The Pla-Doh School of Pharma Marketing

Remember Pla-Doh? More, specifically, do you remember the little machine that you used on it? You would put a hunk of the stuff in the hopper at the top, then put pressure on it with a lever — kind of like a garlic press. Under pressure, the Pla-Doh would be extruded through holes in all kinds of fun shapes — star, squares, and so on. That seems like an excellent metaphor for what's going on in pharma advertising.

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First, the pressure. It is looking more and more like the next Congress is going to do some serious regulation of DTC pharma advertising. Led by Representative Henry Waxman. Last week, the DTC Prespectives blog reported in a post that:

Henry Waxman is not making a secret of his desires
to restrict DTC. Long a critic, Mr. Waxman will now have a friendly
Congress and White House behind him. In a speech to the Prescription
Project on 12/8, a group looking to restrict marketing to physicians
and consumers, the Congressman told the attendees he wants to restrict
DTC for new some new products for up to two years.

The idea of a moratorium on advertising for new
products has been discussed for several years. The drug companies and
advertisers successfully prevented it from happening in the current
Congress. The new Congress will have much stronger majorities for
anti-DTC forces and Waxman will have support to pass something more
restrictive. Currently a few drug companies have agreed on voluntary
delays in DTC up to one year but Congress wants more.

Now, the interesting extruded shapes. Restriction on DTC is only one part of a gradually tightening system that is putting all kinds of pressures on everyone involved in healthcare. Physicians have less time to spend with patients. Patients have less money to spend on drugs. And so on. And one of the results of all this is the gradual development of all kinds of interesting methodologies for patients, using technology, to take control of their own healthcare, in a way they couldn't before.

About the same time, Microsoft's Bill Crounse, in the HealthBlog, wrote a fascinating post about a whole set of online, patient-directed health sites that are coming on line.

Further evidence for how e-Health is transforming healthcare delivery is provided in my newest House Calls for Healthcare Professionals audio-cast.  In this program, Expert Medical Advice Just a Click or Phone Call Away, the CEO of TelaDoc
shares information about his company’s phenomenal growth; a company
that has provided more than one million telephone-based, e-health
consultations to patients across America.  Grad Conn from Microsoft’s Health Solutions Group joins the program to discuss how TelaDoc’s partnership with HealthVault will add value to the company’s services.

Strategically, this is a place where pharma marketers have got to begin to play. The mass media approach of DTC is heading off a cliff, it seems, or at least is going to be a shadow of what it was. And patients, more and more, are seeking information. They have always done this, of course, but they are beginning to seek information in the context of actual interactions with clinicians, just in a differnt setting — online instead of in-office, if you will.

This is not too far afield from some of the techniques that are already being used for patient support in certain circumstances. It is premature to try to guess what interesting shapes things are going to take in the upcoming year, but given the forces that are at work here, and that are gathering momentum, pharma needs to participate and have a voice in the patient's conversations.

Square peg, meet round hole: when, why and how pharmaceutical advertising doesn’t work

In a post put up this morning, Seth Godin discussed the recently-discovered fact that, as he puts it, traditional brand advertising on Facebook is a "total failure." There is a lot to be learned about pharma advertising in this observation, and the thinking that follows it.

Godin goes on to observe that:

First, these big companies are asking precisely the wrong question.
They are asking, "how can we use these new tools to leverage our
existing businesses?" They want to use the thing they have (money) to
get the thing they need (attention)
and are basically trying to force
ads onto a medium that just doesn't want them. Do people really want to
follow P&G on Twitter so they can learn about the history of the
soap operas they sponsored? Why? There are millions of people to friend
or follow or interact with… why oh why are you going to spend time
with Dunkin Donuts unless there is something in it for you?

Traditional advertising is inherently selfish. It interrupts in
order to generate money (part of which pays for more interruptions).
That approach doesn't work at a cocktail party, or at a funeral or in a
social network.

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Pharma advertising, particularly DTC, has followed this model, more or less. Partially because of FDA restrictions, and partially because of tradition, most pharma advertising is simply intended to create awareness, and perhaps convey a few simply brand attributes. Think of, for example, the Lunesta moth. A potent symbol, but not a lot of depth.

That works fairly well when you're marketing into a healthy economy, or at least one that's growing. Particularly with elective drugs like Lunesta, or Viagra, the purchase decision has a healthy amount of impulse or discretion in it. A patient sees the moth. The doctor has seen it, too. During an office visit, the patient mentions occasional insomnia, asks for Lunesta, and the doctor is happy to prescribe it. The patient's insurance covers it, it's just as safe and effective as any of several other options, and all in all, the entire undertaking is not that different from buying a CD or something. It's basically discretionary. The interruption/attention model of traditional advertising works fairly well, particularly in mass media, like television or print, which are good at creating product awareness among millions of people.

Now, alter this scenario by tightening up the economy, and additionally, making the drug something less discretionary, like a medication for MS, or diabetes. There is a lot more at stake to both the patient and the physician. First of all, the patient's copay is higher (remember the weakening economy) so it's not quite such a minor purchase. Second, the impact of an ineffective prescription might be a lot worse than a bad night's sleep.

Under circumstances like this, mere awareness isn't good enough. Everyone involved in the decision is going to have to think a lot harder. There's more at stake. What's needed isn't simply awareness, but engagement. And that's something that the traditional advertising methods and media simply aren't designed to deliver.

They still have their place — in fact, a big place. My point, though, is that using money and/or simple repetition or prominence to create generalized awareness, doesn't cut it when you have a more complex purchase decision, requiring more attention, more involvement, and more consideration. Awareness has to be augmented with engagement. And that is something that traditional brand advertising isn't intended to do, and never was.

This need for more consideration is therefore extended not just to patients and physicians, but to advertisers and marketers as well. Everyone has to start thinking harder about where they're spending their money, and what kind of reaction it will create. This probably means interactive, which demands much more intelligence, understanding and judgment. Using Facebook as a marketing tool doesn't mean simply using it as a place to put up yet more branded advertising. You have to use the media itself, in a way that's based on its inherent qualities. Simply hammering yet another square peg into a decidedly round hole is not going to work.

Unconscious Adherence: The Tootsie Roll Effect

Tootsie up
This is really itneresting. A post on the Neuromarketing blog, and an NPR interview with Martin Lindstrom, author of a new book entitled Buyology, has us thinking.

Buyology is the report, basically, on a colossal ($7 million) study of how consumers’ brains actually work when they’re being marketed to. Using fMRI and EEG imaging — i.e., brain studies — Lindstrom turned over a lot of conventional-wisdom rocks, and reports on what’s actually going on in there. Our two big takeaways:

1) Brands are irrational, and very powerful. They can completely outdo logic., and sometimes literally approach a religion-like level of influence.
2) Brands sometimes can incorporate a degree of ritual — companies encourage consumers to build rituals into their use of a product in order to integrate them into their lives. Think of people who realize, and care, that they always eat the filling first in an Oreo. Or drink Corona with a lime. Or make a prolonged, detailed project out of washing the car every Sunday. Even, way back when, eating a Tootsie Pop.

Hmmmm. How does this apply to pharmaceuticals? And particularly for adherence?

What could be more ritualized and intimate than taking a medication that, because of a chronic condition, you take every day, and will for the rest of your life. Do you store it in the same place? Open the bottle the same way? Is there a way to make it comforting? Symbolic? Reassuring? Can you imbue a simple action with some of the qualities of the brand itself?

This has been done. to a limited extent, in pharma, by brands that identify the product itself with attributes, like Nexxium’s purple pill.

The point of this is that the attributes of the brand move. Rather than remaining connected with the product itself, they expand to include the different parts of using the product. The very act of opening a bottle of beer becomes imbued with meaning. The day we are able to do that with pharma — the day we can get patients to associate the rituals of using a glucose meter to the attributes of health, vitality and freedom — we have taken an enormous step towards adherence.

The Importance of Connection and The Power of Trust

I'm writing this post from a coffee shop. There are big windows that overlook the sidewalk, and tables on the sidewalk. Sitting at one of these tables is a woman who I suspect is mentally ill. Seeing her has gotten me thinking about, among other things, behavioral economics and the need for connection.

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A post yesterday in yesterday's Psychology Today blog made this point as well. The post tells the story of a man who has an illegal business selling pirated downloaded content. For a variety of reasons, he considers, and to a limited degree, pursues getting a legitimate job. However, contrary to all reason, he decides to stay in his existing, shady situation. Why? Well, as the post notes,

[H]e described how he recently attempted to find a regular, legal job.
But giving up the illegal business he had created and nurtured for five
years was very difficult for him.

A second aspect of loss that he described was that of his social
network of customers and friends who are linked to him through business
ties. He proposed that the bond between himself and his customers is
much deeper than the traditional retailer-consumer relationship. After
all, in his line of illegal work the relationships have to involve more
trust, reciprocity, and friendship. All of this makes it even harder to
leave that circle.

This man eventually gave up his search for a legal job and went back
to his life of crime. He knows his decision might lead him to prison.
But he was simply unable to accept the loss of his business and social
network.

The point here is that the man's unique situation created an unusually strong need for trust, and unusually close bonds — strong enough that the man was willing to risk jail to preserve them. I think illness works the same way.

The woman on the sidewalk is not a complete mess — she's not your stereotypical bag lady. She does, however, have a large pile of books, papers and so on, that have been heavily highlighted and annotated, and she's going through them with the frantic, angry air someone who's mentally ill often has. She's talking to herself. It's uncomfortably chilly out, but she's out there. And, of course, she's alone. I'm guessing she's alone a great deal.

Illness does that. It's kind of a side effect. In the case of this woman, I'm going to assume that her behavior has alienated people and prevented her from spending any time with anyone. But the same thing happens with other ailments, particularly chronic ones, although the mechanism is a little different. Over and over and over again, we have learned and heard that patients with Crohn's disease, or MS, or cancer, over time, feel absolutely isolated.

They believe nobody really understands their situation. And they're probably right. Unless you personally experience it, it's almost impossible to understand what someone with Crohn's goes through on a regular basis. The result is that patients tend to withdraw. They tend to disengage from other people. this is tragic in two ways. First, of course, being progressively alienated from other human beings is a terribly difficult way to live. And second, they tend to disengage from their disease, which often really causes their adherence to deteriorate.

And under these circumstances, when they do have contact, if that contact appreciates and understands their situation, as with the illegal downloader of the Psychology Today post, there is an unusually strong bond, and an elevated level of trust. And more and more, this trust, which used to repose in the physician, is now being transferred to the brand, to the pharma company that presumably understand what the patient is going through, because they're helping him cope with it.

It's all powered by trust. Our responsibility is much greater than simply helping patients manage their disease. We're also responsible for helping them stay connected. This gives pharma marketers unusual impact, and unusual power. Nobody's isolation is lessened because they buy an iPod. But for someone fighting breast cancer, regular, relevant communication from the drug company that's helping them stay alive is also helping them, in a small way, to stay connected.

We can't ever forget that.