Melanoma rages, ASCO raves, families cry, patients wait and hope hope hope.

Yesterday my family, which runs a local melanoma foundation that is associated with WISTAR Institute (a truly great foundational science group), had our annual 5K run/walk we call Run4Cover. Our 9th year. If you do not know about WISTAR — and the amazing Dr. Meenhard Herlyn in the center of the poster — then you should. And if you are not keeping your kids (or yourself) off the tanning bed and have not matured past the Sun Worship stage, then shame on you. Seriously. This is such a common sense preventable disease, but once it gets going, you are not left with a lot of options. Until now. As I volunteered at the runners registration, I saw so many family running teams with their loved one’s face on their t-shirts; I spoke to many individuals touched by this scourge of a disease — dad’s, mom’s, sister and brothers. But it was only a few weeks after ASCO, the major annual oncology conference. The news is exciting, more promising than ever — and not one person I spoke to heard anything about it — even those in remission who hear that ticking clock in their lymph nodes. Check out this ASCO wrap-up quote and follow the link below to the full story: The long-term results (abstract LBA9003) show that the combination of ipilimumab (Yervoy) and nivolumab produced an unprecedented median survival of 40 months for patients with advanced melanoma, which is nearly double the overall survival previously reported with either agent alone. “Just a few years ago, the median survival for patients diagnosed with advanced melanoma was as little as a year or less…. So it’s truly remarkable that we’re seeing a median survival of over 3 years in this trial,” commented lead author Mario Sznol, MD, professor of medical oncology at Yale School of Medicine in New Haven, Connecticut. “Even in the latest era of targeted and immunotherapy agents, the median survival is, on average, only about 16 to 18 months with any new treatment alone.”** Now I know oncology marketing is doctor-focused. But it is the patients who should be partnering, not just following, their doctor. It is easy to sit back and read all about “breakthroughs” like for Merck’s new treatment (coming soon), but the companies should be making armies of informed, empowered patients. If Merck has a “breakthrough” then shout to the hills! If BMS combo-therapies can extend life for years, then as a patient, bang on the oncologists door and demand to know everything about it. Last, I leave you with two photos. One, from the Run at the Wells Fargo Center in Philly. For all that pain, look at how people celebrate and fight back with positive energy. Second, my sister, the president of the whom in over 10 years has organized the first ever melanoma global researchers conference. Who has worked with the FDA. Who has given tirelessly and never asked for anything but the satisfaction of seeing people heal, find solace, or find answers through WISTAR’s help. Wistar poster Run4Cover 2014     Yervoy has a patient program called “Your Voyage.” Kudos to them. Because that is exactly what it is — a rocky, hard, scary voyage. But now we have hope, hope, hope. Thanks, Kate. * **Thanks to MedScape for the ASCO news clip.

Why does Fall Make Me Think of Patient Adherence?

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.

Getting Serious About Adherence

Great post today from John Mack’s Pharma Marketing Blog today about adherence.

First, Mach cites an amazing 2003 World Health Organization report on the problem that estimates that worldwide, something like 30% to 50% of medications prescribed  aren’t taken as directed. This reminds us of Lord Leverhume’s famous observation about advertising, that 50% of his advertising was being wasted, but he didn’t know which 50%.

The WHO report, although five years old, is a comprehensive review of the adherence problem all around the world. You can download it here.

Mack then goes on to introduce us to what seems to be a less-than-serious adherence tool — a collar that, when worn, senses when pills have been swallowed. This requires, however, that the pills be implanted with tiny magnets that the sensors can pick up. Uh, no thanks. For one thing, it closely resembles the kind of collar used to train hunting dogs using electric shocks. See for yourself:


Magnetic sensor collar for improving pharmaceutical adherence.


Electronic shock collar for training hunting dogs.

More seriously, though, the big issue with adherence is fairly straightforward — it isn’t easy. To quote his post: It’s not easy to get a good return on investment from a
compliance/adherence marketing/patient education campaign. That’s why
the vast majority of pharmaceutical marketers continue to focus on the
"low-hanging fruit," i.e., new prescriptions (new patients).

This we knew also. Adherence is not simple, and not easy, but when executed correctly, it’s extraordinarily effective, and the ROI is phenomenal. And also, hard as it may be, it’s got to be a lot easier than convincing patients to strap on a collar with batteries and flashing lights. I mean, at least until that thing comes in platinum.  

RM In the News — Again

Last week it was nurses. This week it’s pharmacists. Either way, RM is emerging, bit by bit, as the weapon of choice for holding down healthcare costs. Or at least, so says the Wall Street Journal.

In a story yesterday, the Journal reported on a trial program written up in the Archives of Internal Medicine. In a dozen tracked, randomized trials, regular consultations with pharmacists significantly reduced hospitalization rates for patients with heart failure.

Although the role of the pharmacists varies, generally they help patients stay on their meds, and monitor their basic condition. A similar trial is under way for diabetic patients in 10 cities across the country, in which pharmacists coach diabetics. Both diabetes and heart failure are condition in which regular, consistent use of medication plays a key role. These patients have seen a significant improvement in their blood sugar levels.

The grandmother of all these programs is, of course, the famous Asheville Project. In this pioneering program, the city of Asheville provided city employees with health education, and monitoring and assistance from pharmacists. The program was a classic win-win-win. The patients had greater adherence, better outcomes, lower costs and increased satisfaction with their pharmacists. The city saw lower costs and happier employees. And the pharmacists got to expand their role in the healthcare equation beyond simply dispensing pills. Essentially, by creating an ongoing relationship between the pharmacist and the patient (a relationship, we might add, which is vastly more expensive, complex and difficult than a marketing or patient education campaign) patients were much more likely to stick with their therapies, manage their conditions well, and maximize the benefits they saw.

The bottom line, as always, is that healthcare is at least one part human behavior and participation for each part science. This is especially true for chronic conditions. All programs are not created equal, of course, and your mileage may vary. However, this may portend an expanded new role (or perhaps a return to an old role) for your friendly neighborhood pharmacist. Stay tuned.

Service Is The Most Ignored Form of Efficacy II

We have posted previously about how pharma companies need to begin to understand the importance of servicing their patients. Well, in today’s Wall Street Journal Health blog, Walgreen’s seems to have gone one better at this, by making an acquisition that enables them to begin putting healthcare centers in the workplace. This merits a closer look.

Here’s the relevant part of the story:

Walgreen execs said yesterday that the company’s buying a shop called I-trax for about $260 million and another company called Whole Health Management for an undisclosed amount, the WSJ reports.

After the deal goes through, Walgreen will have more than 500 health
centers, including both its existing retail clinics and the on-site
health centers its buying, the WSJ says. I-trax provides worksite
health services for more than 160 employers, including familiar names
such as Lowe’s and Toyota. Whole Health Management has work site
centers for Continental Airlines and Sprint Nextel Corp., among others.

From an RM perspective, this is fascinating. Given how new this model is, there’s more than a little speculation in thinking about it, but the implications of this could be enormous.

First, it removes many of the compliance barriers that might otherwise keep a patient from simply renewing a prescription or seeking medical advice. When, literally, there is a physician and a pharmacy right down the hall, any systemic friction that inhibits engagement with the healthcare system is substantially decreased.

Second, it also significantly rearranges the channel structure of pharma marketing. The current, classic system in which a patient receives a prescription from a physician then purchases drugs at a pharmacy is a manufacturer to agent to retailer to consumer pipeline, with the physician essentially acting as the agent. In this case, if the physician and the retailer are on in the same, the channel structure changes into a simple manufacturer to retailer to customer.

Thid, and perhaps most interestingly of all, this innovation vastly increases the scope that Walgreen’s has to work more closely with pharma companies to create and maintain patient relationships. Because Walgreen’s represents many different pharma companies, they become, in some respects, the arbiters of the relationship — they have the opportunity to be the gatekeeper for a lot of patients, and if the physician is now in-house, in a much more comprehensive way than they ever have before. Ideally, this will lead to far better service and accessibility to healthcare, which will, in turn, enhance efficacy.

This has already happened in a lot of consumer markets. The same network of companies that helps you take care of your lawn (TruGreen) will help you with home repairs (Servicemaster), cleaning (Merry Maids) and so on. Enterprise Rent-a-Car will pick you up and deliver. Virgin airlines offers limo service to the airport. This is a version of that. It will be interesting to see how this all develops.

REALLY interesting.

Internal Noise and Relationship Marketing

Explaining to traditional pharma marketers what relationship marketing is and how it works is tricky sometimes. In a post yesterday entitled "That Noise Inside My Head" Seth Godin provides a really nice metaphor for explaining RM.


Godin poses the simple, yet difficult, question: "Why don’t people do what they know they should?" In other words, and I’m going to quote Godin here:

Why do people struggling for an income end up using an
expensive check cashing service when the bank right next door will let
them have a checking account for free?

  • Why do students spend an hour fighting about their homework instead of ten minutes just doing it?
  • Why do customers fall for slick come ons or fancy financing instead of buying what’s best for them?
  • Why is it so easy to fool voters with patently false accusations?
  • Why do some people turn a routine traffic stop into a life-endangering argument with the cop?
  • Why can’t worthy charities (with dreary stories) raise more money than they do?

The answer, according to Godin, is an internal " noise that keeps them from being rational, that forces them to
avoid the simple truths sometimes, that makes them unable to take a
shortcut when a long (more emotional one) is available."

Bingo. If patients listened to their physicians, did precisely what the physician told them, including staying on their prescriptions, utilizing all the additional or secondary techniques to support them (i.e., exercising regularly to help combat depression) and in general, uniformly acted like model patients, there’d be no need for RM.

But here in the real world, they don’t. Patients are complex, differ radically from one another, and are subject to a wide range of influences, some of which are good for them and some of which are distracting, wrong, or downright destructive. And this emotional space is the field we play in.

RM is about realizing how patients actually think, feel and act, and responding to it in a way that helps them manage their condition better. Rather than ignoring the white noise, as traditional pharma marketing is sometimes wont to do, we acknowledge it, and strive to create marketing programs based on how patients truly are, rather than how they should be.

Which is why it works.