A Personal Note: Searching

The first article I wrote after TrueHealth launched in 2005, was in BrandWeek. It ran on April 24, 2006, with the headline “Drug Marketers, Take a Look In The Mirror.”

Download drug_marketers_take_a_look_in_the_mirror.pdf

Part of it read as follows:

Get up. Go to the rest room. Look in the mirror, and realize: you are the patient. The guilty secret shared by pharmaceutical marketers everywhere is that every day we ask patients to change behaviors and take actions that we ourselves do not take. Ask your “inner patient,” have you ever suspected there was an issue with your health, but not done anything about it?

I was writing about the most fundamental part of becoming patient-centric — walking in in a patient’s shoes. As marketers, we do not need more focus groups, data, research or positioning statements. What we need is more one-on-one contact with the people who need our products. Compassion is the greatest strategy of all. I have learned this lesson personally, the very hard way. This is the time of year when I think about how the experience being the patient changed my life.

My first foray into pharma was as my family’s Designated Online Researcher. I was the youngest, I had always liked email, they thought I worked on the Internet, you know how families are. Broad strokes.

BudMy task was to learn all about melanoma. In 1998, there was not much online, but I did my job. I visited Web MD, DrKoop (remember him?), Johns Hopkins, the American Cancer Society — ever narrower searches. I found so little tangible information. And what I did find was terribly grim. No way was I reporting what I had learned to my family yet.

 So, I dug deeper, hours every day, on and off work time, evenings, weekends.. . surfing, endless surfing.And with it that sense of increasing frsutation — why were there no answers?

In a month, I knew the answer to a broad range of general questions, all fed by the one underlying major question: will melanoma kill your sister? What are her chances?

I lied to my family. I looked my mother in the eye and told her I found nothing conclusive.

Of course, this lie only lasted a little while — the disease was taking its course, and the facts were evident. I was not the patient, but two years before my sister passed, I had brushed against the shadow of her living with a disease and her subsequent, inevitable death.

My sister, Noreen O’Neill, never admitted to anyone that she was going to die —  even after going through two rounds of interleukin II down at NIH. Her definition of “being the patient” meant never giving in one inch. Take your meds. Demand the doctor’s time. Find a clinical study.  Search, never-ending search.

I care so deeply about my work, and that of my peers, partners and clients, because of her. The best of us know that what we do IS about the patient. Their needs, their gaps, their fears, their wallets and their hearts. It is the wohle human we dela with. And every one of us has been the patient — whether for high blood pressure or a flu to cancer or thousands of other things.  We have either experienced a health crisis ourselves, or been at a loved one’s side during theirs. We have been the patient.

It is our responsibility to do the right thing for people and for their families — to create programs that arm them with knowledge and support. Every one of these people will touch the world of health care communications we create. Compassion should be the first strategic imperative in brand planning. I truly believe the brands that get this will be more successful.

 My sister’s final months were spent using her charm and will to create a foundation for melanoma research. http://www.foundationformelanomaresearch.org/ 

Their are millions searching, searching, searching for informaiton as you read this.

Can Patients Imagine A World Without Your Drug?

The Harvard Business Publishing blog of Bill Taylor ran a fascinating post on Friday, entitled Get Out of The “Middle of the Road” — or Go Out of Business. In it, Taylor, drawing on the management theories of, among others, Jim Collins, takes the position that what makes great companies great is that they focus, consistently and patiently, on a limited number of aspects of their business and excel at them. As Taylor writes:

First, high-performing companies understand that it’s not enough to be
“pretty good” at everything anymore. As a company, you have to be the
most of something—the most exclusive, the most affordable, the most
responsive, the most friendly. Companies used to want to be in the
middle of the road—that’s where all the customers were. But now, in an
age of hyper-competition and non-stop innovation, the middle of the
road is the road to ruin. What do they say in Texas? “The only thing in
the middle of the road are yellow lines and dead armadillos.” To which
we might now add: “And once-great companies that are slowly going out
of business.”

Taylor then goes on the illustrate three ways this is done. It was Item 3 that really got our attention:

There’s a third element that helps to explain extraordinary performance
in these extraordinarily difficult times. Each of these companies
connects with its customers based not just on price and features, but
on identity and emotion. They have become virtually irreplaceable in
the eyes of their customers.

We put a lot of time and effort into developing advocates for our clients — patients who are not just satisfied with the outcome of their regimen, but who emotionally connect with the brand and their illness enough to begin to tell others — to be advocates for the brand. As we’ve blogged about elsewhere, advocates have incredible marketplace influence. They provide a level of credibility, personalization and impact that all the marketing in the world can’t touch.

If you’re a pharma company, the one thing you have to absolutely excel at in order to maximize adherence and therefore profits, is creating and maintaining an emotional connection with your patients. In a sense, pharma has a major advantage here, because for a patient with a chronic condition, the drugs they take have a direct, powerful impact on their day-to-day life. If you have pulmonary hypertension, the drugs you take for it are absolutely central to your quality of life — to your life, period, in fact. Emotional impact doesn’t get much more direct than that.

These are hard times for pharma — profits are stagnating, regulators are looking hard at DTC advertising, and the industry’s public image is at an all-time low. Pharma marketers can’t really do much about these things. Nor can they do much about the safety or efficacy of the drug — that’s work for the scientists. What we can do, however, is strive to connect with the people who rely on our products, who live with them every day, and by making that connection, turn those patients into ambassadors for our brands. If there’s a “most” it’s imperative for us to be, that’s it.

Big Pharma should be more like Richard Branson.

We tend to think of RM in terms of adherence, compliance and profitability for our clients. We are, after all, a marketing firm, and like anyone else, we tend to see every problem as a nail if we happen to be holding a hammer.

However, there’s a much broader way to understand relationships with customers, one that has enormous strategic value for the entire organization. This point was made in a post in DTC Perspectives on Friday, and we think it deserves some thoughtful comment. And, as we’ll see in a minute, a comparison to Richard Branson.

On the 17th, the Wall Street Journal’s Health blog reported the following: On July 15, two leading lawyers from PhRMA, the drug industry’s trade
group in D.C., met with key staffers for the House Energy and Commerce
Committee’s investigations panel, which has been probing
direct-to-consumer advertising practices with a vengeance since January.

DTC advertising, which was never very popular among a certain segment of consumers, has now become the full-fledged whipping boy for Congress. A lot of bloggers and thinkers have already delved into how and why this is happening and what it means. A different question, however, ought to be asked — why didn’t the drug companies see this coming?

Congress is not known for acting quickly, or delivering surprises. There has been plenty of telegraphing of this particular punch. Yet, here we have the sight of Big Pharma CEOs being barbecued in public by Congressional committees.

But, as the DTC piece points out, drug companies in general are inadequately focused on other aspects of their operations. In exploring responses to this situation, one suggestion is that ... drug CEO’s need to get more involved in ensuring their
organizations are more consumer-centric. I have said this many times,
but drug companies are still largely detail sales, clinical research,
regulatory and legal organizations. Neither their senior management
teams nor their boards are usually consumer-centric in background and
action. Are there any senior managers reporting directly to the CEO who
represent consumers?

This is a role RM can fill easily, and to some extent already does. But it needs to be expanded, and it needs to be moved up the corporate food chain.

In virtually every other consumer business, top management is obsessed by the need to understand, in depth, what their customers think of their products and services. As consumers, we are constantly bombarded by surveys, focus groups, 800 numbers and a host of other channels for helping companies understand what’s going on.Sir Richard Branson himself frequently acts as a steward on Virgin Air flights, taking notes on customer reaction to the service.

The defining feature of RM is that it enables patients and consumers to talk as well as listen. Any pharma company engaged in RM already has a great deal of information about what consumers think, don’t think, like and don’t like. With some minor adjustments and enhancements, this information could, and should, go straight to the CEOs office.

If it did, it would be considerably less likely that you’d see the top executives of pharmaceutical companies looking like deer in the Congressional headlights. They would have seen and understood the scope and depth of the backlash against pharma DTC ads, and could have taken steps to respond to it before Congress did.

Adherence Begins with Acceptance

Everyone FINALLY seems to be talking about the need for more focus (ie. budget) on Adherence. While long overdue, it is good news for patients and families of all sorts.

So, when we look at the landscape of issues and possible solutions, it is so easy to be seduced by all the myraid of offerings that can be used to form a comprehensive adherence solution. There are technologies galore, pharmacy closed-loop programs, database-triggered email programs, pill counters, alarm clocks, and now, the expensive but interesting human touch with Health Coaches. (www.hummingbirdcoaching.com)

But as usual, as an industry we rush to solutions and in doing so, seem to pass by the patient. (“Don’t worry, we’ll get back to you!”) If there was ever a business that needed to “measure twice and cut once” it’s us. The missing and first element we all need to discuss is the patient behavior. All the devices, gadgets, strategies and methods in the world are useless if they revolve around a noncompliant patient.

I was recently reading a piece by a MS nurse talking about the issues of MS patients and adherence. MS is a textbook example for studying adherence, because it’s a long-term, chronic condition, because medications can retard the disease’s progression but not cure it, and because it’s physically disabling, which makes adherence challenging. This nurse made a very astute comment about adherence — yes, it is made up of compliance and persistence. But the most important element, the real first behavioral barrier is acceptence. Does the patient actually accept that they are sick, or need this treatment, or will get better if they take it? This is a huge insight.

. Acceptance isn’t a one-size-fits-all situation. It can range from simply, finally, irreversibly accepting that you have a disease to having a positive attitude about recovery. Regardless of its nature, acceptance is an absolutely necessary element of any form of change, which definitely includes adherence.

Adherence and compliance ultimately require a patient to revise and maintain a different, and somewhat artificial self-image, one that requires more commitment and effort than that of an acute illness. A patient with an acute illness — say, an inflamed appendix — sees himself as fundamentally well, basically the same as he always was, but with a temporary, treatable disorder. This is not a difficult self-image to maintain, because it inherently incorporates a previous self-image, and any variation from that is known to be transient.

A chronically ill patient, by contrast, has to come to see himself as someone who will always have the condition. The condition has to become part of their identity, and a new self-image has to be developed that incorporates both their previous notion of themselves and the reality of their current medical status. This isn’t easy, and for some patients it’s impossible.

This is something every 12-step program knows well. The very first of AA’s steps, for example, is that the alcoholic admits to being powerless over alcohol, and that their lives had become unmanageable. Until that happens — until the alcoholic fully accepts the idea that his disease is not something he can choose to accept or deny — treatment is pointless.

Acceptance is everything. A patient who accepts his condition can, and will, see a rational reason for complying. One who doesn’t, won’t, and must rely on sheer willpower, which is a pretty limited resource. To change what you do, you have to change who you think you are. Simple as that.

Underfund online, underfund RM

On Thursday, right before the three-day holiday weekend, the World of DTC Marketing blog published a post indicating that pharma advertisers, relative to non-pharma advertisers, are significantly underspending online. Specifically, the average or typical pharma marketing budget has only a 3.1% allocation for online. That is very small, and is about half the amount non-pharma marketers devote to online.

There are, as always, a number of possible reasons for this. One is that online can require a considerable upfront investment. Another is that online social media, such as blogs (such as this one) are very foreign to pharma marketers, and also implicate their concerns about running into trouble with the FTC. A third is that good emarketing people are scarcer than hen’s teeth, and there simply aren’t enough to go around.

While this data is bad enough, it’s particularly bad for those of us in relationship marketing. Online is the single greatest RM platform ever, and by underfunding it, pharma companies often underfund the channel that could really make a difference for them..

When we prepare a plan, or respond to an RFP, there is almost always a very healthy and robust online component to the project, unless the client has some compelling (EXTREMELY compelling) reason not to. 

Online is unique, relative to other media, because it’s the only one in which the communication goes two ways. Properly developed and operated, it creates an open channel for patients to communicate directly with the pharma company client. The information gleaned through this dialogue typically is extraordinarily valuable

In fact, as we have noted before in this blog, the value of this two-way dialogue is to great that it is beginning to morph into three-way conversations. On websites such as Patientslikeme.com, online communities have sprung up which are created and operated directly by the patients, and in which patients share experiences, symptoms and nuances of treatment with one another. Sites like this have a major impact on the marketplace’s perceptions of conditions and treatments, and underfunding online is effectively deciding to ignore this.

Online is clearly, and unquestionably, both the medium of the future and the ideal platform for relationship marketing. It’s particularly valuable for patients who feel isolated, either because of a chronic condition, because their condition carries some sort of social stigma or is disabling, or because, perhaps, they are living somewhere remote. The enormous differentiator between online and other channels is simply that when communicating online, it is not particularly difficult to make the conversation two-way.

This can be as simple as a “Contact Us” link at the bottom of a Web site, or infinitely complex. Whatever approach you choose, the closest thing to a true human relationship between a brand and its customers is online. Mail, print and broadcast are, at best, approximations. When it comes to relationship marketing, the Web is the realest deal, and is continuing to improve and grow. Underfunding online is underfunding your single most powerful marketing device. Not smart.