Some of the most beautiful women in the world are on our side

In today's Wall Street Journal Health blog, there's a great post about a new television ad campaign that's been launched that features, among others, Lauren Bacall (in her prime, perhaps the Most Beautiful Woman Ever to Walk the Earth and even today, at 84, elegant beyond belief) and Mary-Louise Parker, the stoner-housewife of Weeds. And the issue: chronic diseases. Since that's our line of work, we think this is wonderful.

The women are advocating on behalf of a group called The Partnership to Fight Chronic Diseases. Their message, which is part of a million-dollar advertising and PR campaign, is simple. In a great ad, they urge people to get in touch with their legislators, and "beg, kvetch, annoy, bother and bitch" until more money is spent on the prevention of chronic diseases, which as the ad points out, constitute 75% of the healthcare system's costs. Take a look:

In a lot of ways, our healthcare system is overweighted towards treatment, procedures and intervention. We're nowhere near as good at managing chronic illness, which is what we help our clients help their patients do, or even at preventing them. For a long time, the burden chronic diseases puts on everyone they touch — patients, caregivers, the healthcare system itself — has kind of been swept under the rug.

That appears to be over. And we're delighted. We make our living thinking about helping patients manage chronic illness. The first step, always, is to get both the patient and the caregiver to understand what a chronic illness really is, and how it affects the patient's day-to-day life. Which means getting everyone to think about it in the first place. Which this ad is a terrific first step towards doing.

Thank you, ladies. Great work.

Drugs Can’t Just Treat Your Disease

Seth Godin has an interesting post today about the tendency of consumers, especially American ones, to demand ever-more-impressive performance, features, service and so on from their brands. The same is true in pharma. Efficacy isn't enough. This is partially due to human nature, and partially due to pharma marketing.

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As Godin points out, in his usual spare, incisive ways, consumers are getting incredible amounts of value for next to nothing (and sometimes, actually nothing) and they're never, ever satisfied. To quote his post:

  • How long after getting a big promotion does it take for an executive to get antsy?
  • Why does a powerful senator take small bribes and risk his entire career?
  • Why do Amazon customers, with a choice of every book, delivered
    overnight, for free, whine about their customer service going downhill?
  • Why do customers at a truly great 4 star restaurants often feel a little bit of a let down after the last course is served?
  • Why do Facebook users (a free service that they used to love) complain so vehemently about a change in layout?
  • Why do the very same Apple lovers who waited in line for days now scoff at incremental (free) improvements in their iPhone?

"Is that it?"

This state of ennui explains why we'll never run out of remarkable,
why consumers are restless, why successful people keep working and
taking risks. It explains the self-centered, whiny attitude of some
bloggers who can never get enough from the world, and it explains why a
rich country like the US could almost bankrupt itself in search of ever
more.

In pharma, patients are now routinely receiving drugs that are light-years better than anything available a generation ago. Mevacor, the first statin, was only approved by the FDA in 1987. Highly active antiretroviral therapy, which completely changed the outcome for HIV patients, was introduced in 1996. And so on. And with many chronic conditions, such as hypertension, the mere fact that the drug effectively treats the condition makes no difference — adherence rates are still appallingly low.

As marketers, to some degree we have to answer for this, particularly if you're a carpet-bomb-them-with-DTC marketer. The ultimate example of this might be the infamous Robert Jarvik ads for Lipitor, in which Jarvik is shown sculling on a mountain lake — something he did not actually do. Despite all the regulation in the world, a lot of advertising conveys benefits many patients will not experience, in one way or another.

Such is marketing in the real world. If you hire Accenture, you're probably not going to be like Tiger Woods. If you buy a Lexus, you're not necessarily going to swoop up the winding road to the country club there to be met by your trophy wife, who happens to be wearing a sexy dress. This is true in pharma, too — just becuase you take Boniva for your osteoperosis, you're not going to spend time in the gorgeous backyard garden of a REALLY nice house like Sally Field.

This isn't even bad, necessarily. Jarvik's Lipitor commercials got a lot of people to check on their cholesterol with their doctors who presumably otherwise wouldn't have. However, one side effect of good marketing is creating expectations. As pharma marketers, we shouldn't be surprised when those expectations keep increasing, That's what we do, and that's what they do.

Engaging Voices From Down the Path

Something we are constantly striving for here at TrueHealth, on behalf of our clients, is patient engagement with a phama company's product and/or brand. Tara Parker-Pope's column today in the New York Times, Well, has done an outstanding job of this with a series called Patient Voices. It strikes exactly the note we, as marketers, are trying to hit.

The premise is incredibly simple. Eight patients with chronic diseases simply talk about their lives and their diseases for two minutes. It's recorded, and a few photos of the patient are put up on the screen. And that's it.

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It's powerful because it's real. In the piece on eating disorders, you hear a 17 year-old high school girl from Ohio talking about the constant struggle anorexia has been for her. She has a heavy Midwestern accent, and sounds like a completely normal teenage girl who just happens to be talking about a disease that might kill her. Then you hear Kristin Haglund, also blonde, also from the Midwest, describing the same downward spiral in the confident, modulated voice of someone who's spent a lifetime on stage because she was Miss America. Same story, different voices.

These voices have an incredible immediacy and impact. I have never had Parkinson's disease, or pancreatic cancer, or any of the other chronic diseases these speakers portray. Yet, hearing someone speak about them firsthand — openly, candidly, seriously — opens an incredible window into what these illnesses do to both the patients, and their caregivers.

In another vignette, Lisa Bartlein, from Marina Del Rey, California, talks briefly about spending a year caring for her brother, who had, and ultimately died from, pancreatic cancer. She's sparing, and rather unsentimental about it, and simply from the way she constructs her sentences and the things she chooses to say, it's clear that helping her brother battle this illness has made her a very, very tough woman.

If I were a fellow patient, these voices would remind me that I was not alone, that other people had walked, and were walking, the same path I was. We would have something important — perhaps the most important thing in our lives — in common. That, folks, is engagement, and that is what gets patients to stay on therapy, to hang in there with their illness, and to have the best possible chance of staying as healthy as possible. And all it takes is two minutes of talking.

RM Online, or Whose Site Is Stickier?

An interesting piece in yesterday's Wall Street Journal Health Blog analyzed the online traffic data for the ten most heavily trafficked pharma websites. According to digital measurement company Comscore, AstraZeneca's site for Nexium, purplepill.com, won the race, with over a million unique visitors a day in the second quarter of 2008. Lined up behind it were sites for other drugs, such as Ambien, Actos, Gardasil, Lexapro and so on.

There is a LOT more to data than this than meets the eye, and much of it speaks directly to RM. One of the key principles  of RM is engagement with the patient. The pharma company needs to position itself, and its product, as a long-term partner with the patient in managing a chronic condition. There are many different touchpoints at which this happens, but one of the big ones, obviously, is the Web. Whether you're using online communities, social media, wikis, blogs or whatever, a product which successfully builds long-term relatinships with patients will generate return traffic on its web site.

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In addition, the site will be "stickier." Visitors will stay longer, view more content, and view more pages when they do. The Comscore data doesn't address any of this. As reported, it simply consists of the number of unique visitors per month. In other words, in a given month, this is how many different people actually visited a particular website. While this data may be broadly directional, for the purposes of evaluating an RM program, it's almost useless.

As consumer-centric marketers, what we really want to know is what visitors are doing once they hit the site. It's great that they're visiting (although a million unique visitors a month, to put that number in perspective, is only about 1% of what google.com does) the site, but what really matters is how engaged they become with it.

This requires different data. However, there is a very rough way to estimate this, using another online tool. Alexa.com is a free Internet trafic measurement service. You can go to the site, and type in the URL of any website (or several, if you want to compare them) and Alexa will give you baseline traffic data. One of the metrics it provides is "page views per user." In other words, how many pages, on average, does each user look at then they visit the site?

This data is interesting. Over the last three months, Nexium got 1.94 average page views per user. In other words, the average visitor looked at just slightly under two pages on the site. Actos got even fewer, at 1.75 pages per viewer. Januvia got 2.3. You would need a lot more detailed data to draw any final conclusions from this information, but one definite possibility is that Januia patients, for example, are more engaged with the site than Actos patients.

Januvia and Actos are both therapies for Type 2 diabetes. They are competitors. Presumably their pateitns have similar demographics, and are similarly tech-savvy. However, Januvia's site, on average, generates about 30% more page views per visitor, on average. There are, again, a lot of possible explanations for this, such as site design and layout, amount and type of advertising each drug is going, and so on. But the bottom line is that visitors to Januvia's site absorb more content, and that if they are active patients, they have a stronger relationship with the brand.

Why does Fall Make Me Think of Patient Adherence?

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Well, it must be something in the air. I enjoy fall, but like most people, my enjoyment has a little bit of melancholy as well. Thousands and thousands of writers have described this much better than I ever could, but for me, along with the leaves turning, fall also delivers that sudden feeling of disappointment when you notice the sun is going down earlier. The days are shorter, the nights are colder and longer. Winter is on the way, and here in New England, that means something. The most ancient, mechanical process in the universe has the power to provoke strong, deep-seated, equally ancient feelings.

Professionally, the slow decay of fall reminds me that this is the consequence for many non-compliant people in our country today. If you've got a chronic condition, you're either moving forward medically or you're moving backwards. There are far too many patients out there moving backwards.

We all know them. Is it our father who forgets his lunchtime pill? Or the husband who refuses to take his blood pressure medicine. Or perhaps the mom who is too busy to put herself anywhere high enough on the list to take care of herself? These people are not strangers.

And yet, in this business there's a tendency to quantify this so far that it starts losing some of its meaning, or impact, or humanity. People say it is all about changing behavior.We have dozens of studies, hundreds of articles, blogs and analysis and on and on, but where in all this are the people? Why do they do this? What are their lives like? What do they think about? Or avoid thinking about?

Ultimately, helping to increase adherence means communicating with patients. We have got to use words, images, concepts they understand, scenarios that resonate. All the statistics in the world won't help us do the job until we can really put ourselves in the shoes of that busy mom, who is so rushed, so stressed and so consumed with caring for everyone else that she literally starts putting her own health on the line.

This kind of behavior is deeply irrational, but it's also deeply human. We need to understand it on a gut level in order to help stop it. That is why we are going to interview a few working family practice psychologists, Dr Anne McGee and Dr Eleanor Murdoch.These women work every day with the people who are our patients. They make their living understanding and working with the patients we are trying to reach.

Dr. Murdoch sits in her office, and hears the deepest, most profound thoughts and feelings of people who are struggling with some very big, eternal issues. We know what those issues are, but we don't know exactly how these people describe them, navigate them and live with them. By finding out, we hope to be able to field a deeper, more potent kind of insight to create, and field, deeper, more potent marketing, and to help our patients take better care of themselves.