Welcome to the adherence party, Sears. And The Gap. And Target. And …

When it comes to marketing, the pharmaceutical category is usually more conservative than typical retail marketers. Not anymore. A story in Wednesday's Wall Street Journal seems to prove that when it comes to adherence, it's the retailers, not the pharma people, who are late to the party. But, at least they're here.

The piece, which is behind a WSJ password, is about how the current economic downturn is affecting big retailers like Target, Sears, The Gap, etc. Here's the heart of the story:

It's number-crunching time. Marketers, their ad budgets under
increased scrutiny amid the economic downturn, are mining their
customer databases and reaching out to loyal consumers with targeted
ads, instead of relying on the traditional yuletide blitz.

Rather than create one TV commercial or send out a single, shotgun email promotion, uneasy retailers such as Sears Holdings, J.C. Penney, Target and Gap
are tapping statistical models and other technologies to send specific
consumers promotions based on what is potentially on their shopping

This is adherence, dressed up in a Gap sweater and khakis instead of scrubs. The first point here is that the retailers have discovered, according to the Journal, that:

Acquiring a new customer costs about five to seven times as much as
maintaining a profitable relationship with an existing customer, says
Marc Fleishhacker, managing director at WPP's Ogilvy Consulting, which
designed the campaign for Sears.

No kidding. Really?

In pharma, we don't market new products to old customers. We try to sustain and enrich the relationship we already have with patients. We do this, at least here at Ryan, by getting a 360-degree view of our patients, and based on what we learn (and we learn a LOT) we can tailor our message and our medium around who they are, what they need, and what they really care about.

Just as the retailers have learned that simply flooding the airwaves with untargeted brand ads during the holiday season isn't the best use of marketing money, pharma learned long ago that just dumping money into DTC advertising, especially television, wasn't such a hot idea. So, we work to understand who our patients are and what they need, and then we deliver it to them.

A key difference, however, is that keeping patients on their therapies is, over the long haul, vastly more important to the patient than selling him a sweater. What we want is for that 46 year-old patient with a high risk of heart problems to begin taking statins, and to stay on them. The most advanced drug in the world will not make a difference unless you can keep the patient using it, which means understanding them, which means doing research, which means making sure that your communications are targeted and structured according to data, not guesswork or dollars.

Sound familiar? Welcome to the party, folks. Just leave your coats in the spare bedroom.

Mashup: Seth Hawken, Meet Paul Godin

More and more, what they're actually in is the information business. Seth Godin sort of says so. So does (or did) Paul Hawken. A mashup of the two provides, we think, the right answer.

First, Hawken. Paul Hawken is the founder of Smith and Hawken, the garden company, and an extraordinarily prescient, original writer and thinker about business. One of his best books is The Next Economy, and here is a quote from a chapter entitled "The Informative Economy." it's almost eerily on target:


Since using more energy, whether directly or indirectly, makes goods more expensive and therefore less available, we will have to use less energy to produce the same or better goods if we are to maintain our standard of living. To do this, the amount of information per unit of prodution must increase correspondingly. Remember, we are defining information here as design, utility, and durability or, to put it another way, the application of the knowledge of how to best make or accomplish something.

 Now, here is a quote from Seth Godin's post today, entitled How to Make Money Using The Internet.

Make money: not by building an internet company, but by using the
net as a tool to create value and get paid. Use the internet as a tool,
not as an end. Do it when you are part of a big organization or do it
as a soloist. The dramatic leverage of the net more than overcomes the
downs of the current economy.

The essence is this: connect.

Connect the disconnected to each other and you create value.

  • Connect advertisers to people who want to be advertised to.
  • Connect job hunters with jobs.
  • Connect information seekers with information.
  • Connect teams to each other.
  • Connect those seeking similar.
  • Connect to partners and those that can leverage your work.
  • Connect people who are proximate geographically.
  • Connect organizations spending money with ways to save money.
  • Connect like-minded people into a movement.
  • Connect people buying with people who are selling.

If you are a pharma company marketing a drug for a chronic condition, providing the drug is increasingly only part of what you're selling. The FDA will make sure that the drug is safe, efficacious and so on. The other part of what you're selling is connecting patients with information, or the source of information, even if you don't yet know exactly what they want. This role fits into at least three of the bullet points Godin mentioned; I've highlighted them.

Whether it's an 800 number for questions about using a glucose meter, an online message board where MS patients can communicate stories, experiences and approaches, or web site copy that explains, directly and meaningfully, what the side effects of a medication are, it's no longer enough to simply hand patients medicine and then move onto the next one. The better your drug, the more information will be available to patients along with it. Your job as a pharmaceutical comany is to connect patients to those information sources. Use as many channels as possible. Make the connection as strong, flexible and vital as you can. The patients can, and have, and will, take it from there.

Open Letter to Steven Colbert: Want a Job?

We give up. We know when we're beaten. Years, hell, decades of experience, effort and thought about pharmaceutical marketing seem kind of trivial now. Steven Colbert, host of Comedy Central's The Colbert Report, is a pharmaceutical marketing genius. We can't compete. Denying the obvious won't help.

 Yesterday's Wall Street Journal Health blog reported on a new segment on the Colbert Report, "Cheating Death With Dr. Steven T. Colbert." Along with startlingly visionary commentary on cutting-edge research in healthcare, Dr. Colbert also provided marketing insights and recommendations that have us sick — sick, we tell you — with envy and professional jealousy. To quote the Journal piece:

On Wednesday, Comedy Central’s Stephen Colbert, of all people, weighed in with some remarkably trenchant analysis on the results of the Jupiter trial.
That’s the study that showed people with normal cholesterol but high
C-reactive protein, a marker of inflammation, had a reduced risk of
heart attack if they took AstraZeneca’s statin Crestor.

“This is a great breakthrough in the battle to find things to
prescribe to people who don’t need them,” he declared midway through a
segment called “Cheating Death with Dr. Stephen T. Colbert, D.F.A.”
(That’s Doctor of Fine Arts, and is apparently qualification enough for
some biting medical analysis.)

“True, the drug costs $100 a month,” he explained. “But that is a
small price to pay to not have the heart attack that there’s no way of
knowing that you would have had.”

After a video clip of Stanford cardiologist Mark Hlatky sounding a cautionary note on the results, Colbert quipped, “sounds like someone hasn’t gotten enough free Crestor pens.”

As if his "use pens" insight wasn't revolutionary enough, Colbert went on in his signature, seemingly effortless style, to sketch out yet another paradigm-shifting approach to marketing statins to patients at high risk of cardiac disease. Dr. Colbert proposed a new class of drug, which we're going to christen "facilitator" compounds, that will do more to promote adherence and compliance, and minimize noncompliance, than any approach we have ever arrived at without the help of a mind like Colbert's. 

The complete structure of his analysis is far beyond the scope of this blog, and probably our intellects as well. The best way to summarize his work is to paraphrase his segment, in which he proposes the creation of a compound he christened Vaxacrest, which would increase a patient's cholesterol until his blood was transformed into a substance not unlike the cheese that's used in nachos, thus making statins a necessity. Now that's marketing.

Mr. Colbert, anytime you decide the television thing has gotten a little stale, and you want to be, say, director of strategy at a hot ad agency focusing on relationship marketing for pharmaceutical clients, your office is waiting.

Don’t Touch That Switch

One aspect of relationship marketing that we've discussed a lot is the creation of online communities. There are lots of examples, such as patientslikeme.com out there. But once someone has joined a community, the battle is only half-won. The other half of the battle is keeping them there, and keeping them engaged.

An interesting post on Tuesday (okay, it's a few days old) in emergencemarketing.com on this topic suggests that the way to prevent switching is to create transactional switching costs. In English, this means make leaving the community such a pain in the neck that nobody wants to leave. This is a very negative strategy. Basically, what it's saying is that although you may want to leave, you won't.

This is sort of like the Recording Artists Industry of America taking it upon itself to sue people who were engaged in peer-to-peer downloading. Suing your own customers is never, ah, good marketing, and it also masks the underlying problem — people illegally download music because they feel the industry's available options are not really meeting their needs. So they switch.


If you're running an online community, especially around a chronic condition, punishing people who want to switch has a similar flaw. You're not getting at the real issue, which is that they're dissatisfied, for whatever reason, with what you're offering. So they start looking around.

I think that a much better approach is a kind of aggregation strategy. The goal is to make your community the hub of the issue — kind of the operating system for the condition. You are already working with, incorporating and therefore aggregating all the other possible resources. There's nowhere else for patients to go because you've already got it.

This approach was nicely described in a November 3 post of the Pharma 2.0 blog. The post describes a community site developed and launched by Bristol-Meyers Squibb for women living with advanced breast cancer. I'll let the post speak for itself:

Perhaps the most impressive thing about the initiative is that it
involved buy-in from 13 non-profit organizations! See the list of
participating breast cancer patient advocacy organizations below.

Breast Cancer Network of Strength (formerly Y-Me)
Breast Cancer Research Foundation
The Linda Creed Foundation
Living Beyond Breast Cancer
Metastatic Breast Cancer Network
Sisters’ Network
Susan G. Komen for the Cure
The Wellness Community
Young Survival Coalition

Now, who in their right mind is going to join this community, and then leave? Where, exactly, are they going to go? By involving all these organizations in the process of creating a community, they have started with a community focus from the very beginning. Everyone's involved, everyone stays, this site basically becomes the standard.

Taking Notes: Ethnography and Pharma Marketing

In advising clients on relationship marketing, one of the topics we hammer on relentlessly is the importance of understanding how a chronic condition affects patients' daily lives. In his Customer Experience Matters blog, Bruce Temkin wrote a nice post yesterday about Wells Fargo using ethnography to understand, in depth, how to communicate effectively with clients. It's fascinating stuff, and has major implications for pharma.

In case you're not familiar with the term (I wasn't) ethnography is an academic discipline that's the branch of anthropology that deals with specific human cultures. It's the study of how people live their daily lives, and how their culture, situation and background affects how patients cope with a particular disease, how they treat it, and how it affects their daily lives. A big part of how you do it is observing their daily lives, taking and compiling careful notes, and interpreting what you've seen.

Ethnography is accurate because it's rigorous. It's based in close observation of the subject, the gathering of data, and the interpretation of that data to uncover qualitative information about how real people really do things. The findings this kind of work provides often flatly contradict what we believe we know — information and points of view we've gathered through other approaches, or even through completely unsubstantiated beliefs.

Failing to do your ethnographic homework can result in products that solve problems nobody really cares about. It can mean missing critical day-to-day aspects of a product or a therapy that are incredibly important to patients, but completely unknown to pharma companies that fail to do deep, in-person research. And in marketing, it can mean failing to communicate with your patients in a way they can understand, relate to and respond to.

Wells Fargo's study taught them a lot. They learned that:

  • Customers wanted the bank to communicate like it knew them, similar
    to other communications they received from organizations like AARP.
  • Marketing messages, especially those with presumptive language
    like ”Congratulations!” or “Good News,” were viewed quite negatively;
    customers used words like “ploy” and “scheme” to describe them.
  • The bank could mitigate negative reactions to bad news like a
    notice of insufficient funds if the communications provided relevant

Now, mentally replace this customer with a patient who is suffering from Crohn's Disease. Constant abdominal pain, frequent trips to the restroom, nausea. How does this affect their daily lives? How does this change the way they work, the way they relate to family and friends, and most important of all, how do you communicate with them? Do you use a tone similar to the Wells Fargo model — as if you know them — or do you pitch your information a little lower, and little more clinically. When you discuss side effects and unpleasant aspects of the condition, should you also include suggestions for how to handle them, or should these go elsewhere? And so on.

Essentially, for the pharma marketer, ethnographic research provides the final measure of knowing, as opposed to guessing or surmising. It's the difference between reading about what it's like to ride a motorcycle, or hopping on one and kicking the starter. And used carefully, and rigorously, it can be the difference between a prolonged, healthy relationship with a patient, based on really understanding them, and a patient who, after a few months, isn't your patient any more.