Flexion

Extrovertic got my pre-commercial company started on the right foot with our consumer CRM efforts and helped us select the right agency and negotiate a competitive rate. I would recommend them to any pre-commercial company looking to launch into a highly competitive market.
Consumer Director, Flexion

The Downside of Patient Empowerment

Downside of Patient Empowerment

“I could have had a mastectomy with reconstruction and skipped the part where I got cancer. I feel like the biggest idiot for not doing so.”

Those self-flagellating words made my heart scream like it was stabbed.

I read “The Breast Cancer Gene and Me” by Elizabeth Wurtzel in last Sunday’s New York Times Op-Ed Section. Here is someone who could not have reasonably known that she carried the BRAC gene and was at a relatively high risk of developing breast cancer.

Yet she berates herself for not having a prophylactic mastectomy.

Ms. Wurtzel understands that “the science is ahead of policy” in terms of health insurance coverage. Multiple studies show that as a woman of Ashkenazi descent, she has about a 10-fold higher chance of having the cancer causing BRAC gene. However, “most insurance companies cover testing specifically for Ashkenazi Jewish women only once [they] present with breast cancer.”

But despite being able to point to a flaw in our health care system, she blames herself.

BRAC gene

True, there is now a relatively inexpensive test that women can purchase from Color Genomics to see if they have this deadly gene.  But the most talked about risk factors for the BRAC gene did not point to her genetics as being particularly troublesome. When she found out she had breast cancer, Ms. Wurtzel says, “I caught it fast and I acted fast.”

But still she blames herself for not getting tested.

This despite the fact that testing does not make for black and white decision-making.  Certain BRAC gene mutations are responsible for a substantial fraction of hereditary breast cancers and ovarian cancers among women with Ashkenazi Jewish ancestry. However there are a myriad of BRAC mutations with no clear causal relationship.

Here is where paternalism rears its ugly head. Part of the excuse for not encouraging more BRAC testing is the fear of getting grey-zone results that can cause unremitting anguish for patients. But as Ms. Wurtzel makes clear, no matter how much pain is involved in agonizing over a health care decision, having cancer is worse.

Patient empowerment flag

 

I’ve been carrying the patient empowerment flag in my work as a health care communicator for over 25 years. Usually stories of medical paternalism make my heart race in anger. But the searing self-blame here made my heart stop in sadness.

What’s needed here is a little compassion. Much has been written about the power of physician compassion in health care.  There is far less about self-compassion in health care. Patients will need more self-compassion for the inevitable mistakes (or non-mistakes, in Ms. Wurtzel’s case) that will be made as they take the helm of their health care management.

So for those of us health communicators cheerfully prescribing patient empowerment to patients, it’s time to add a dose of self-compassion on the side.

4 Ways to Become an Activist Pharmaceutical Brand

Yesterday I wrote about consumer’s increasing expectations for brand activism in a post entitled, “Tough Times for Timid Pharma Brands.” In a nutshell, many progressive consumer brands outside of the pharmaceutical industry are increasingly taking stands and acting on social issues.

So why should a pharmaceutical brand manager care about this trend?

Because according the Edelman’s 2014 BRANDSHARE report, consumers are more likely to purchase, recommend or defend a brand if they perceive the brand is meeting an important societal need. Consumers are also more likely to engage with the brand, sharing personal information and forwarding branded content. And Millennials aren’t the only ones with high expectations of brands.  Edelman found that consumers across all demographic groups are looking for companies to be a force for positive change in the world.

Brand Activism: What’s a Pharmaceutical Brand Manager to do?

So consumers want brand activism and there is a real business value in providing it. So how does a Pharmaceutical Brand Manager meet consumer needs for increased brand activism?

  1. Start talking about something other than your brand.  Engage in Content Marketing. Content Marketing is defined as “a strategic marketing approach focused on creating and distributing valuable, relevant, and consistent content to attract and retain a clearly-defined audience — and, ultimately, to drive profitable customer action. I detailed a few ways to get started using Content Marketing in my blog post “Building Great Brands byTalking Less About Them.”
  2. Partner with a governmental or NGO on issues that are important to your customers, whether they be payors or patients. For example, both patients and payors are interested in using big data to understand more about individual health risks and to improve the patient experience. There are many organizations such as PatientsLikeMe or 23andMe that have teamed up with pharmaceutical companies for research purposes, from finding the genetic basis of diseases to better understanding the real world concerns of their patients.
  3. Clean up your therapeutic area’s digital environment. There is a lot of garbage out there, much of it dangerous to patient health. How about assembling experts in your therapeutic area to weigh in on the most egregious misinformation?  A a digital clean up day of sorts.
  4. Sponsor a healthy debate. Consider obesity. There are those who feel pharmaceuticals have no place in the treatment of obesity. Obviously, pharmaceutical companies who sell medications for obesity feel otherwise. A debate between two reasonable experts in some sort of public forum would be newsworthy and garner much “earned media.” People’s deeply felt views won’t change, but you may convince people sitting on the fence that treating obesity with a pharmaceutical product is the way to go.  Plus your brand will gain added credibility for being open enough to debate the issue.

Certainly, undertaking brand activism is not a “set it and forget it” kind of tactic. But as consumers take an increasingly larger role in health care decisions, it will be increasingly important to incorporate their evolving views on brand activities into your marketing plan.

Tough Times for Timid Pharmaceutical Brands

Tough Times for Timid Pharmaceutical Brands, picture of pill and capsuleConsumers demand more outwardly focused brands

Consumers, driven by mindful Millennials, are demanding that brands take a stand on social issues. It is no longer acceptable for brands to look at the messy world and say, “Not my job!” Certainly Pharma brands are more constrained by consent decrees and regulations. However, that won’t stop consumers from saying, “Not my problem,” when it comes to demanding more from their health care brands.

According to one of my favorite trend spotters, Trend Watching winning brands will start contentious, painful and necessary conversations.”  That means going beyond product claims and bland unbranded campaigns to talk about polarizing topics. Take Starbucks, which recently jumped into the fray about race relations.  One example with particular relevance to Pharma is Pantene India’s campaign that asks consumers to point out ridiculous claims made by beauty products that don’t work. How about Pharma pointing out the ridicules claims made by nutraceuticals?

Picture of Pantene India campaign

Talk is necessary, but not sufficient

But talk is not enough. Today’s consumers demand action. Describing their “Branded Government” trend, Trend Watching boldly pronounces 2015 as “the year for progressive brands to initiate, undertake or support meaningful civic transformation.”

One example of this Private-Public Partnership is the WAZE traffic app’s Connected Citizen’s partnership that exchanges data with local governments around the world with the aim of improving traffic patterns. And it is not just new school companies taking civic action. Volvo is partnering with the Swedish Government to create roads that can charge electric vehicles.

Waze Connected Citizens Campaign

Brand Activism: What’s a Pharmaceutical Brand Manager to do?

Certainly there are enough unmet health needs for Pharma to partner with government to make people healthier. What about a weight loss brand teaming up with local government to promote better eating habits? This initiative may also seem less self-serving, because if successful, the campaign would slim down the market for the prescription weight loss products.

To health care purists, branding has no role to play in the choice of a pharmaceutical product. The product should be chosen based on efficacy, safety and increasingly, price. However in practice, physicians often have 2-3 brands they feel are interchangeable. In categories such as Multiple Sclerosis, HCPs often let the patient chose. Why? Because then the patient has skin in the game.

In addition, research conducted early in the DTC era, found that patients who ask for and are given a specific brand are more likely to be adherent compared to patients not making a request. So to me (admittedly not a health care purist), branding is more likely to be beneficial than harmful to patients.

No more navel gazing for Pharma

Picture of navel caption No more navel gazing for Pharma Marketers

So it pays to do it right. And paradoxically, in today’s socially conscious environment, good branding involves talking less about the product and doing more in the world. No more navel gazing! The key to building great brands, is to talk less about them. The old axiom, “actions speak louder than words” is today’s branding rallying cry!

For ideas on how to apply this trend to your pharmaceutical brand, check in tomorrow for my next post, “4 Ways to Become an Activist Pharmaceutical Brand.”

For Breakthrough Health Care Communication, Try a Visual

 For breakthrough communication, add a visual

How one picture turned the tide against obesity

For most people who read the New York Times article, “Americans are Finally Eating Less”, there was exciting news about the fight against obesity. But for alert pharmaceutical marketers, the article contained the key to changing patient behavior: an effective visual!

While study after study had described the magnitude of the obesity problem, it wasn’t until a researcher put up a set of bright blue maps did people begin to grasp the magnitude of the problem. These maps graphically depicted the dramatic rise in obesity rates in all 50 states from 1991 to 1998.

Power of visual

The article points to the blue map visual as sparking the turning point in the fight against obesity. In the article, Hank Cardello, senior fellow at the Hudson Institute, is quoted as saying “People became more aware of it in a very visual and impactful way… That created a lot of attention and concern.”

An underused tool in pharmaceutical communications

In Pharmaceutical marketing, each word directed at the patient is scrutinized endlessly. Visuals or videos are often an afterthought, if they exist at all. While Pharma has embraced the concept of health literacy, its execution has been incomplete, with a narrow focus on grade level.

But visuals are critical to driving health behavior change. For example, in one instance with a low-literacy population at particularly high risk for pneumococcal infection, the group that had viewed a simple visual communication aid was five times more likely to have received the pneumococcal vaccine than those who had not received the visual education tool.

Not just for low literacy populations

But it is not only the low literacy population that gets more out of visualization. Consider Cisco, a world leader in IT, which found that 96% of its customers watch videos for business.  So Cisco started creating videos, over 1,000 new videos a year.

And visualization doesn’t have to be expensive. According to Cisco’s Leslie Drate,“it doesn’t really matter how much we spend on producing the video. The results for what we spend $100,000 on could be similar to what we spend $1,000 on. It just has a lot to do with content and audience.”

                                 Picture Source: Movie CLIP

So to paraphrase the famous phrase from the movie The Graduate, I want to say one word to Pharma marketers responsible for changing patient behavior. Just one word, Visuals!

To meet patient’s need for speed, Pharma needs more lawyers

What kind of crazy talk is that? Everyone knows that it is the legal and regulatory teams and the whole review committee process that keeps Pharma moving at a lugubrious pace. Certainly that’s the biggest excuses I hear for why patient complaints languish in the blogosphere or why websites aren’t updated on a regular basis.

It can’t be the shear size of the pharma organization that slows decision-making. Larger companies have shown they can be nimble when it counts. Take Apple, the largest company in the US and how their rapid fire response to the Taylor Swift incident. It took Apple less than one day over a weekend to reverse a policy about paying royalties during the Apple music trial period. And Apple’s senior vice president of Internet Software and Services, Eddy Cue, communicated it simply with a tweet.

Moving faster requires real teamwork, the type of teamwork highlighted in Fortune magazine’s recent profiles of the small teams within big companies like Nike, Starbucks and J&J. And it is shared goals that fuel these integrated teams’ stellar performance.

In my opinion, Pharma’s sluggishness comes down to the antiquated brand team structure. Most teams are comprised of three marketing sub-teams (HCP/Patient/Payer) overseen by a legal/regulatory/medical review committee with an entirely different reporting structure. Operating in siloes, these different departments often have different, and often, conflicting goals. The legal and regulatory departments are charged with protecting the company and the brand marketers are charged with growing the business.

But what if the Pharma brand team was a fully integrated team—with marketing, legal and regulatory all aligned around improving patient outcomes?

More crazy talk! What if reviewing patient comments, whether online, over the phone and deciding how to respond, was a daily job shared by all? What if lawyers attended focus groups? How about the regulatory team member meeting with patients at an advocacy event? What if everyone was co-located? What if marketing/legal/regulatory acted as a unified SWAT team dedicated to listening, responding and creating new ways to improve patient health?

For the SWAT team concept to work legal and regulatory colleagues must function as full members of a brand team, not just as a panel of judges at weekly review committee meetings. That’s where the idea that Pharma needs more lawyers (and regulators) comes in to play. Moving faster means brand teams should include marketing, legal and regulatory expertise to make decisions on a daily, if not hourly basis.

With consumer expectations regarding company response time rising across all industries, speed needs to be the rule in Pharma rather than the exception. And contrary to expectations, moving faster requires ongoing, rather than foregoing legal and regulatory input. Simply put, Pharma needs more lawyers (and regulatory experts) to move at the speed of patients.

Three Prescriptions for Patient Centricity

Patient Focused. Patient Centric. Patient First. There are lots of buzzwords companies use to describe their aspirations for a new focus on patients. But as my 8th grade Latin teacher once told me,

“The road to hell is paved with good intentions.”

Whatever phrase your company uses, here are three prescriptions on how to “walk the talk” of patient centricity in 2015 (and avoid a dance with the devil):

1. Fully infuse the voice of the patient into drug development. Historically, patient marketers are among the last to join pre-commercial or even launch teams. To be more patient focused, teams need to be staffed with patient experts early in the game.
And once in the game, these patient marketers should make development of customer service and adherence programs the first order of business. As payers and patients have to increasingly make cost/quality trade-offs, it will be critical that marketers can prove that their patient services actually make a difference in adherence rates, patient experience and clinical outcomes.
In fact, patient services already a factor into 3rd party purchase decisions. For example, according to a Duke physician I heard speak at a conference, Eliquis was chosen over competitors because the brand had the strongest co-pay assistance program.
Or just listen. Patients in clinical trials are already shaping opinions of the drug through their online conversations. An extrovertic social media analysis found an average of 30,000 patient conversations taking a place every month by patients involved a clinical trial.

2. Partner with providers and payers to meaningfully improve the patient experience at the point of care. HCPs, Integrated Delivery Systems and Payers are going to be judged on outcomes and patient experience. Pharmaceutical companies have the know-how and resources to help their customers meet the triple aim of improving patient experience, lowering costs and driving better outcomes. Take a look at all the governmental metrics requirements and pick a few to partner on.
It will also be important to have an expansive definition of point-of-care, both in terms of place where care happens and the people who provide the care. Care is now being highly distributed, it’s happening at home, at the retail pharmacy, at work, at Costco and at urgent care centers. And with the looming primary care physician shortage, care will be increasingly be delivered by nurses, physician assistants and even lay health workers.
And let’s not forget the increasing role patients are playing in their own health with the explosion of wearable technology and the whole quantified-self movement. The point of care is now everywhere and the smart pharmaceutical marketers will be conducting pilots to figure out how they can add to the patient experience.

3. Adopt a cross-channel patient experience framework to conduct marketing activities. A good patient experience is one that is consistent throughout every interaction, whether it be through a website, a phone call or in person meeting. Many of these touchpoints are managed by different functions in a pharmaceutical company, yet to the consumer it all comes from the same company. So the company has got to start acting like one company.
And this one organization needs to be reoriented towards driving patient satisfaction rather than driving sales. Driving satisfaction doesn’t mean revenue generation takes a back seat. A whole body of literature supports that higher customer satisfaction scores result in higher sales and profits, in industry after industry.
But first the voice of the patient needs to be heard. This will require an integrated system of collecting patient feedback in a way it can be acted upon. For example, how well is the medical information call center doing in meeting patient needs? I would guess most marketers don’t know.
So take these 3 Rx’s and make 2015 the year that pharma companies turn patient centric talk into action. (And Mr. Riggs, I really did “disce diligentius.”)

The #Powerof1Million changes everything

Last week, I got an email from 23andMe announcing that they had “genotyped more than one million people worldwide,” and that I was number 85,552. Big news for a company that has weathered a lot of ups and downs, particularly in November 2013 when the FDA demanded that they stop providing health information.

As number 85,552, I had signed up prior to the health information shut down, so I was privy to my health information. Luckily, as it turns out, my health information didn’t contain any earth shattering news. My ancestry results however were a big surprise.

Even with my unexpected genealogy results, my 23andMe results didn’t have a big impact on me personally. However, professionally, as a health care communicator, I believe that the fact one million consumers are willing to be genotyped is a big deal.

As their press release states, “Today, 23andMe has the world’s largest database of re-contactable individuals who have consented to participate in [genetic] research.” Talk about empowered consumers.

And 23andMe is just one of the many emerging services and products aimed at putting more health information into the hands of consumers. Consider the Scanadu Scout, a device that sends blood pressure, heart rate, temperature, and blood oxygen levels to a consumer’s iPhone.

I believe that the colossal amount of health information now available to consumers ups the ante for health care communicators in three ways:

The ability to explain complex health information in simple ways is even more critical than ever before. Having a commitment to health literacy built into a company’s DNA will be the cost of doing business in our data rich world.

Factoring in the consumer’s emotional increases in importance. Understanding the impact health information can have on a person’s emotional state can be the difference between effectively communicating and sending a consumer into a downward spiral of fear and confusion.

Helping consumers turn knowledge into action is vital. Providing concrete next steps to help consumers act upon what they have learned turns reams of data into potentially lifesaving information.

As health care communicators, our ability to help consumers process the avalanche of health care information coming their way can make a real difference in people’s lives. For a robust understanding of what is coming down the pike, read Eric Topol’s latest book, “The Patient Will See You Now.” The book is a veritable canon on the trends in personalized medicine. As 23andMe’s #Powerof1Million announcement makes clear, the future is closer than we think.

My Madeleine Albright Moment

I signed up for 23andMe a few years ago for professional reasons. This was before November 2013 when the FDA told 23andMe to stop providing health results. As a health care marketer, I admired how the company’s whimsical pink and green infographics made genetics both appealing and understandable.

When I mentioned to friends that I had signed up, many said that they wouldn’t want to know if there was some disease lurking in their genetic code. I’ll admit that a chill went through my body as I thought, “What if I find out something really bad?” Luckily, my repressed WASP upbringing allowed me to shelve any looming unpleasantries in the back of my mind.

When the 23andMe test results came, nothing really bad popped up. My results weren’t that earth shattering and made sense based on my family history. I was higher risk for Venous Thromboembolism (VTE) and Atrial Fibrillation.

At the time, I largely ignored the ancestral results. They were pretty lame, telling me what years of sunburnt skin told me: I was 99.9% Caucasian. As for country of origin, I knew that I was a U.K. mutt with a small German streak.

Several years went by, and 23andMe continued to email me with updates. One day in April, I happened to click on one all the way through to the ancestry data.

And that was when I had my Madeleine Albright moment: 19% ASHKENAZI.

When my mother was later tested, it revealed that she was 49% Ashkenazi, totally unbeknownst to her. We hypothesize that my maternal grandfather, Irving Crook, was probably Jewish. He came to America from England when he was 6 months old. But that didn’t mean he was of English descent. England was most likely just a stopover for his Eastern European parents escaping persecution. We will probably never really know, and most likely Irving didn’t know either.

How does this change my life? Not much. I still sing in the church choir and help organize our annual Fish & Chips dinner. However, the bigger question is what impact did my health results have on my behavior? The biggest change is that I now get up during long plane rides to help prevent blood clots, something everybody should do anyway.

I recognize that for many people, the 23andMe health results can have major consequences. Had I gotten more devastating news, it could have sent me down a rabbit hole of unnecessary, expensive and potentially dangerous medical testing. As Atul Gawande says in his recent Yorker article, “Overkill”, “Millions of Americans get tests, drugs, and operations that won’t make them better, may cause harm, and cost billions.” I also realize that not everybody is equipped to deal with bad news like Angela Jolie, who upon learning she had the BRCA gene, chose prophylactic surgery.

But despite these caveats, I think the author of “The Patient Will See You Now”, Eric Topol is right, the personal data genie is out of the bottle. In the opening pages of his book, he makes the following bold statement:

“We are embarking on a time when each individual will have all their own medical data and the computing power to process it in the context of their own world. There will be comprehensive medical information about a person that is eminently accessible, analyzable and transferable. This will set up a tectonic power shift, putting the individual at center stage.”

It is true that our health care system with its practice of defensive medicine and misaligned economic incentives has the power to distort good data into bad unintended consequences. This fear drives the cry for a more measured approach to personal health data transparency. We end up like the little Dutch boy with his finger in the dike, trying to hold back the flood of health care information.

However, the time and effort is better spent helping this free flow of personal data transform our flawed health care system into a more patient oriented system. That’s why education and good health care information are even more critical going forward. Don’t withhold information, teach people how to deal with it.

Overcoming the DTC Fear Factor

FDA gets on the “Less is More” bandwagon

The “Less is More” approach is gaining traction in health care. Fear is what often causes people to gird themselves with potentially unnecessary health care interventions: fear of getting it wrong, of missing out, of being criticized, of dying. Atul Gwande details the bravery required to challenge the medical status quo in his recent book Being Mortal. Gwande does a great job of debunking the myth of “more care is better care” when it comes to end of life treatment.

Now “Less is More” is being applied to health care communication. The FDA is overcoming the DTC Fear Factor and casting aside unnecessary risk information with the intent to drive superior patient comprehension. The FDA has issued draft guidelines that require less, not more, risk information in the Consumer Brief Summary portion of DTC print ads. PharmaGuy provides a comprehensive (and as always, entertaining) review of the proposed guidelines in his February Newsletter.

But the FDA is not using the editing pen wily-nilly. Knowledge born of research, is taking the edge off of their DTC Fear Factor. Upcoming research includes a study on the risk information presented in television ads. The objective is to see whether listing only the most actionable risks leads to better comprehension than the usual mind-numbing laundry list.

Certainly the FDA has reason to fear getting the level of risk information wrong. As Daniel Carpenter, a Harvard professor who studies the FDA posits in a Health Affairs article, the FDA is driven by it’s “desire to safeguard its reputation for protecting the public’s health.” The FDA’s “Less is More” approach certainly has its critics. Public Citizen criticized the FDA for its proposed August ’14 guidelines on how pharmaceutical companies should present risk information to physicians

This new “Less is More” approach to risk information demonstrates that the FDA is willing to undergo reputational risk to do the right thing for patients by presenting the information in a way patients can understand and act on. There is substantive evidence that links lack of patient understanding with negative health outcomes.”

So what is the likelihood of pharmaceutical review committees embracing the “Less is More” philosophy regarding risk information? Certainly the new review FDA guidelines will help, but as anybody who has sat through a review committee meeting can tell you, there is wide latitude in how FDA guidelines are interpreted. Many opt for the most conservative approach.

My guess is that review committees won’t get over their DTC Fear Factor anytime soon. There is just too much reputational risk. And it is hard to blame them. The media’s knee-jerk reaction is to attribute any misstep to a nefarious motive on the part of Pharma.

Overcoming the DTC Fear Factor will require Marketing Departments to do the hard work of proving that using fewer and simpler words to describe a product or disease state results in better comprehension. Just as the FDA Researchers helped their Reviewers get over the DTC Fear Factor with data, Pharma marketers will need data to bolster the courage of their Review Committees with solid research.

However, conducting research brings along its own “Fear Factor.” What if the language causes consumers to overestimate the efficacy or underplay the risks of the product? So why bother? In the past, trying to boost outcomes by improving communication comprehension was a “nice-to-have,” despite the compelling health literacy case.

But now, the Affordable Care Act makes reimbursement dependent on outcomes and patient experience. So ensuring patient comprehension is critical to the financial viability of Pharma’s direct customers: physicians, hospital systems and health plans. So follow the dollar. Customers care, so pharma marketers should care too.

Complexity is easy in Pharma communication, just go to the label. Eliminating the DTC Fear Factor in Pharma will take hard work. However, in health care, the “Less is More” train has left the station. Time to put fear aside, join the FDA and jump on the “Less is More” bandwagon.