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.

Customer Experience: Consistency is key

Recently, I heard a radio ad as I was driving to work about the “spa-like” patient experience of getting a mammogram at my local hospital system. While it sounds like an over-promise, having been a patient there, I can tell you it is not.

My experience at the mammography center started with a warm greeting by a friendly receptionist. I was then whisked away into a spa-like changing room, complete with honey colored wood lockers, thick terry robes and ethereal music floating in the background. The scent of eucalyptus hung in the air. To top it all off, I got a pretty faux-pearl bracelet commemorating breast health awareness month.

But rather than float happily away, I was mad.

My experience with the very same hospital system earlier in the day couldn’t have been more different, in a negative way. I thought, if this hospital system can even make a mammogram pleasant, why was the earlier pediatric appointment for my daughter so maddening? For that appointment, I entered what looked like beige food court in a mall, little booths for each pediatric specialty ringing the room, each manned by a booth lady. Threatening signs dotted the walls cautioning against letting your children bounce on the furniture.

I approached a booth. When I simply inquired whether my daughter’s appointment was for 3 pm or for 2:45 I was told, “I don’t know when your appointment is for, just sit and wait for the doctor.”

Yes, this was the same health system.

The negative pediatric experience overshadowed any good will that surely would have blossomed from the spa-like mammogram. And this is where most patient/consumer experiences fall short: consistency. No one had bothered to think thru the entirety of the journey a patient may have in the health care system. In my case, playing different roles: parent, patient and parental caregiver.

A study by McKinsey & Company of 27,000 American consumers found that consistency is the key to customer satisfaction. The study, which spanned 14 different industries, found that focusing on the entirety of the customer experience rather than isolated events in the journey has the potential to measurably impact customer satisfaction and raise revenues up to 15%.

Given the impressive McKinsey numbers, what is preventing companies from providing a uniformly positive customer experience? In my experience advising companies in health care, it often comes down to one word: silos. Organizational silos prevent a holistic view and tracking of customer interactions across a company. Based on the experience with my local hospital system, it is pretty clear that the Mammography Center and the Pediatric Department do not share much at all.

For Pharma companies, customer experience is increasingly viewed as “the next big thing,” for differentiating products in highly competitive categories like diabetes, hepatitis C and the upcoming battle amongst PSK9 drugs for high cholesterol.

Makes sense. The Accountable Care Act links patient experience to reimbursement, so the traditional pharmaceutical customers­— HCPs, Hospitals and Payers—are now interested in how pharmaceutical companies can help them improve the patient experience. And patients themselves, accustomed to higher service levels in every other aspect of their lives, will begin to expect more from Pharmaceutical companies.

However, Pharmaceutical companies are notoriously siloed. So much so that I even know of one company where two separate customer experience projects were initiated by different departments. So imagine how difficult it will be to get people to line up behind any sort of uniform tracking approach!

Any customer experience or patient centricity effort that does not address the organizational barriers, therefore, is doomed to failure. And as I can tell you based on my experience with my local hospital system, no matter how much you advertise the positives; the inconsistencies will always pull you down.


Purple Cow or Bull in a China Shop?

How to make change stick

A colleague once generously called me a Purple Cow.

I say “generously” because he used the phrase as Seth Godin did, to mean someone/something intrinsically different. As a Pharma marketer, I constantly pushed for new marketing approaches. However, much of the time I tried to drive change, I probably behaved more like a bull in a china shop than a remarkable purple cow.

In fact, the Pfizer Health Literacy principles were launched internally two times because I had not fully involved my marketing colleagues the first time. After the initial launch, less than 25% of the patient literature coming out of my own department adhered to the principles. When even the people you directly supervise refer to a pamphlet written according to health literacy principles as using “dog food language” you know you haven’t done a good job socializing the concept.

As the founding partner of extrovertic, a health care consulting firm focused on delivering innovative marketing solutions, I continue to seek out new marketing approaches. However, I now appreciate the importance of involving others and managing the change process. So extrovertic has enlisted the help of a former colleague of mine, Susan Domotor, an expert in change management, to help extrovertic clients to successfully implement the change they seek to build their businesses.

According to Susan, studies show that business initiatives rolled out with less than adequate focus on the employee aspects of the change have about a 30 – 40% success rate” (Blanchard, IBM). As I found out in rolling out the Health Literacy Principles, this translates into significant amounts of wasted time and money.

Here are Susan’s top three recommendations for getting your colleagues to embrace the change you seek:

1. Create a strong business case – A business case helps people understand the importance of the change, conveys a sense of urgency for what you are trying to achieve, and generates a sense of ownership for a successful transition. A strong business case answers three questions: Why is the change necessary? What is the change? How will we achieve the change?

2. Ensure that Leadership is visibly engaged and is driving the change – Visible leadership support is critical for success and it cannot be delegated because employees will only commit to efforts that are driven by their leaders.

3. Develop a focused Communication Plan – An effective communication plan is critical to influencing employee behavior. The plan must create understanding for the initiative; provide employees opportunities to question, digest, and internalize the change; and as the initiative progresses, celebrate successes, share best practices, and capitalize on opportunities to highlight the performance and behavior that are valued in the new way of doing business. It is important to build the communication plan before kicking off your initiative. You can modify it along the way.

Change is being continually foisted on the pharmaceutical industry. Chances are that no matter what your job function, it now involves change. Whether it is to instill a new patient-centric mindset into your organization or to get your colleagues to embrace multichannel marketing for physician outreach.

Lucky for me (and patients struggling to understand health care information), my colleagues gave me a second chance. After the re-launch, over 95% of the patient pieces produced met the Pfizer Health Literacy Guidelines. But with a strong change management plan, you don’t have to count on being lucky, just being prepared.

Data is king but emotion rules

Seems every other article on marketing I read says data is king, but if you want your brand to be differentiated, you have to get emotional. While the basic tenets of “brand building 101” requires generating both rational and emotional insights, the emotion I am talking about here is different—it is about letting yourself get emotionally involved.

As business people we are taught to prize distance and rational thought. But my experience working on a Hepatitis C brand taught me that allowing yourself to get emotional generates uncommon insights and that these insights are what power brand differentiation.

Here are three ways to start the differentiating sparks flying.

First be willing to explore your hunches. Trust your gut. My client had a hunch that understanding what Hepatitis C patients went through to overcome their addictions would generate uncommon insights. About 50% of Hepatitis C patients have experience with intravenous drug use. So we conducted a deep dive into all sorts of addiction: food, drugs, alcohol and tobacco. We spoke to addiction experts and the addicts themselves. We came away with a paradigm shift in how we viewed our customers, from people with disabilities to people with special abilities. This new perspective colored our entire communication plan.

Second interact with your customers every chance you get. Get uncomfortably close. It is one thing to read that hepatitis C patients often have trouble with basic life skills. It is another to be the recipient of a panicked call at 6:30 am from a patient advocate worried about fronting the expense on an invoice slipped under her hotel door.

By getting close, you experience the patient’s issues on a deeper level. As the saying by Confucius goes, “I hear and I forget, I see and I remember, I do and I understand.” Incorporate experiential learning into your research plan along side the traditional A&U studies. You can even contract with one of those researchers that arrange for marketers to spend a loosely structured weekend with patients.
Be forewarned though, you may feel uncomfortable or awkward at times. It was personally painful for me to come face to face with my unenlightened views of addiction and evolve my thinking.

Third, try to empathize with your customers. I still remember the anguish I felt listening to one man I met at a Hepatitis C patient meeting. A former intravenous drug addict, this soft-spoken, dignified man told his story of “falling off the wagon” when his two beloved Chihuahuas died unexpectedly. But he climbed back to sobriety. We heard story after story of patients staying off drugs.

I remember thinking; I can’t even muster the discipline to resist a second helping at dinner, would I ever be able to overcome drug addiction? These people are superhero fighters. It was this insight that led to a very distinctive “boxer” campaign. The power of empathy to generate differentiating insights is abundantly clear when you compare the boxer campaign to that of the product’s main competitor.

As compelling as I hope these examples are, it is not easy to ask for money for activities that don’t have a straight linear path to the bottom line. However, know that if you do the same sort of research as your competitors, then you will end up with the same insights. Having the data on customer habits is necessary but in the end it is the emotional insights that differentiate your brand.

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.