Can you Measure Hope?

Hope is like the elephant in the living room; it sits there and stares at us in gloating self-evidence. We marketeres see it, know it, and ignore it. What do we do instead? Why, we send mailings. We fill boxes in cavernous pick-and-pack warehouses full of calendars and collateral and magnets. We build better and better Web sites. We do e-CRM. And none of it, alone, seems to move the needle.

Nothing is wrong with any of that, because it does help patients. What, as pharma marketers, don't we get?

Two things, one functional, one emotional:

1. True surround sound support strategies where all the pieces have a role. This part takes a good team, and lots of hard work and the putting-aside of territorial instincts, but it is doable.

2. Hope. Now that is a hard one.

Speaking to a psychologist who has been in practice nearly 40 years on the topic of why patients do not adhere to their medication.

"They lack hope," she said while sitting under a tree in the hot summer sun. "When someone starts something new — like a new medicine after a new diagnosis — they inevitably have to put other things aside. But usually these were things they loved or enjoyed. So, despite the best of intentions, two things occur:  frustration and a need for hope. The short-term and the long-term. Interestingly enough, the person or persons who actually help that person at those early stages deal with their frustrations, can also offer hope of sticking with it…and that sense of hope can keep people going."

I then asked the hard question: can you measure hope? It turns out that answer is "yes." There are two primary psychological indexes used to measure the degree of hopefulness in patients. The first is the Hertth Hope Index, developed by Faye Herth in 1989. Patients answer 12 questions such as "I feel scared about my future." on a 1-4 scale. There is also the Miller Hope Index. It's a lot like the Herth Index, except that it's based on 40 questions rather than a dozen.

Hope, like pornography, is something everyone knows when they see it, but is very hard to define. The best description we've seen, by psychologist C.R. Snyder is that Hope is a state of mind, in which there is both a will — a desire to work towards some kind of desirable future outcome, or at least believe in it, and a way — a clear path towards achieving that result. In the case of illness, the result, of course, is getting better

Pharma is Ithe provider of the way — the drug that will treat the symptom. However, the patient has to provide the will. How can we help them do this? With advertising that:

Reframes the situation in a more positive light.

Helps the patient appreciate, and focus on, the current moment.

Encourages socialization with patient groups, for example, that help the patient know that they're not alone.

Patients need a lot more than facts. They need to be shown both a pathway towards a better future, and given a set of tools, including support, that help them keep moving down that path. In many ways, good patient-level pharmacy data does that. And the entire grassroots advocacy/mentor work is about sharing peer-to-peer hope.

We certainly could do a better job "messaging" hope. And insert ourselves in the most human of processes — change.

This Picture Will Get You to Keep Taking Your Statins. Right? Right?? Hey, I’m talking to you. Yes, you. Pay attention.

 Much of what drives RM is the basic, but surprisingly controversial fact, that patients are human beings, and human beings tend to act in illogical (i.e., emotional) ways. Just because, say, a cardiac patient has had three coronaries, a triple bypass and a stent does not mean that he will do the logical thing and, say, quit smoking. In his fascinating book Change or Die, author Alan Deutschman goes into some detail about both why we don't do what we know we should, and what drivers and influencers can be harnessed to help patients make the right decisions. This, in a nutshell, is what RM is all about. Alan, if you want a job, give me a call.

A couple of recent blog posts make this point, too. One of them, in a neat little blog called Neuromarketing, describes a direct response test run by a South African bank for a loan product. As part of the test, the bank offered a broad range of interest rates, which should logically be the only thing, along with repayment terms, that really matters to consumers. They also tested a variety of what they euphemistically call psychological features — details of the offer that have nothing to do with the loan itself, but are intended to alter customer behavior.

Like, say, a photograph of an attractive woman.

In a post on Friday, here's what Neuromarketing had to say about the results:

For the male customers, replacing the photo of a male with a photo of female on the offer letter statistically significantly increases takeup; the effect is about as much as dropping the interest rate 4.5 percentage points… For female customers, we find no statistically significant patterns.


A similar concept is discussed by Guy Kamasaki in his terrific, and widely-read blog How to Save the World. In a recent post, he discusses the work of a prominent linguist, George Lakoff, who is profiled in a recent issue of the Chronicle of Higher Education.  Lakoff's insight, which he used to consult to the Democratic National Committee, among others, was pretty straightforward.

In his new book, Lakoff takes aim at "Enlightenment reason," the belief that reason is conscious, logical, and unemotional. Harnessing together work from several fields, particularly psychology, neuroscience, and linguistics, he mounts a polemical assault on the notion that people think rationally — which, he argues, is fundamentally at odds with how the brain actually functions.
Approximately 2 percent of the millions of pieces of information the brain absorbs every minute are processed consciously. The remaining 98 percent are handled by the unconscious brain. The mind, in other words, is like a tiny island of conscious reasoning afloat in a vast sea of automatic processes. In that sea, which Lakoff calls "the cognitive unconscious," most people's ideas about morality and politics are formed. We are all, in many respects, strangers to ourselves.

In other words, we think we're rational, but we're anything but. As pharma marketers, we think our patients will respond to information about risks, outcomes and facts. Wrong again. People are emotional as well as rational, and the sooner we understand that, the more effective we'll be.

“I Hate Doctors” Redux, or Why We Have a Job Here

Last week, our post, "I Hate Doctors" generated some interesting response. It also helped us put a different, and we think, valuable slant on a piece in today's Well — the New York Times health blog. Entitled "Six Ways to Be a Better Patient", the post is a shortened version of a longer post by "Dr. Rob" in his blog Musings of a Distractable Mind. Dr. Rob and his blog demonstrate perfectly why I have a job.

In order to be a better patient, Rule Number One, according to Dr. Rob, is The Doctor Can't Do It Himself. He goes on to write this:

The best doctor can do very little with patients who ignore
instructions.  Sometimes noncompliance is partly due to physicians not
explaining things well, but medical compliance is ultimately in the
hands of the patient.

I am mystified as to why some patients will ignore nearly everything
I say and yet continue coming in for regular appointments.  It is
frustrating, causing some physicians to get angry with these patients
(and even discharge them). I figure it is the patient’s dollar that is
being spent, not mine.

The reason patients do not comply, Dr. Rob, is that they're human beings. Human beings have a lot of reasons for doing what they do (or not doing it) and guess what? They're not always rational, particularly when they're sick. Especially if they're very sick.

Doctors will line up to rail against evil pharma sales reps, greedy drug companies and inappropriate DTC advertising. Yet, for whatever reason, an incredibly important, difficult conversation with your doctor, one that has a profound effect on your health, takes place in an office, according to Dr. Rob, that is a rushed madhouse, pretty much always on the brink of anarchy. I'm not exaggerating here — a few more quotes from the post:

  • I have over three thousand patients. 
  • My staff has a very demanding job.  Remember that you are not their
    only responsibility – you may be the 100th job for the day . . .A staff member is generally more valuable to
    me than a single patient, and I need to show my staff that they are
    valued by me.
  • A doctor’s office is always on the brink of chaos – with an incredible
    amount of information coming in and going out, a large number of phone
    calls, insurance company headaches, and personnel situations that can
    throw the best system flat on its face.  People forget that there are
    hundreds of other patients with thousands of test results the office is
    dealing with.

This is exactly why relationship marketing has a role, and why it works. This is not the kind of environment where it's easy to ask questions or get help, and it's certainly not the kind of environment that's going to follow up with a patient who's borderline noncompliant, or help him stay on his meds. There isn't time, and there isn't money. None of this, by the way, is Dr. Rob's fault, necessarily,

In the real world, the world we all live in, the only resource a patient has after leaving the doctor's office is us. In a perfect world, of course, we wouldn't be needed. But until then, RM is a harried doctor's best friend.

Why Didn’t We Think of This — “Next Stop, Lipitor Station”

Great story in today's Wall Street Journal — Dubai is selling the naming rights to stations on its 45-mile netowrk. With pharmaceutical experts taking a beating in Congress over their DTC approaches, why not just sponsor a rail station in Dubai? "Lipitor Station" has a nice ring to it, don't you think?

Dubai is an interesting place. It's an emirate on the Arabian Peninsula. The average high temperature there is north of 100 degrees five months out of the year. So, they have built the world's only indoor ski hill. Ski Duabi! I am not making this up.

The place needed a hotel, so they built the Burj Al Arab — remember this one? 25 stories, shaped like a billowing sale, peach-scented elevators, $3,000 a night for a room, butlers for every room, yadayadayada.

The thing about Dubai is that, unlike all of the other Emirates, it doesn't have much oil. So, the economy is built on tourism and trade. And in this spirit, I guess, they're selling companies the right to have stations on the railway named after them. In fact, if you have enough cash, you can have the entire line named after you.

As the Journal pointed out, given that this is the Middle East, you're not going to see, say, the Victoria's Secret Line, or the Jose Cuervo Line, or Hooters Station anytime soon. However, everything else is up for grabs.

The Nexium Line. I can just see it.


Patients Get the Marketing They Deserve

Seth Godin's blog post today on marketing started with the following provocative question (Seth's good at that): Are consumers responsible for the behavior of marketers?

Ours certainly are.

de Toqueville once said that "If it's a democracy, people get the advertising they deserve."
David Ogilvy said, "Clients get the advertising they deserve."
And in our business, patients get the marketing they deserve.

Relationship marketing — what we do, as if you couldn't guess — is all about establishing an ongoing relationship between the consumer and the brand. Although we enjoy our work, we don't do this for fun. We do this because in healthcare, adherence is a huge problem.

Up to 50% of patients stop taking the drugs they need within 120 days of it being prescribed. And this isn't because of cost, at least not entirely. It's because particularly with chronic conditions, patients don't see any kind of improvement as a result of taking their meds. And taking the meds is a pain. Sometimes literally, as with diabetes injections, and sometimes it's just one too many hassles for them.

And patients are human. So they fall off the medication wagon. Which is bad for them, and bad for us.

Patients deserve to get better. They deserve to get the full benefit of the hundreds of millions of dollars that went into developing the drug. They deserve to have all the benefits of their treatment.

Pharmaceutical marketing used to be considered the opposite of treatment. Now, it's becoming more and more apparent that particularly with respect to chronic conditions, they're all part of the same continum. After the patient's diagnoses, and a treatment's prescribed, the process is just beginning. The patient has to accept the diagnosis and the change in their situation. They have to integrate the treatment into their lives, and their self-image. And they have to KEEP AT IT.

Our job is to understand what motivates them at every step, and to tune our marketing in to that so the marketing we deliver resonates with the patient, and helps them to stick with their therapy, and ultimately, to get better.

That's what they deserve.

“I Hate Doctors”

There's an amazing, more-than-a-little depressing piece in last week's New York Times. Written by Tara Parker-Pope, the piece, entitled Doctors and Patients: A Rocky Relationship is exactly what it's name implies. It's a feature piece about the deteriorating relationship between physicians and patients. Not mincing words, Parker-Pope describes patients as being frustrated, angry and resentful at the quality of the care they're receiving.


What it all seems to boil down to is time. Because of managed care, paperwork, Medicare reimbursement payments and so on, physicians seem to have next to no time to spend with patients. They are unwilling to answer questions, do not tell patients what's going on, and as patients see it, just aren't really paying attention.

The article itself is fascinating, but what's really amazing is the comments on it. The piece ran in a blog called Well, which is part of the  the Times' health section. It was followed — and remember, this all happened within a little over 24 hours–by an incredible number of online comments, virtually all of which were incredibly vitriolic. Other blog posts came in with 35, 50, 70 comments. This piece garnered 241.

A few unscientifically chosen excerpts:

  • It’s because most doctors are, despite their ‘12 years’ education,’ poorly educated. They are not capable of independent and logical thought and instead revert to their standard lines scarcely different from a parrot.
  • I hate doctors.
  • Suffice it to say that the medical profession would have to crawl several steps up the food chain in order to earn my contempt.
  • Your remarks are astounding for they show just how pompous medical doctors can be when their “authority” is questioned.

As the article also points out, one of the side effects of this mistrust is noncompliance.

There are a lot of reasons relationship marketing is a rapidly growing field. One of them, sadly, is that what physicians don't seem to be providing in their offices anymore has to come from somewhere. So, it comes from us. Ideally, of course, patients would have a close, cooperative working relationship with their physicians. When that doesn't, or can't, take place, the relationships we create are the next best thing — and we think they're pretty good.