Forest vs. trees

The DTC Perspectives blog reported today that according to the folks at Harris Interactive have polled the public, and found that the overall reputation of the drug industry declined again in 2007, dropping by two points to a new low of 26%. That means that 26% of the general public give drug companies a positive rating. The only industry with a lower rating is tobacco, at 10%.

As the post goes on to observe, one of the major issues driving this is the perception of overly high prices. This includes a lack of understanding of the availability of price-support programs, and the belief that drug companies make profits a higher priority than safety.

While none of this is good news, obviously, it’s interesting to think about loud about how bad it actually is for individual pharma firms. The answer may actually be “not very”.

A generalized animus towards the entire pharmaceutical industry — all $289 billion of it — is one thing. However, the perception of an individual patient taking a particular drug for a particular condition is an entirely different thing. One is the forest, and the other is the tree.


For that individual patient, particularly if the disease is chronic or severe, the reputation of the industry matters a lot less than more specific concerns when they’re thinking about how to treat their condition, and how to stick with the treatment. As our Patient Power study (email us for a copy) has demonstrated, patients take most of their cues when thinking about healthcare from family, friends and other trusted, personal sources. They are concerned about cost, of course, but they’re also concerned about side effects, efficacy, and other details of their treatment.

And where it really gets interesting is after they’ve been on a drug regimen for a while, and they’ve emotionally integrated (or not) the treatment into their daily lives. They become intensely curious about what others taking the drug are experiencing, tips and approaches for managing a condition like MS or diabetes. This is particularly important when the condition is asymptomatic — like hypertension. Until something goes really wrong, a lot of patients with high blood pressure don’t see any day-to-day difference as a result of taking their medication. Consequently, they’re much more likely to stop, which is not good.

The point here is that when you are dealing with an individual patient, who is treating an ongoing, very serious, condition, what lies beneath the surface is at least as important as what’s on top. And I suspect that in that context, everyone’s general attitudes about pharma companies turn out not to matter so much after all.

Never Ask a Patient if They Are a Loser

I love studying registration forms — in fact, to really go for the Nerd Points, I have to admit that I study the whole experience of filling out forms at the behest of a company — the value proposition, the number of questions, how it is laid out in paper or digitally, how long it takes to complete, how they set expectations,  any evidence of best practices… My check list goes on for a while. Some of it is intuitive, but some of it's also supported by data. And the criteria do change by industry.

It is proven that bad or poorly thought out registration forms, whether online or on paper BRC's will hurt response rates. This isn't supposition, it's fact. Quantified and in the books. Call ComScore if you doubt this — they will back me up.

The basic rule behind all decent surveys is deceptively simple: only ask what you absolutely need to know.

Pharma marketers often overlook the key dynamic of the registration process — the Closer, really. First, when devising a form you need to see the whole experience from the consumer or patient's perspective. It's not an uncommon experience for them — consumers sign up for things all the time — your CVS card, your Blockbuster membership, NetFlix, Shop 'n Stop, Pampers, on and on. Online, this is such a common practice that there are software packages, like Roboform, that do this automatically.

In addition to really, truly putting yourself in the consumer's place, what you also need to do is learn from the masters — those brands that engage and pull the consumer along, resulting in completed, useful forms. Here are some links to a pair of good registration pages from non-pharma companies:

SurveyThe Pampers site is a nice piece of work. It's attractive, well-organized, and best of all, provides a separate section that explains why they want the information they request, question by question. No game-playing.

Oprah's website is a completely different animal. It has one of the longest, most intrusive registrations I have ever done. Yet, it was fairly easy. Every step was well-defined. and when they even asked the value of my house and income, I was taken aback, but I did not hesitate. I was motivated: by registering I got a slew of free Oprah content and the chance to get free tickets to be on her show. Now that is an offer!

One registration from pharma-land I recently discovered was for Shire's Lialda, a drug for ulcerative colitis. I am curious about it on a number of fronts. First, it seems to be using Golden Questions to determine customer value and proclivity to adhere. If this is the case, it's an extraordinarily smart thing for them to do — they're attempting, presumably, to market only to patients who are statistically likely to succeed. However, it has that old British expression, "too clever by half," smell about it. If you're unfamiliar with the expression, it means being confident of one's intelligence in a way that other people find annoying.I wonder how many people complete the form. It looks like it was developed by someone with a considerable amount of brilliance and an algorithm, but who doesn't really understand what the people who are actually going to fill the thing out feel and think.. The Golden Questions sound great, but think of the patient; alone, curious, committed, about to tell you private things for some brochure, emails or coupon. Be that patient when you compose the form. You will get better results.

The real clincher is the questions toward the bottom of the Lialda form. They're an assessment of the patient's emotional perception of having UC, and of their likelihood to try a different drug. The questions are larded with words like "afraid", "helpless", "worrying" and worst of all, "my doctor doesn't understand." This series of questions might as well boil down to one: "Are you a victim?" If you agree with half of what the Lialda folks ask you, you are basically saying you are weak and a loser. I think that in the first week of Marketing 101, they teach that informing your customers that they're losers is Not Good Marketing. This ranks right up (or down) there with the RIAA suing its own customers.

Let's finish with a few friendly tips to keep in mind when thinking about any experience where you are asking a consumer to supply information to you:

  • Assume they will ask "why" to every question you have. Get ahead of that curve and have a good answer ready. After all, if you ask someone such personal questions, all the algorithms in the world mean nothing if nobody actually completes and submits the form.
  • Everyone, clients especially, who works with the Web needs to read Steve Krug's brilliant usability book, Don't Make Me Think.
  • Think through the Value Proposition/Value Exchange communication to the consumer. The simplest advice is: make clear what they will get for what they give. Doing this work up front can increase response rates and form completions.

Pharma RM is a far different discipline than any other industry. It includes a big dose of complex science, it often discusses unpleasant issues, and it's very heavily regulated. But being regulated does not affect common sense, like asking too many or too intrusive questions.  And since we're working with human beings here, common sense counts for a lot.

Then again, if you want the free information, just lie.

The Doctor Will See You Online Now

In past posts, we've written about patients having assistance from and access to all kinds of people in the healthcare system, including nurses, pharmacists and other patients. Now, as reported in the Wall Street Journal Health Blog on Thursday, the Rubicon has been crossed. Patients are now able to have an immediate consultation with a physician online.

According to the Journal, A patient who wants an online doctor consult can log on and get
something approaching a complete doctor visit, often without waiting.
The doc can review the patient’s record, make a diagnosis, write a
prescription and make a referral, all online. Patients without a webcam
can talk to the doctor on the phone.

Now, there are obvious limitations to this. An online physician cannot do an examination, really diagnose anything new, or act on anything besides what the patient tells him. That being said, there are an awful lot of times when a patient just wants a quick answer, or a suggestion, or a referral. This system will do that.

It's significant that the system will not necessarily connect patients with their own physicians. Instead, patients are connected with any of a pool of physicians who happen to be online at the time they place their call. The drawback, of course, is that the physician to whom they will speak is a complete stranger, and knows nothing at all about their individual condition. The benefit is that a new perspective may unearth something the primary care physician has missed. And, in any event, the online physician's notes on their consultation with the patient are forwarded to the primary care physician, so the loop is always closed.

One of the many reasons physicians, particularly primary-care doctors, are increasingly dissatisfied with their profession is the incredible infrastructure required to practice medicine. In today's system, you need a pretty significant staff to handle paperwork, to process patients, to do all the preliminary stuff so you spend the well-known and precious few minutes with every patient.

In order to avail themselves of this, your patients need to schedule an appointment, get themselves to your office, wait (and wait and wait and wait), get gone over once in an examining room by a nurse or another member of your staff, and then finally, having run this gauntlet, they get to talk to you. Your staff has to spend legendary amounts of time handling paperwork and dealing with insurance companies in order for the physician (and them) to get paid for all this.

It's more than a little like iTunes. Remember the old days? You had to get in your car, drive to the store, find the record you want, buy it, get into your car and drive home, and then listen to it. Very convenient for the retailer, but a real pain in the neck for consumers.

Online consultations with physicians promises the same kind of benefits. More than anything, it's a great way for patients to keep engaged with their treatment. This is particularly important when dealing with a chronic disease like MS or lupus, where it's absolutely vital that the patient continually manage a condition.

It's another fascinating example of technology being used to enhance, improve and support the engagement of patients and their conditions.

E-Prescribing, the Web and RM

In a post on the 5th, World of DTC Marketing has an interesting post on the growing use of e-prescribing, which is Medicare's pending imposition of penalties for doctors who don't do it. This is a little like the Eight Simple Rules for Dating My Daughter. Rule Six ends with the sentence "If you make her cry, I will make you cry." Once the government ties Medicare reimbursement to the use of e-prescribing, it's a done deal.

Here's how it works. Instead of writing out a prescription on a pad, which then gets taken to the pharmacy, the physician instead prescribes through a computer. The prescription is automatically transmitted to the pharmacy, where the prescription's filled. If the patient is using a pharmacy-by-mail program, the prescription is simply mailed to the patient. This means that all they need to do is visit the doctor. Everything else is automatic.

And here's where it really gets interesting, and fun. "After 2 weeks the patient receives an eMail from his or her doctor
informing him that it’s time to renew the prescription along with a
link to health information about the health condition and product."


In other words, the beginning of an RM program is built right into the computer system that generates the prescription. The entire system is what steel manufacturers call vertically integrated — beginning with the doctor visit, and continuing indefinitely,

This benefits everyone. The physician can keep closer tabs on his patients, and do all kinds of follow-up reminders automatically. He or she also doesn't have to worry about whether the pharmacist can read the prescription, or whether there's some other kind of screwup. The pharmacy runs more efficiently, and benefits as well from the reduced chance of mistakes.

But the real winner here is the patients. The system is virtually seamless, and makes it incredibly easy both to get your meds, and to stay on them. Short of actually sending someone over to pop the pills in your mouth, it's hard to imagine a more user-friendly system. As time marches on, which it has a habit of doing, the Baby Boomer patients are increasingly going to be supplanted by Generation X and Y types, who live on cyberspace. For them, this system is tailor-made. In fact, it's necessary to the point of being obvious.

We can only fantasize about where this is all going. At the moment, most e-prescription followup is pretty straightforward, and basic. But we can see a day when video, blogs and all kinds of other media are integrated into a vastly more sophisticated RM system, that includes demographic and geographic data, and the features programs custom-designed for each patient.

Stay tuned.