Matching patients to products

There are advantages and disadvantages to marketing a product for one type of patient.

On one hand, a doctor may immediately associate your product with the profile you've detailed. On the other, you've pigeonholed your product to just one profile.

Whether this strategy is advantageous to your product or not, describing a patient type best suited for a drug's effects and side effects continues to be a main marketing strategy. It is worth examining, therefore, just how the doctors you call on match their patients to your products.

I believe there are three main strategies doctors rely on to do this: process of elimination, the "override principle" and identifying "symptom clusters."

Process of elimination

The process of elimination relies heavily on your marketing focus and, to some extent, on that of your competitors. When I look at the list of all the antidepressants on the market, I know that all 21 are theoretically effective for depression. So I look for reasons to pick one antidepressant over another.

For example, if I consider once-a-day dosing, that narrows the list down to 18 or so. If I consider products that have minimal drug interactions and lack sexual side effects, then I'm down to two!

My choice is much easier now. I can tell the patient: "I am giving you drug X because you only take it once a day at bedtime, it will not interact with your other medications and it will not change your love life."

This is possible because the drug I choose has been given what I call a "positive tag," a specific detail about the drug that comes to mind when I consider the product. That detail was planted by the product's reps who called on me.

"Negative tags" - unfavorable characteristics planted by competition - allowed me to narrow the list as well. Rather than include drugs for their positive qualities, I tossed them off the list of choices because of their shortcomings.

I have picked up a prescription pad and thought, "Drug X causes sedation, drug Y has to be given three times per day and drug Z has a lot of potential interactions." I'll narrow the list by remembering those negative tags - whether or not I have ever seen those problems myself.

Of course, the patient may have a negative experience despite my efforts to avoid it through drug selection. There are no guarantees, but the process is what is important.

A busy doctor needs help to quickly narrow down a big list of drugs, and positive or negative tags may help. I can think of at least two positive tags for every antidepressant currently detailed in my office. I can think of at least three negative ones planted by their competitors.

Overriding concerns

The "override principle" is another way doctors match a patient to a particular product.

I recently interviewed several neurologists for a program on how doctors treat Parkinson's disease. Eight out of 10 "always prescribed drug Z" because, they told me, "it is neuro-protective."

When I asked what they would do if the patient failed to respond systematically, they all said they would keep the patient on the medicine. I mentioned cost, because most patients with Parkinson's disease do not get medications paid for through Medicare, and almost all said it was still worth the price.

Why? The majority believed they were prescribing a medicine that prevented further demise in their patients. In their eyes, practicing preventive medicine was practicing the best kind of medicine.

A psychiatrist I know always uses atypical antipsychotics first because, as she puts, it, "I don't want to be the one who gives the patient tardive dyskinesia." (Tardive dyskinesia is a disfiguring movement disorder caused by long-term exposure to some medications.) Some doctors will match a drug to an illness because of a belief they have that overrides all other concerns. Your challenge is to find out what that principle may be.

Symptom clusters

Another common strategy of matching a patient with the right medication involves the "symptom cluster" strategy. This occurs when a product is identified with a number of symptoms it may help and with the potential elimination of polypharmacy in some conditions.

The symptom cluster strategy often works well because it gets to the basics of how doctors are trained to make diagnoses. Most diagnoses are discerned using a symptom checklist.

For example, recently a patient was brought to the hospital by her grandchildren, who were concerned about her new onset-memory problems. Dementia is common, but when I learned she had dementia with unsteadiness on her feet and incontinence, the symptom cluster indicated she had a condition of normal pressure hydrocephalus.

Many drugs come with a list of symptoms they target, and when a doctor is familiar with these, a light bulb goes off when the patient names a few symptoms on the drug's target checklist. This process allows the clinician to associate the symptom cluster to the diagnosis, which is then directly associated to a particular drug.

Gaining a level of respect for a product takes time, experience and a good relationship with its sales representative. But whether doctors make prescribing choices by the process of elimination, because of an overriding concern or according to symptom clusters, matching a patient to a product is a great starting point for use of a drug. PR