This year I had the pleasure of not only attending Digipharm but also of chairing part of the event, including a round table discussion on engaging with stakeholders. As with many of these conferences the most enjoyable part is the networking and catching up with fellow digital evangelists, such as InVentiv’s Emma Darcy and Merck’s Shona Davies. Content wise the event covered many of the same old, age old, topics but there were a few interesting snippets and case studies that were shared.
Some of the key themes that emerged were around the need to be more customer-centric, the importance of insights and strategy, and the potential impact of CLM and MCM. These are topics that have been doing the rounds for a few years now so for me, and many other attendees, they were not particularly insightful. This led to a few tweets questioning why we were still talking about this and why more digital “newbies” were not attending these conferences, as they would benefit from this content.
The answer to both these questions is that firstly we are still talking about this because much of it has still not become a mainstream reality for much of pharma. The second point is that perhaps these “newbies” are still newbies because they are not interested in coming to these events or perhaps because the conference organisers are not targeting them. Either way I fully agree that we need to start seeing more non-digital brand managers and pharma marketers attend these conferences. Those of us in the know should probably be going now to non-pharma digital events as this is where the innovation is being discussed.
That said I still enjoyed Digipharm and there was some great content presented and shared on twitter. Going back through the tweets from Digipharm I pulled out some great quotations and some key messages and insights. Unfortunately I failed to copy paste most of the people who originally sent the tweets – so if you see your tweet please flag that this was your great content in the comments below!
Some Key Messages from the event:
1. Focus on the customer
“How to be #goodpharma balance moral & commercial drivers. 1 focus on patient, 2 go beyond pill”
“Pharma must develop customer intelligence to fulfil unmet needs – a key message from the last 2 days”
“We need to use that channels that are used by the customer segment”
“Need to know your customers to know which digital channel to use”
2. Stop being so promotional
“Recurring theme through the 2 days. Don’t start with promoting your product! Ask customer needs, engage with them, then Tailor”
“Pharma marketing – too much push, not enough pull!”
3. Digital is just part of the equation
“Dr Tim Ringrose. Digital should be used as an augmentation of existing communication channels, not a replacement. Absolutely!”
“Digital won’t replace the rep, says Tim, as docs use all channels and still value F2F for some discussions”
“Stop measuring the rep’s performance alone – measure qualitative data. Move from rep data to customer insights”
“You need to make your reps great story tellers. Make your reps amazing storytellers so the HCPs will recall the story once the rep has left”
“Still a lot of focus on the rep channel but discussions missing on cost of interaction”
4. ROI is not the issue
“It’s hard to prove the digital ROI” disagree, it’s the easiest channel to manage ROI as long as you know what to measure and how”
“100 rep visits we set out on, only 20 talk to the physician and only 8 docs remember the meeting. WHAT’S THE ROI??!!!!”
5. Senior Management needs to get involved – even if they are not today
“Great point Rene we spend 80% on build and 20% on promotion and mgmt when it should be the other way round! Top mgmt take note”
“The problem in pharma is that change needs to be led from the top, and snr mngt just don’t engage”
Some really interesting Ideas and Insights:
“Need to find a way to get bright, lateral thinking people to the top straight away” @nickbroughton
“It should be company policy to slap anyone that calls anyone but the patient a customer” (!)
“Docs give patients musty old mags in the waiting room – let’s give them health tools instead
“Univadis – 70% of members opt in for promo messages from MSD. That is a permission database of 1.5 million!! In some markets it’s up to 95%”@ShonaLDavies
“Univardis #merck . It may be a non commercial engagement but the value of reach and trust is clear”
“How much does Univardis cost per year? Even if €10 million, that’s less than €5 per customer. Good value!”
“Why has Univadis succeeded? It is part of the corp culture says @ShonaLDavies, in other words leaders have stayed behind it”
Univadis success due to leadership commitment and vision for long-term engagement
“24% of interactions with JP HCPs are eDetails. Highest eDetail market in the world”
“Univadis philosophy –customers expect corporations to be doing something of value originating from a core product”
“Measuring Univadis relationships – user retention, engagement levels, customer satisfaction and NPS”
“Nice segmentation of engagement levels (light, deep, extensive) as KPI’s for Univadis. Engagement on its own is too vague”
“@ShonaLDavies customer relationships aren’t a mystery, can be measured in multiple ways, challenge is translating measurement”
“82% of HCPs interested in engaging with pharma – HCP communities = great value. Obvious way to know your audience to be relevant”
My favourite Quotations from #Digipharm:
“Digital innovation = talent x time x budget x culture” @xaviolba
“Our obsession with compliance at all costs is responsible for pharma’s loss of virtue” @NickBroughton
“Engagement means getting a response” (Sorry I didn’t jot down who this came from … if it’s you please mention yourself in the comments!)
“Mobile is not a technology or a platform, it is a behaviour” @nickcampbell
Xavier Olba @Sanofi “we must provide engaging services to our Patients not just medications”
‘we are redefining MSD as a healthcare company not just a drug company’ says @ShonaLDavies
“It’s not about digital marketing, it’s about marketing in a digital world” Dr Ringrose
In my last blog post I summed up some of the discussion points at the Fleming eMarketing conference in Barcelona. One of the speakers, Nicolas Pokorny, talked about emotions and behaviours and this really inspired me and resonated with me. I also believe it is an area that companies, and physicians, often underestimate.
It is well known now that changes in technology have led to changes in behaviour, for all stakeholders, including patients and physicians. As a marketer and strategist I have long been familiar with the customer journey, a tool used in the FMCG market to get a better understanding of customer behaviours leading up to purchase. This is a tool that I have also used with digital agencies within healthcare, looking at how the key interaction and health decision points for patients in their journey from being ill to being healthy. However within pharma companies strategy and marketing is still often based on the traditional customer journeys, for both physicians and patients, not taking into account these new interaction points that now exist thanks to technology. The reality today is that the customer journey for pharma stakeholders has changed dramatically thanks to new technology.
The other element that has a role to play here is emotions. As mentioned the impact of emotions on our decision making is huge but rarely mentioned in the far more analytical approaches to marketing and strategy development. Generally we look at demographics and perhaps some top level behavioural elements but we never really talk about the emotional drivers. For example if we look at a patient’s emotional reactions and feelings to a physician interaction we may actually see a number of different behavioural decisions – not necessarily rational and certainly not positive but none-the-less relevant.
Looking then at behaviours from an emotional point of view we then get a clearer picture of what stakeholders really do and also of how we can influence these behaviours and decisions. Taking a look at the patient in the example above who had the negative physician interaction, we could see that in today’s patient journey her next step may well be to go online to look for support. Here is a great opportunity to counteract the emotional negative experience, providing positive emotional stimuli to help her modify her behaviour in the direction it would have gone post a positive physician interaction.
Who provides these positive stimuli depends of course on the situation but there is a role for everyone within healthcare here. A physician, for example, who comes across our sad patient, may encourage her to go get a second opinion, reassuring her that not all physicians are the same and she just had a bad experience and she should not give up hope. The physician is not providing any medical advice – purely support and direction to get formal medical advice offline. In fact this act alone may help re-energise her to behave most positively from a health perspective. A pharmaceutical company could play a role here, for example, by sponsoring a support group who could provide the positive stimuli or directing a KOL or KOI to this discussion – with hopefully an end result of a more compliant patient.
Even if we do not take the final step in proactively engaging, as suggested above, companies and healthcare providers need to be more realistic around today’s reality and the reality of human behaviour. Decisions need to be based on this understanding, and not on the comfort factor of sticking with the way things always have been done in the past. By truly understanding the customer emotions, behaviours and the full customer journey, that those of us working in healthcare can bring true value and make a positive impact on our customers, and on patient’s health.
Last week I had the pleasure of attending and presenting at the Fleming eMarketing conference in Barcelona. It turned out to be a very interesting and fun conference – great insights, great presenters, fabulous location and social focus!
First let’s start with a disclaimer – given my somewhat dodgy memory I will be writing this up based largely on my tweets (a further demonstration of the value of Twitter) so there may be some bias towards speakers who spoke while I still had battery!
The conference included the normal rhetoric around the need for the industry to change, get on board the social media train (which has now left the station) and start taking digital far more seriously. This was nicely balanced with some great insights and case studies – showing that some companies are already very comfortably onboard the said social media train and other have already implemented the organisational changes needed to be truly effective in digital.
Shona Davies, from Merck, gave a very insightful presentation around Univadis, showing how a non-promotional digital, global presence can bring value to a pharma company. Univadis is also a great example of a global service / tool that is localised and adapted by local markets – providing value at local value whilst following a strict global branding guideline. There is also flexibility at local level to try out new offerings or to ignore new global offerings based around what works in the local market. Univadis’s global klout also helps with partnerships, bringing access to global publications to local markets – as well as helping well known local publications, such as the Lancet, gain global klout and audiences. Another important factor that came out during this presentation was that “Univadis is well placed to engage at a time when face-to-face engagement is getting harder.”
Haider Alleg from Gedeon Richter, shared some great information around global / local process and implementation and co-operation. What I found particularly exciting was when he talked about how he had got HR involved in the digital process to look at changing the reward and recognition system to accommodate the changes needed for successful digital implementation, for example long term goals and co-operation.
There was also some emotive talks about patients and participatory medicine. The delightful Emma Darcy gave a fascinating presentation about the changes we are seeing as a result of behavioural and technological changes. She talked about how we have gone from information overload to engagement overload – however as an industry we are doing nothing to help physicians and patients to deal with this. She also made a fantastic point – namely that the pharma industry is now facing new competitive pressures, not from within the industry but from outside the industry, in the shape of companies innovating to get a part of the healthcare “pie”. As Emma said this must be a wake up call for pharma. Another great quote from Emma was around multi-channel: “it’s not about multichannel – it’s about me!” – flagging that the essence of multichannel is about individual channel preferences.
Xavier Olba from Sanofi made a very good point when he said that at Sanofi digital is part of the value proposition – it is no longer just about the drugs. Sanofi has been demonstrating this through some of their innovative use of digital – offering new technology products to support patient in their key therapeutic areas, such as diabetes. Cancer survivor, Andrew Schorr, gave a very powerful presentation around the power of the internet and social media for patients, highlighted by the fact that he felt he would not be alive today had it not been for the internet, and the experts he was introduced to via digital connections. This was such a fantastic point that pharma really could learn from and should be listening to – and as John Mack said “you can’t really argue with a cancer survivor”!
Nicolas Pokorny did a great job of following this emotive presentation by giving a fascinating perspective on the impact of behaviour on the industry. He pointed out that it is all about emotions and behaviour. He quite rightly pointed out that everything is “based on behaviour and personal decisions, Pharma often underestimates feelings and emotions”. I think this is so true! Personally I often see a huge emphasis on analytics and numbers – with decisions being based purely on this highly impersonal, quantative approach, and not taking into account that we are human beings and we are very emotional beings. There is plenty of research showing that humans often do not make rational decisions – i.e. they do not follow the decision the numbers predict. To be truly effective we really need to start bringing in far more of this human, emotional element to our decision making – especially in multi-channel decisions.
One final comment made by Nicolas was that smart companies invest profit into innovation. I love this point and I think this sums up the feeling coming across from many of the presenters, myself included. We need to start investing in the future, and not the present. We need to start changing the way we work as an industry to be ready for the future – because before we know it the future will be now and as we stand as an industry now – we are not ready for that “today” – we are in fact not even ready for the present today – still too focused on old business practices and process. It is time pharma leapfrogged to meet the future head on – here and now.
And finally the highlight of the event for me? Well I think the photo says it all!
I have just finished my slides for a presentation I am giving in September at the Pharma eMarketing Congress in Barcelona http://pharma.flemingeurope.com/pharma-emarketing-congress. I will be talking about global and local social media. A tricky subject but one which companies do need to look at.
Then again as I was writing my slides I did also wonder whether for many pharma companies this is still too advanced. After all the sad reality is that despite the fact that social media is no longer new, has become a part of day to day life, and is increasingly becoming one of the top communication channels, some life science companies still are not embracing it. I am still having conversations with pharma clients about how they should tackle social media – still with that wary, keep-it-at-arms-distance, “oooh it’s scary and dangerous” mentality.
However there are now also many pharma, and some medical device, companies that have embraced it and are ploughing ahead. It is these companies that are now looking at taking their social media to the next level. They have an established global presence, they often have various local social media initiatives, and they have gone through the pioneering days of pilots and trial and error. They have the experience, they have the confidence and it is they that now need to start looking at social media in a more professional, corporate and consolidated way.
As is often the case with pioneers many of these companies have done great work, but their presence is not always consistent and there are clear disparities between the pioneers and the champions and others. Sometimes they have an amazing global presence but no local presence to speak of. Other companies have some great local examples but no global presence to shout about. The next step is to look at how these disparate groups, at local and global level, can start to work together.
So how can a company tackle a global channel such as social media at both a global and a local level? After all we are governed by local laws and regulations, and in fact it is fear of these regulations that have held many companies back, both at global and local level. The answer as we have clearly seen is not to sit back and do nothing! The answer lies actually in embracing social media and social media principles whole heartedly at all levels.
By embracing these principles, and introducing more open leadership and a new era of communication and co-operation, companies can start to move to the next level, and not just in social media.
If we look at the global local issue the fact is at the heart of it often lies poor communication, and inadequate support and co-operation between global and local teams. Each team has different objectives, goals and needs. The concept of a common purpose and vision has often been lost in these huge organisations. However when you strip everything back there are still common goals which can be worked towards jointly. Better relationships with stakeholders, for example, is something that most pharma teams – be they global or local – would like. This is something that the principles of social media address very nicely.
Once you put stakeholders at the middle and start to look at your communications and marketing from their point of view (as opposed to the pharma-must-push-sales-messages mentality) you realise that a stakeholder does not want 101 contact points with your company. They want one contact point – and they do want to interact with you – not listen to your sales message. They want companies to provide them with value and then they are happy to listen to what companies want to say.
This is of course also where location comes in. Stakeholders, in particular patients, do not always care where you are based, nor are they aware of the regulations that govern the industry. It is therefore really irritating to be on an English language Facebook page and to be trying to interact, and ask a very relevant question, only to be ignored because you are physically based in the wrong country.
This is where communication and co-operation come in company side. If a US Facebook page, for example, has a comment or question from a UK resident then the best course of action is not to ignore this or tell them that you are only interested in US residents. Far better – direct them to the right contact point in their country or if it is a question that you can actually answer (less likely) then do so. The problem here is that the communication and process needed for this rarely exist.
Looking into building these and other better global/ local communication and process channels will benefit not only social media but the company as a whole. Global and local are not enemies or from different planets. They have the same over-arching goals and objectives and are all working on the same team. It can only benefit an organisation if people at global and local really do start working like a single team rather than competing entities. Will social media help? I hope so.
Following on from my dreadful experience with the Spanish endocrinologist I am now preparing to see a British endocrinologist at the local Nuffield Hospital near my parents house. Naturally this preparation involves going online, checking with UK patient associations such as the British Thyroid Association and the British Thyroid Foundation. The choice of associations, support groups and information in huge.
On the one hand as a patient it is great to have access to such a wide array of support and information. However the negative side of this is which information to look at? I have limited time so which association or support group offers the best, most relevant information? It appears that if I were a newly diagnosed patient there is tons of useful information – however as a patient looking for ongoing support and advice, for example recommendations on thyroid tracking apps, I need to dig deeper.
This is of course a common problem for patients who are often faced with an overwhelming amount of information online, from a huge variety of sources. How does a patient know which resource or app is the most appropriate and has the best information? Unfortunately very often I find asking my physician for help in this area does not help as they rarely seem to know themselves.
Patients will increasingly need help in this area, especially as the amount of information online will only increase. Physicians will need to start having answers, at least to some of the common diseases such as diabetes and depression. I will of course be asking my endocrinologist this afternoon if he can recommend a thyroid tracking app … but I have low expectations, especially as he does not appear to have an email address (for “security reasons – but that’s worth another post in itself!).
The other day I had what was, without a doubt, the worst medical experience of my life. The occurred when I went for an appointment with my Sanitas endocrinologist, here in Barcelona. This was actually my second experience with a Sanitas endocrinologist – the first one had been bad enough for me to refuse to see that endocrinologist a second time and I had demanded to see a different endocrinologist for my next appointment. Needless to say I will not be. using Sanitas services anymore.
Let me first provide a bit of perspective before going into the details of the poor service. I was diagnosed nearly two years ago with hypothyroidism. At the time it was a huge relief. I had been putting on weight despite swimming up to 10km a week and dieting, and I had been suffering from bad depression (partially diagnosed by my continual exhaustion). My diagnosis explained both issues and I was happy to hear that on proper medication things would go back to normal, and I would not notice any effects from the hypothyroidism. This has only been true to a certain extent. Initially I struggled to find the right dose and brand, but in Switzerland I finally got to a stable, if very high dose, of thyroxine, which seemed to work. My life – and weight – started to return to normal and all was good . . . for a while. Then about six months ago I suddenly put on 10kg and started to feel lethargic, exhausted and depressed again. Initially I put this down to stress and work problems, how ever the symptoms persisted once I moved to sunny, chill and relaxed Barcelona. Again, despite dieting and regular swimming, I was slowly putting on yet more weight. I had a relatively relaxed lifestyle (one of the benefits of being self employed) and yet was constantly exhausted and I started to get aches in my joints (and I really am not that old!).
Like so many patients with chronic diseases I turned to the internet and social media for advice and support. It looked like, based on my research, my hypothyroidism was no longer under control. I also was surprised by how many people I knew who also suffer from thyroid problems. More worryingly was the common theme that was coming out through my friends and the support groups on Facebook. It looked like Thyroid disease is hugely under-diagnosed but also poorly understood, and many physicians are rather bad at handling the disease. As I had good private insurance with Sanitas I decided it was time to go see a specialist. An endocrinologist would after all understand my disease, the implications it had for me as a person, and be able to provide me with expert advice. I also wanted to find out, if possible, what was causing my hypothyroidism.
So it was with this in mind that I, a highly educated patient with plenty of support and information from other patients, went to see my first endocrinologist at Sanitas. I had specifically asked to see an endocrinologist specialised in thyroid disease so I had high hopes. You can then imagine my total shock when, after I had asked her about my weight issue and concerns, she promptly replied, without asking me any questions on my diet or lifestyle, that I should eat less! Anyone with hypothyroidism will tell you weight is a prickly issue and it can be very hard to deal with. What we hypthyroid patients do not expect is to get told that our weight it totally down to eating too much! Had this doctor even bothered to take a minute to ask me about my eating habits she would have found out that I would be hard pressed to eat less – I had been living off salad, sushi and very healthy food and I exercised nearly every day. A more appropriate response would have been to have a discussion with me, ascertain if eating “too much” was really the primary problem, and discuss the option of seeing a nutritionist to identify an appropriate diet.
Based on her inappropriate approach I decided to ask to see a different endocrinologist after I had had my blood test results. I walked into the consultation room and handed the doctor my blood test results. After a very brief, cursory, introduction she glanced at my results, asked me what dose of meds I was on, and then told me she was going to reduce my dose and promptly started writing the prescription. Done. Dusted. In less than five minutes. Next!
Except I pushed back and questioned her response. I asked her how she could reduce my dose when I still felt so bad? Her response was swift and blunt – if I did not like her opinion I should go talk to another doctor. End of discussion. Again I pushed back – this time on the verge of tears. I told her how desperate I was and how I could not go on with things the way they were – I needed help with this disease. I told her that something was very wrong and I could not cope anymore. Her response was very cold and disdainful, “it’s not my problem” and that I should go see a “head-doctor” as it was clearly a mental issue. I was flabbergasted. Here was a patient in clear distress – with very physical symptoms typical with thyroid problems – and a medical “professional”, specialised in thyroid conditions, was telling me to go away and that is was not her problem. She also showed no regard for my distress and handled me with total utter disdain – she had no regard for me as a patient, my health or indeed my safety. I took my prescription and left in floods of tears. I have never left a doctors office in such total, utter distress and so distraught. Had I been suicidal I would without a doubt have killed myself – I was so devastated by not only her response but the inhuman way she had treated me.
I went home and cried and cried – alone at home. It was only hours later that I was able to briefly post to my Facebook page and the support group. I got an overwhelming outpouring of support, sympathy and love. I was not alone and it turned out that as horrific as my experience had been others had also had dreadful experiences. How could a medical professional be so callous with someone’s life? I then also checked my results online – doing my own research and found out that my results actually suggested I may have Hashimotos. The endocrinologist had not even mentioned these results – purely focusing on my TSH results. I also contacted my brother, who is a GP, and he responded very rapidly telling me under no circumstances should I up my dosage as my TSH levels were dangerously low and a higher dose could actually be very dangerous. Again the endocrinologist, knowing that I had been asking about increasing my dose, had not even bothered to warn me about this. Without my brother’s response I would have gone ahead and increased my dosage and possibly ended up having a heart attack!
I am aware that there may be cultural differences in how Spanish medics deal with patients, and that traditional Spanish doctors have been more paternalistic, if not dictatorial, with their patients. However cultural differences aside a doctor has a duty to patient’s safety and a duty of care. Even if this endocrinologist did not appreciate my challenging her response, she should have informed me of the dangers I faced if I did increase my dosage – failure to do so endangered my life. Also given the link with depression that this disease has, and having a patient sitting in front of you saying they can no longer go on and they cannot carry on living like this, should raise flags. Again duty of care should have resulted in her making sure I was not suicidal. Ignoring my mental state and telling me to get out of her office could again have had severe results for my personal health and safety. As it is I am fortunate to be health literate, mentally resilient, and to have access to great health support and advice online. Another patient may not have been so lucky and this doctor’s negligent attitude could have cost a life. Even if a doctor does not personally like a patient or takes umbrage at a patient challenging them they should never, under any circumstances, endanger a patient’s life, deliberately or through negligence.
Unfortunately I have very low expectations that Sanitas will do anything against this professional negligence – and I will not risk my health, and my life, with such poor care. If I am going to pay for private insurance then it will now be in the UK or Switzerland where I am confident of the level of care I will receive. But I have to say thank God for social media – my thyroid support group provided me with the information, support and hope that I needed. I just wish that my endocrinologist had done the same.