This is part two of a series on relationship marketing. Please check out the first post,  7 Biggest Mistakes in Digital Relationship Marketing, and make sure you’re not committing any of these before figuring out how to fix them. That post will also give you a bit more background on relationship marketing, but I’ll include a brief overview here as well.

[PS: If you're looking for more on my take of how relationship marketing and pharma fit together, then check out my white paper on "The Future of Digital Relationship Marketing in Pharma." It's the most downloaded white paper on Dose of Digital.]

Here’s our definition of relationship marketing (courtesy of our Chief Marketing Strategist, Bob Gilbreath):

“Relationship marketing is ongoing, direct, added-value communication.”

Ongoing: It’s a rhythm of regular, expected communication.

Direct: It doesn’t mean buying media, but owning it: You have permission to communicate, and it can be done in many forms.

Added Value: The marketing itself fills a need; usually, the greater the value to the customer, the greater the ROI.

That last one is important: “fills a need.” If you’re not doing that, then you’re probably just annoying your customers.

So, to ensure you’re not doing this, I’m going to share with you what I call the 7 Golden Rules of Digital Relationship Marketing. This is your list of “what to do.” Follow these seven rules and you’ll be well on your way to a very successful program.

One note, some people refer to relationship marketing as CRM, or customer relationship marketing (or management). For the purposes of this post, I’m saying they are the same thing.

So, here’s the list of what TO do:

7 Golden Rules in Digital Relationship Marketing

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1. Sharing, partnering, endorsing
2. Perfect pitch
3. Personalized and individualized
4. Keep it simple, stupid
5. Members only
6. Personal investment
7. It’s not about you

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1. Sharing, partnering, endorsing

If you are completely reliant on your own promotional efforts to increase enrollments in your program, then you’re missing a giant opportunity. At a bare minimum, you should include social sharing tools that make it easy for people to share your offers with others and encourage them to join your program. Incentive strategies, where you pay current members something for each new member they enroll, fit in here as well. Beyond social sharing, if your program is good enough, you can look towards industry groups and, in the case of healthcare, patient advocacy groups to grow your enrollment. If your program is valuable enough to their members, these groups will help you and will be your most effective enrollment tool. In the case of healthcare, physicians can become recruiters too if you show them how your program both benefits their patients and helps them to more easily manage these patients.

2. Perfect pitch

(Image from The Brand Builder Blog)

In order to keep people engaged over time, you have to communicate with them regularly (but not too regularly) and about things they care about at that moment. This is simple to achieve if you’re willing to do a little planning. Before building anything, plan out what you want to say and what channel you think is best to communicate it. From there figure out when it makes the most sense to communicate. For example, you probably should hold your stories about cold and flu until cold and flu season hits. Once you have these three pieces, then it’s simply a matter of laying it all out on a timeline.

Doing this accomplishes three things. First, it ensures that you’re covering your main points of communication and what your customers care about over a set time period. Second, it also serves as a commitment and motivation tool for you. Once you have it down in your timeline, you’re far more likely to actually do the work to launch the piece on time. It makes it far more tangible. Finally, having a quality timeline will help you make budget decisions should you receive more funding or (more likely) have some cut. You’ll be able to tell where you have additional capacity or where you can use some more.

3. Personalized and individualized

I’ve written about this before and spelled out what I think the difference is between these two terms (yes, there is a difference).

Personalization means adding some personally identifying information to your communications. This usually means putting someone’s name on the top of an email or direct mail piece. It’s remarkably simple to do with digital media and has become very simple (and cost effective) in print as well. Adding someone’s name to an email, for example, is much better than sending an email with “Dear Person” or “Dear Cancer Person.” I only joke because I have seen these before. I assume they were mistakes, but I saw them.

Individualization is something different. For our purposes, individualization means creating communications that are tailored for each and every individual person. The test to see if you’re sending out individualized messages is simple: does someone read what you sent and think, “Wow. They wrote this just for me.” If not, then it’s not individualized. This too can be really simple and more and more companies are embracing it. Here’s a great example that my colleague, Bob Gilbreath, wrote about on his Marketing with Meaning blog:

First, Delta included his name. Good. That’s personalization. However, then they go on and apologize for sticking him in a middle seat on his last flight and offer him some miles to say sorry. Interesting point to note, Bob didn’t ask for this or complain to Delta. They just did it. Delta knew the situation and sent an individualized response. Question: if Bob got this email and the 500 miles or another email that simply gave him 500 miles without the individualized touch, which would have more impact? Each results in the same value for him, 500 miles. But clearly the one that talks about his specific situation makes a lasting impression. So, you can’t just give away stuff and expect that to be enough. You have to make the extra effort to make it meaningful.

If you invest the time and effort to know what your customers are doing and what will be meaningful to them, then your communications will become more and more relevant to them. As they pass over hundreds of other emails they receive, but can’t remember why, yours will be the one that stands out.

4. Keep it simple, stupid

We marketers like to complicate stuff. One of these things I mentioned in the 7 Biggest Mistakes in Digital Relationship Marketing. It was number 4: Make it hard. Basically, if you make your enrollment process really difficult or make it a hugely daunting task to get any sort of individualized information, people just aren’t going to do it. So, you have to make it easy…simple, that is. Of course, our programs can be highly complex and necessitate a knowing a bunch of information in order to give good information back. That’s all right.

If your program requires a complex or lengthy process to yield the best information in return, you can’t just start with this. You need to start with a “light” version of your process to get people interested and engaged. Later on, you can add in something more complex once people are committed to your program and want to do even more with it.

For ConAgra Foods’ program Start Making Choices, our company (Bridge Worldwide), created two different ways to get individualized information. The first consists of just five questions on a simple slider bar design:

If people wanted the most individualized information (likely after seeing the quality information they received from the “light” survey) and their personal Balanced Life Index (BLI), then they are presented with a 23 question, multiple choice, survey. However, instead of making this question after question of text (or worse, 23 pages with one question each), we created an engaging design in which people swiftly entered all the relevant information. They did this because the questions were simple, but also the design kept them clicking and onto the next question, which kept dropout rates at a very low level.

5. Members only

Everyone likes being part of an exclusive club. They like the special perks that come along with membership and they like the prestige that comes with being a member. They like knowing that they’re getting something that everyone else can’t get. That’s just human nature. Do you belong to any clubs like this? Better question: do you wish you did?

Take Neiman Marcus’ InCircle program. On the surface, it’s basically a rewards program. Spend this much, we give you this much. However, because it’s Neiman Marcus, they are also dealing with people who are members of a lot exclusive programs and for whom a $100 gift card isn’t that meaningful. Neiman Marcus needs to provide them much more. So, when you get to the President’s Circle (just spend $75,000 or more in a year), you get special offers that others don’t such as exclusive off-hour shopping events.

Not every program is like InCircle, but the concept is the same. You need to reward your customers who are part of your programs lavishly and regularly. They are your best customers, the ones that spend the most, and who talk about your products to others. They’re the most engaged, as evidenced by them joining your program in the first place. Keeping them your customer is an important priority. One note of caution, simply giving people incentives without changing their underlying attitude is one of the 7 Biggest Mistakes in Digital Relationship Marketing (number 5, Dollars don’t change everything).

Giving gifts to people in the healthcare space is pretty much prohibited either by company or government policy in most countries, so this makes it a bit more challenging. You have to think beyond gifts and consider things like access. This could be access to industry experts like, say, the leading physician in lung cancer treatment. If your patients are fighting lung cancer, they want to hear what this person has to say. Limiting it to members provides a special reward to those who have given you something (their business and trust) and also makes it possible to do more. You can do more because instead of spending $5 on a hundred thousand people to give them some tiny gift, you can spend the same amount and conduct a series of powerful programs (and even travel to where patients are). That’s just one example, but the point is clear. You can provide member benefits in any industry regardless of the specific regulations.

6. Personal investment

If people aren’t personally invested in your program, it’ll be a failure. Their investment is almost always their time (but can also be financial in the case of membership fees). Time is very valuable to people especially people who are fighting a disease. They don’t have time to invest on every website about their disease. They have to focus on one or two for the long-term and everything else is likely to be ignored.

People must invest their own time in order to be engaged with your program over time . There is only one way to get people to invest their time: give them something of value in exchange for their time. This doesn’t mean offering them rewards for coming back to your site or buying things. It means that your program should become more valuable to them for each minute they invest. A great example of this is Patients Like Me.

The more information you provide about your disease (including tracking your progress and compliance with treatments everyday), the more you’ll learn about your disease. You’ll be able to track your progress against “the norm” and receive information on how to improve your situation. If you’re not willing to input this information up-front and over time, you won’t get much out of the site. However, if you are willing to do this, you receive a hugely valuable item in return: information on how to improve your health.

7. It’s not about you

This is a common sin committed by us marketers. I’ve talked about this before in the context of how to appropriately participate in social media. The same idea applies here. People inherently don’t care about your brand. Actually, they don’t care about your brand as much as you do. Because of this, creating a program that only features your brand is sure to be a failure. Instead, you need to balance your program with a mix of information about your brand and related information from which your customers are likely to get additional value.

P&G maintains one of the largest consumer databases in the world and is among the biggest users of relationship marketing. Our company works on Everyday Solutions, which is the central program for all of P&G’s products. It’s a single stop for brand offers and new product announcements, but there’s much more. There is also relevant content that matches with what each consumer has either said is an area or interest or whose behavior (pages visited, coupon offers redeemed, etc.) indicates that they are likely interested. In other words, people come to the site (or open emails or direct mail) not just for product offers and discounts, but also for other information. Those who initially come for offers see that there’s more to it than just a couple dollars off a certain purchase. This encourages them to return or to sign up for the program.

To be sure, the brands are prominently featured and are the focus of the program, but it’s not just one brand message after another. Every marketer wants to get in every core message at each customer “touch,” but that’s not necessarily a winning long-term strategy. There will be time for your messages if you can show people that your program is more than just a commercial.

Those are the 7 Golden Rules of Digital Relationship Marketing. Follow these and your program will be head and shoulders above nearly everything else out there. In case you missed them, be sure to check out the 7 Biggest Mistakes in Digital Relationship Marketing so you know what to avoid.

If you’d like a POWERPoint version of this, you’re in luck. You can download a copy of The 7 Golden Rules in Digital Relationship Marketing (506 downloads) right here. One request: if you do download it, how about sending out a tweet?

Possibly related posts (auto-generated):

1. The 7 Biggest Mistakes in Digital Relationship Marketing
2. The Future of Digital Relationship Marketing in Pharma
3. If You Charged for Your Content, Would Anyone Pay?

For those of you who have heard me talk about my company, Bridge Worldwide, you know that I always say that we’re a digital AND relationship marketing agency. We’ve always been the latter, going back to 1979 (and the former for almost that long). It’s an important distinction to me. Digital agencies make a lot of cool stuff, but many lack the fundamental skills that are required to build lasting relationships with customers.  Of course, we can make cool stuff too (and win the biggest awards in the process), but we pride ourselves on being able to deliver the relationship marketing piece.

So, with that, I thought I’d share what I know and have learned about relationship marketing from working with some super talented people over the past few years and from the experience we’ve gathered from managing programs that now have more than 30 million total members. I should pause for a minute and, of course, mention that we think relationship marketing is evolving to something better called Marketing with Meaning. However, the basics of what makes relationship marketing REALLY work is embedded into Marketing with Meaning.

PS: If you’re looking for more on my take of how relationship marketing and pharma fit together, then check out my white paper on “The Future of Digital Relationship Marketing in Pharma.” It’s the most downloaded white paper on Dose of Digital.

To get started, relationship marketing isn’t this:

Just because you ask someone’s permission before bombarding them with ads, doesn’t mean you’re not still bombarding them (of course, no one is asked to”opt in” in Minority Report, where the clip above comes from). That’s not real relationship marketing. Here’s our definition of relationship marketing (courtesy of our Chief Marketing Strategist, Bob Gilbreath):

“Relationship marketing is ongoing, direct, added-value communication.”

Ongoing: It’s a rhythm of regular, expected communication.

Direct: It doesn’t mean buying media, but owning it: You have permission to communicate, and it can be done in many forms.

Added Value: The marketing itself fills a need; usually, the greater the value to the customer, the greater the ROI.

That last one is important: “fills a need.” If you’re not doing that, then you’re probably just annoying your customers.

So, to ensure you’re not doing this, I’m going to share with you what I consider the 7 Biggest Mistakes in Digital Relationship Marketing. If you’re doing any of these, stop now. Seriously…now. In a later post, I’ll share my 7 Golden Rules in Digital Relationship Marketing. That’ll be the list of “what TO do.”

One note, some people refer to relationship marketing as CRM, or customer relationship marketing (or management). For the purposes of this post, I’m saying they are the same thing.

So, here’s the list of what NOT to do:

7 Biggest Mistakes in Digital Relationship Marketing

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1. No enrollment
2. Program lapses
3. Loss of interest
4. Make it hard
5. Dollars don’t solve everything
6. No customer ownership
7. All about the brand

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1.  No enrollment

If your metrics for your program look like this, well, you can imagine that your program isn’t likely to be a success. While having more enrollments in your program doesn’t mean that your program is better than one with less, low enrollment numbers (i.e., well below your target) does indicate a larger problem. This problem can be a number of things, but it usually points to a lack of commitment in the program by some function within the organization. Presumably, you set your targets based on solid estimates and extrapolations. Perhaps it was a certain percentage of people who visited your website. Well, if “corporate” pulls funding for all the traffic drivers to your website, then you aren’t going to hit your target for enrollments either in this example. If you have a bunch of enrollments followed by a bunch of opt-outs, then your program just might be bad (or commit a number of the sins below).

Figure out why and fix it.

2. Program lapses

Nothing annoys me more than this one. I enroll in your program and one of two things happen. Either you send me a welcome email or direct mail right away and then I don’t hear from you for months or you don’t send me anything initially and three months later send me the first correspondence. If you’re doing this, then don’t even bother continuing. Put yourself in your customers’ position. They probably get a lot of email that appears to be junk everyday. If an email for a program they signed up for three months ago and have long forgotten shows up, how do they react? <DELETE>. And that’s your best case. Worst case, they’ve literally completely forgotten about signing up for this program and think that your message is unsolicited spam. They report that spam to, say, Google (via their Gmail account) and before you know it, Google thinks you’re a spammer. Not good.

3. Loss of interest

This is somewhat related to number two above, but has an entire other component as well. If you never send me anything, I’m going to forget why I spent the time signing up in the first place. I’ve moved on. I probably signed up for your competitors’ programs too and if one of them is taking care of me and I’m using their products too.

And to illustrate why it’s so simple to lose interest in your program, I’d like to show you a random day from my Gmail inbox. I chose July 16 because right now I miss the summer. Here’s what it looked like:

Almost all of the emails I got that day were for programs I have signed up for at some point. You’ll also notice that I didn’t open a single one of the emails. That’s what I mean by “loss of interest.” Why did I lose interest? Simple: if your offers and correspondence are always the same, people forget why they signed up in the first place. Something interested them. Something sparked a touch of excitement. That’s long gone and they aren’t even opening your emails anymore.

4. Make it hard

There’s no better way to kill your program than to make the enrollment process a pain. Someone sent a screenshot to me of this form a while back (they can’t recall where they found it, so if it’s yours, speak up and I’ll give you the credit).

It’s a perfect example of what I like to call an “are you kidding me?” form (usually I put an expletive in there as well). An “are you kidding me?” form is one that a person takes one look at, says, “are you kidding me?” and clicks onto a different site. If your enrollment process makes someone say “are you kidding me?” then change it immediately. Keep in mind that you don’t need to know everything about the person at the beginning. Think about it as though it’s a first date. If you asked all the questions you ask on your “are you kidding me?” form, then you wouldn’t have many second dates. Instead, get the basics now and later on collect more information. Remind people that the more they tell you, the more tailored your offers will be (they will be tailored, right?). Then deliver this. The more the customer sees this, the more information they’ll share. And, by the way, you don’t get a pass by making your two thousand, initial profile questions “optional.” Just the sight of them or the thought that one day they’ll HAVE to answer them to get anything useful from this program, is enough to turn people off.

5. Dollars don’t change everything

Hold onto your hats, this one’s a bit technical. For those psychology experts out there, you’ll love this one. The main idea here is that simply “bribing” your customers via more and more offers or discounts over time isn’t likely to be a winning long-term strategy. The reason for this is simple. First, you have to keep increasing the offers to keep these people interested, which will eventually bankrupt you. If it doesn’t bankrupt you, it’s because you’ve withdrawn the best offers and likely lost a ton of very unhappy customers.

So, why, you might ask yourself, do people who previously have been given so much instantly desert me when I stop the offers? This is simple and, ironically, it turns out that those who are offered less, will likely be the ones who stay with you forever even when you take away their small offers. It’s a classic case of cognitive dissonance at work. In this case, your loss of customers is explained because you never changed their attitude towards your products. You only changed their behavior because of the money (or other offers) you gave them. When you take away the incentive, you’re left with the same attitude they’ve always had, which means they go back to the original behavior (i.e., not buying your products). This phenomenon is called the Point of Minimum Justification (which is explained really well in one of my favorite business books: Universal Principles of Design). It’s illustrated like this:

As you increase incentives, you change behavior (red line). This is the idea behind “everyone has their price.” That is, for the right amount of money, people will do almost anything. The blue line shows how attitude changes with increasing incentives. It too increases at first with increasing incentives, but eventually disappears. Attitude here is your attitude to the product or service (or situation). An increase in attitude on this chart symbolizes a positive change and you want people with a higher, positive attitude towards your product.

Why does this graph look like it does? Simple. When you give people a lot of money to do something, they justify doing it because of the money and NOT because they think what they are doing is a good or enjoyable thing. On the other hand, if you give people very little incentive to do something and they start doing it, they justify the reason for doing it because they believe that what they are doing is a good or enjoyable thing. It’s all because of cognitive dissonance. In the case of a product being marketed through relationship marketing, increasing your incentives will get people to use your product because they are simply taking advantage of your incentives. When the incentives are gone, so are they. On the other hand, having just the right incentives causes people to truly consider why they are using your product. They become more invested and perhaps learn more about what makes it so great and even become advocates. Since they aren’t justifying using your product because of incentives, they justify it in other ways.

The point at which you can provide the smallest incentive with the greatest change in behavior AND attitude is the point of minimum justification. It’s what you want to shoot for in your program. In the case of pharma, I see too many new adherence programs relying soley incentives to keep people on the drug. This isn’t a winning strategy. For people to truly want to continue their treatment, they need to understand why they are taking it and the risks and benefits. If they’re just taking it to collect your incentives, then they aren’t doing this. You’re not changing attitude, which won’t be effective over time.

For more on where this concept was born, check out the Wikipedia article explaining Festinger and Carlsmith’s classic experiment back in 1959.

6. No customer ownership

If I have nothing invested in your program, then I’m not going to continue with it. My investment is usually my time and if I haven’t given you this, then I’m not going to be a part of your program for long. However, be careful that you don’t create this investment while you commit sin #4, Make it hard. Don’t create work for people just so they waste their time. That’ll get them to quit your program really quickly. Instead, find ways to ensure people’s time investment yields them something of value. Consider the time people invest in tracking their runs via Nike+. It would be hard for another competitor to come along and steal away any regular user of this program simply because they have so much invested. They’d have to start from scratch and they’d lose all the “credit” for all the runs they’ve done, lose all connections to people they’ve challenged, plus having to learn a new system. Nike+, of course, gives great information back in exchange, so people feel that their time investment is worthwhile and at the same time, they make it harder and harder for themselves to leave the program each day.

Remember these things? They were everywhere for a long time. What made this so effective is that AOL realized the more free time they give, the more likely you are to stay with them when you run out of free time. Why? Simple. You’ve invested so much time into it by the time 1,000 hours (or 45 days) rolls around. You’ve got an email address you’ve shared with others, a profile that took a long time to get just right, friends who you IM…you’re not leaving all of that. AOL used this concept perfectly and became the largest ISP almost overnight. Of course, if your service stinks, then no amount of investment will keep people forever.

7. All about the brand

People don’t inherently care about your brand. The sooner you recognize that, the better. Certainly, this is true for most pharma brands. And, while some brands might have an almost cult following (Apple, Harley, etc.), most brands don’t have this luxury. Because of this, your program has to offer more than just a connection with your brand. There are already so many other programs out there connected to specific brands and stores that people lose track. Instead of getting overwhelmed, they just drop everyone. Does your stack of loyalty cards look like this?

Do you think any of these stand out from any other? Is it any wonder why people never have their card when the cashier asks?

To stand out, you program has to offer more. It has to be more than just the product. Nike+ isn’t all about Nike’s products. It comes with a valuable service that makes me (all right, makes other people) better runners and, in turn, healthier.

So, those are the 7 Biggest Mistakes in Digital Relationship Marketing. Steer clear from these and your program is already far ahead of most that are out there. Coming soon, I’ll share the 7 Golden Rules in Digital Relationship Marketing, which will highlight what you SHOULD be doing to make your program a success.

If you’d like a POWERPoint version of today’s post, you’re in luck. You can download a copy of The 7 Biggest Mistakes in Digital Relationship Marketing (538 downloads) right here. One request: if you do download it, how about sending out a tweet?

Possibly related posts (auto-generated):

1. The 7 Golden Rules in Digital Relationship Marketing
2. The Future of Digital Relationship Marketing in Pharma
3. If You Charged for Your Content, Would Anyone Pay?

With just a few days until the long awaited FDA hearings on pharma’s use of social media, the buzz in our little community has certainly picked up. Heck, there’s even a site to track it all courtesy of Fabio Gratton. If you want the latest about these hearings, this site is a pretty good place to start. You can get a bunch of logistics information, see the Twitter buzz, and even download the presentations of those people who have made them available (you can get mine here).

It’s all great. We’re finally going to have some guidelines around social media, which we all have been clamoring about for a long time.

Enter the cynic part of me. I’m not so sure that most people are going to be happy with the results of this meeting. I was talking with a client yesterday who asked if I expected the guidelines to be vague/ambiguous or specific. Presumably, the latter being preferable to marketers. Of course, the guidelines can’t really be specific. For example, they can’t say, “Do this, this and this on Twitter, but not this and that.” The guidelines HAVE to be vague otherwise they’ll be outdated next year as the technology changes. I wouldn’t have it any other way. Ultra-specific and highly directive guidelines is not what you want…trust me. Don’t you already have that with everything else? Have you seen a pharma print ad recently?

That’s 40% ad and 60% fair balance. Do you need more rules like this?

My point is here is that slightly ambiguous rules, will allow many marketers to continue to justify their lack of participation in social media. Sure, nevermind that their peers are already doing quite a lot (see it all on the Pharma Social Media Wiki). Doesn’t matter. They’ve always had one objection and they’ll continue to have it.

That’s right, you guessed it: “adverse events.”

I’ll say this, if I never hear the words “adverse events” from another brand marketer, I’ll live my life out a much happier and less stressed person. When I was a brand manager and social media really wasn’t all the rage as it is today, I don’t think I ever said “adverse event” one time in three years in the context of reporting. It was something that happened and we had a whole team just to handle them, but I didn’t concern myself too much with them as a marketer (thankfully, on a product with very, very few reported adverse events).I relied on more classic “rationale” when I didn’t want to do something…you know, things like “no budget,” “regulatory,” and “ROI.”

But now, that there’s social media, it’s a whole new set of “rationale.” Of course, the one that rises to the top is adverse events. To figure out a bit more about this, I informally asked some pharma marketing people about what they thought “adverse events,” specifically “reportable adverse events,” really were and was pretty surprised by the results. None of the five I asked knew the completely accurate answer. I realized that this might be part of the problem.

It became clear to me and I crafted this analogy: Being afraid of “adverse events” in social media is like being afraid of swimming right after you eat.

Someone always told you that if you went swimming right after you ate that you’d cramp up and sink like a stone and drown a horrible, if sated, death. Except you won’t. No one knows where this “old wives tale” came from or certainly the scientific proof for it, but yet it persists. There’s probably a hint of science in there…maybe you’re body is spending resources digesting the food that would ordinarily be used to help you swim, so therefore…well, you can see how these things happen. Same thing with adverse event reporting…someone heard that one time someone posted an adverse event on a website and a pharma employee saw it and didn’t report it. This employee was subsequently tarred and feathered, fired, spent 12 months in real prison (no white collar stuff) and the company was fined $1 billion.

Ah, urban legends.

So, knowing that there’s a bit of a misunderstanding about adverse event reporting, I’m going to clear it up with some good old-fashioned numbers that I know your average marketer (myself included) can relate to. When the guidelines come back from the FDA and you don’t like them, you won’t have the whole adverse event issue to hide behind anymore. If you still want that security blanket, then stop reading now.

[Important safety tip: I am not an attorney, much less your attorney, so this should not be considered legal advice.]

By now, everyone has seen Nielsen’s report on the incidence of reportable adverse events on health-related sites. If you haven’t, get the paper now. In summary, Nielsen pulled out 500 random posts from the massive amount that they monitor (more on that in a minute). They then analyzed these to see if any of them had a “reportable adverse event.” What do you need to have a “reportable adverse event”? Simple. You need four things: an identifiable patient, an identifiable reporter, a specific drug or biologic involved in the event, and an adverse event or fatal outcome. If you don’t have all four, don’t bother submitting it because the FDA won’t accept it. In their words, “[Without these four pieces] a report on the incident should not be submitted to the FDA because reports without such information make interpretation of their significance difficult, at best, and impossible, in most instances.” [ital. added]

Of the 500 posts Nielsen reviewed, only one (yes, 1) had all four criteria. That’s 0.2% for those scoring at home. So, 0.2% of all posts, should contain a reportable adverse event. Impossible you say? Here’s why it’s so low: the rate-limiting factor here isn’t what many people think. It’s not that the, say, identifiable patient piece is difficult because of the anonymity of the Internet, for example. It’s much simpler than that. Most of what you might think is an “event” is not required to be reported.

In the Nielsen study, they looked for events that would need to be reported within 15 days of receipt per FDA regulations. These are the most serious events and have the strictest reporting standards. Events that must be reported within 15 days are those that are BOTH serious/life-threatening AND “unexpected.” The former is pretty simple and includes outcomes such as “death, a life-threatening…experience, inpatient hospitalization or prolongation of existing hospitalization, a persistent or significant disability/incapacity, or a congenital anomaly/birth defect.” The latter, “unexpected,” is a bit trickier, but also is pretty straight forward. “Unexpected” is  “any adverse drug experience that is not listed in the current labeling for the drug product.” [Read the full code on FDA's site]

This means that if someone reports they got a headache while taking your drug, for example, and headache is listed in your labeling as a known side effect, then you do not need to report this in 15 days or any other day. If, on the other hand, they report that their hair fell out and that’s not in your label, then it might be reportable since it’s “unexpected.” However, it’s not serious or life threatenting, so it would not be required to be reported within 15 days. Events that are EITHER serious/life-threatening OR “unexpected” need to be periodically reported to FDA (hint: you’re already doing this). Drugs launched in the three previous years needs need to do quarterly updates on these types of events. Those drugs that have been around longer than three years need to do annual reports. For the purposes of this discussion, I’m really only considering the events that would fall under the 15-day rule (as did Nielsen), as these are the ones that are most labor intensive and require immediate attention. Those that fall outside this rule can use your normal channels for reporting back to FDA, which you’re doing already.

Most of the confusion I’ve seen is around this issue is around defining exactly what qualifies as an adverse event that requires action. I mentioned already that only 1 posting in the 500 Nielsen reviewed met all four criteria including the adverse event part. However, I asked Nielsen for a bit more information on this and got some great help from my colleague at Nielsen, Melissa Davies. She informed me that only 4 of the 500 posts had events that were reportable under the 15-day rule (i.e., an event that was BOTH serious/life-threatening AND “unexpected.”) . Three of these were missing one of the other criteria required for reporting, so you’re left with one in 500.  I’ve heard a bunch of debate about this study because it doesn’t consider some companies’ required due diligence around investigating reports that are missing one of the four components. For example, there might a company policy that says you must investigate to find a reporter’s name including sending them a direct message or email from the site where the event was posted. Nielsen didn’t (and shouldn’t) account for every company’s policy on this.

However, regardless of your due diligence policy, you can’t report something that didn’t happen. If there’s no adverse event, it doesn’t matter if you have the other three pieces or not. Show’s over. No need to go further. So, the way I see it, the absolute worst case scenario is that only 4 out of 500 posts are potentially reportable, which is 0.8%. That’s not a big number, of course, but how many posts are there every day? That would tell you how many potentially reportable adverse events there are in a month or year.

Nielsen shared with me a bunch of data for my FDA testimony. They shared that their BuzzMetrics product regularly scans more than 100 million sites. Around 1,350 of these are healthcare-specific and have some discussion component to them (blogs, forums, Q&A, etc.). These 1,350 generate almost 83,000 new posts each DAY.

Here comes the math:

Math problem #1: Multiply the total number of posts per day by the number of posts that contain adverse events that are both serious/life-threatening AND unexpected and have the other three criteria required for an adverse event  = adverse events generated per day that need to be reported in 15 days to the FDA.

Math problem #1 answer: 83,000 X 0.2% = 166

If you want to use the more conservative number…

Math problem #2: Multiply the total number of posts per day by the number of posts that contain adverse events that are both serious/life-threatening AND unexpected, but do not necessarily have one or more of other three criteria to have a reportable event =  the maximum number of adverse events generated per day that need to be reported in 15 days to the FDA.

Math problem #2 answer: 83,000 X 0.8% = 644

Let me put that to you another way…the ENTIRE PHARMA INDUSTRY, assuming they were responsible for EVERY SINGLE discussion online, would have to manage 166 reportable adverse events per day. Divide that out across the number of companies out and there’s not a lot of work for people to do.

Of course, you are not required to monitor everything out there and you only have to report events that are reported to you (which would include posts or comments on sites you manage or control) or events that you come across elsewhere online. Unless you’re a really fast searcher, then you’re probably not going to read through 83,000 posts a day (hint: that’s about one per second). If you only concentrate on your little neck of the woods, then you might never come across a reportable adverse event in months. How many posts or comments does your social media program get? Looking at what’s out there, not many. So, if it takes 500 posts to see one, then you might not see one in your lifetime.

The point of all this is simple. Are we really holding back everything there is to gain from properly engaging in social media because of 166 reportable events a day? Does that add up for anyone else?

Possibly related posts (auto-generated):

1. Monitoring Adverse Events in Social Media for Pharma’s Biggest Brands: Hopeless Task or Simple Project?
2. The Myth of Adverse Event Reporting
3. Pharma Should Forget About Social Media Monitoring

My topic was Marketing with Meaning as it applies to pharma, which I’ve talked about here before in a three part post ( 1, 2, 3). After much preparation, I felt I was finally ready. I was the last to go and, because it would have been too easy otherwise, there was a major glitch with my slides. Instead of seeing the slides I supplied them and checked the day before, I saw “slightly” edited slides that had all the titles cut off or otherwise misformatted. Sometimes this resulted in nonsensical statements and, at other times,  the results were quite amusing. Either way, I had to improv my way through not just this difficult format, but also the additional challenge of a little mystery every time a new slide appeared.

If you want a copy of the ACTUAL slides, as they were supposed to appear, you can download them here. You’ll see the titles and, therefore, slides make a lot more sense this way. This also includes my speaker notes as well.

Without further adieu, here’s my presentation:

In the end, it worked out fine and I was told my presentation was even better because I had to fight through the slide format issue. Of course, I think I should be insulted by this because no one saw my presentation the “right” way so they couldn’t actually make this comparison. But, hey, I’ll take it.

You can dig through the Twitter hashtag feed for the conference to see everything discussed and you can find the feedback that I received as well (I’m afraid to look). The hashtag was #epatcon and I’m @jonmrich.

Here are a few photos from my talk as well. (Photo credit to E-Patient Connections/Kru Research)

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Here’s the presentation on SlideShare. Click through to see the notes for each slide.

Possibly related posts (auto-generated):

1. How Marketing with Meaning Can Save Pharma — Part 2
2. How Marketing with Meaning Can Save Pharma — Part 1
3. How Marketing with Meaning Can Save Pharma — Part 3

I’ve been involved in a few discussions lately about how pharma can  improve compliance to their medications. Of course, this isn’t the first time I’ve had these discussions and, likely, it won’t be the last. Part of my last job at AstraZeneca was managing our compliance program for their breast cancer products. If you’re in pharma, you know that this debate has been going on for years. Within the last five years or so, interest has really picked up in this area likely because someone really started crunching the numbers. As pharma sales growth has slowed, they’ve needed to look at different ways to sell more of their products. A seemingly obvious place to start is compliance. If you do some quick math, you figure out that if you can get people to stay on treatment, you can put hundreds of millions, if not billions, of dollars to the company bottom line. Seems simple enough…

Somewhere around a third to a half (or more) of patients don’t take their medications as prescribed. If you want to see a ton of stats about this covering a bunch of different diseases, check out the ultimate in compliance resources, AlignMap. Oh, and by the way, maybe you’re thinking that those patients who are non-compliant are those with less serious diseases. You’re wrong. From AlignMap citing multiple sources…

• Approximately half of the patients who chose to undergo the pain, risk, and emotional trauma of a kidney transplant do not adequately follow their medication regimen prescribed to prevent rejection, and 25% regularly miss doses of prescribed medications.
• In one study, 58% of patients with glaucoma who were told that failure to use their medication would result in blindness were noncompliant; 42% of patients who had already lost sight in one eye after they failed to comply with their medications persisted in their noncompliance.
• Another study estimated that half of those surveyed had missed doses in the two weeks prior to the survey, although they believed the medication to be effective and potentially life-saving.

That’s a problem.

It’s a problem we’ve tried to fix for a long, long time. And, we’ve tried a lot. Here’s a list of the most common compliance interventions out there (again, credit to AlignMap, take the hint and check it out):

• One on one counseling
• Educational videos, brochures, and tapes
• Court mandated and monitored treatment
• Promotions of self-reliance and self-efficacy
• Improved patient-clinician communications
• Directly observed therapy
• Mechanical or electronic reminders
• Adherence programs provided by a pharmaceutical manufacturer
• Automated or personal phone calls or email
• Disease management programs
• Celebrity endorsements
• Public Service Announcements
• Simplification or alteration of regimes
• Assistance to increase accessibility

So, how many of these have you tried at your company? How many have made a big impact? The reality is that very few interventions make a significant difference in compliance rates. We haven’t figured out the magic bullet. If we had, we wouldn’t still be having this conversation. For my part, I believe the reason we haven’t made an impact is because we test and use one intervention at a time. That is, you create a text message reminder program to improve compliance. But what if I don’t use text messages? What we need to offer is a wide choice of different compliance programs with each individual enrolled in the programs that are going to impact them. Of course, this might not be completely practical, as it would require you to create twenty (or more) different compliance programs (see the above list) so that each person had enough choice. That could get pricey. Sorry to say, but likely that’s what’s going to be the thing that significantly impacts compliance when the first company decides to take the plunge and create a comprehensive platform like this.

In the meantime, let’s look at something different. Let’s try something not on the list…something that hasn’t been done before. It’s called fun.

Perhaps you’ve heard of it (from Merriam-Webster).

FUN, Pronunciation: \ˈfən\, Function: noun

Etymology: English dial. fun to hoax, perhaps alteration of Middle English fonnen, from fonne dupe

1 : what provides amusement or enjoyment; specifically : playful often boisterous action or speech <full of fun>

Okay, glad I could remind you. Fun. You like fun, right? Not much from that list above appears to be fun. So, what does fun have to do with drug compliance?

Maybe everything.

Watch what fun can do…

Now, if the pharma industry (myself included perhaps) was asked to increase the number of people who chose the stairs, we’d probably do it a little differently. Likely, we’d put up some signs that show the benefits of exercise on cardiovascular disease (and you know we’d use the word “cardiovascular” a lot). We’d also probably tell you about the risk of not getting enough exercise. Maybe we’d even get a celebrity that we could put on the signs (or make cutouts)…I’m thinking one of those trainers from “The Biggest Loser” would be great. And, we’d probably put in some sort of flashing light to call attention to the people who decided not to take the stairs.

Ho hum. All of those things have one thing in common…they aren’t very fun.

I was recently at a great meeting (in Iceland) where I met people from many different industries. One of the people I spent a lot of time with was Toby Barnes who is Managing Director for a company called Mudlark. This company does a lot, but in the end, they’re a company that makes games. Toby has incredible passion about gaming, but he’s not the guy who sits in front of the XBOX all day. He simply believes in the power of games to change behavior. Toby really just wants to create fun. One of the many things he told me that stuck with me was really simple. I’m going to paraphrase, but the gist was this: humans learn by playing. From the moment we’re born, through our most important developmental years, we learn by playing. The roles we play in life, how things work, what’s good and bad behavior, and how to communicate with others…all from playing. Somewhere along the way though, we stop playing and stop learning.

So, what is playing? Well, first, playing is supposed to be fun. Without that, the rest doesn’t matter much since no one will play with something that isn’t fun.

Let’s go back to the Volkswagon video. They created something fun, something people played with. People saw that taking the stairs could not only be fun, but also that it wouldn’t kill them to do so from time to time. We all know that we should take the stairs more often. It’s a simple way to improve our health that’s available to almost everyone no matter where they are. But, just like our medications, we don’t do what we’re supposed to do. By simply changing the way we encourage people to change their behavior, we can create something different, something that might just work.

Digital technology makes it really simple to create fun and engaging games–games that can teach us to change our behavior while we’re doing something we enjoy. When I mentioned earlier that I had an idea that wasn’t on the list above and hadn’t been tried before, I wasn’t being totally honest. You see, someone has taken this approach in healthcare…and it worked. I actually wrote about this a long time ago in a post called Gaming To Save Healthcare Marketing.

The greatest example of fun leading to a behavior change in healthcare is Re-Mission. This game was created to help kids fighting various cancers. It’s essentially a first-person shooter-type game, but you’re battling the disease.

Well, isn’t that nice. They created a game for kids fighting cancer to help them pass the time during treatment. Right? No. This game was designed to improve outcomes. In fact, the company behind this game, Hope Lab, conducted a randomized trial to test the game’s effectiveness. Half played Re-Mission and half another video game. The results were published in the journal Pediatrics. Here are some high points:

• “Self-efficacy and knowledge were significantly improved in the intervention group compared with the control group.”
• “Adherence to at-home medication (trimethoprim-sulfamethoxazole and 6 mercaptopuring) was significantly improved in the intervention group compared with the control group.”

Yes, you read that right: “Adherence to at-home medication was significantly improved.” How did Re-Mission manage to do this? The game is fun and, if we follow Toby’s logic, we learn by playing. That’s just what happened here. These kids learned about their disease and its treatment by playing. Not only that, they learned by playing something they enjoyed.

Perhaps this is the real key to improving compliance. It’s not about creating fear-laced predictions. Not about creating nagging reminders. Not about creating tedious tracking tools. And not about spying on people. These are the things we do in most of our compliance programs today. They aren’t working like we need them to, so isn’t it time to find something different?

PS: There are a couple more experiments beyond the stairs that Volkswagon tried. All with the idea of fun, check out what else they managed to do:

Possibly related posts (auto-generated):

1. Can Your Electric Bill Show Us How to Improve Medication Adherence?
2. RealAge, Wii Fit, and Pharma Marketing
3. Gaming To Save Healthcare Marketing

We’ve now established what the concept of Marketing with Meaning is and how it might relate to pharma. I gave the example of Baxter’s marketing for Aralast as a perfect demonstration of how it can work. I’ve also offered you a few  other examples from healthcare and other industries, which can be found on the Marketing with Meaning blog and in the free download of chapter two of the book.

Some people have told me that sometimes I oversimplify concepts like these. That is, they interpret my posts sounding as if I’m saying, “But, this is so simple…why in the world are you standing around doing nothing?!?” But having worked in pharma for many years, I realize, it’s never that simple. But I like challenges like that form my readers, so to show you that this is an important concept for pharma and one that they can and should embrace right now, I’m going to give you a three of examples of what Marketing with Meaning could look like for a few big pharma brands. I’ve somewhat randomly picked these brands, but if any of you skeptics think I “cherry-picked” these, just leave me a comment and let me know for which brand you want me give an example. (PS: I’ll take up that challenge for any brand in any industry, by the way)

Two disclaimers before I get into these. First, you’ll probably look at a few of these ideas and think that no one would want to engage with a pharma company in the ways I’m suggesting. You might be right. At least, you might be right today and I probably agree with you. But, if people won’t participate in my program because they don’t trust me, is the solution to never do a program ever again? No, the answer is to do the program and show that you are trustworthy. It won’t happen instantly, but if you do it consistently over time, then it will happen. These first programs might not have huge participation, but they’ll show the world that pharma can do it differently and in a way that they can trust and find very valuable. Second, I don’t have in depth knowledge of the marketing plans for these products. So, these ideas might be off equity and probably not in line with the brands’ marketing objectives. Not much I can do about that. The concept is what’s important, not the specific tactics. In addition, these ideas will certainly be controversial and difficult to get approved, but that’s sort of the point. We’re just going for a demonstration of the concept, not a comprehensive marketing plan. So, here goes:

Gardasil/Cervarix

I mentioned in part one of this series the controversy stirred up by anti-pharma people people regarding Natalie Morton’s unfortunate death. The anti-pharma people tried to blame it on the vaccination for HPV she had gotten hours before. It turns out that a massive undiagnosed tumor is what killed her. A sad story to be sure and one for which pharma companies got unfairly clobbered. I mentioned that a lack of trust of big pharma (no surprise to most of you) is one of the things that makes situations like this impossible for pharma to defend. It’s hard to listen to anyone telling you that all is well when you don’t trust them. That was the point of this Marketing with Meaning series. I think it’s the best way for pharma to get back that trust. As I said before, it won’t happen overnight, but it will happen if we’re consistent.

These vaccines are to prevent the spread of HPV, which causes most forms of cervical cancer. HPV, of course, is usually spread by sexual contact. As you probably know, we’re a little uptight about sex here in the United States. Discussing the need for the vaccine also requires discussing sexual activity. To some degree, this is related to the debate about whether you give teens free condoms. Does it encourage or condone them having sex or is it simply an acceptance of the reality that they will have sex, so you might as well help keep them from catching and spreading sexually-transmitted diseases? I’m not here to answer that debate.

Discussing sex with your kid is pretty tough for most people. It’s uncomfortable (for everyone). Parents might not be sure how far to go and what level of detail to provide. And they likely aren’t aware how much their kid already knows. When your kid senses this, it makes the conversation even worse, so many parents struggle with this parenting challenge. In many ways, this discussion is like talking to your kids about drinking, smoking, or drugs. These can be uncomfortable as well for parents. But, parents have gotten better at these over the years thanks to some really good campaigns from government agencies, non-profits, and even manufacturers. The free download of chapter two of the book from Marketing with Meaning has a great case study about the Partnership for a Drug Free America (PDFA) on page 42. They’re the people who brought you the “This is your brain on drugs” ads. But, they’ve left these behind to focus instead on educating parents about how to talk to their kids about drugs. Check out what they’re providing for parents on their site.

While weighing the risks and benefits of the HPV vaccine is an important part of the decision process being able to have a frank and open discussion about sex with your kid is a key part as well. A parent might think they can put off the decision to have their child vaccinated for a few more years because they aren’t sexually active when, in fact, they are. So, here comes the Marketing with Meaning part: why not help facilitate this discussion? Do exactly what PDFA did to help parents talk to their kids about drugs, but make it about sex instead. Help parents with the difficult questions, with the details, and with knowing when you should have the talk. No one’s providing this really well on a national level and it’s a great chance for a pharma company to demonstrate some Marketing with Meaning. This isn’t selling vaccines or promoting a brand. That comes over time when parents trust you more. This is providing something meaningful to parents who are your most important customer for these vaccines. You’ll be able to talk about your product later when they’re actually listening.

Enbrel

For those who don’t know, Enbrel is a treatment for moderate or severe cases of rheumatoid arthritis (RA). It’s also one of the top ten selling drugs in the world. But what would happen if the incidence of rheumatoid arthritis started to decrease? What if someone was helping people slow the progression of or delay the onset of arthritis? Check out this campaign for Tylenol. You’ve probably all seen these billboards by now. What are they doing?

These billboards appear to be showing you a way to avoid taking Tylenol. If there are fewer people with headaches, then doesn’t their demand (and then sales) go down? Of course, what Tylenol knows is that providing this advice helps people create a better connection with the brand. People view these and believe that Tylenol isn’t simply out to make a buck, they care about your health. When you’re about to pick up a pain medication in the store next time, who do you turn to? The company that you know cares about your health or some private label store brand? Of course, this doesn’t create an emotional connection with everyone, but over time it has an impact. These ads are Marketing with Meaning. Yes, they’re billboards that are somewhat inherently interuptive, but you choose whether or not to read the words. When you do, you realize that they give a tiny, but valuable piece of information that can help in the future.

So what does this all have to do with Enbrel? Let’s take the same approach as Tylenol and help prevent those with the earliest stages of RA from progressing into the more serious, latter stages. It’s just like a headache medicine helping you prevent headaches. How can Enbrel do this? Exercise is an important part of preventing the progression of arthritis. Of course, some of the most debilitating effects of RA happen on the hands. They become painful and lose flexibility over time. You can slow this with proper exercise, but how do you exercise your fingers? Well, WebMD has an entire section dedicated to this. Any other ways, just in case you find those boring? Hint: if you’re writing a comment about how there’s no way to do this, you’re doing it. Typing and moving a mouse can be a good way to get some exercise in both the hands and fingers. Not too much to the point that your hands get sore or lead to carpal tunnel syndrome or anything, but enough to get people moving their fingers around everyday. But how do you get people to type? With a game.

The onset of RA typically occurs in middle age and women are disproportionately affected. This group is also big players of “casual games.” Seriously. Here are some stats from two sources ( Pew and ESA):

• Average game player age: 35
• 26% are 50+
• 36% of gamers 65+ say they play EVERYDAY or almost everyday (the highest of any age group)
• 50% of gamers are women

These are simple, often Flash-based games that can played quickly and might have an interesting rewards system. It’s games like Bejewelled.

You could create a game that requires you to use increasing amounts of finger dexterity (up to the level you can comfortably do) in order to get through puzzles or move onto the next level. Perhaps part of the play requires you to use one hand and quickly press a few different keys in order that are spread in different keyboard positions. The faster you do it, the more impact it has on the game. It doesn’t have to be complex (but it does have to inherently be a fun game and not just an exercise tool). You would make the game open to the public and it would just carry a small Enbrel logo in the corner. If you make the game good enough, you’ll help people prevent the progression of their RA, something they’ll be incredibly grateful for…something that will dramatically build their trust in you. And, if it’s good enough, the game will get played and spread around by people that don’t have RA, but it will also increase their trust in you as well. More trust with more people is just what pharma needs.

Lipitor/Crestor/or any other statin

I already gave you the Aralast example of providing free test kits for their drug. They have to because the disease is so rare that your average health insurance plan would see it as a waste because it would cost a fortune to find a handful of people with the disease. It would be a tremendous burden on the health system with little wide-scale benefits. So, Baxter takes that on as part of their marketing budget.

If we were in the UK right now, I could simply walk into the pharmacy and pick up a statin off the shelf. Statins are an over-the-counter (OTC) product there. There’s been debate about making certain statins OTC in the US and this debate will likely continue for some time. The arguments for allowing this is that more people will get treated. Presumably, this is because there’s far fewer barriers to getting an OTC product than a prescription one. There’s no trip to the doctor, no passing a slip of paper, and waiting for you pharmacist to fill the prescription…you just walk in and take what you need. The arguments against focus on concern about people managing their own heart disease; something, they say, should be monitored by a physician. I’m not here to declare who’s right and who’s wrong.

So, if the argument for allowing this focuses on giving more people access to these drugs by making it simpler to get treatment, can’t the prescription drug companies do this too? It’s a hassle to go to your doctor and get a blood test, wait for the results, maybe go back for a follow-up to discuss treatment, get a prescription…and on and on…you get the idea. Many people get their cholesterol counts during annual check ups, but not everyone gets one. So, why not eliminate some of the barriers? Take out the first few steps of the process by supplying at-home, cholesterol testing kits to those who ask for it. You already can get them without a prescription for about $15, so this isn’t completely crazy of an idea. Before you panic, let me tell you how it would work. Test kits can be made available through different media promotions, in-pharmacy displays, etc. The person gets the kit, takes the sample and mails it back. They can choose to have the results sent to themselves or to their doctor. You also allow them to request additional information about your company or your products, but you don’t keep their information. That is, you can’t keep the test results to use later on. Sorry, too much room for abuse there.

Here’s the simple math, which I admittedly haven’t done with absolute precision: is the cost of the tests (and processing) less than the incremental sales your product would get from people who would never have found out they had high cholesterol? If the answer is “yes,” then this is a simple decision. Let’s see…a test costs $12 to manufacture and process (I’m thinking bulk discount). Let’s assume that only one in four who take the test would actually be a candidate for statin treatment (based on this). That means you have to spend $48 ($12 x 4) to find one highly qualified and motivated patient (I classify them as such because they’ve had to do a lot to get to this point unlike, say, someone who just visited your website). Perhaps only one of the four actually goes to the doctor and gets a statin. That means, you have to spend $192 ($48 x 4) to get one motivated person a statin prescription. At around $130 per month, each person needs to take their treatment for an average of 6 weeks for you to break even. Of course, you won’t get every prescription, so apply your brand’s market share here as well. This doesn’t factor in the PR benefits and free media placement you should expect as well. Not sure if the math works (I think it’s actually conservative)? You could do this as a small, localized pilot to see what the rates of response are before going national.

Like Aralast, pharma gets to play the hero because they are reducing the costs within the healthcare system by absorbing some of the testing costs themselves. They are getting treatment to people who would go onto have severe heart disease without ever knowing it. But, you say, will people trust pharma to do this? As I said before, maybe they won’t at first, but enough people will. With those people as your proof, you show the world that you are doing this with good intentions and that there isn’t anything underhanded going on. It would be a slow process, but it would work over time.

There you have it. Three examples of Marketing with Meaning for three big pharma brands. These might not be ideal programs for these products, but consider them illustrative. Imagine what the people on these brand teams can come up with as they apply their intimate knowledge of the brand. I guarantee they’d be even better. These examples weren’t meant to say that these brands should do these programs, but more to demonstrate how it’s possible even for pharma to do meaningful marketing. Some already are, but if we can do it consistently throughout the industry, we can change public perception and get back to a place where people are glad pharma companies are around to provide them with life-saving or life-enhancing medications and not as something they need to protest against.

Possibly related posts (auto-generated):

1. How Marketing with Meaning Can Save Pharma — Part 2
2. How Marketing with Meaning Can Save Pharma — Part 1
3. Gaming To Save Healthcare Marketing

When you last left this blog, I outlined some of the big issues facing pharma marketing and provided a pretty striking example of how the lack of trust in pharma by many in the general public manifests itself. As a recap, I outlined three big problems that I think can be addressed by changing the way pharma companies market their products.

1. Horrible PR and public perception from  marketing tactics perceived as questionable
2. No public belief in the cost to value equation for pharma products (i.e., people don’t think they should cost so much, which means they think the products aren’t worth it)
3. Falling sales and profits

Sure, that doesn’t capture every issue, but whatever the issue, it likely fits somehow under catch-all issue number 3: falling sales and profits. My assertion was that a concept called Marketing with Meaning could improve all of these. For those who closely follow this blog, you’ll know that Marketing with Meaning is a concept developed by Bob Gilbreath, our Chief Marketing Strategist here at Bridge Worldwide. So, yes, I’m a little biased in thinking this is a really important concept that every industry and every company should understand and implement, but I’m also one of the biggest skeptics out there and if I didn’t think it was a fit for pharma, I wouldn’t be writing about it. Now…on with the show.

First, a little background for those not familiar with Marketing with Meaning. It’s pretty simple really. Marketing with Meaning is two things: marketing that people choose to engage with and marketing that itself improves people’s lives. It’s the opposite of interruptive, broadcast advertising. Simple enough, right? So, why is the first part important? Let’s look at some numbers, shall we?

• Do you like using TV ads as a marketing tactic? Well, IDC Research has shows that 2/3 of DVR owners skip commercials all or most of the time. For the most popular shows, Nielsen Media Research reports that 20% of ALL television viewers (not just those with DVRs) are skipping commercials.
• Remember telemarketers? Probably just a distant memory for you. That’s because 76% of Americans signed up more than 150 million phone numbers on the Do-Not-Call List within months. What’s the next list?
• How about Flash banner ads? Heck, our company makes them all the time for clients. Are these working? Well, 6 million Firefox users have installed AdBlock, which eliminates every one of these ads. (Even the Cannes Gold Cyber Lion winners like our “Can Hands” ad. Sorry, couldn’t resist.)

Not a pretty picture. You’ll notice that digital marketing isn’t immune. People are just as frustrated with digital marketing that isn’t meaningful as they are with any other channel. So, what do we do? Well, the good news is that some companies have already figured out what to do. And while they may not be calling it Marketing with Meaning (yet), that’s just what they’re doing. “So what,” you ask? Our research at Bridge Worldwide shows that “the more meaningful people find your marketing, the more they’ll be willing to pay for your stuff, the more of an investment they’ll make in it emotionally, and the more motivated they’ll become to spread the word.” (from “The Next Evolution of Marketing: Connect with Your Customers by Marketing with Meaning“)

Sound like what you’re trying to do with your marketing plan every year? More people buying your products. More people creating deeper emotional connections with your customers. And more people talking to others about your products. You’re probably spending millions right now to deliver some of these goals right now.

You probably want an example of Marketing with Meaning by now. First, let me tell you what it’s not. It’s not cause marketing and it’s not marketing that is somehow against conspicuous consumption. Meaning in this case means “personal value.” It’s what you find meaningful. That’s going to be different for different people. A cause like saving the rainforests might not be important to your average teenage boy, but a funny, viral video he can share with his friends might be. He’s also not interested in a program that improves high cholesterol, but his father might be. Because everyone’s a bit different, there isn’t a one-size fits all approach. Like anything, you’ve got to match you meaningful marketing program to the needs of your customers. But, there are also many ways that you can be meaningful.

Now for the examples…

Samsung could have put more billboards all around airports that no one would have noticed, but instead, they paid to install charging stations for travelers like me who can never seem to find an outlet. And, by the way, they get to show me, a very grateful traveler who is charging up a bunch of electronics (which eventually are going to need to be replaced), some of their latest gadgets.

When Adidas bought Reebok in 2005 and threatened Nike’s domination in athletic shoes, Nike didn’t react like they always have by doing a massive media blitz. Instead, the reconnected with their core audience, die-hard runners, and created Nike+. In case you don’t know, Nike+ is a chip that fits into your Nike running shoe and syncs with your iPod allowing you to track your runs and get a little verbal encouragement along the way. It all connects back to a website that features a giant community of runners that now numbers in the hundreds of thousands. 30% of Nike+ users come to Nike’s site three times a week. That is, they CHOOSE to come to Nike’s website…three times a week. Is anyone choosing to do that with your website? Oh, one other thing, Nike CEO Mark Parker credited an 8.1% rise in quarterly profits just 6 months after introducing it to Nike+. Remember, that’s in the face of millions spent on media by the Adidas/Reebok behemoth to capture Nike’s share. It didn’t come close to working.

More? No problem. I’ve got hundreds of these. How about one that fits under entertainment? Yes, entertainment can be meaningful to some people and it can come in many different forms. If you haven’t seen the charging stations or used Nike+, I know you’ve seen this next one. Instead of spending millions on TV and print advertising, in 2006, Dove took a different approach. It created “Evolution” (credit to sister agency Ogilvy Toronto). A “simple” video all to support a campaign that would later be called “The Campaign for Real Beauty.” This concept was borne out of research the agency did that showed that 50% of women say that their body “disgusts them.” 50%. “Disgusts them.” Clearly, there was an opportunity to change that. So, with little hype (and no mass media buying), “Evolution” was launched. If you haven’t seen it, watch it. If you have, it’s always worth watching again.

If that doesn’t stop you for a minute, I’m not sure what will. That video, thanks to a massive viral spread, has been seen more than 500 million times. How much would it cost you for 500 million impressions? How about 500 million impressions on people who WANTED to see your commercial? $500,000? $1,000,000? $3,000,000? Nope. Try $50,000. That’s how much “Evolution” cost to create. Sure, not everything is “Evolution,” but you probably don’t need 500 million views of your video. However, you probably want more than the few hundred or few thousand it has now. “Evolution” launched an entire campaign around improving women’s self-esteem. Meaningful, right? Effective too. The Dove brand, which was previously flat, grew by double digits during this campaign.

I’m not going to list every example here. We’d be on Part 9,381 of this post if I did. If you want more examples, then you’ll have to check out the Marketing with Meaning blog or, even better, you can download a chapter of the book, which describes a lot of these examples and many more. It’s a free trial (Hint: also can be a form of Marketing with Meaning). Download chapter two of the book here.

Well, maybe just one more example would help. Since I know my readers, I know that you’re all saying, “That’s all well and good for Dove or Nike, but we’re not selling shoes and soap. We’re making medicines here that save people’s lives and we’re pretty restricted in what we can do.” Both true. The products you sell prevent, treat, or cure diseases. What’s more meaningful than that? So, shouldn’t your marketing be just as meaningful? If you’re saving someone’s life with, say, a chemotherapy for breast cancer, does it somehow reduce the meaning of the product if you’re promoting it in a simple print ad? Doesn’t that cheapen what it does just a bit? I think it might. It almost certainly does in the eyes of your average consumer who sees almost all advertising as interruptive and irrelevant. And, yes, you’re in a regulated industry, but some pharma companies are already doing Marketing with Meaning.

Meet Aralast. Aralast, marketed by Baxter, is a treatment for alpha-1 antitrypsin (AAT) deficiency. It’s a pretty rare condition in which there are low levels or no levels of AAT in the blood. AAT is an enzyme that protects the lungs from neutrophil elastase (NE), another enzyme that is produced by white blood cells. Without AAT, the NE can attack healthy lung tissue. The result can be early emphysema and liver damage. Here comes the “good” news and bad news. Only 100,000 people in the US have this condition. So, it’s a good thing that it’s not more widespread. However, the bad news is that no one has ever heard of it, so no one knows (including your average primary care physician) to look for it. 95% of people that have the disease are undiagnosed. The result is late diagnosis oftentimes when there’s not much that can be done.

A critical marketing objective for Aralast is creating awareness of the disease and encouraging physicians to test for it. If we followed the traditional pharma approach, we’d consider a massive TV or print campaign to inform people that they might have the disease and to get tested. Sure, for most people that see the ads, it won’t apply, but perhaps it’ll reach those precious few where it could help. Of course, we’ll annoy and further distance everyone else, but that’s the price we pay, right? Maybe instead, Baxter should spend a fortune lobbying Congress and health insurance companies to make the tests mandatory. Again, more annoyed people than satisfied people.

What Baxter does is totally different. It gives away the tests (and the lab processing) to anyone who requests them. Concerned consumers can request the test and have their doctor administer the simple blood test and physicians can also request a supply for their offices. The test themselves are, of course, marketing the awareness AAT deficiency (just like our commercial would have tried to do). They’re also branded with the Aralast name. Marketing the product right on the test package?!? Isn’t that exploiting the importance of detecting the disease? Aren’t doctors turned off that the test has been commercialized? No and no. Why? Because the test is Marketing with Meaning. Once again, Marketing with Meaning is marketing that people choose to engage with and marketing that itself improves people’s lives. When it comes to these tests, check and check. Yes, people are choosing to engage with it. Doctors and patients alike are ASKING for the test either through the brand’s website or sales representatives. And, these tests are improving lives. Without access to the free test, many people wouldn’t have thought about getting checked and many others wouldn’t have received it because of pressures within our healthcare system to try to reduce unnecessary tests. (Thanks to Bob G for his post about Aralast, which I borrowed heavily from for this section)

The marketing of Aralast, which comes in the form of free tests for AAT deficiency, improves lives. The product itself clearly improves lives by saving people from early emphysema and liver damage. But the marketing does also. It increases awareness of the disease, it reduces the costs to our healthcare system, and it makes it easier for physicians to diagnosis a difficult to detect disease. It does all of this at the request of customers. People seek out Baxter’s marketing for Aralast (in the form of free test kits). Who’s seeking out your marketing?

So, if a modest-selling product like Aralast can do it, why can’t a top-selling drug like Lipitor do it?

In part three of this post (yes, there’s more), I’m going to tell you how Lipitor can do it. I’m also going to tell you how several other drugs from big sellers to niche products can do it too. Free Marketing with Meaning advice. Stay tuned for Part 3.

(Warning…here comes some commercialism, so if you’re easily offended by that sort of stuff, you should skip this. If you read on, you don’t get to complain later.)

Since you’ve made it this far, I do have to add one more thing. This is going to be a commercial, but I think it’s also Marketing with Meaning. One of the ways we spread the word about our agency, is via this blog. You won’t see an ad for Bridge Worldwide in your latest trade journal (though we did one once a couple years ago though) or at an exhibit booth at a convention. Instead, we invest in this, Dose of Digital (among other things). The Marketing with Meaning blog is, of course, another way we market our agency. We think the information we share in these blogs is valuable and is an example of Marketing with Meaning. You’re choosing to engage with it, right? And it improves people’s lives. Not in the way Aralast’s marketing improves lives, but it makes your job as a marketer easier (we hope). That’s improving lives. There are different degrees, to be sure, but you can always achieve even a modest improvement.

With that, I’d like to tell you about something we’re particularly proud of here at Bridge Worldwide. Last Friday was the official launch a book written by Bob Gilbreath, our company’s Chief Marketing Strategist (and my boss, so be nice). The book is called “The Next Evolution of Marketing: Connect with Your Customers by Marketing with Meaning.” While Bob was the author, we’re all really proud of the book and we have made it the cornerstone of what we do here at Bridge Worldwide. If you have read Bob’s blog or find what you’re reading here pretty intriguing, I encourage you to go get a copy of the book. Not only is it full of great examples, like the ones in this post, but unlike other business books, it tells you exactly how to bring Marketing with Meaning to your company. Step-by-step, internal and external.

Intrigued? How about a sneak preview? You can download chapter two of the book here. It’s a good place to start because it’s the first chapter that really sets up the concept of Marketing with Meaning and also gives some great examples.

One more offer…

Use Twitter? Then I have a request/offer. However, only do it if you’re buying into the Marketing with Meaning concept or read the chapter and liked it. I want you to tweet this only if you really think people should get book. It’s not supposed to be spam.

Okay, here’s the offer: I’ll send EVERYONE that tweets the following message an awesome Marketing with Meaning sticker (or 10…whatever…just share with your friends). There are going to be as cool as the Apple sticker someday, so get in on the ground floor. It’s not a massive token of appreciation, but if you’re a believer in the cause, you’ll want one.

Okay, here it is (please copy and tweet it EXACTLY like this or I won’t know you did it.):

Download a free chapter from the new book, “The Next Evolution of Marketing” Please RT http://bit.ly/twitter_bww

I’ll DM you and to get your mailing address after your tweet goes live.

Of course, if you’ve seen enough and are ready to buy some copies of the book, here’s the link to the book on Amazon. If you buy the book, I’ll send you stickers too. I could require you show me the receipt, but I’d rather it be on the honor system. Just use the contact page to let me know you bought a copy and where I can send the sticker (or stickers if you are going to share them with friends).

Okay, thanks for listening to my little commercial and for supporting the cause. Hopefully, you see how it’s Marketing with Meaning as well. If you’re interested in talking with others who are getting behind the cause, you can join the community. We’re just getting started.

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1. How Marketing with Meaning Can Save Pharma — Part 3
2. How Marketing with Meaning Can Save Pharma — Part 1
3. Pharma Marketing with Meaning Pecha Kucha

There’s no question that pharma is in trouble. There seems to be a scandal a minute (whether real or created). Billion dollar fines seem to be the norm instead of billion dollar products. Sales growth has stalled for many and workforce cuts seem to come everyday.

That’s all pretty bad, but it doesn’t even capture the number one problem and it won’t come as a surprise to anyone: public opinion of pharma is terrible. Not just bad, terrible.

As a regular user of Twitter, I use Tweetdeck and one of my columns shows every tweet with the word “pharma” in it. Today, I noticed this tweet:

I thought it was maybe just one anti-pharma zealot. Then I saw it again. And again. And again. In fact, after searching, I realized there were hundreds of this exact same tweet (see for yourself). Hundreds of tweets all with the same message: a pharma conspiracy. Pharma conspiracy theories aren’t new, but this one stood out for me.

For those not familiar with the story, Natalie Morton was a 14 year-old in the UK who received a government-mandated injection of the cervical cancer vaccine and died hours after receiving it. In the UK, it’s mandatory for all teenage girls to receive the vaccination. For good reason too, it prevents a leading form of cancer, cervical cancer. A vaccine to prevent cancer. Imagine that. Back when Nixon declared a “War on Cancer” in 1971, how thrilled would be to know we had a vaccine to prevent one form of cancer? Instead today, it’s not seen that way at all. It’s just another pharma conspiracy to get more profits.

Back to Natalie’s sad story. Immediately after Natalie’s death, several news organizations jumped on the story. Here’s what Huffington Post ran. It appeared to every anti-pharma person that they’d finally been vindicated. Here was big pharma’s vaccine killing a perfectly healthy girl. Of course, none of them mentioned that 1.8 million girls had already received the vaccine without a single death similar to Natalie’s reported. Of course, the anti-pharma outrage should have stopped today, when an autopsy was performed and found that Natalie died from complications of an undiagnosed tumor. The medical examiner reported the following: “The heart was heavily infiltrated by a tumor which extended to the left lung. It was so severe death could have arisen at any time. The role of the immunization appeared to be minimal.”

End of story, right? Wrong. That’s when the tweets started. Rather than concede that the vaccination didn’t cause this girl’s death, she was used to infuse a little emotion into the anti-pharma zealots’ rhetoric. Yes, it’s really easy to fake a massive chest tumor during an autopsy.

Why is it like this?

Instead of praising pharma companies for potentially eliminating the approximately 11,000 incidences of cervical cancer each year and preventing about 4,000 deaths in the United States alone, “big pharma” gets beaten up. Why?

No doubt there are countless reasons, some of which the industry has brought upon itself with some questionable marketing tactics and scandals followed by massive government fines. But this isn’t the only reason. People are very passionate about the cost of the medications (but not very passionate about the costs of the other aspects of their helathcare). Since most people don’t know what an MRI costs and many don’t pay for a dime of the cost of one, they don’t get upset when their insurance company gets the bill. But when you pick up your prescription at CVS and have to shell out your cash, it’s a different story. That makes people mad.

Clearly, I’m not going to be the one to solve that problem. I’m not going to tell you I know how to completely fix all the PR issues pharma has. But I think we can make a dent.

So, let’s look at three major pharma problems:

1. Horrible PR and public perception from  marketing tactics perceived as questionable
2. No public belief in the cost to value equation for pharma products (i.e., people don’t think they should cost so much, which means they think the products aren’t worth it)
3. Falling sales and profits

Question: Can Marketing with Meaning improve all three of these?

Answer: Not overnight, but yes, it can.

Question: Does pharma really need this now with all of its other challenges to worry about like patent issues, healthcare reform, and increased government scrutiny?

Answer: Because of these challenges, there’s no better time.

Interested?

In part 2 of this post, I’ll tell you all about how Marketing with Meaning can do all this. In the meantime, you should read up on what Marketing with Meaning is all about. You can also register yourself for the upcoming E-Patient Connections conference where I’ll be presenting this concept (in 6 minutes and 40 seconds). If you do register, use promo code jr500 to get $500 off. Finally, a perk from this blog.

Possibly related posts (auto-generated):

1. How Marketing with Meaning Can Save Pharma — Part 3
2. How Marketing with Meaning Can Save Pharma — Part 2
3. Pharma Marketing with Meaning Pecha Kucha

So today I’m here telling you how pharma can cut out the doctor all together. I’m not talking about DTC advertising, I’m talking about a world where pharma makes it unnecessary to go to a doctor’s office as part of the transaction of obtaining a prescription drug. Of course, today you need a doctor to write a prescription for many products. The patient then has to take it to his or her pharmacy to get the medication. That’s quite a hassle. Why not cut out having to go to the doctor? Sure, many Canadian “pharmacies” have made quite a living on this premise using their on-staff “physicians” to do a phone consultation with patients before writing a prescription; a prescription that I’m going to guess is only valid at the pharmacy they work at for many reasons. Naturally, I’m not recommending this approach.

I know that many of you are pretty upset at this idea right now, but bear with me for a moment. You’ll either be much more mad in a moment or intrigued.

Where did I come up with this hair-brained idea in the first place? As a routine, I try to stay on top of new developments in healthcare, especially new uses of digital technologies. A while back, someone called my attention to a company called American Well. I love the concept and what the company is about, but I never really thought of an angle for pharma marketing. Until now…

American Well’s simple tagline is: “The doctor will see you now.” That about says it all. What American Well does is provide a system that allows patients to talk via live chat, including video, with a physician any time of the day or night. Physicians are recruited by American Well and offered payment to be “on-call” during what might ordinarily  may be an off day. When you log into American Well’s system, you have some choices regarding which physician you’re matched up with. It’s not going to be your regular physician, but it’s going to be quality doctor who is willing to see you right now. They can’t do everything and they likely don’t have your full medical history, so think of it like a walk in clinic. Obviously, you can’t have them stitch up a cut or set a broken arm via the Internet, but for routine care, this is perfect. It could potentially save a trip to the emergency room for many and would be a godsend in the middle of the night for some tired parents.

For a moment, think about the economics of this for a health insurance plan. Compare what they save on walk in clinic costs and emergency room visits opposite what they pay for American Well’s services. Since health insurance companies are pretty interested in these economic aspects of care, they’re on top of this. If you’re a member of Blue Cross/Blue Shield in either Hawaii or Minnesota, then you’re in luck. Access to American Well’s service is part of your standard coverage. How nice is that? For the rest of us, we’ll have to wait to use American Well. It’s got to be a no-brainer that many other plans will be offering this soon.

But I don’t want to wait and neither should you. However, I don’t have the resources to launch this service for me and all of my readers. Hmmm, I wonder who might though?

Ah yes, pharma companies. Picture this. You log onto, say, the Singulair product website looking for information about seasonal allergies and you’re trying to figure out if this drug is right for you.  After a little research, you decide that you’re going to ask your doctor about it. Now, your allergies are pretty bad, but they’re not killing you, so you try to set up an appointment with your doctor. Two weeks out is the soonest they have available for your non-emergency. Over the two weeks, do you forget about Singulair? Do you even keep your appointment (especially if your allergies got a little better or your schedule forced you to cancel a few times)? Well, if you forget about Singulair or don’t show up for your appointment, Merck is out of a new prescription.

On the other hand, if Merck had licensed American Well’s platform on the Singulair site, then you simply could have clicked a button and spoke with a doctor that second. The doctor would have examined you (as best as possible via webcam), did a thorough history, and asked a few other questions before deciding which allergy medication was right for you. Yes, this doctor won’t know everything about you and they couldn’t do a full hands on physical, but you’re not experiencing chest pains either. The patient, of course, could ask if Singulair is a good option. This physician isn’t a Merck employee and isn’t paid by Merck, so she could pick whatever she thought was appropriate…just like if you went to the office. Managing this kind of condition might be a perfect case where the American Well model works really well. Merck had to pay for the service, but will more than make a return with this new patient now starting treatment.

In the traditional sense, this would be going around the patient’s doctor, but it’s not cutting the doctor out of the equation like a sketchy Canadian “pharmacy.” A qualified, licensed physician made a diagnosis and prescribed a treatment just as he or she does in their “real world” practice. How much different is this than someone going to the Take Care Clinics at Walgreens or similar concepts in many other chains including Walmart? What about stand along “quick care” or walk in clinics? Not much as I see it. In the case of the clinic at Walgreens, you’ll be seeing a PA or NPA in person. In the online version you see an MD (or DO perhaps) via webcam.

Since the physicians on the other end of the service are ordinary doctors looking to supplement their income a bit, they still get the same promotional attention from pharma companies as any other physician in the country. You aren’t likely to find doctors who will only write prescriptions for the company that is sponsoring the use of the service. Even if you could, I doubt that American Well would stand for that and I doubt that any pharma company’s legal team would allow it either. So, what’s wrong with a pharma company providing patients live access to a physician 24/7? Isn’t this an incredibly valuable service to the community? We’re talking an awful lot about healthcare reform right now and about how some people can’t afford to go to the doctor. Well, here’s a pharma company bringing the doctor to you…for FREE.

Am I missing something? Is there any possible way to cast this in a negative light? Perhaps some doctors who aren’t interested in being a part of the American Well program will be a bit upset, as they might lose some patient visits and they’ll claim (probably correctly) that it isn’t the same level of care that they could provide. Fair enough, but is the upside worth the downside? As a pharma company, you can break it down by cold, hard math. Is the value of the increased prescriptions more than the cost of the American Well system plus the loss in prescriptions from doctors who hold a bit of a grudge against the company? Simple math really. Requires some estimation, but not many factors to consider.

So, is this a potentially an amazing example of Marketing with Meaning or a horrible idea that hurts patients and physicians (and “the system”)?

Just to be clear, before you leave angry comments, I’m not suggesting that pharma companies try to cut off the relationship between patients and their doctors. Nor am I suggesting that this be a replacement for an ongoing relationship with a physician who can manage your health over time. Having said that, there are going to be more technologies available that make it easy for people to get the products and services they want using the methods they want. Healthcare is no exception. So, while this might not be the answer or a feasible marketing tactic for pharma, did you know it even existed? If not, what else is out there that you should know about?

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You’re probably wondering what the image above is all about. Sorry, you’re going to have to read on to get the answer.

Sometimes the biggest inhibitor of the innovation process is ourselves (personal knowledge, expertise, ability, etc.). Sometimes it’s external forces (regulations, guidelines, naysayers). Still other times it’s our interpretation of the external forces. This last one is perhaps the most menacing. Most of us are aware of our own limitations. I’m not about to go out and try to invent a new way to design an airplane wing. I’m not going to try to bring something new to the discussion around a unifying theory of physics. At the same time, most of us know the rules and are forced to live under them. There are these pesky things called laws that always seem to make it all a bit more complicated. Like laws, rules and regulations, such as those from the FDA, often dictate what we can and can’t do. You simply can’t put up a billboard in Times Square proclaiming: “LIPITOR is great for everyone…and whitens your teeth.” Not that you’d do a billboard anyway, but you get the idea. Rules are a good thing in many ways.

However, many times we don’t really know the rules or understand them. Worse still is when we think we know the rules, but really don’t. When this happens, we essentially create a set of “ghost rules” that inhibit our thinking and that of our colleagues. What makes ghost rules especially bad is that they’ve often been around for a long time and no one has ever thought to challenge them. Because these “rules” have often been invented along the way, they are impossible to ever really refute. You can prove that a “ghost” rule is real. Just go look it up. When you see the rule is some FDA guideline, then you’re proved it’s a real rule instead of a “ghost” rule. But how do you prove that a ghost rule isn’t real? If you search for it, you won’t find it anywhere, but because its been around for so long, people might assume that you didn’t look in the right place. It has to be a rule because we’ve assumed it was for so long.

Ghost rules inhibit our thinking and help ensure that we never push to find out what’s possible. You’ve probably been to seminars or had internal training programs about this issue. Maybe you got something out of these sessions and maybe not. For you cynics who didn’t get much out of these sessions, I’m asking for moment that you suspend your skepticism and eye-rolling while I explain why I’m telling you about ghost rules.

Here’s a story that’s been passed around a few times, but the first place I heard it was from David Brennen, the CEO of my former company, AstraZeneca. While I’m not sure his talk was all about ghost rules, his story certainly applied. Here’s the story he told as best as I can remember.

One day a little girl was helping her mother cook Christmas dinner. It was family tradition to prepare the biggest ham they could find along with the many other holiday treats. The little girl watched her mother get the ham ready for the oven and she noticed that just before her mother placed the ham in the oven, she cut the ends off of the ham. The little girl asked her mother why she did that. Did it help the ham cook faster or make it juicier? The mother thought about it for a minute and realized that she didn’t know the answer. The mother’s mother had always done it that way, so she always did it that way. So, to figure out the answer, they called the mother’s mother (i.e., the little girl’s grandmother…stay with me). The little girl asked her grandmother why she cut the ends of the hands. ”Simple,” said the grandmother. “When I was growing up, our oven wasn’t big enough to fit the entire ham, so we had to cut off the ends to get it to fit.”

So, do you cut the ends off of the ham and don’t know why? That’s letting ghost rules control the situation. Of course the little girl’s family’s oven could more than accommodate the ham’s size, but they still cut off the ends. It was always done that way, so it continues to be done that way. No one thought to ask why or to understand the purpose. How many rules are you following where this is the case?

Where am I going with this? What’s this got to do with digital marketing in healthcare?

Notice the title of this post again: “What If There Were No Rules in Pharma Marketing?”

I ask you then, “What If There Were No Rules?” There’s no FDA, no DDMAC, no FTC. Your company guidelines and rules don’t exist and your regulatory and legal teams have been disbanded. It’s a free-for-all and there are no rules. The question is: what would you do?

Sounds great, right? But before you answer, keep in mind one very important thing. While there may not be any rules about what you can say, claim about your products, or do in promotion, there’s an unofficial regulatory body that still does exist. People. Patients, doctors, caregivers, researchers, payors, random pharma critics, and commentators/writers (like me). So, you can say whatever you want, but you’re going to be kept in check by all these people. They are the ones who are going to review what you do and decide what’s right and wrong. For those companies that take advantage of this lawless society, the people are going to react negatively. They’ll reject those that make exaggerated claims, those that mislead, and they’ll also reject programs and promotions that just don’t make any sense.

Let’s say you can do anything you want in digital (aka, e-marketing). Would you?

Before you say “yes,” remember a few more things…

• Even in our lawless, hypothetical world, you still have a budget. All the regulatory people are gone, but there are still plenty of finance people. So, whatever you do still has to fit within your budget and you still have to allocate it across channels.
• Just because you make it, it doesn’t mean that people are going to use it. Don’t waste your money to build something no one is going to use.
• People are going to reject and react violently to misleading advertising. Misleading advertising may work in the very short-term, but it’ll kill you over time. Don’t do it just because you now won’t get caught by the Feds.
• Your competition has the same rules (i.e., no rules). Yes, they came along with you to this magical world.

All right, here’s your big chance. No complaints about how regulated the industry is. No fretting about FDA guidelines (or the lack of them). No excuses about how you can’t do anything innovative in digital in the healthcare industry. So, what’ll it be? What are you going to do first? As a little experiment, please answer the poll below to indicate the tactics you might try and their order of priority. If you want to do something that isn’t listed, then write it in. I’ll write a follow up post to share the answers along with some commentary in the next few days. You can choose up three. (Read on after the poll for more commentary.)

Now, since you already answered the poll, let me guess what you chose. Something social media, probably the community on your brand website. Maybe you picked the Facebook or Twitter page. Alternatively, maybe you chose to “enhance” your messages by showing that data that the FDA won’t allow you to promote. Great. Go crazy. Do whatever you want. There are no rules, right?

I tried to warn all of you who went too crazy. Just because there aren’t any official rules, do you think society is going to let you get away with whatever you want? Sure, you can stretch the claims for your product and get out the data from all those clinical trials the FDA won’t let you promote, but are your target physicians going to fall for it or are you going to make matters worse? Sure, you can create an online community on your brand site, but is anyone really going to join? Do they want to be a part of a pharma company’s community or will they just stick with any one of the many out there already? Same thing goes for your Twitter and Facebook accounts. Do I want to be friends with your pharma brand?

Here’s my point with all of this…the FDA isn’t your problem. But you might have two other problems. First, if you and your company cut the ends off the ham as I mentioned in my story, then you might be the problem. Not exactly you, but the way things are done at your company. The second potential problem is everyone else. You might be allowed to do everything in the world, but is it going to work? That is, will it have a positive impact on your brand?

I guess I’m turning this entire debate about the lack of FDA social media guidelines on its head. Sure, you might like a little guidance, but how much differently would you really do things? Even with no rules whatsoever, you still can’t just do anything you want. There are always unofficial “regulators” and picky, smart consumers who know value when they see it and…well…the opposite when they see that.

Possibly related posts (auto-generated):

1. Is the FDA Already Creating Digital Promotion Rules?
2. How to Avoid FDA Regulations Using Mobile Marketing
3. Crushing Pharma’s Digital Marketing Dreams–Part 2