I recently posted the agenda for the meeting, but it has been updated. You can download the new agenda here:

Updated Agenda for FDA Social Communications Hearing (140 downloads)

(By the way, for the latest and greatest on all things FDA social media hearing, just go to the #FDASM site created by Fabio Gratton.)

I was given the privilege of being one the people who will have a chance to speak at this meeting. The meeting has been broken up into two parts. November 12 and the afternoon of November 13 will tackle the first four questions in the FDA’s announcement. The fifth question in the announcement gets the entire morning of November 13. This question deals with the handling of adverse events (AEs), which even the FDA recognizes as the major stumbling block for companies in dealing with social media.

I will, in fact, be speaking twice. The first will be covering an issue I see with adverse event reporting. The second deals with Question 3 of the FDA’s hearing request (go here to see all the questions and specifics).

Question 3 was this: “What parameters should apply to the posting of corrective information on Web sites controlled by third parties?”

Since the FDA wanted to have everything in advance so they could print it all out for their committee members (why, I don’t know), we needed to turn our presentations into the FDA a week in advance. That was yesterday. Like my friend Wendy Blackburn (also speaking at the hearing) noted while working on her presentation, I too felt like I was working on a critical final paper back in college. Not sure why, as I’m constantly creating presentation it seems (working on one right now, in fact), but being the FDA added a bit of intensity and certainly made me focus a bit more. It’s a big opportunity that the FDA has given everyone here and I am putting a lot behind my efforts, as I’m sure the other speakers are as well.

Since all of the testimony from the meeting is public and will be posted in advance of the meeting, I wanted to give my readers a sneak preview of my testimony. You can download the POWERPoint of each presentation below. It includes my rough “script” that I’ll be using as well. That should ensure the slides make some sense as you review them. They might not without the notes. Just a fair warning.

For Question 3, my presentation focuses on answering this question: “Can a LACK of regulations improve the quality of healthcare information available online?” Sounds odd, but think about it for a minute. The current rules, actually the lack of them, is making many companies reluctant to participate in discussions online. What is happening in many of these discussions is people are sharing inaccurate and sometimes dangerous medical advice with one another. Not on purpose, but that’s the net result. Pharma companies would welcome the chance to correct some of this misinformation (in an appropriate manner), but feel they can’t under the current rules. My question is this: if the FDA is charged with protecting the public health, is allowing companies to fix incorrect medical information online more dangerous than doing nothing? I’d argue that the “risk” of having companies attempt to correct this information is FAR less than the risk posed by the inaccurate information itself.

I’ve also proposed an approach for how pharma companies can be allowed to engage in these discussions, while still allowing the FDA to retain some control. I owe a lot of the thinking behind this idea to Dr. Val Jones, CEO of Better Health. She talked with me for about an hour the day before all of this was due and had some great ideas on how to make this all work. It wouldn’t have come together as well as I think it has without her help. If you haven’t had a chance to work with Val (or Dr. Val, as most people call her), go find her. She’ll likely be able to help with whatever you’re working on.

Here is the presentation I’ll be doing for Question 3: FDA Social Media Hearings Testimony (233 downloads)

For Question 5, regarding adverse events, my presentation is focused on asking the FDA to clarify precisely what is required for an adverse event to be reportable. We all know you must collect four pieces of information, but how far does a company have to go to find that information and what qualifies as a “good enough” answer to the question of “what is the reporter’s name?” for example. Is, say, a Twitter handle good enough or do you need the person’s full name? When the rules for collecting adverse events were created, events were almost exclusively collected by doctors and it was all done via paper. The doctor knew all the people involved including real names and could get all the other details as well simply by asking some questions. Today, with the Internet and specifically social media, events are talked about all the time and they rarely rise to the level of “reportable” because there isn’t someone there to immediately ask follow up questions about an event talked about in a forum. This makes it very difficult to collect that information. So, how far do pharma companies have to go to find it? Are we going to turn them into private investigators running around trying to figure out people’s real names? That doesn’t make sense to me.

Here is the presentation I’ll be doing regarding adverse events: FDA Social Media Hearings Testimony Adverse Events Specific (328 downloads)

I’d welcome any feedback you have. Please leave it in the comments. I’d love to hear what you think and to have some additional thoughts heading into the meeting next week.

Wish me luck.

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Catchy, right?

In any event, since this is a public hearing, people were allowed to request both a seat to attend the meeting and also to speak at the meeting. If you haven’t already applied for a spot, forget it, as the deadline has passed and all the seats are gone. Apparently, there were more than 800 requests for the 300 or so seats (John Mack has a nice recap of all this). We also knew that around 60 people would be speaking over the two days.

The meeting has been broken up into two parts. November 12 and the afternoon of November 13 will tackle the first four questions in the FDA’s announcement. The fifth question in the announcement deals with the handling of adverse events (AEs), which even the FDA recognizes as the major stumbling block for companies in dealing with social media. The morning of November 13 will deal exclusively with the AE question, so there is a great deal of attention being paid to it. Those requesting to speak (or who were invited) could request to speak on any of the questions. Those who wanted to cover question five and another question (and who were accepted as speakers) were given two speaking spots.

The speaking times have been limited to between 5-15 minutes, but it appears that most are around 10 minutes. How do I know all of this? I have the privilege of being one of the speakers and I will be one of the people who covers question five and another (question 3), so you’ll get to hear me twice. For those who can’t attend, the FDA has set up a webcast to watch it live.

So, you probably want to know who’s speaking. Here’s the list with a link at the end to download a PDF copy of the draft agenda. This agenda is subject to change (according to FDA) based on speaker confirmation and availability, but this is this first release of names and tentative times. I’ve removed the times from my list below, but they are included in the PDF at the end of the list. You’ll see a company name and then a person(s) representing the company here. Again, some names you’ll see twice because they are speaking twice and covering different issues.

November 12

Pew Prescription Project/The Pew Charitable Trusts-Alan Coukell

Coalition for Healthcare Communication-John Kamp

Eli Lilly and Company-Michele Sharp

AdvaMed Advertising and Promotion Working Group-Tony Blank

Center for Medicine in the Public Interest-Peter J. Pitts

Ogilvy 360 Digital Influence-Rohit Bhargava

PhRMA-Jeffrey K. Francer

Pharma Marketing News-John Mack

The Advertising Coalition-James H. Davidson

Arnold I. Friede & Associates-Arnold I. Friede

Integrated Media Solutions/The Sandino Group/Caleco Pharma Corp-James A. Sandino

Interactive Advertising Bureau-David G. Adams

National Research Center for Women & Families-Diana Zuckerman

VuMedi, Inc.-Robert Winder

WebMD-Wayne Gattinella

WEGO Health-Jack Barrette, Bob Brooks, and Marie Connelly

Consensus Interactive

Global Prairie Integrated Marketing-Alex Vandevere

sanofi-aventis-Craig M. Audet

Social Media Working Group-Mark Gaydos

Yahoo!-David Zinman

Waterfront Media Inc.-Ben Wolin

Johnson & Johnson Family of Companies-Philomena McArthur and Elizabeth Forminard

Manhattan Research-Mark Bard

Acsys Interactive-Stan Valencis

comScore-John Mangano

Envision Solutions, LLC-Fard Johnmar

MISI Company-Kathleen Fourte, Alejandra Diaz, and Jerilyn MacLaren-Hall

Compass Healthcare Communications-Peter Nalen and Maureen Miller

Euro RSCG Life 4D-Lawrence Mickelberg

McCann Healthcare Worldwide-W. John Reeves

Google-Mary Ann Belliveau and Amy Cowan

November 13

(morning session on AEs)

AdvaMed Advertising and Promotion Working Group-Tony Blank

Individual Consumer-Kim Witczak

Consumers Union-Steven Findlay

LehmanMillet-David A. Saggio

HealthCentral-Christopher M. Schroeder

Semantelli Corporation-Shaleen Gupta

PhRMA-Jeffrey K. Francer

Ogilvy 360 Digital Influence-Rohit Bhargava

The Advertising Coalition-James H. Davidson

Arnold I. Friede & Associates-Arnold I. Friede

GolinHarris-Rick Wion

Heartbeat Digital-Bill Drummy and MK Tantum

National Research Center for Women & Families-Diana Zuckerman

PatientsLikeMe-James Allen Heywood

Pharma Marketing News-John Mack

Sermo-Daniel Palestrant

TGaS Advisors-Donna Wray

VeoMed-Aaron Krinsky and Kay Metis

v-Fluence Interactive-Jay Byrne

WCI Consulting Ltd.-Tara M. Churik

WEGO Health-Jack Barrette, Bob Brooks, and Marie Connelly

Word of Mouth Marketing Association-John Bell and Melissa Davies

Bridge Worldwide/Dose of Digital-Jonathan Richman

Accelerated Medical Ventures-Zen Chu

(afternoon session, non-AE related questions)

Individual Consumer-Kim Witczak

Consumers Union-Steven Findlay

PatientsLikeMe-James Allen Heywood

Bulletin News/Custom Briefings-Paul Roellig

ORC Guideline, Inc.-Morris Whitcup

HealthCentral-Christopher M. Schroeder

LehmanMillet-David A. Saggio

Heartbeat Digital-Bill Drummy and MK Tantum

Semantelli Corporation-Shaleen Gupta

Sermo-Daniel Palestrant

TGaS Advisors-Donna Wray

VeoMed-Aaron Krinsky and Kay Metis

Bridge Worldwide/Dose of Digital-Jonathan Richman

Ignite Health-Fabio Gratton

imc2 health and wellness-Hensley Evans

RAPP-Robert Grammatica

Rosetta-Jamie Peck

W2 Group, Inc.-Larry Weber

Word of Mouth Marketing Association-John Bell and Melissa Davies

Digitas Health-Bruce Grant

Cadient Group-Jim Walker

Intouch Solutions-Wendy Blackburn

Pfizer-Freda C. Lewis-Hall and Clifford Thumma

Here is the PDF with the times: Promotion of FDA-Regulated Medical Products Using the Internet and Social Media Tools Draft Agenda (265 downloads)

Remember, you can still submit your comments until February, so do it if you’ve got something to say. I’ll be sharing my slides for the meeting sometime next week (you get a sneak preview). Of course, I’ll be tweeting like crazy from the meeting and will do a full recap afterwards, but do tune into the webcast if you can.

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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)

[View with PicLens]

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

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I had seen and heard a lot of what was discussed at this meeting before simply because I get to spend a lot of my time thinking about it. For others that have a different focus in their day-to-day jobs, I’m sure they took away even more than I did. For me, the best part of the conference was the informal, “unconference” discussion that took place for the last two hours of the final day and was lead by Brad Pendergraph from Novartis. There was no stage, no slides, no official speakers, just a bunch of people really interested in digital pharma marketing talking to each other. It’s perhaps not surprising that the conversation almost exclusively focused on social media, as it seems like THE thing to talk about right now (and has for a while). The upcoming FDA hearings on this topic naturally make it more relevant and top of mind (PS: I’ve been invited to speak at the hearing and can’t wait to get in my two cents).

The participants of this final discussion were a good mix of pharma employees and agency/consultant types like me. I mostly listened to the conversation and took a few notes. At some point, I heard one of those simple statements that suddenly helps it all make sense. The “ah-ha” moment.

With constant debate of can we?/can’t we? in pharma companies when it comes to social media, I’ve been saying for a long time that we’re making it too complicated. While there are a lot of objections and concerns within pharma companies when it comes to social media, the one I hear most often and that really bugs me is about the internal regulatory/legal process. There are a lot of other objections that come up, but this one seems to particularly bother me. Here’s what I’m talking about. Let’s say your company starts a corporate blog and (imagine this) allows people to comment. Sure, moderate the comments if you’d like. No problem, just let through the legitimate ones.

Now, here’s where I get frustrated. Let’s say one of the comments is something of a question…something like this: “Great point, but don’t you think that [insert whatever ending you want]?” Clearly, it’s something that the person would like an answer to. They want to engage with you and have a discussion. It’s a great opportunity, right? You know that, so you decide to respond…and that’s when the wheels come off.

Since you’re going to create a response to publish, you have to send it through your review process. It takes a solid two weeks to do that using your normal channels. Or, maybe you’re lucky, you have an expedited process for this type of thing and you can get something out in a couple of days. Of course, by this time, the commenter probably has forgotten all about you. You likely missed a chance to make a major, positive impression. But why? Why did your response have to go through your whole process? “Well,” you say, “you know the answer to that Jonathan. If we post something online, then it has to through our regulatory process. Same rules as if we created a printed piece. What’s wrong with you…have you forgotten everything you learned working at a pharma company?” Okay, so maybe you’d leave out the last part, but you’d say the first part pretty much exactly as I wrote it.

“But, why?” I ask again. I have actually struggled to come up with a simple response to why you could justify NOT putting something like this through your official review process, but hadn’t come up with something yet. As pharma expands its social media efforts, at some point, this becomes a major issue. Are you going to review every tweet, every Facebook status update, and every “Hi, welcome to our forum” comment? You must either really love those regulatory meetings or you really have way too much spare time. Clearly, this isn’t going to be practical. At some point, you have to trust that people will do the right thing and follow the rules without reviewing every single thing they say before they say it.

Crazy…I know. Or is it? As I said, I struggled for a way to simply explain why this isn’t pure madness. It came to me while in the discussion at the conference. My epiphany came courtesy of Brad, who I mentioned earlier. He had the perfect analogy. I’m going to paraphrase just a bit, but here’s the gist:

When someone calls your company’s call center with a question about your product, do your representatives answer the question or do they tell the person that you’ll get back with them in 2-3 weeks?

Not to be outdone, Steve Woodruff, added to this (again paraphrasing):

When your reps are talking to a doctor and the doctor asks a question about your drug, does the rep have to pre-clear a response and get back with the doctor 2-3 weeks later?

Think about both of those statements for a minute. Obviously, we don’t make our call center representatives or sales reps wait for our regulatory process to review their answers before responding to a customer’s question, so why would we have to do this to respond to a customer question on our company blog? Do we trust our sales reps more than the person responsible for our blog? Do call center people get a special set of rules?

I don’t know the answers. I really don’t. You might argue (especially if you’re a lawyer), that the blog response  is “on paper” and therefore, more discoverable while the two analogies are just conversations that aren’t recorded. I suppose it would be harder to “get in trouble” if they aren’t recorded. Of course, this doesn’t put too much faith in your representatives to follow the rules and, the last time I checked, we had these things called voice recorders. If someone really wanted to get you in trouble, they could. Does anyone know the answer to this? I’m not saying that you should let every Tom, Dick, and Harry at your company respond to blog comments, but shouldn’t someone be allowed to do this without having everything approved before they say it?

One final comment that was said around this discussion came from Xavier Petit from Shire. His point related to the fact that we simply can’t ignore that people want to talk to us, so, basically, we have to respond when they come to us. We can’t just ignore them. His analogy was something like this (again, paraphrasing because I can’t write fast enough):

When we realized that people were going to call us on the phone when we gave out our number, did we suddenly decide to cut all the phone lines?

Of course not, but isn’t that what we’re doing when we don’t respond when someone asks us something via a social media channel? We create places for people to comment, but when we realize that they’ll actually do it, we cut off the communication. Actually, it’s exactly the same thing.

So, why are you still here? Shouldn’t you be calling your IT group and telling them to turn off the Internet?

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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:

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