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.

Tom Brady and Atul Gawande: Designing a Different End Game

Tom Brady and Atul Gawande, two Bostonians with wildly divergent careers, both take the same approach to designing a different end game; they flout the conventional wisdom to achieve their objectives. For marketers wanting to change the trajectory of their brand, company, industry or career, these two prominent Bostonians show the power of doing things differently.

Tom Brady, the New England Patriots quarterback, has always been vocal about wanting a different end game, one that would keep him playing high-level football in his 40’s. So according to a recent New York Times Magazine article, Tom defies conventional training practices designed at building strength in favor of those that create more pliable muscles. He credits his unique training practice with sparing him from career ending injuries, ultimately enabling him to win 4 Super Bowls (so far).

Atul Gawande, Boston surgeon and best selling author, challenges the more medicine is better medicine dogma that runs deep in our American cultural veins. Gawande addresses the literal “end game” in his best-selling book Being Mortal, to propose a radical new approach on appropriate care in our last years. Rather than doing everything possible to ensure maximum patient safety and longevity, Gawande contends that instead, a doctor’s role is to ensure that people leave this earth in a way that respects their values and priorities.

To do this, physicians and family members need to understand what constitutes quality of life from the patient’s point of view. In one example, Gawande tells of a daughter’s surprise at her father’s definition of quality of life as “being able to eat chocolate ice cream and watch football.” Her father had been a professor emeritus so she assumed he would not have wanted to live unless it was as a fully functioning intellectual. It was this knowledge that helped her make an entirely different choice for her father when faced with a life and death decision by her father’s surgeons.

I wasn’t so lucky with my father. The idea that more medicine, more effort, is not always appropriate was a totally foreign concept to me for most of his illness (and most of my life). So the poor guy cycled in and out of the hospital to rehab a number of times, getting weaker with every visit. By the time a palliative nurse friend of mine, helped me to see the light, it was too late. Having made the decision to bring him home after our post-dinner talk, I received a call the next morning that he had died in the Rehab institution.

While I can take comfort that my father seemed to enjoy all the attention he received at the Rehab facility, I often wonder if he would preferred a different ending. With my 88-year old mother, I have an opportunity not to make the same mistake.

The lessons of Gawande’s Being Mortal and Tom Brady’s historic Super Bowl victory transcend their individual career choices. Their work is testament to the truth of Einstein’s definition of insanity–doing something over and over again and expecting a different result. These two different men offer the same valuable lesson about the need to challenge the status quo to achieve a different result.

In the pharmaceutical industry where my company, extrovertic, does most of its work, there is a lot of organizational dogma about how to drive sales. It includes “HCPs write prescriptions, not patients,” or the time honored “the sales representative call is the best way to reach physicians.”

I know a lot of talented and progressive marketers who are confronting these doctrines on a daily basis. It’s hard work to be the one constantly going against the grain. But the experiences of Tom Brady and Atul Gawande are proof that a successful end game is worth the fight.

Scrap the core vis-aid, it’s a patient-payer world

This is the twelfth and final blog post in a twelve part series that transforms ideas from the marketing world at large into practical plans for pharmaceutical marketing in the time of health care reform.

There’s a strong patient and payer bent to the topics I chose for this blog series. That’s because I believe we are coming to the end of physician marketing, as we know it.

From now on, it’s going to be a patient-payer world.

There will of course be communication to physicians. But rather than providing 20 glossy pages parsing minute differences between drugs, I believe promotional efforts will increasingly revolve around improving the patient experience, outcomes and costs. And payers, not physicians, will be the primary arbiters of what constitutes acceptable results at a good price.

In the future state, there will be virtually no “work around” solutions for products that don’t have a real value story.

And I am not alone in my views. At a Marcus Evans conference I attended,

Kurt Graves, CEO Intarcia, said the decision to launch a product now comes down to one question, “Is there enough value in this product for payers to pay for it.”

Physician marketing will also have to change, according to Steven Pal, Corporate Vice President, Global Strategic Marketing at Allergan. In his Marcus Evans talk, gone says Pal, are the days of the large mass-market field force. Instead, companies need to deploy, “smaller, more agile sales forces that are more attuned to customer needs.”

Patients will be at the forefront of any value equation in the future. In fact, according to Ben Haywood, co-founder of PatientsLikeMe, it will be patient value that defines market value, His company is helping industry incorporate relevant patient reported outcomes (PRO’s) into their drug development efforts.

Patients are finally getting the information they need to assess the price/value equation for the healthcare services they consume.  The Health and Human Services Secretary release of the irrationally variable costs for common in-hospital procedures was a first good step. Across the country, the public’s eyes have been opened to the need to price shop, given the wide variability, even within the same city.

And quality of services, long held to be outside the ability of most patients to evaluate, is more readily available and digestible. For example, in Minnesota, patients can compare how individual clinics fare in helping patients meet their diabetes management goals.

Pharmaceutical marketing in the future will need a radically different game plan, one that is decidedly patient and payer oriented. Healthcare is evolving as we speak. Substantial change will happen regardless of how the Affordable Care Act, popularly known as “Obamacare,” is implemented. The outsized and often irrational costs of our current system have brought us to the place where the status quo is no longer possible.

As the popular saying goes, “People don’t change when they see the light, they change when they feel the heat.”   Pharmaceutical marketers are now feeling the heat with shrinking budgets and sales forecasts. My intention with this blog series is to provide a little “light at the end of the tunnel” by demonstrating how others have addressed similar problems. Extro-analogs aren’t brain surgery. All you have to do is use the 3 e’s:

  • explore industries beyond pharmaceuticals
  • extrapolate the core idea, eliminating the excuse of regulatory limitations
  • export the idea in a “pharma-safe” way into your marketing

I hope this blog series is helpful in sparking some new ideas and thinking. Let me know! Love to hear your comments. 

Thanks for letting us share,

Dorothy

How to Jay-Z DTC

Learning from the mastermind of media

This is the eighth blog post in a twelve part series that transforms ideas from the marketing world at large into practical plans for pharmaceutical marketing in the time of health care reform.

Can Jay-Z help DTC advertising? (DTC-Z anyone?)

Turns out he can, or at least his promotional approach can be applied to DTC advertising. Jay-Z is a modern day master of media.  When launching a product, whether it be a book or his recent CD, Jay-Z appears to have a three part formula: 1) develop a “talk-worthy” concept; 2) make a big but short-lived splash using traditional media and 3) employ digital and social promotion for the long-tail promotion.

Consider Jay-Z’s recent launch of his new album, Magna Carta … Holy Grail.

  1. Talk-worthy concept: Created a talk-worthy concept of providing his album to Samsung Galaxy owners 5 days earlier than to the general public
  2. High profile media: Launched the promotion in a highly visible, three minute commercial during Game 5 of the NBA finals
  3. Drive to digital: Drove people to the album website where they could download the free app

But the concept is not limited to Jay-Z. Going back a few years, Starbucks used this three-step process during the 2008 election. They used the formula as follows:

  1. Talk-worthy concept: Get a free cup of coffee for voting
  2. High profile media: Run the ad once on Saturday Night Live’s “Election Bash” episode the weekend before the election (Remember Tina Fey’s hilarious imitations of Sarah Palin?). 
  3. Drive to digital: As Howard Schultz says in his book, “Onward” a torrent of digital and social media activity would amplify the 60-second spot.”

 

By creating a talk-worthy concept that is introduced in a high profile way, the brand automatically becomes more relevant to consumers. And relevancy and emotional connections are hard to come by in pharmaceutical marketing these days. Tightening interpretations of the commercial content by the Office of Prescription Drug Marketing (OPDP) make it hard to go beyond the basic product facts and create an emotional connection with a traditional DTC ad.

Without some way to make a meaningful connection, it is hard for a traditional branded DTC ad to be the type of triggering event that can prompt change in a health habit.  A well-placed, high impact communication unbranded communication that really connects with consumers could be an important health care wake-up call. The high profile unbranded splash would serve as high impact “screener” to get the attention of your target customer and make them curious enough to follow through to a branded site.

 

While the high profile splash is expensive, the opportunity to create an on-going drumbeat with digital makes the effort very measurable and affordable. Using this three-step process, extrovertic recently recommended a new product launch plan that relied on one-fifth the advertising expenditures of the brand’s closest competitors.

So how could this be exported for use to a pharmaceutical brand? Consider the straightforward Astra Zeneca Crestor print ad running in major magazines. A picture of a doctor asking the question, “Is your cholesterol at goal?”

How much more attention would Crestor get if they associated the product with the broader concept with setting and reaching goals and introduced the effort in a high profile sporting event followed by a deep digital push? (The winter Olympics will be here before we know it!).

So here are two thought-starters on how to export this idea to your DTC efforts:

  1. Scour your brand for relevant hooks and events. What relevant anticipated governmental or healthcare organization announcements coming up? Can you link your brand to the news in a meaningful way?
  2. Have your agency cost out a media splash/digital long-tail type of plan. Can you save money and increase impact?

Check back on Thursday for the ninth post in the twelve part series3 ways to take your marketing to the street.” In this post I explore how hospitals and payers are making their services more accessible to patients and how pharmaceutical marketers can get on the retail bandwagon.

Thanks for letting us share,

Dorothy