In the July issue of Pharm Exec we discussed the first pitfall in problem solving: an ill-defined problem. This month we'll look at the other barrier that
impedes effective problem solving: looking for the solution within a confined set of parameters when the solution actually
exists outside of those limits.
Poor adherence is becoming the staple problem in the pharmaceutical industry. The problem has been clearly articulated for
several years and takes a prominent position on most of Big Pharma's game plan for improved revenue. Perhaps if we keep flogging
that dead horse he might just rise again!
Let's assume we appropriately specified our problem and have, indeed, identified the correct target audience—that is, those
who are predicted to be non-adherent in the future. What do we do with them?
Typical adherence solutions are built around patient self-report and/or attitudinal segmentations. The fundamental problems
with these two approaches are that they assume, respectively, that (A) the patient has the meta-cognition to articulate their
subconscious state of mind regarding irrational behavior, and (B) attitudes cause behavior. These two assumptions will lead
to the development of highly engaging, but, unfortunately, ineffective interventions. Here's why:
The Limitations of Meta-Cognition
It is generally accepted within cognitive science that individuals are relatively poor at explaining the mechanisms behind
their own behavior and thought processes. We refer to this as weak meta-cognition. Indeed, even experts in the field of cognitive
science often struggle to explain behavior and thinking processes. If I were to ask you to state the top two most acceptable
reasons for non-adherence, you might say side-effects and cost. Some of you might say forgetfulness. Sure, they all seem plausible.
However, we know that these are not really the top reasons for non-adherence because if they were, then low-toxicity drugs
would have superior adherence to the high-toxicity drugs such as chemotherapy, generics would not have an adherence problem,
and reminder programs would actually work.
If, on the other hand, I were to ask you for the top two least acceptable reasons for non-adherence what would you say? That's
a much trickier question. What if I asked you why you didn't let that crazy driver pull in front of you this morning, or why
do you choose black shoes with a blue suit rather than brown ones? What if I asked you to explain why you didn't follow your
doctor's recommendation to take a mildly toxic drug that could potentially save your life and instead opted for a bag of French
fries for lunch? We shouldn't ask innocent consumers to explain what we, as pharmaceutical experts, haven't been able to explain
despite years of investigation. They will give you the best answer they can think of—and nothing more.