Breaking the (Spin) Cycle

There’s been plenty of ink expended lately on the publication transgressions of some of the largest drug companies. You know, the unreported safety data, misrepresented efficacy results, misleading study conclusions, etc, all of which smacks of deception to the average reader. However, there may be a lesser known but more insidious issue when it comes to the presentation and communication of scientific results: spin. And in the ongoing discussion on the dwindling trust between Pharma and its customers, it deserves attention.   

Expected, say, from an adept politico or effective lawyer, spin is a way of life in many public arenas and de rigueur for some occupations. But what about in the realm of scientific investigation? Are some scientists—supposedly guided by the gods of objectivity and bound by tenets of the scientific method—twisting their reported data towards the more positive, be it intentionally or inadvertently?       

The answer in a word? Oui. French researcher Dr. Isabelle Boutron and colleagues reported that spinning the nonsignificant (negative) results of RCTs was fairly common. In an analysis presented at the 2009 International Congress on Peer Review and Biomedical Publication, they found spin in 18% of paper titles, as well as in 29%, 43%, and 50% of the results, discussion, and conclusions sections, respectively. Perhaps more alarming was the finding that 1/3 of abstracts of the 70+ papers they assessed contained a high level of spin, and more than 40% had spin in multiple text sections.

Confronting and solving the spin problem, she thinks, will require scientists, journal editors/reviewers, and consumers to review and read study papers “differently”, ie, more critically. And maybe develop guidelines on how to recognize and deter the language of spin.       

I think we in the medical communications profession have a key role to play, too. We need to be aware of the tendency of at least some scientists to present the fruits of their labor in the best possible light. We need to redouble our efforts to communicate data transparently, clearly, and accurately. And we need to have the expertise to see, and the moxie to challenge, spin wherever it emanates.             

Boutron’s conclusions made me think of something I learned in graduate school about the theories of the Polish philosopher-physician Ludwik Fleck. In part, he proposed that researchers were incapable of finding scientific truth because they were always prone to see what they wanted to see in the results of their studies.

The cynic in me agrees with this assumption on human nature…but both the idealist and pragmatist in me believe something can be done about it.

- Ted J. Slowik, Director – Scientific Information, S+R Medical Communications

Will Social Media Help Clear the Road to Transparency for Big Pharma?

It seems like everywhere you turn, you’re hearing about it. Every channel, radio program, and news site has had a story about it. Month after month, someone discovers something new about it. Even the government wants to get in on it. And some of us, quite frankly, wish it would just go away.

Obviously, “it” is big pharma’s credibility. And right now, it’s somewhere between the oil industries after the Exxon Valdez and banks after the implosion of the financial markets in 2008: in the toilet. But all is not lost. According to a recent Harris Interactive Poll, the pharmaceutical industry managed to beat out the auto and tobacco industries as a less hated industry by Americans.

After a year of scandals, misinformation, and what many perceived as an exaggerated pandemic for commercial gain. Whether exaggerated or not, that thought alone demonstrates how far we have to go

to restore credibility and trust. So what is the answer? Part of the answer could be the elephant in the room that we all know and love: social media.

Social media and pharma have been like oil and water lately. Many feel both could benefit from the other, but because of the highly regulated structure of pharma marketing, few companies are ready to take the leap. But, if there ever were a time for big pharma to engage with the public, it’s now. All it would take is a few social baby steps to get pharma to break down the wall of mistrust and get back on the road to credibility.  

Where can pharma start?

1. Corporate communications and PR: Give a face to your company and allow patients and physicians to engage with you.
2. Knowledge centers: Make important information easy to obtain. Pharmacovigilance, adverse events reporting, new studies, new products, crisis management, and basically all non-marketing information could be reported and distributed through interactive platforms.
3. Customer service: Permit physicians and patients to have their questions answered by qualified personnel.

These are just a few of the many early steps pharmaceutical companies can take on the road to engaging the physician and patient consumer in social media. Nevertheless, someone must take the leap, dip their marketing or educational toe in, and boldly go where….you get the point. You see, by not engaging, pharma may be strengthening consumer mistrust. Why won’t pharma talk to me? What are they trying to hide? I see all these conversations already occurring, where is a knowledgeable representative I can trust? Well, where are you, pharma?

- Ayubu Azizi, Copy Supervisor, S+R Medical Communications

The Doctor and the Industry…Reformed

At the risk, dear blog followers, of making you want to gouge your eyeballs out if you hear one more story about healthcare reform, I submit yet another. Like the uncle who came to visit for the holidays but still hasn’t left, healthcare reform still dominates the national conversation. And so I offer you The Latest Thing to Be Worried About: the coming shortage of doctors and what it means for pharma.

Surely you’ve read about this in recent months:

• 25 to 46 million new patients going into the healthcare system¹
• A predicted shortage of 50,000 primary care doctors²
• Dire warnings of overflowing waiting rooms and long waits to get appointments

This crisis will be with us for awhile—a student entering medical school today would not complete his or her primary care training until 7 years from now. This has huge implications for patient care and physician workload.

So what does this mean for pharma? As doctors face this bolus of patients coming through their exam rooms, will they make time to talk to sales reps? Will they have time to listen to anyone from pharma? More patients mean more prescriptions, but access to primary care doctors (already suffering) may fall off a cliff.

Add this to the mix: A recent Med Ad News article³ cited studies by HCI that showed that in 2001, 50% of physicians surveyed considered sales reps a “highly important source of information on new medical developments.” By 2009, that number had dropped to only 17%. If fewer doctors think reps are worth seeing and if their waiting rooms are soon to be overflowing with newly insured patients, how will product managers determine and defend the marketing mix?

As a marketer, it seems that you have 3 options:

1. Keep doing things the way you’ve always done them and hope for the best.
2. Crawl under your desk and suck your thumb.
3. The only real option: Accept the new realities of the healthcare marketplace and start making radical adjustments.

You can’t stop the tidal wave of patients about to hit physician offices. But every crisis creates opportunities. Busy doctors need good educational materials and product information more than ever—your company just needs to make them realize this fact.

How? By addressing their needs in an honest and transparent way. Do this by meeting doctors and patients where they are—give them the information they really need and deliver it in the ways they want to get it. Break the mold and let’s get moving!

References:

1. Jurek, Alex. Doctor shortage would pull plug on health care reform. INDenverTimes. October 9, 2009. http://www.indenvertimes.com/doctor-shortage-would-pull-plug-on-health-care-reform. Accessed January 12, 2010.
2. Stern, Andrew. ANALYSIS-Shortage of doctors could damage healthcare reform. July 23, 2009. http://www.reuters.com/article/idUSN21255541. Accessed January 12, 2010.
3. Detailing’s decline: calls for media mix re-evaluation. Med Ad News. 2009;28(12):19.

- Ed Leon, Senior Program Director, S+R Medical Communications

The Future of Detailing

There has been a cacophony of voices addressing the role and value of the pharmaceutical “detail person” – you know, the person who is potentially most important and influential in Pharma’s efforts to promote their brands. A lot of the debate has centered on physician perceptions of pharma sales representatives and the value they bring. In a few words, the perceptions are more often than not negative and filled with anger, mistrust and skepticism towards the rep and the industry.

If the pharma industry is to regain the benefit of its most potent and successful marketing/education resource, it must change current perceptions and ensure that these detail persons deliver quality service and high value to physicians. Here are just a few personal thoughts on how this might be achieved.

Select for Presence & Personality: Among the first things any customer assesses in a sales interaction is the sales person’s presence and personality. Confident, respectful, listening, well-spoken and knowledgeable are among the key descriptions of any sales person who is worth their salt. So Pharma, forget about how many pizza boxes the rep can carry and stop looking for the “hottest”, most eye-catching human specimen you can find. You’ve out-sourced, in-sourced, ex-sourced and re-sourced every kind of sales training available, but still don’t get the right people. Focus on the person’s brains, integrity, and communication/presentation skills to make sure that they can earn trust and provide value to the customer.

Make Them Know Their Stuff: Your sales force in 2010 may be leaner, but is it really meaner? Good training and deep knowledge are essential if reps are to successfully do their job—educating physicians about their brands so that patients enjoy better outcomes. This means reps need to know all of the “ins and outs” of the diseases their products treat. They must completely understand the pharmacology, as well as the pros and cons, of their products. They should fully understand the competition and other treatment options a physician has. They should know how to engage physicians in a clinical discussion using credible, third-party evidence. They should know, and be able to convey, the best practices of their local and regional thought-leaders. When reps are trained in this fashion, it goes a long way to restoring value, trust, and a relationship with their physician customers.

Marketing, Do Your Damn Job Correctly: To effectively sell, reps need promotional and educational materials. These materials must communicate and graphically display the brand’s message and essence in a credible, transparent and easy-to-understand manner. They must address physician and patient needs, precisely depict the ideal patient for the brand, offer a full and engaging conversation about the brand and display clinical support information that truthfully depicts actual patient outcomes. It is Marketing’s responsibility to provide promotional and educational materials that are based on full-disclosure and ultimately help the rep provide realistic solutions that result in better patient outcomes. If Marketing adheres to these practices, physicians will value their brands and company at a higher level.

Agencies, Do Your Damn Job Correctly: Stop being a Marketing enabler! It is the agency’s and education communication company’s responsibility to drive the change for better communication solutions. As communication companies, we know the best ways to communicate and illustrate messages that engender understanding, correct product use and customer trust. It is incumbent on us to use those skills to provide the promotional and educational materials that ultimately allow the reps to present a convincing, truthful story.

Be Mindful of Who You Are Speaking With: Ensure that your reps stop trying to use a “cookie-cutter” approach with physicians. They must know the demographics, issues, needs and important preferences of your customer—in other words, the essentials of building good relationships. They must learn what is most important and “precious” to the customer. They must sell customized solutions that put your products in line with better patient outcomes. If they do these things, you will win more respect and business.

Quality & Truth First – Always: The final point is simply plain, common sense. Stake your company’s and reps’ reputations on the fact that you will constantly provide high quality information and state the honest truth each and every time you call on a physician. Impress that upon the physician both in your words and your actions. This will enhance your business and relationship, as well as support the premise that you are an important part of the healthcare delivery process. Remember that it is always about better patient outcomes!

Some of you may read the thoughts above and say, “we’ve know that for years now.” But have you? Have you really looked hard at what’s happening at your company’s “frontlines”? If you reside in the C-suite, have you genuinely promoted changes in these areas from the top-down? I doubt it—because the pharmaceutical landscape would look different today. The approaches I’ve outlined may sound like “ideals,” but they really are strategically and operationally achievable.

The future sales representative, in my opinion, will need to be a combination of what I’ve discussed above. Not all pharma companies will openly agree with these recommendations, and some may agree with most of these recommendations, but never put them in to practice. However, those that do agree—and do so openly by changing the way in which their representatives promote their company and brands—will stand to gain a renewed sense of value, respect, trust and business from their target physicians.

- David H. Recht, CEO, North State Resources, Inc.
Holding Company for S+R Medical Communications, Friday Morning,
and Scienta Healthcare Education, Inc.

How we’ll survive

Who’s behind the madness? This wacky viral campaign that has been labeled “brilliant,” “borderline genius,” “idiotic,” “over-the-top,” a “viral pharma phenomena?”

S&R Communications Group in Durham, North Carolina, launched the Pharmageddon 2012 campaign in July of this year. Pharmageddon2012 stemmed from years of angst among our company’s pharma veterans and newbies alike. Watching an industry that had given us so much hurt itself to this extreme was a punch in the gut. Unprecedented times called for a change. A breakdown of physician trust, impending patent expirations, shrinking pipelines, poor marketing practices, overzealous sales goals, poor targeting, feeble attempts in new technological mediums, misinformation, disjointed messaging, confusion, collapse. These are a handful of the issues, a snowball effect over the last decade in the pharmaceutical industry.

Pharmageddon 2012 is a conversation. It is one of which many have been aware for some time, but few have had the stomach to acknowledge and adjust. As we presented, analyzed, and discussed the issue facing pharma, S&R Communications Group, after 18 years in the business, decided to become 2 specialized companies: S+R Medical Communications, which will concentrate on redefining branded medical education, and Friday Morning, an exciting advance in the philosophy of what promotional consultants can provide to pharma.

S+R Medical Communications

Curriculum That Communicates

S+R Medical Communications is a full-service, independent, medical
communications company relentlessly pursuing breakthrough creative strategies and programs for its clients. S+R Medical Communications will provide the educational vehicles that brands need to rebuild trust and help physicians and patients make better, more informed choices in healthcare. It provides educational programming that is needs-based, transparent, engaging, and disseminated through multiple channels, from traditional to digital media. For more information, please visit srmedcom.com.

Friday Morning

A New Approach to Yes

Friday Morning is a reaction to the breakdown in promotional effectiveness and commoditization of ideas pervading pharma. It offers solutions on a project basis, through a powerful combination of deep industry experience and unique insights into what physicians will and will not respond to as promotion. As promotional consultants to the pharmaceutical industry, Friday Morning collaborates with like-minded individuals who appreciate the necessity of communicating with physicians in a more profound way. With a philosophy and process fostering fundamental reexamination of its customers’ external and internal communication practices, Friday Morning is dedicated to the idea that patient outcomes, physician confidence, and client success are inextricably interconnected. For more information, please visit fridaymorning.com.

MedAdNews

Read more about Pharmageddon 2012, S+R Medical Communications, and Friday Morning in the November issue of MedAdNews

How Medical Education Can Help Rebuild the Trust

Pharmaggedon 2012 has primarily been dedicated to revealing and providing insights into the troubling issues that exist between the pharma industry and its primary customer—the physician. However Pharmaggedon 2012 also recognizes its responsibilities to reveal and provide insights about how we might address, change, and improve that crucial relationship. As we have stated many times on this site, it all comes down to trust.

In our deep search for the root problems that have caused mistrust and anger among many physicians, we heard a frequent, common thread: A key role of the pharma industry is to educate the potential prescribers about their products. Fulfilling this role permits  informed decisions by the physician and results in better outcomes for the patient.

In fact, even at this point in the deteriorating relationship, physicians indicate that they want to look to the industry as an important information source for disease state and therapy information. The notion of “branded” or “in-label” education is welcomed and expected. But there is a severe disconnect despite their desire.

The information that has been presented by the industry, even in an “educational” format, is under suspicion. It is under suspicion because there is repeated evidence that the industry has not been fully transparent—clinical information has been stretched, withheld, and misdirected. In other words, there is little to no credibility or trust.

So we are faced with a problem: Physicians want and need education provided by the industry, but they don’t trust the information being provided. Therefore, we need to determine how might the industry can fulfill its responsibility and at the same time help physicians gain trust.

Here are a few simple yet potent suggestions. Remember that it is one thing to agree with these suggestions, but it is another to commit and make them happen.

•   All education must be needs-based. There are a wide number of ways to accomplish this, and it is absolutely essential that education programs have this foundation of support.

•    Understand and use the principles of adult education and learning. They are well demonstrated and widely available.

•    Commit to using clinical data in a transparent and entirely truthful manner. If you give physicians the good, the bad, and the ugly, it is much easier to define how, when, and where a product should be used effectively and safely. Of course this presupposes that industry competitors recognize that in most cases their product is NOT the best choice for EVERY patient.

•   Use credible and knowledgeable healthcare professionals in preparing and delivering educational information, be it written, electronic, or live presentation. If you cannot imagine a healthcare professional presenting an educational program on your brand’s behalf without having to call out your brand’s name every other paragraph, then perhaps you should reconsider education as a strategic/tactical option.

•    In fact, consider that some of the education content you provide will be non-product specific. This is a sure way to gain physician trust and belief that you are doing the “right thing”.

•    Use a variety of mediums to ensure that you can effectively communicate across a broad range of target physician demographics.

•    Finally, know the answer to these questions: What is the overall educational outcome that you expect? How will you measure success? These answers are essential to closing the circle on needs-based programming.

If done in the correct fashion, education—especially the “branded” type—is a beneficial way to gain back physician trust. It is a choice that you can make as a “marketing type” from which you can realize a direct, positive impact.

You Get What You Pay For

You get what you pay for. It’s an old cliché, but like so many clichés, it’s so true. And it is especially true when it comes to the creation of pharmaceutical product messaging and medical education initiatives. Physician research shows that physicians think Pharma’s creative product and medical education initiatives, in a word, suck. How did we get to this sorry state of affairs? This lack of trust by our most important customers? Well it’s simple—we’re getting what we pay for.

Pharma management really thinks it’s getting a bargain by using purchasing agents and reverse bidding practices to beat down the hourly rates of their agencies and medical education providers. Here’s a real example of the genius behind such thinking. There is a Pharma company out there (you know who you are) whose head purchasing agent previously worked for a national office supply chain. Now there’s a person who really understands the creative process.

Dudes, the creative process isn’t like buying a boatload of 3-ring binders from China! Do you really think that you’re getting the best creative team available at a blended rate of $95 an hour? Of course not! You’re getting the rookies, the newbies, the guys that don’t know their butts from a $2 baseball! Yet you’re perfectly willing to let the destiny of your most important asset—Your Brand—to purchasing agents who don’t have a clue what they are buying or what the creative process and THINKING really involve. God, no wonder we’re all heading towards Pharmageddon.

The end is near Mr VP of Marketing. When you don’t make your budget number next year because your message isn’t resonating with your customers, ask yourself this, “How much blame is the purchasing department that got you those great hourly rates going to take?” My guess is, not much. Well, you got what you paid for.

How are you going to survive Pharmageddon?

Signed,

Pharma Vet/Agency Vet

Who is behind this?!

Who is behind Pharmageddon 2012?

what are we going to do about it?!

Find out in the November issue of…

A Sales Call in 2013

It might sound a way’s away, but 2013 should be right around the corner of your mind.  In the aftermath of the 2012 Pharmaggedon patent-expiry meltdown, physicians will have become even tougher to see and many pharma companies will still be struggling to understand how they will reach, communicate and convince prescribers.  So, what will the underpinnings of a great sales call be in 2013?

Let’s assume that the pharma sales representative will still exist. After almost managing to destroy this model, pharma companies realized that nothing beats the value and power of having one-on-one, interactive selling that is wholly dedicated to their brands—provided physicians don’t feel overwhelmed.

And while we’re talking about the industry’s most important customer, it’s clear we will have heard, understood and addressed their issues—namely the lack of trust in company messages, information and motivation. (Frankly, if these issues had not been addressed, we could end the discussion right here and have a nice day).

So again assuming the industry is willing to communicate in a different way, we will perhaps be reaping the benefits of their concerted effort to repair trust. To do that, the product sales call of 2013 will include:

• Factual, transparent disclosure of data and the clinical application of such
• Frank conversation and language about product benefits as well as drawbacks
• Specific identification of patients who will best benefit – not its “great for all”
• Clear language and visual elements that accurately convey all information
• Use of presentation mediums that effectively help convey information
• No sales discussion or suggestion of product use other than approved labeling

Another hall mark is a well-trained sales representative.  The rep will have a thorough understanding of the disease state, the pharmacologic management options, the benefits and drawbacks of the company’s product as well as the competition and a speaking knowledge of the key clinical papers in the given practice area.

Finally, the sales representative will not primarily be a “pizza delivery” person.  Rather, they will bring informational value to each and every sales call.  They will help the physician better understand how their product fits into his/her practice as well as bring insight into how the physician’s colleges choose to treat such conditions.  The sales representative will be personable, well-spoken and respectful of the physician’s time and office conditions.

The sales call of 2013 will only occur if the industry, through its sales force, can rebuild the relationship, trust and value that physicians once believed in.  It can and must be done if the pharma industry expects to have an important seat at the patient treatment table.  If this doesn’t happen, it may well be playing a significantly lesser role in future healthcare practice interaction.  What are you and your company doing right now to be ready for 2013?

Growth, Profits, and Integrity

OK, it’s has been a couple of weeks since the latest pharma debacle – you know, the one with the $2.3 billion fine being levied.  Over that time I’ve asked myself repeatedly what it is about our industry’s ethos that seems so difficult for almost all of us to understand? Our collective mission is to discover, develop, and sell safe, effective medicines that help patients overcome disease. Implicit to this is our duty to educate both healthcare providers and patients in a clear, concise fashion. Simple, right? And once upon a time, profitable enough, too. But along the way, a new “mission” crept in that seems to have affected pharma marketers en masse. Call it pushing the envelope, or sailing close to the wind, or whatever. That has certainly been the mission of the advertising industry.

The company at the center of the storm was fined for violating the spirit and article of regulations that specifically prohibit attempts to use egregious means to entice physicians to prescribe their product.  I believe that “egregious means” would include luxury resort weekends of golf or skiing.  It would also include payments or honoraria for work or effort that is not in a consultant, speaker, or research capacity. Egregious also encompasses operating on the fringes of labeling or making claims with limited support.  And across the industry, I doubt there are many pharma marketers who haven’t tried one sort or another “egregious mean” to some degree in striving to boost their sales—often just to meet targets set by those higher up who really should have known better and were complicit in these activities.

Unfortunately, while such practices are no longer as endemic as they once were, the industry’s reputation is still periodically besmirched by egregious means with reports generally on the front page amplified by web 2.0 communication.  There are the glossy sales and promotional materials that tell partial stories and the sales representatives who have to keep a straight face while delivering messages such as, “You know, doctor, my product is best for every patient with this disease.” The wasteful gimmicks and premium items that the industry only recently and reluctantly gave up. Perhaps most damaging of all has been the willingness of so many of us to promote our products just a little outside of the approved labeling. When sales representatives are given materials and directives to discuss (read “promote”) products beyond their approved uses, the tragic case cited above shows that some patients might actually die because of this illegal activity.

Who gets the short end of the stick in this mélange of deceit, cheating, poor judgment and circumvented ethics?  You guessed it – the physician prescriber, the patient, the third party payer and you and me – the taxpayer.  And there is wonderment that trust in the pharmaceutical industry got to such an all time low!

So I ask myself, when will our industry produce a counter-flood of those who have the courage, morale fortitude and common sense to stand up and denounce this constant BS?  When will we all step forward and promise to conduct our business in a responsible and forthright fashion? Take active steps to rebuild the lost trust of their customers through transparent communication, honesty and clarity?  Faith will only be restored when all companies once again train and send their representatives into the physician’s office with a firm commitment to bring true value and meaningful interaction to the prescriber. And when advertising agencies become skilled at making conservative pitches as interesting and compelling as the inflated ones.