Make It Concrete

Today, we're going to approach the problem of adherence from an interesting place. The real world. As a matter of fact, the extremely real world. The key, it seems to handling procrastination in the real world is to think of the task at hand in concrete, rather than abstract, concepts. Would this work for adherence?


Here's how an article in PsyBlog described this concept:

In a new study published recently in Psychological Science McCrea, Liberman, Trope & Sherman (2008)
examined one possible technique for decreasing procrastination. From
previous work they hypothesised that how much we procrastinate might be
affected by the level at which we construe it. Across three studies two
levels of construing tasks were examined:

  1. Abstract construal.
    Say you want to cut the grass, an abstract construal would have you
    imagining those beautiful stripes imparted by your roller-mower and how
    beautiful your garden will look once it's done. Perhaps you'll be
    reminded of the grass courts of Wimbledon and then how the smell takes
    you back to the time when…well, you get the picture!
  2. Concrete construal.
    Now, instead of being carried off by a flight of fancy,
    concrete-construers would concentrate on whether the grass is wet, what
    length to cut it and whether there's any petrol left in the mower.

The interesting thing about the tasks considered in this study, as well as several other referenced in the PsyBlog post is that they were all assumed to be fairly difficult, complex tasks, as well as being prolonged and sometimes unpleasant. Think of, for example, mowing the lawn. Because of this assumption, successful anti-procrastination techniques included things like setting artificial deadlines, thinking about the abstract, long-term benefits of completing a task while working on it, and so on.

Adherence typically does not involve any of this kind of task. Assuming there's a prescription in hand, the tasks involved are pretty easy — go to the pharmacy and pick up a prescription, and at a set time every day, simply put a pill in your mouth. That's it. That's all. Literally, a reflex.

Which, perhaps is the answer. If someone is having a really hard time with adherence, maybe the best approach is simply to train them to think of what needs to be done in the most concrete possible construal — just go to the medicine cabinet, put a pill in your mouth, and swallow. Leave thinking about the implications of this for another day.

Or, as Nike would say — "Just do it."

Web 2.0 for Doctors: Think Small

From PharmaLive  "… It turns out that 60 percent of physicians are using—or are interested in using—online social networks, according to a study released on Tuesday by Manhattan Research."

About 10 years ago, during the dot-com boom, the buzz was always about "convergence" — TV, Internet, phone, PC — all coming together. It was a great dream, but limited by technology and we consumers have ended up with more devices than ever. Humans like choices, even when, as Barry Schwartz pointed out in his book The Paradox of Choice, more choices aren't always a better thing. Well, for better or worse, a different form of convergence is occurring in the world of healthcare communications and it looks like it is leaving Pharma sales and marketing behind.

Actually, to be more precise, pharma does not seem to be invited to the party which is being held in Washington. Who actually was invited? Well, you have Senator Grassley and the renewed Sunshine Law. You have Henry Waxman with his vendetta on DTC. You have Masachusetts and New Hampshire and the AMA allowing doctors to opt out from meetings with pharma sales reps. Suddenly what was always the bulwark of selling to doctors is fading away. It is creating a vacuum — and as nature abhors a vacuum, something's going to have to fill it.

I believe that something is social networking. This convergence of trends and change have created the opening for true, independent online HCP communities. Thus, we have, an online community for physicians. (Which I cannot get into without having a DEA number of my own.) And doctors do not want to have a community which has anything to do with a pharma company. Doctors are human too- maybe they want more choices, not less, on how they get their credible information.


Maybe everyone is asking the wrong question. The real problem is the issue of "sales" not science. Sales folks just do not have the credibility, nor are they real scientists. This inherently handicaps the efficiency of a traditional sales force. Back in the day, when there weren't too many other options for physicians who needed to learn about pharmaceuticals, the classic "detail man" was really the only option. Not anymore. So, what should pharma companies do?

Integrate, that's what. Instead of thinking about sales as a blunt instrument, or a fungible force, begin to see it as just one option among many, and begin reconfiguring it to reflect the state of the brave new post-DTC world. Simple sales firepower is not enough anymore. The industry needs something more nuanced, more targeted and more effective. Which means thinking smaller.

To begin with, pharma firms need to start to layer their connections to doctors. Turn the issue of the sales force being squeezed out on its head. What if you kept a smaller sales force for traditional sales detailing, which will not go away entirely, but added some other elements of communication and influence?

Try this idea out: what about creating smaller communities of pharma-employed scientists assigned to clusters of doctors where they have a direct science conversation, not sales. Or, even better, what if you used your KOLs and created a series of condition-specific communities for them to speak directly to doctors and specialists? The company would sponsor it, but the the sites could be managed by a third party. It would be a cluster of KOL's forming the core of the conversation, with invited doctors to join in or just observe.

This would create micro-communities, smaller, more manageable and relevant. Pharma could move from the sales focus to the science focus it once owned with unimpeachable credibility.

And in the end, the Sunshine Law, the banning of reps and DTC, would have an impact, but the creation of micro-HCP communities run by KOL's or pharma employee researchers, would leave intact the core goal of the sales force: influence.

RM 2.0 , the FDA, and J&J: The Big Kids Want to Play

We have been putting a great deal of thought into the next phase of relationship marketing for pharma. Note: watch for a white paper, coming to a website near you. Anyway, according to a post by Eye on FDA, quoting a Congressional Quarterly Politics article, two of the seriously heavy hitters in pharma –  the FDA, and Johnson & Johnson — are beginning to say and do things that sound like what we've been saying and doing. Here come the big kids.


Let's get a little more specific. We have put a lot of thought and work into filling in the outlines of what we think the next phase of relationship marketing for pharma is going to look like. Boiled way, way down, we think it's going to consist of marketers using online communities to create self-supporting groups of patients.

Originally, pharmaceutical marketing consisted of companies pushing information at patients. That information was almost completely about their drug, specifically safety and efficacy. As patients grew more informed, and "lifestyle" drugs like Viagra and Rogaine appeared, and as the financial structure of healthcare made getting advice directly from a physician more and more difficult and less and less affordable, patients began taking responsibility for their own healthcare. The result was relationship marketing. In this 1.0 world, smart marketers put the patients at the center of their thinking rather than the drug.

As the Web has evolved, so has this model. Increasingly, patients are now forming independent on-line communities. Think of Web 2.0, except applied to pharma. Patients create their own content, and provide information and support around how the drug affects their day-to-day lives. In this environment, the smartest move for pharma companies to make is not to try to avoid or overpower this community model or control the community, but instead to support it. By being the creator of an online environment in which, say, sufferers of Crohn's Disease can virtually gather, communicate and share information, encouragement and so on, a pharma brand can become incredibly central to the lives of patients, and incredibly valid and strong.

Interestingly, it looks like both the FDA and J&J are reaching the same conclusions, or at least beginning to think along the same lines. Given that the FDA is, well, the FDA, and J&J is the biggest pharma company in the country, this is not unimportant.

J&J has built (or at least is sponsoring) an ADHD website — a place here parents of kids with the condition can interact, share stories and support, and so on. The CQ piece describes this initiative as follows:

Parent company Johnson & Johnson has
been in the vanguard of this kind of indirect, community-oriented
online marketing for prescription medications — setting up blogs,
Facebook pages and YouTube channels to help extend its brands. Some
drugmaker marketers see campaigns like those as the industry’s future.

genie is out of the bottle,” said Peter Justason, a global marketing
director for Johnson & Johnson, in a recent TNS Media Intelligence
report on using “social media” for branding. “Now it doesn’t cost
anything for a million people to get online and talk to each other.
People are trusting people like themselves more and more, as opposed to
some sort of third-party authoritative figure.”

Not to sound conceited or anything, but Justason's observation about "people trusting people like themselves" could have come straight out of our writings on advocates.

The FDA may be inadvertently supporting this shift towards online as a marketing channel by focusing all of its regulatory firepower on DTC, while DTC is simultaneously becoming ever more tightly regulated, and may be on the point of being regulated out of existence. The CQ piece makes this point, too:

FDA’s regulations for digital
communications are the same as those for direct-to-consumer
pharmaceutical messages in other media, including rules against
promoting a product’s possible off-label uses and requirements that
drug companies clearly disclose potential side effects and adverse
reactions. If anything, the Web may provide better opportunities for
that kind of disclosure than the tiny type in magazines and the
fast-talking voice-overs on TV.

Nonetheless, drug
companies have been slower than other industries to explore social
media’s potential. A key concern: “user generated content,” such as the
stories and comments posted on ADHD Moms. Some in the industry fear
that user comments will dramatically increase reports of possible
adverse reactions, which the companies are then legally required to

Such worries have kept many drugmakers from
doing anything more online than buying some ads and creating static,
carefully vetted Web pages. But that could soon change. In a series of
videos posted on his site, EyeOnFDA blogger Mark Senak notes that
Congress is likely to consider imposing a moratorium on TV ads for
newly approved drugs and restrictions on direct outreach to doctors and
medical groups — moves he predicts would accelerate the pharmaceutical
industry’s online shift. “Traditional concerns” about Internet
marketing “actually crumble in the face of the fact that coming reforms
are really going to demand new approaches,” says Senak, who’s an
executive at Fleishman-Hillard.

They certainly are.

The Problem Isn’t Knowledge. It’s Impact.

In the first post of the new year, maybe it's time to thing big. What do we do? Why do we do it? The answer, of course, is held by Seth Godin.

If it sometimes seems like we worship at the Temple of Seth Godin, well, there's a reason his is the most popular marketing blog in the world — it's really, really good.

Take today's post, entitled In the Mood. If you read it, and apply it to pharma marketing, you arrive at some pretty unsettling conclusions that nonetheless seem to be common sense.

For instance, how about the conclusion that the last thing most patients with chronic conditions need is more knowledge? That's kind of conversation-stopping, because virtually all pharma marketing drums it into people that the one thing patients all need, all the time, is knowledge. About side effects, about their conditions, about clinical trials.

Well, to quote The Far Side, maybe that's true and maybe it ain't. Pharma companies are required by law to provide information, and most do a great deal more than that. You could make the argument that anyone with a laptop and a brain can learn virtually all the information they could ever want or need about a drug online, instantly. The industry is not lacking in information, and as a group, neither are patients. In fact, if any part of the information isn't quite right, people sue.

What is lacking isn't information. It's something a lot messier — inspiration, beliefs, motivation. The point isn't getting them information. The point is getting them to care, and to act.

  • How do you get a 34 year-old man with Crohn's Disease to stay on his medication when he is suffering so much he has basically stopped caring what happens?
  • How do connect with someone with MS?
  • How do you communicate with someone who has high blood pressure, but doesn't care?

You don't do it by shoveling more information towards him. You do it by understanding him, by researching the living daylights out of him. You then take the information you uncover and you use it to reach out to him wherever he is, however he communicates. If we really thought that skywriting was how most of our clients' patients received their information, we'd do that. The point is that the patient dictates whe medium. Actually, the patient dictates everything.

Because the key to relationship marketing is impact. You have got to get through to the patient. You've got to reach them where they are, and convince them that they have to get engaged with their condition, and their treatment. You have to get them to care.

They know what to do. The hard part is simply getting them to do it.