early years that helped me to grow in confidence and caliber.  

In my summer vacation of Class 5, my elder sister asked me to learn some well-known poems of famous poets from an old poetry collection from my mother’s college days. They were all in English. As I learnt them with an intent to recite well, I re-read them several times. They awakened in me an understanding of the power of expression of the most nuanced elements of life and its challenges. From then on, I assimilated Hindi and English poetry from my textbooks, learnt all of them, recited well to win accolades and awards, and started to ace these subjects due to an elevated level of interest in the art of expression. I started using these prose and poetry in my essays and answers, and began to be picked for debates/elocution competitions in school. I then discovered that writing an argument for a debate or a speech requires another level of preparation in order to communicate, but I was determined to do it well. I learnt from my parents’ thoughts, ideas and verbal/written skills. I won many debates during school and college, and became known for my oratory skills- thanks to having developed an interest in Poetry.

Lesson – Once you taste success, you strive to taste more and more. Even those with talent, need to discover them and may not be lucky to receive the right opportunity, so one must keep trying diverse areas of interest and never be disheartened with failure. Had I not re-read the poems often with an intent to be able to ‘recite well’, I would not have discovered my interest or their beauty!  Moreover, it is prudent to never undermine or ignore guidance of trusted elders and teachers. The task of learning tough poetry of the likes of Rabindranath Tagore wasn’t easy or attractive for a 10-year-old, but I decided to comply by dedicating some time for it every day. 

The second incident concerned my participation in a school play during high school. My talent in speech and delivery of poetry and dialogue was noticed by teachers and I was offered a role in a Two-Act Play in the school annual function. I had to be the lead character’s best friend with a limited presence. This was a time when I wore braces in my teeth, which made me very conscious about my appearance as a teenager. I suspected that this was the reason I was not offered the lead role of the King’s lost daughter despite my belief in my acting abilities!  However, my brooding was noted by my sister, who persuaded me to try and express my interest to the drama teacher. I mustered all my courage at the age of 14 to express my desire and the teacher thoughtfully agreed to give me an audition. I was chosen for the lead role, not just because I was at least as good as their choice, but partly also because the lead character withdrew due to academic pressures of her final school year. I am certain that this opportunity wouldn’t have come to me if I had given up on my expectations too soon.  The one-hour long play won a lot of appreciation from the audience, school faculty and students for my performance and was remembered for several years hence. 

How did you plan the steps to get into the career you wanted? Tell us about your career path

My undergraduate years in MBBS were no cakewalk, and helped me understand that hard work requires discipline, persistence, stamina and mental toughness. I couldn’t dislike and choose which subjects to study well since everything is equally important. One has to find innovative ways of learning as the choices become limited and goals become larger/loftier, such as ‘saving lives’.

My MD in Radiation Oncology didn’t demand a lot from me due to paucity of equipment and resources at my chosen institution. But I was wiser, after my MBBS years, to set goals for myself, use all the available resources to the best potential and emerge as learned as any of my peers from better colleges. I went to an affiliated institution in the city to seek stints of practical learning and no one ever refused a keen student. I was persistent and driven to gain knowledge and the Radiation Physics professor there once remarked- No one can stop a river that flows! The topic of my MD thesis required a certain investigation to be undertaken on patients for objective evaluation. Since that test was not available in any of the city hospitals, I took patients’ consent to have it done in a renowned public hospital in another city and often travelled myself to ensure that the patients did not face any difficulty. 

Indeed, it is not only important to be self-aware through introspection but also be aware of your surroundings to understand what solutions may be available to your problems, just outside your comfort zone! 

After my post-graduation in Radiation Oncology, I worked in renowned hospitals in Delhi and Mumbai. I joined as a Research Fellow on a Phase-3 clinical trial that was evaluating the latest techniques of Radiotherapy delivery at Tata Memorial hospital and happened to attend a seminar on Clinical Research. This seemed like a very attractive option given my aptitude and interest in research. I walked up to the presenter, an MD, DM, Pharmacology and shared that I too would like to explore a role in Industry like his own and sought advice for the same.  

Few months later, I got a call for an interview that I cleared and got into my first role in the industry as Oncology Medical Advisor at a renowned MNC Pharmaceutical company. 

I joined Pfizer in the Medical Affairs department, where I started as Oncology Medical Advisor and went on to become Therapy lead for the Oncology & Clinical development at the country level and as a Medical Advisor in the Asia-Pacific Commercial Team. I was responsible for the lifecycle-management of all marketed products in the Oncology portfolio at country level, including medical development plans for these drugs besides mentoring and leading training sessions for medical advisors across Asia Pacific in the regional role. I also spearheaded the medical strategy in the launch of New Oncology products, including innovator molecules and the first ever Oncology generics for Pfizer India by analyzing current treatment landscape, conducting surveys and through publications. I also led the Outcomes research portfolio for Pfizer India and drove the local clinical development of in-line range of products across therapeutic areas. I created a network of practicing oncologists to generate relevant data for specific cancer types and steered medical advisory board meetings with Oncology experts at national and international levels. 

I relocated to New Delhi and decided to hone my skillset in clinical development and operational activities. My next jobs were in SFJ Inc, as Associate Director, Clinical Development and IQVIA as Associate Medical Director (Oncology) for Asia, where, I had the opportunity to supervise CRO activities of Phase-1 to Phase-3 clinical trials, formulate the recruitment enhancement strategy for the sites, work with regional site feasibility teams, serve as the key medical contact for investigators across Asia-Pacific Region on those clinical trials in precision therapeutics in Oncology, assist in due diligence reviews of new projects and provide strategic and medical inputs into protocol-related questions from regulatory bodies globally. 

My experiences in the Pharma and CRO industry not only expanded my knowledge base of bringing the drug from bench to bedside but also gave me a renewed appreciation of the pillars of good clinical practice and research that rests on seamless coordinated activity of dedicated professionals in research, sales, marketing, market access, regulatory and safety divisions. 

After 7 years in Pharma/CRO, I decided to build upon my experience and refreshen my practical knowledge of General Medicine including management of chronic comorbidities that often accompany cancers and also pain and palliation for improving patient outcomes. That’s when I joined two hybrid learning courses – a 2-year Diploma program in Family Medicine from CMC Vellore and a Fellowship in Palliative Care from IPM, Calicut respectively. Further, to gain a stronger foothold into clinical and outcomes research, I completed the following courses while being employed in the pharmaceutical industry. 

i. PDCR (Professional Diploma in Clinical Research), 2009 From Catalyst Clinical Services

ii. Post graduate Certificate course in Health Economics and Outcomes Research, 2013 From University of Washington, Seattle

iii. Postgraduate Certificate course in Clinical Pharmacology, drug development and regulation, 2011 From Tufts University, Boston.

Through motherhood and rearing my two children, I never stopped upskilling or learning to be a better version of myself.  I was prepared when the opportunity to take the next leap landed. In my current role, at the age of 48, I relocated to a land of opportunities for enabling a wider exposure and material wellness for me and my family. 

How did you get your first break?

As I said earlier, I happened to attend a seminar on Clinical Research. This seemed like a very attractive option given my aptitude and interest in research. I walked up to the presenter, an MD, DM, Pharmacology and shared that I too would like to explore a role in Industry like his own and sought advice for the same.  

Few months later, I got a call for an interview that I cleared and got into my first role in the industry as Oncology Medical Advisor at a renowned MNC Pharmaceutical company.

What were some of the challenges you faced? How did you address them?

I realized that more often than not, you are captive to your limitations and if you decide to break through the self-imposed walls, the world is your stage. 

After my abysmal Mathematics performance in Class IX 1st terminal examinations, one thing that really helped me was the teaching strategy adopted by my mathematics teacher. By explaining the concept first and then waiting for students’ first responses to solve the problem, she brought out my hitherto unknown potential to the fore. I started to focus more and think fast as I wanted to be able to be the first to help the teacher with the next steps of the solution!

I realized that one size doesn’t fit all and the best teachers recognize the unique abilities of their students and employ appropriate learning methods to bring out the best in children. 

In life, I have carried these traits of excellent communication (written & verbal), the attitude of problem-solving and insightful training skills into my later years and it continues to be my forte in my current role. 

I have always loved to help and be useful. I also loved to solve problems. I was inspired by the selfless service of Mother Teresa and Florence Nightingale for the poor, sick, wounded and the needy. So, I decided being a medical doctor will allow me to be the person I wanted to be.

Where do you work now? What problems do you solve?

I am working in the Clinical Research Industry (ICON plc) as a Medical Director and Therapeutic Expert for the areas of Oncology/Haematology in the APAC region. I provide medical strategy and technical inputs into the design and appropriateness of clinical trials for all cancer types, in the context of current standards of care, risk evaluation-mitigation in their conduct, and oversight of the safety of the clinical trial patients as well as ensuring integrity of clinical trial data.

I collaborate with cross functional teams from clinical operations, project management, Investigative sites, Ethics Committees,  regulatory and Pharmacovigilance personnel Across diverse geographies. This is essential for the smooth execution of complex study designs and multiple demands of precision focused therapeutic agents in clinical development, the unique adverse event profile of the agents, use of digital tools/ measures and decentralized or hybrid nature of current clinical trials. 

What skills are required for your role? How did you acquire the skills?

In my various job profiles, I have contributed by application of the following skillsets of: 

  • Envisioning, strategizing and leading while maintaining high professional and medical ethics and standards with excellent problem-solving and team management skills.
  • Cross-functional collaboration with various industry and regulatory stakeholders in the areas of new product launches and clinical trials initiation and conduct.
  • Strategic alignment, medical guidance and execution of the full scope of medical affairs activities, including goal setting, lifecycle management of marketed drugs, data dissemination, evidence generation, and establishing knowledge-based relationships with the medical fraternity. 
  • Expertise in identifying issues, forming hypotheses, designing and conducting analysis, synthesizing conclusions and recommendations, and implementing change.
  • Ability to devise and implement initiatives to improve the quality of medical services, diagnostic and institutional disease management protocols, and patient medical records for effective patient care while ensuring adherence to strict quality standards
  • Competence in delivering scientific presentations to investigators at advisory boards and to regulatory authorities and engaging in relevant scientific discussions and critical analysis of evidence-based medicine.
  • Training colleagues in Industry such as marketing and sales personnel on technical medical concepts -simplified for their understanding, mentoring other doctors in medical affairs and in Medical monitoring of clinical trials, across multi-cultural settings in the pharmaceutical/CRO industry 
  • Administering all aspects of the day-to-day operations of the hospital, patient counseling, preventive and palliative medical practice in community settings and planning for adequate medical care for patient satisfaction.
  • Serving as a co-faculty for the Family Medicine programs of CMC vellore for practicing physicians across India.

While some roles in Industry offer the flexibility of continuing medical practice on a part-time basis, others do not. With my responsibilities, I did not opt to be sailing on too many boats and focus wholeheartedly on the job, I took up. However, I continue to offer my voluntary services to Singapore Cancer Society. 

How does your work benefit society? 

My present role of a Medical Director in Clinical Research Oncology is crucial in advancing medical knowledge and improving patient outcomes. My work plays a pivotal role in designing and overseeing clinical trials, ensuring ethical conduct, and maintaining patient safety during the research process.

By leading and coordinating clinical research in oncology, I contribute to the development of innovative treatments and therapies. My work facilitates the evaluation of new drugs and medical interventions, potentially leading to groundbreaking discoveries that can extend and enhance the lives of cancer patients. This progress not only benefits individuals but also benefits society at large by reducing the burden of cancer and improving public health.

Moreover, my work helps in disseminating scientific findings, enriching medical education, and influencing healthcare policies. By driving evidence-based practices, I contribute to the evolution of oncology care, leading to more effective and accessible treatments for cancer patients worldwide. 

I go to work every day with the assurance of playing an instrumental part in developing life-saving and disease modifying cancer drugs to patients through the highest standards of clinical trial conduct. 

Tell us an example of a specific memorable work you did that is very close to you!

In my clinical role, I worked in a community setting in a hilly town in India, and implemented a system of online record keeping for the hospital, thus creating an objective and accurate data repository of the ongoing status of patient’s heath, trajectory of the illness as well as a record of assessments. I also conducted an audit focused on patient needs assessment and identified patients for the ‘Palliative care register’ for further assessments and Planning per the established global guidance. This work currently provides baseline data supporting the first step in setting up palliative care services in that community and for creation of a Non-Communicable Diseases registry in that area. I also conducted a community awareness program on Palliative Care that helped to identify interested volunteers for home visits and need for training in the local language. I then led the Hindi translation of WHO’s ‘Workbook of Careers’ for training Health volunteers in Northern India- who are not well versed in English and is a handy tool for their use.  I am very happy to have made this positive change in services and resources available to a large community of healthcare workers in the Hindi Speaking belt  of India.

Your advice to students based on your experience?

  • Continue to learn and unlearn. It’s never too late.
  • Don’t be afraid to experiment and to lose-it’s important to keep moving and keep trying.
  • Do not ignore the advice of trusted elders, friends and teachers without giving it a thoughtful consideration.
  • Trust in your own abilities, do not be afraid to speak for yourself. If you won’t, people may never know.
  • Introspect and learn to be Mindful at all times. Invest time in learning to meditate and have greater self-awareness. It requires practice and discipline.
  • Stay updated and abreast of the changes and the surroundings. Be ever mentally agile and ready.

Future Plans?

Digital Health is gaining momentum and is here to stay. From transforming drug discovery, to managing supply chains and remote clinical trial conduct, from development of digital biomarkers and endpoints of assessment to dose optimization, to digital characterization and phenotyping of patient profile, rapid progress is happening on these fronts. I intend to deep dive and be prepared to take on the next wave of change.