A Prescription for Change

March 1, 2007
Daniel Rehal
Successful Product Manager's Handbook

With doctors prescribing more than ever, it's surprising to learn that they're not making choices solely based on a drug's efficacy, safety, tolerability, or cost. Need a hint? It's more human than you think.

Pharmaceutical marketing has changed dramatically over the past two decades. Sales forces have increased in size, yet with recent reductions at companies like Pfizer and Eli Lilly, we cannot help thinking the industry has gone beyond the point of saturation. This change points to one important aspect of pharma marketing: Physicians don't always make choices based on the details in the data. If physicians solely made decisions based on efficacy, safety, access, and cost, why wouldn't they just find information on the Web? It's because physicians use social and emotional reasons in making prescription decisions (see "Why Physicians Choose to Prescribe").

Another dramatic change in pharma marketing has been sales representatives' limited access to physicians—most doctors would actually prefer contact to be reduced by 20 to 30 percent. In addition, more restrictive regulatory and compliance guidelines have forced industry executives to think creatively when it comes to delivering messages effectively and ethically.

Yet while access to doctors has changed, the need to deliver effective product messages to them has not. So how do you get into the head of today's physician? Physician prescribing is complex, but the idea behind what makes doctors tick is simply typical buyer behavior.

Think about people's perception of the iPod, which has changed so many aspects of our lives. From exercising to traveling, to exercising while traveling, everything seems more enjoyable and more informative, when we incorporate the iPod. But Apple did not invent anything new—it took a complex product and made it simple. Once they made it simple, marketers created a brand that inspires users to feel something special. We can get the same type of product with more features, in different colors, and for less money, but these products don't make us feel the same type of joy that we feel with the iPod. It's the emotional impact of a brand.

Physicians have traditionally been willing to attend speaker programs based upon three factors. First, and most importantly, is the content; they want to learn something new to improve the way they practice medicine. Second, in order to do this effectively, they want to hear from national thought leaders. Third, the venue is like the icing on the cake because it is the common ground that brings these colleagues together.

Similarly, ten years ago, who would have thought we'd be paying $2 for a bottle of water? It has, however, become a social phenomenon. It may not be the most pragmatic use of spending money, but there is a healthy social status to carrying a bottle of water. Even though the iPod may not be the least expensive or most technologically advanced choice, and bottled water is certainly not required by our bodies, we make these choices despite clear alternatives which would provide equal or improved benefits at lower cost. But when making choices, we don't always think logically, or pragmatically.

At Takeda, we have looked very closely at why physicians make the choices they do for our professional programming. From there, we create models to capitalize on these brand-building opportunities to bring products and messages to healthcare professionals so they can improve the lives of their patients.

Let's take a look at a few examples.

Create a Dialogue

There are three major factors that influence physicians to want to attend a speaker meeting or program.

First and foremost, content is king. If physicians are going to spend time away from their practice, they want to learn something new and, ideally, cutting edge. Doctors aren't going to want to learn from just anybody either. They want to pick the brains of illustrious thought leaders, which brings us to the second most important influence on speaker program attendance—high-level authority figures. Venue and location is third on this list because physicians want a place that is easy to travel to with a pleasant environment (see "Pyramid of Influence").

Physicians make decisions to improve patient care based upon influences that come from others around them (social), their own personal experiences, the patients persuasiveness and impact (emotional), and reasons of logic (pragmatic). These are not mutually exclusive and each of these elements plays into every decision they make; some play into the decision more than others.

But just because a company has all three factors, doesn't mean it's smooth sailing. Marketing teams can encounter a Catch-22 when it comes to the speaker recruitment process. High-level speakers are hesitant to travel for small venues, which means less interest in the program.

But less attendance also means thought leaders are less inclined to speak to smaller groups. Local speakers don't have the same impact as their national counterparts in attracting physicians to programs—which ultimately drops attendee interest.

To overcome this issue, Takeda took a two-pronged approach. We knew we had to overhaul our professional programs if we wanted to overcome this basic challenge: to present high-quality content hosted by national thought leaders at a top-notch venue.

What we came up with turned our hopes into a reality.

"The Power to Know"

Takeda launched a series of national broadcast programs that provided solid content to doctors in an accommodating atmosphere. One recent program dealt with the topic of diabetes.

Circle of Friends

Broadcast live from a studio, numerous thought leaders engaged in a high-quality discussion about the disease. In lieu of a studio audience, the session was fed via satellite across the US and right into the middle of doctor dinner meetings—whether the meeting was in Denver, Chicago, or in Boston, every venue would get the same information transmitted to their respective locations at the same time. Plus, because doctors could ask thought leaders questions by calling in, it created an engaging atmosphere.

Creating the technology was one thing, marketing this type of new program to physicians was another. Product managers from Takeda's professional strategies team worked with graphic designers and agency personnel to create a unique logo and name that conveyed our message. We wanted healthcare professionals to feel like they were attending a cutting-edge, highly scientific program that would help them better care for their patients with diabetes.

In order to create a social and emotional feel with this initiative, every detail—from the invitations to the choreographic timing of the salad being served—needed to be considered.

Although the program was broadcast live via national satellite, and the speakers were not in the restaurant with the participants, it didn't matter. Healthcare professionals wanted to attend because they knew respected thought leaders would be providing must-know information—there was a social buzz prior to the event. This social appeal became a key element to delivering quality education. A product manager also ensured that content met all the standards set forth by Takeda's internal medical, legal, and regulatory groups.

The first Power to Know program launched a year ago and is now synonymous with Takeda. It was created by a team committed to providing an effective forum for physicians to learn new ways to care for diabetes patients.

As a result, nearly 2,000 healthcare professionals have participated in a dialogue with top thought leaders in the comfort of local—and high-end—venues using the latest technologies. They even left the session asking when the next telecast will occur.

"Diabetes Dialogue"

There's typically a stigma against organizaing programs around local speakers. National speakers are highly sought after because they have the knowledge and delivery that surpasses local speakers, who might not have the same resources or credentials to deliver high-quality discussions.

Yet, local speakers also have the ability to identify with the challenges facing colleagues who practice medicine in the same community. These local experts know the physicians and hospitals in the area, and they can relate to the regional or cultural differences in treating patients from the surrounding neighborhoods.

Simply put, they know their colleagues, and familiarity breeds an engaging experience that leads to better care for patients.

One significant challenge of local speaker programs is inconsistency—messages are often not articulated in a way the audience understands. Some speakers, for example, do not like to use slides, though adult learning principles have demonstrated that adults retain about 10 percent of what they hear, 40 percent of what they hear and see, and nearly 70 percent of interactive content. Interactivity adds a social element that improves retention and learning.

But many differences in communication styles can lead to less-than-optimal educational programs. Even though these thought leaders typically have the answers, they cannot always explain them in a way that allows a diverse audience to gain reasonable understanding.

One of the ways to overcome this issue is to pair these speakers with highly trained moderators. The speaker who might deliver a mediocre message, can suddenly increase message effectiveness. The moderator can assist by focusing on audience cues, such as eye contact, body language, and vocal gestures of inattention or boredom. Moderators can ask topical questions to re-engage participants into the educational program.

In this initiative, Takeda partnered with a company that provided a highly skilled and trained moderator group—and sent the group into the field to lead speaker programs. Now, instead of having disorganized and inconsistent programs, moderators who understand the educational objectives are there to ensure goals are met. Additionally, they force the audience to participate by asking pointed questions, which aid in retention. This social impact also adds an element of emotion, which helps brand the program—just like the Power to Know series.

Branding this initiative as the Diabetes Dialogue, a Takeda project manager immediately helped physicians understand the goals of the program and set the tone of what the organization was trying to accomplish. This emotional impact improved participation, and physicians felt they were gaining a positive educational experience.

Building this brand of dialogue is similar to what Apple did with the iPod. Takeda's team took a familiar concept, but created emotional excitement and a social feeling around it. Of course, to keep audiences coming back, you must live up to your brand promise.

In this case, the Diabetes Dialogue brand let physicians know that Takeda shared the same focus: patients.

No Doesn't Mean No

As the industry has changed, some physicians are refusing to see drug reps in certain situations. When this happens, we have less opportunity to educate physicians on groundbreaking products and science. An internal analysis has shown that nearly 30 percent of physicians who attend association meetings refuse to see reps in their offices. This group prefers to get scientific information from the American Heart Association or American Diabetes Association meetings, or the Internet. A no-see strategy is critical for companies to overcome.

Doctor may refuse to see a representative, but they can't refuse to see what's right in front of them. Takeda used this mantra to its advantage to increase awareness of diabetes drug Actos (pioglitazone) by creating cartoon-like characters to represent the brand. Like Lamisil's Dirk the toe fungus, and Rozerem (ramelteon)'s ads featuring Abe Lincoln and the beaver, Takeda used their Circle of Friends campaign to help doctors recall its brand at conferences and events.

Characters like Happy HDL, Tubby Triglyceride, and Burned-out Pancreas were created to tell a story, not just about Actos, but about the myriad of disorders that go along with diabetes. Because these characters pair science with emotional appeal, physicians can get a sense of how the brand goes beyond simply treating the glucose levels of patients with diabetes.

It's a quirky and simple way to help healthcare professionals remember the brand, but it's enough to make a social impact on doctors who might discuss the campaign at conferences or dinners. Physicians can recall the characters and remember what they represent—another effective method to get drug education to doctors who refuse to see reps.

No matter how we look at our business, it's critical that we accept that change is inevitable. Even if physicians made decisions based solely on efficacy, safety, tolerability, and cost, the methods of delivering information would continue to be endless. But the fact is, physicians are making healthcare choices for their patients—much more than ever before—based on social, emotional, and pragmatic reasons.

We need to build brands within our brand. While prescribing behavior is complex, it's a good thing that healthcare professionals have unique reasons for selecting the appropriate product for each individual patient. Otherwise, there would not be the need for pharmaceutical marketing—maybe then, we'd all be trying to get a job with Apple.

Daniel Rehal is senior project manager for diabetes for Takeda. He can be reached at drehal@tpna.com