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Cyberchondriac? You’re Not Alone.

By now, many of you have seen the report from Microsoft detailing a study they did on “Cyberchondria,” which the New York Times describes as “the practice of leaping to dire conclusions while researching health matters online.” Without getting into too many details of the study (available in all its statistical glory here), basically it shows that many people (as many as 30-40%) have searched online for a symptom they have (like a headache) and have escalated it reach the conclusion that they have a serious condition (like a brain tumor). 

This headache/brain tumor connection in particular seemed to be fairly popular, as it was one area in which the study focused. The reason why so many people reach the conclusion that they have serious conditions is because online searches aren’t filtered in any way. You receive the results ranked by algorithms that decide what is most relevant. However, no search engine today is smart enough to reliably make the assessment that, while you may be searching for X, you really should be searching for Y. They also can’t determine the most likely answer to your question (i.e., what is causing my headache?) though they certainly try.

The incidence of brain tumors is 15 to 20 cases per 100,000 people or 0.00015%. Pretty small odds. You’re almost certain to have every other condition statistically speaking before you get to a brain tumor. However, a search engine doesn’t put all this together. There isn’t a feature that allows the search engine to say, “Hey, pal, I know you’re thinking your headache is a brain tumor because I see the pages you selected from the search results, but I thought you should know that you’re odds of dying in a car accident this year are 1 in 6500, so you should start wearing a seatbelt instead of worrying about this. Oh yeah, your headache is most likely caused by the six tequila shots you had last night.”

So, where can healthcare companies help this? While developing a super intelligent search engine is probably out of the question with today’s technology (I hope), it would not be difficult to create a simple algorithm that checks your symptoms and suggests a handful of possible “diseases” that might be causing it. WebMD has taken a good first step with its Symptom Checker, but it’s got a long way to go. During my session where I told the Checker that I had a headache, it presented me with some possible options that, while not including a brain tumor, did include “Aseptic Meningitis” and “Botox Injection.” Check out my partial results:

So, the question is: does this reduce the chance of cyberchonria or increase the risk? While serious diseases like brain cancer are missing, there are still a lot of highly unlikely diseases still included. The list of candidates is in no particular order and you’re left to decide what is most likely the cause of your symptoms. How much additional effort would it take to include the relative risk of each of these conditions? That is, add an additional column that has the most likely cause first (with a relative risk of 1) and then followed by the next most likely with a smaller relative risk. Immediately, you’ve helped people know that it’s really unlikely that they have Aseptic Meningitis compared to a tension headache. The Web MD tool only makes matters worse.

Valuable applications can help educate and give patients and their caregivers the right information at the right time. Far too many online tools offer no meaningful segmentation in an effort to try to cater to everyone. Basic marketing principles tell you that you can’t be everything to everyone, so pick something and own that. Be the resource for headache pain and help people make a real differential diagnosis instead of allowing them to search and search only to find that they have a brain tumor. When they figure out that you’ve got a brain tumor, they’re probably going to call their doctor. How much cost do these emergency visits to physicians cost our system each year? How about the tests that are basically only to calm them down and protect the doctor from a malpractice suit? Healthcare companies have an obligation to educate patients not just on their products, but also the category, competitive products, and overall lifestyle issues that will prevent them from needing their products in the first place. I know, not popular in the boardroom, but essential to long term success.

“Seriously. We Don’t Like TV Ads” — FDA

I came across this rather innocuous looking story in MM&M today about the FDA considering a requirement that would add a toll-free number to all DTC TV ads to allow consumers to report adverse events. The full text of the news alert is here:

“The FDA is weighing requiring DTC TV ads to carry a toll-free number for adverse events reports and is surveying 1,600 consumers to find out what they think, the Associated Press reported. The requirement would dovetail with one already in place for print ads, but some at the agency are concerned that a toll-free number would distract viewers from risk information. The survey will test ads for a fictitious blood pressure drug, AP reported, with an eye to how the placement, wording and timing of the statement impacts comprehension and recall.”

The FDA doesn’t have the final say on whether or not DTC advertising is allowed (Congress does essentially), but they can sure make it clear that they don’t care much for it. You might have noticed when watching any drug ad the litany of side effects and risks that are included. It goes a little like this: “With Curital you may experience headache, dry mouth, toe fungus, liver cancer, vertigo, nausea, upset stomach, night sweats, death, hearing loss, and tooth decay.” That’s the FDA. They don’t want to police these ads so they make it much harder to them to be meaningful or have much of an impact. This toll-free number would go one step further.

I, for one, could care whether or not DTC TV ads disappear. I’ve never believed them to be effective, but I do believe they are easy. As a brand manager, you simply hand over a bunch of money to your media agency and tell them to show your drug to as many people as possible. Easy. You can then tell your managers that you spent a whole bunch of money and made a whole bunch of “impressions.”

Isn’t there a better place for all of this money? Spending the money to do targeted advertising like search marketing or developing digital applications specific to your target audience is hard. It takes a lot less money, but it’s hard. There are only a few agencies (and fewer pharma companies) out there that really understand it and know how to make something like this come to life. Instead, they stick with what’s “worked.” By “worked” I mean shows up as a planned tactic each year. Instead of spending money on DTC TV, why not instead try to find the people that will really benefit from your product and who are likely to derive a big benefit from it? Those are your customers for life.

A flash in the pan TV ad isn’t going to capture reliable patients. For many who respond to your ad, they want a quick fix and after your quick fix, it’ll be the next quick fix. But, what to do instead eludes a lot of companies. Ask around, read this blog, question your advisers (and certainly your agencies), find out what’s possible. Remember my personal adage about TV commercials: There wouldn’t be a single TV commercial if those who worked on the advertised brand were forbidden to talk about it at a party.

Think about that for a second.

An Interactive Test for Alzheimer’s Disease…Got 20 Bucks?

Within the last week, a company called Medinteract launched an interactive tool that you can use to determine if you have early signs of Alzheimer’s Disease. It’s called the ALZselftest. According to the company’s press release, the test is based on one developed by “Dr. John H. Dougherty, a leading neurologist, founder of Medinteract, LLC and Medical Director of the Cole Neuroscience Center at UT Medical Center in Knoxville.”

Here’s how the company describes the test: “In 2002, Dr. Dougherty developed the Self Test, a paper test designed to identify cognitive impairment at the earliest possible stages. Due to the alarming rate of Alzheimer’s Disease sufferers going undiagnosed, Dr. Dougherty has adapted his existing test for computer use, and has made it available directly to the public online.”

Sounds great, right? Did we mention that it costs $20?

Now, in the grand scheme of life, $20 really isn’t that much. In fact, Medinteract must have gotten a copywriter to help them with this line to help you see this fact: “About the cost of your doctor’s office co-pay $19.95.” Now, I get that this company has to make money to stay afloat and I don’t fault them for charging money for this test. It seems like a reasonable price for the information you get. The test claims to be 98% accurate and earlier diagnosis and treatment of Alzheimer’s usually corresponds with better outcomes, so it seems like a worthy investment. My issue isn’t with Medinteract, it’s with Pfizer, Eisai, Novartis, Forest, Sciele Pharma, and Ortho McNeil.

What do all these companies have in common? They all produce or market drugs to treat Alzheimer’s. Dr. Dougherty’s test has been around, in paper form, for six years and yet none of these companies thought to create a free, interactive version of this test. Instead, we have to pay for it. Part of any manufacturer’s responsibility is ensuring that the right patients receive their drugs. This means ensuring that poor candidates don’t receive it and that excellent candidates do receive it. With this test, they have an opportunity to do both. They can find new, appropriate candidates and provide some reassurance to the thousands of people with family histories that they are fine and don’t need treatment.

What would the value of that be for any one of these companies? I’m sure that creating an interactive version of the test took some investment, but not much when you consider how much they invest in their current websites. The all-Flash and heavy video-laden site for Razadyne I’m sure was at least $500,000-$1,000,000 project (likely more). Two drugs, Exelon and Cognex don’t even have websites that I could find (of course, naming your drug after large, existing companies makes it a little hard to search for your product, but that’s another posting). Consider that either of these drugs could have done the development of the ALZselftest site and placed a “Sponsored By” ad on the site and gotten likely more press and traffic than they would have by building a brand site.

I’ve noticed this as a pattern for many drugs in that they are reluctant (or unable?) to create a tool that will help people predict if they have a disease or when it is likely to get worse. Consider the case of asthma. There are many brand sites out there, but none provides a tool that helps patients predict what is causing their exacerbations and what triggers they should avoid. Most sites give you a list of things to avoid without any personalization. A few sites have tracking tools that allow you to plot your symptoms and even details about the situation like your activities or time of day.  Here’s one I did on the Asmanex site.

You can see that the site is gathering some pretty in-depth information, but that’s all it does…it gathers. It doesn’t interpret, it doesn’t help customize any information to my situation. Instead, I’m left alone to figure out what it means. With this amount of information, it would be really simple to create a tool that actually evaluated all these factors and gave some analysis. A simple algorithm could tell you to avoid exercising after 7pm when the air quality is low, for example.

Hellooooooo out there! We have these things called computers now and they can interpret things and even do math I hear.

Imagine if you were one of these asthma drugs and through your test someone who has suffered their entire life with asthma flare ups now suddenly has none because he knows exactly what to avoid. What would that be worth? The problem is that it is worth $0 in terms of sales…at least directly. Unfortunately, some companies are this short-sighted. “Why create a tool that’ll keep people of my drug?”

I believe, as a former pharma person myself, that inherently most companies understand the value of ensuring the right people are taking their medications and the value of keeping off those who don’t need it. This philosophy should help a great deal in overcoming the negative stereotypes that pharma companies have attributed to them. Companies can talk all day about wanting to do this (with no one listening), but an application like I’ve mentioned show that they’re actually doing it. Imagine the positive press and the traffic that your site would get (leading to a ton of free promotion) if you created a tool that could accurately predict and help prevent asthma flare ups. Your company and your product would suddenly be the experts on asthma and doctors and patients would turn to you  for answersfirst, which includes your drugs.

One last reason why no healthcare company creates these tools is something you’ll hear me say a lot…they don’t know that it is even possible. Few healthcare companies have the internal capabilities to know the interactive and digital options that are available. Their ad agencies are typically “traditional” agencies that don’t know either. As money moves away from DTC TV, it’s got to go somewhere. Let’s hope it’s not print or online display ads. Instead let’s hope that it’s invested in something useful to everyone like the tools that Medinteract is getting $20 for each time, everyday. Not a bad business if you have foresight to create it.

The Digital Rules…First Things First

Mini White Paper

Before we go too far, I thought I should share with you the Digital Rules that are important to any healthcare brand. Without these, pretty much anything else I’ve got to say isn’t going to mean much to your brand. Call this the required list and everything else I’m about to tell you the optional list. If you don’t do the required things, then the optional things won’t matter much.

These rules I developed were actually published in Pharmaceutical Executive magazine this summer under a title I never liked but they created, Exercising Your Brand. (You can download it here.) Yes, that is my picture…nice lighting, right?

Here are the rules for those who didn’t click through. Print this out and refer to it from time to time.

The 10 Digital Rules to Keep Your Brand Healthy:

Interactive Marketing in Pharma

1. Show; Don’t Tell: A demonstration, picture, or video always beats never-ending pages with thousands of words. Make your content scannable (easy to read quickly), and make it memorable. KnowMenopause.com uses videos of both patients and healthcare professionals (HCPs) to deliver content, instead of using countless pages of text.

2. Build an Integrated Approach: Do your website, e-newsletter, banners, AdWords, widgets, blog, emails (and so on…) all work together? Do they work in concert to drive action? And you’ve got to do all this before even considering your TV, radio, and print. While an over-the-counter (OTC) product, pharma could learn a lot from the marketing of alli, from GSK. The OTC version of the weight loss pill Xenical was launched with a large media campaign, but included several other unique consumer programs. Among these was a comprehensive starter kit with each bottle, which included a well-designed pill case, and a highly customizable website at myalli.com. What made the program stand out for me was the alli cookbook with special recipes that help you stick with a healthy diet and avoid foods likely to cause undesirable side effects. In-store efforts pulled all this together with excellent product placement strategies.

3. Deploy Rapid Segmentation: With digital technologies you have no excuse for sending the same thing to everyone or for providing the same information to everyone. Find out what each visitor needs and provide it. Repeat. PurplePill.com, the Nexium branded site, does this well with its navigation. You can select whether you are just curious about symptoms, are suffering from symptoms, are ready to talk to a doctor, or are a current Nexium patient. Depending on what you select, you have immediate access to content tailored to your needs.

4. Create Value for Everyone, Not Just Your Brand: If it just benefits the brand, people will reject it. No one trusts big pharma anymore, right? Instead, create something that helps the patient, and they’ll help you. This is done successfully for a number of brands that use an unbranded site to truly educate patients and help them find the information they need. Roche has done this well with fluFACTS.com, including the first movie tie-in for a pharma product. This site offers some good, basic information about the flu and useful tools like a flu tracker all without pushing their flu product, Tamiflu. This approach has undoubtedly has driven traffic and awareness of Tamiflu.

5. Structured, but Flexible: While you don’t need to include every feature ever conceived, you do need to give people the ability to make your stuff their own—whether it be customized home pages, content they can borrow, or a section of your site that they alone own and manage. Once they make your site their own, they’ll be more likely to return to it because they’ve already invested time and energy. This rule hasn’t been fully embraced by any pharma companies, but brands throughout healthcare have effectively leveraged this rule for years.

6. Clinical Doesn’t Mean Colorless: Research shows that consumers find visually appealing sites more credible than their plain counterparts. Did you make your site look like an exam room? (Incidentally, in the same study, HCPs had the exact opposite reaction, preferring more plain-looking sites.)

7. Something Old, Something New, Something Borrowed: Because imitation is the sincerest form of flattery, flatter. Learn from what’s worked, and what hasn’t. Don’t stop at looking within your company or even within pharma. Apply lessons from other companies and industries. From this, create what’s never been done before, but don’t shy away from something because it’s been tried before. If it’s effective, then go with it.

8. Simple, Cost Effective, and Scalable: Just because you need to impact a lot of people to meet your goals it doesn’t mean that spending more money is the answer. Find out what your patients want and deliver it. Create programs you can build over time in planned phases. As you get positive results and more funding, build on your successes and cut your losses. Resist the temptation to create more one-off campaigns that don’t have a long life span.

9.Don’t Let Legal Run Your Program: Yes, pharma and healthcare have their own unique set of regulatory hurdles, but this doesn’t mean you have to ignore all of the new channels available to you. So, if the latest tools (e.g., Facebook, MySpace, widgets, etc.) aren’t allowed, find smart people who can figure out how to take what patients love about those tools and distill it into something you and your legal team can agree on. Reckitt Benckiser is one of the few companies willing to reject the idea that MySpace and sites like it aren’t a place for pharma. You can visit their MySpace page and become friends with “addiction411.” This page links to their TurnToHelp.com site. The effective use of MySpace to help educate adolescents (a key demographic of MySpace) about the risks of and treatments for prescription painkiller addiction shows that just about any digital channel can be brought into regulatory compliance.

10. The Patient Is the Boss: With infinite choices online, you have seconds to show why you are genuinely different before your audience moves on to the next search result. If you obey all of the above principles but ignore this one, you might as well give up now.

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