• Obesity
• Addiction
• Lung cancer

Without ever conducting this poll, I am reasonably certain that the results would be overwhelmingly in favor of cancer. Why? Because a great number of respondents, if not all, would say that cancer is a terrible disease, which it is; few will ever deny that fact. In contrast, the other 2 illnesses are considered by many to be self-inflicted, created and perpetuated by the person. Although this may be the popular point of view, it is wrong.

Despite growing recognition of it as an important international health problem, addiction suffers neglect from clinicians, researchers, and the pharmaceutical industry. This is largely because addiction is viewed as self-inflicted and caused by personal weakness.

More than 72 million people in the United States are obese. More than 30% of US adults and 16% of US children are obese. According to the Centers for Disease Control and Prevention (CDC), the medical cost of obesity may be as high as $147 billion annually. This is almost 10% of US medical spending. Are all these people weak of will, or are they actually sick?

The National Cancer Institute says on its website, “Lung cancer is the leading cause of cancer death among both men and women in the United States, with 90 percent of lung cancer deaths among men and approximately 80 percent of lung cancer deaths among women attributed to smoking.” Whoa! Does that mean that over 80% of all lung cancer deaths are self-inflicted by the act of smoking, which, by the way, is a common behavior brought on by an addiction to nicotine? Let us take this 1 step further. Ask smokers who have tried to quit smoking what happens to their weight; it often goes up, and for some that weight never comes off. Some former smokers gain so much weight that their BMI classifies them as obese. These 3 therapeutic areas are so interrelated that it is difficult to see where one begins and the others end.

My point is that the public has preconceived ideas of which disease states should be given the most support and which patients the most sympathy. The idea that any person who is suffering from a disease or disorder should be viewed as a second-class citizen because of etiology is illogical. Illness, no matter what its origin, is devastating to patients, their families, and society as a whole. We must recognize that the cause of disease or illness is irrelevant when considering the need to devote time, energy, and funding to its study and treatment. It is time to view these and other diseases as preventable—and not self-inflicted—for no other reason than it is the right thing to do.

At Brandkarma we have instituted the 80/20 rule, and no, it’s not the Pareto Principle, but rather our client communications principle of 80 percent listening and 20 percent asking the right questions. We often record client calls (with their consent) to see what percentage of time we are listening vs talking. I recommend going through that exercise. It can be enlightening!

Another important point the Heath brothers make is the logical mind often gets lost in its own short-circuits. If it does, no decision gets made, or emotion wins out. The emotional mind as elephant and the logical mind as elephant rider is a simply brilliant metaphor for how we make decisions.

I like to think that in our world of marketing we are here to help people make decisions. Let’s create an industry-wide experiment. Let’s pioneer the notion of putting the emotional benefit first for pharma products. Let’s see if we can generate more choices that benefit our products and patients. I know these approaches don’t always show strongest in market research, but you have to get the research right to know you are going in the right direction. If you ask research questions that are logical, the logical mind will answer. But we know which beast is really stronger.

Thanks Heaths. You are making human behavior clear utilizing the power of story.

Numerous times, my firm has been given the task of marketing products that should succeed on a rational level, but are simply adopted slowly. What’s wrong with them? What’s wrong with people? Most of the time, for us, it’s the doctors’ behavior we are questioning. This is where the mob mentality comes into play, but it is the REVERSE of what we would normally think. This is how it seems to work: “Because I don’t see or know many people using this product, I won’t either. Even if I feel it may be a good product, I must be wrong or everyone would be using it.”

Few of us want to be the early adopters or the first to do anything that might embarrass us. Think about it: doctors did not always wash their hands before surgery or create a sterile environment to work in. Somewhere along the line, people caught on and the mob turned in our favor. Imagine the first time clinicians were told that bloodletting was not effective. They probably thought the suggestion was preposterous! The way that others respond to or perceive a particular situation or product significantly impacts our actions and attitudes.

However, it’s getting harder to defend pharma when it comes to “me-too” drugs. “Me-too” drugs are pharma’s version of a bandwagon. One company finds a drug that treats a disease, and suddenly ten other companies are developing something similar. This happens for two reasons: (1) to get a piece of a large pie, or (2) to soften the hit when a blockbuster goes generic.

My Piece of the Pie: A good example of this is the TNF alpha inhibitors. Enbrel, Remicade, and Humira each had sales of over $3 billion in 2007. Big pie! However, many would argue that their efficacy, safety, and tolerability profiles make them, essentially, similar.^† Many people though, including me, do not consider these classic “me-too” drugs; both Remicade and Enbrel were approved in 1998 and Humira in 2002. The novelty of biologics provided some latitude for close follow-on drugs in the early days. Recently, two new TNF alpha inhibitors have been approved: Cimzia (2008) and Simponi (2009). These new entrants will need to show some practical improvement over existing treatment options, or they will likely suffer the “me-too” curse. No one wants to be the next Bystolic, which was the 19th beta-blocker to be approved by the FDA (2007) and averages about $20 million in yearly sales.

Patent Extender: Pristiq was approved in 2008 as a treatment for major depressive disorder, which made it the 367th drug available for this indication.^‡ What’s Pristiq? Pristiq is desvenlafaxine, which is the active metabolite of Effexor. Pristiq is what Effexor is thought to become in the body that makes it work in the brain. Wyeth, now Pfizer, wants to protect the Effexor franchise (sales of $3.8 billion in 2007 and going generic in 2010) and did so by creating a drug that is essentially Effexor but can be sold at a premium price. It hasn’t worked out too well. Pristiq sales numbers have been much lower than hoped for, regardless of the company’s spin. Here is the juicy part: Pristiq’s original lead indication was to treat menopausal hot flashes and night sweats. This would have made it a first-in-class drug, but poor clinical trials forced Wyeth to go to the back-up plan.

Patients and insurance companies are not going to pay for a branded drug that provides little incremental benefit compared with a generic. Outcomes research will allow drugs once destined for “me-too” status to differentiate themselves in ways that will convey a sense of utility to all key stakeholders. This is one way that comparative effectiveness will have a significant impact in shaping the future of health care.

*http://www.cbo.gov/ftpdocs/76xx/doc7615/10-02-DrugR-D.pdf.
†Some patients will respond to one and not another, but, in the bigger picture, differences are minimal.
‡Yes, I’m kidding. Only 14 drugs are approved for MDD.

• NPR recently reported on doctor “speed-dating” at a Dallas-area hospital.  This practice is gaining traction: patients appreciate being able to vet practitioners quickly and in one shot, and physicians are grateful to have help growing their practices. The hospitals say they do it because it’s good business for them to make the docs’ lives easier — something every successful pharma marketer knows.
• An opinion piece in the LA Times sees a physician lamenting all the choices available to her in prescription drugs. It can get overwhelming: “…having options isn’t always all it’s cracked up to be. Often an obviously ‘best’ choice doesn’t exist.”
• This one has been bookmarked for a while: a fascinating article in Wired last summer about how the placebo effect is gaining strength (and why that’s bad news for the pharmaceutical industry).
• Perhaps we need placebo “chill pills” for worried parents: a new study finds that parents have a much darker view of their children’s health than the kids themselves do. While the ‘rents are sure their child’s quality of life is suffering (because of epilepsy, in this case), Junior is focused on the now, worrying about the things kids worry about: tomorrow’s math test, tonight’s Little League game, and OMG, is that a zit!?

At Brandkarma, we approach every situation with a client like a doctor approaching a patient. The foundation of medical practice, regardless of your specialty, is a good history and physical (H&P) examination — or what the advertising industry calls the research and discovery phase. With every patient, whether new or existing, doctors take a good history of what’s going well and what’s not going well. Then we conduct a thorough physical exam with other diagnostics that will lead us to a diagnosis.

When a client comes in with a very specific complaint or issue, at Brandkarma, we always try to conduct a thorough H&P. Once we come up with a diagnosis of the problem, then we formulate a treatment or solution.

Why can’t the pharma world put data in its place?  Why can’t they focus on the reason to believe the story, and not just the story itself? “Now more than ever” (I like to quote myself), we all need a good story to break through the clutter in our daily lives. Why should a healthcare professional listen to blah blah efficacy of X percent more than blah blah with side effects including: heart failure, inability to operate heavy machinery, possible thrombosis and halitosis? Wouldn’t they be more likely to respond to the positive story we can tell about what a product can do for a patient’s life? Or how our service makes life easier—even if the life in question is the healthcare provider’s?

Regulations aside, I say it’s worth fighting for. Heck, I do it every day!

Agencies used to tout their expertise in specific areas like advertising, promotions, medical education and public relations. Nowadays, agencies identify themselves as being communications experts—implying that they have expertise throughout the communications spectrum and across all channels. I see the lines increasingly blur as agencies try to expand their expertise just to grab a bigger slice of the pie. How many agencies can truly achieve broader expertise? Or is it just smoke and mirrors?

What makes a communications expert? I suggest it’s about having the right talents represent your agency and then focusing on certain areas as your core competencies. Be specific and not vague like those following the current trend. Being communications experts means you have to bring a diverse group of people to the table who can legitimately discuss everything from branding to strategy to advertising and promotions to public relations to medical to market access to public affairs and more. You can see that the list is long, and for those who call themselves communications “experts” it is necessary to understand what they can really bring to the table, or else you will do your own business a disservice.

So, the issue isn’t that this new era of communications doesn’t exist; it’s a matter of whether your agency can meet the challenge—and, ultimately, your needs. You must ask the right questions of your agency and peel back the layers to understand what they are really experts in—agencies will always say they can do everything. Look beyond the obvious and make sure your agency fulfills the role it promises.

However, no matter how smart the scientists were who developed this cure, no matter how well it worked in clinical trials, this miracle of modern medicine is 100% ineffective if the patient does not swallow the bloody thing.

Now, this scenario is an exaggeration, but the actual truth is not so far-fetched. Some studies estimate that 50% of all patients with chronic obstructive pulmonary disease (COPD) do not follow their treatment as prescribed. As a result, millions of patients do not get the maximum benefit of medical treatment, resulting in poor health outcomes, lower quality of life and increased healthcare costs.

So, whom do we blame? It is not just the patient who should bear responsibility for the non-adherence (aka non-compliance) epidemic. A closer look reveals that there is considerable culpability to go around and some of it lies in the laps of healthcare professionals. If we want to improve on this situation, we need to educate, communicate and empower our patients.

Educate - Many patients have a poor understanding of their disease state, and this may translate to an under-appreciation of the need for full adherence to treatment. Patients need a working knowledge of the disease process in order to crystallize the importance of treatment.

Communicate - Improving two-way communication between healthcare professionals and patients on what is happening—and what will happen—will return positive results. This is when the medical profession is the most valuable, because the patient is at their most vulnerable. Setting proper expectations of treatment, including how it will work and when it may begin to work, is crucial to fostering success.

Empower - Patients are often reluctant to accept their important role in this process, and I do not only mean the physical consumption of medication. Patients need to feel empowered and recognize that they do have some say over a situation that they may believe is totally out of their control. Patients need to feel comfortable about asking questions related to their disease and any treatment that is/will be prescribed. Physicians should welcome this sense of involvement and not automatically think of this as a nuisance.

The noted clothier, Sy Syms, said it best over 30 years ago: “an educated consumer is our best customer.” He was correct then, and his words ring true today. An educated healthcare consumer may ask a few more questions, and even push back a little, but at the end of the day, this informed and engaged patient will see the bigger picture and take their medicine.