I’m twenty-five. It’s early mid-morning. I’m wearing a tweed jacket, grey flannel trousers, brogues. It’s the mid eighties, after all. I arrive on time. I’ve even combed my hair, God rest its soul.
I sit there patiently. I read through a Women’s Weekly. A No Idea. A BRW. I can remember Alan Bond’s face was on the cover. I’m warming a seat for a good 40 minutes.
Mr Bowll? I look up. “Doctor will see you now. Do you have your Medicare card? I forgot to take the number before.”
I’m ushered into a tiny office. There’s posters on the wall of skeletons, of blood flows. Charts showing what you should eat. Who could live on that much cereal and that little meat, I ask you? The desk is tidy. But covered in pads for prescriptions, for notes, all emblazoned with the brand of a pain killer, a beta blocker, an anti-inflamatory, Brufen I think.
He comes in, not that much older than me. May-be 35. Looks at his watch. Crosses his arms. “Right you’ve got ten minutes. Do your song and dance.”
Understand this is the first market research interview I‘ve ever tried with a Doctor. He’s been written to. I’ve had someone ring his receptionist and word him up about how important this is. He’s even charging me for the time on the bulk-billing scheme. Still, he couldn’t have been ruder. Wouldn’t complete the interview (only two questions to go) which made the whole thing pointless; throws out all of the other statistics. I was at minute 10 when he put down his glasses and said he had a clashing appointment. There was no-one in reception, I could see through the glass window in the door.
The culture lives for humiliation
This is what Phamaceutical companies have to put up with every day of the week.
Humiliation is the life of the drug rep. If you can survive this, you may get to be a product manager and one day a marketing manager in Phamaceuticals and the rest of this article will be useful, perhaps.
I’m told it’s getting worse, not better for the Pharmacy rep, at the bottom of the industry ladder. That the Doctors make them buy morning tea; cakes, focacias, coffee, the whole she-bang. Three of them in the surgery kitchen and they give you five minutes. And keep talking about their week-ends while you’re mid speech.
Here you are, knowing that your career depends on convincing some 20,000 doctors in OZ to prescribe your drug when they see certain symptoms, often hard to detect, often confusing. (When is a sweaty palm a sign of a fever, when is it part of a heart attack?) And the ‘market’ doesn’t want to know? No, I take that back. I don’t believe they don’t want to know. The ‘market’, doctors, simply don’t have the time. It’s because they are underpaid, due to down-ward pressure from politicians, so they need to squeeze in as many appointments as they can to keep the office turning over, which means they can spend scant time on your drug and your sales people’s presentations, and just as little time considering what a patient is presenting with.
Big, Profitable companies
Pharmaceutical companies do however manage to struggle through this problem relationship with Doctors with flying colors. Of the six or so biggest companies in the world, three are Pharmaceutical ones. Why? Because a patented cure for a common disease afflicting the planet’s population is intensely profitable.
Why so profitable? Because you can buy the chemicals by the tonne for say a few hundred dollars. A typical formula means you mix chemical A with C and Z, cook them for a few minutes then add a drying agent and put it into pills. Within minutes you’ve taken commodity inputs worth only several hundred dollars a tonne to outputs worth thousands or hundreds of thousands of dollars a kilo.
Price big issue
Price is becoming a real hot potato; getting to the tricky stage. The patents system and its monopoly effect has to really come in to question when you consider pharmaceuticals. As is discussed in web chat rooms across the globe, why not a special arrangement for them? Say 20 years? How can you justify a longer payback period when the profits are so huge and the need so great, the suffering so widespread. But them again, do we really want the third world to be much healthier? Do we want a grossly over-populated world?
It’s interesting to note Merck, big US based manufacturer, after a lot of political pressure, recently agreed to reduce prices for African AIDS sufferers. To one tenth the price of the same drugs selling in the USA. (eg. Crixivan from $6,016 per patient annum US to $600 per patient annum for Africa. Stockin from $4,730 to $500 p.a per African.) Which demonstrates beyond doubt to everyone the margins being made.
Greed may be good for some, but the African’s making their own AIDS drugs is just the start. What will the industry do if poor countries go wholesale into knock-off drugs? The technology is on the web. How can you stop them? How can you stop them selling drugs back to the West? Think about pirated CDs. You can only make it not worth their while by sensible pricing.
System Out of Date
Couple the above with an antiquated, class-based system in the West, which is designed to keep the doctors in clover by insisting many drugs must be made available only by prescriptions, so you are forced to see your ‘family’ doctor, for anything. He/she always gets their slice, even for the umpteenth repeat of a standard drug with no known side effects. (Ignoring the value of the peasant’s, sorry, patient’s time or any other relevant efficiencies.)
As a marketer, I’m on a knife-edge here. I don’t know whether to laugh, cry or take a pill. I see an extremely efficient money-making machine, and I’m suggesting price control. Shame on me. I’m seeing an extremely inefficient health system, being rorted by its suppliers, and I’m suggesting wholesale reform. If someone suggested making advertising more efficient, I’d be furious.
But I still feel sorry for the Pharmacy companies. They are in the main producing things that make our lives less painful and often way longer. And so are Doctors.
But the Doctors hold a status position in our society which flies in the face of their often appalling day to day behavior. Doctors are in the main spoiled, sexist, big headed, schoolboys. Bright schoolboys who’ve never had to learn to deal with grown-ups. They’ve gone from school to uni to hospital to surgery; all closeted environments designed to keep their ‘important’ brains focused on saving lives – and away from the distractions of the real world. Almost none of them have had a job where they were not the center of attention. So they behave badly. In no other business can you be so rude to your customers and get away with it.
And they also do it because they are time-pressured and bored at the same time.
I think it’s a terrible waste that we have some of the smartest people in the country spending the bulk of their careers dolling out prescriptions for antibiotics all day. Wouldn’t we be better to put other folk in that role and get the really bright ones working in more productive occupations? I think this sheer boredom leads to mistakes, how can you care if you’ve seen it all before too many times to count?
Yes, I do need a Doctor occasionally, and I’m grateful when I find a friendly one. But I’d rather be using a computer into which I could punch my symptoms and get an accurate analysis, (like the program Medical Director) than pay a doctor to do precisely the same thing at $45.00 a ten minute session. Why? Not because of the money, but because of inaccuracies. I have little faith in doctors. For good reason.
Doctors are people, regardless of how they see themselves. As humans, even with the checks in place, they are capable of making mistakes. And they frequently do. There are some 1500 drugs available on the PBS list. They can’t know them all. They can’t get the ratios right, for body weight and age etc., with them all.
The Society of Hospital Pharmacists put out a report the other day that indicates 5.63% of prescriptions (more than one in 20) have to be changed because they were plain written wrong by the Doctor. (Keep in mind this is Hospitals, staffed by young doctors, under incredible time-pressure and usually exhausted by ridiculously long working hours. I’m not saying these stats run across the board.) In 36% of those changed, the adjustment was to decrease the potential adverse effects of the medicines prescribed. In a staggering 16% it was to ‘reduce morbidity or mortality.” An independent review panel, worried about the results, found 1.1% percent of prescriptions would have killed the recipient. One in a hundred? I’ve probably been to the doctor a hundred times over the last 45 years. When is it my turn? Much sooner if the wrong one reads this article.
How do you market Pharmaceuticals?
First, get your focus right
As a marketer of Pharmaceutical or biotechnology in this country, you are essentially in the business of educating doctors, (dentists and vets for that matter) pharmacists and nursing staff about the purpose, use and complications associated with your products. It’s getting through the clutter that’s hard. But that’s why you hire creatives, like Starship, isn’t it?
Get your wonder drug
Find a good, constant human problem, like diet-induced diabetes or sex induced AIDS, work out how much it can pay by multiplying population by affliction rates by affordability etc. Got anything that might relieve part of that problem? Worth a couple of million punted on a couple of billion return? Yep, let’s do the final tests/ research…. (It’s a real boon if you can find another use for something you already have in the larder, like Carvedilol an old Beta Blocker, re-launched by Glaxo Smith Klein as a Conjunctive Heart Failure treatment.)
Do your tests
Work with the leading experts in a couple of countries to ensure there’s no culture cringe. (Humans, except for some genetic-related problems, such as cardiovascular, usually respond similarly when they present similarly, no matter which country, but the Poms rarely believe the French, the Chinese distrust the Yanks). Make very sure you get results that are statistically accurate. I’m talking thousands, not hundreds. Even if your drug only works in 20% of cases and has to be used in conjunction with someone else’s, if the trials are accurate and the results indisputable, the money is there for years.
Get your write-ups
Because you’ve obviously been working with people who can get a write-up in The Lancet or the Australian Medical Journal, this shouldn’t be hard, but it’s best if the paper is presented at a world-conference, making it inarguable news. Especially if you’ve had the TV crews and the newspaper journo’s attend.
Get your PBS registration
Funding via whichever country you are operating in is usually the biggest hurdle (after scientific discovery of course). Hire good lobbyists. Be extremely careful not to look like you are trying to influence too much.
Run your conferences
The ‘sexy’ issues are currently Aged Care, Degenerative Diseases, and Mental Health. Reflecting an ageing population, dare I say it for cash-flow reasons? Again for cash-flow, ‘alternatives’ are also a very sexy topic. Alternative medicines/practices now account for way over 30% of the medical spend in Australia. (Doctors are looking at the hippies down the street sticking pins into people, or massaging their feet and scratching their heads saying “How can I get a slice of that action?”.)
It’s a funny balance you need to make between really upsetting the Doctors by too much hype and still pushing them over the line with it. Too much and they’ll look for an alternative just to spite you. So steer away from Today Tonight, but try to get a mention, depending on the subject, on shows like George Negus’s men’s health program on the ABC, or on 3LO in the mornings etc. Just the right balance of media choice and presenter is important to add credibility, boost awareness and get the patients asking….
The Pharmaceutical companies have very in-depth web operations. Often all of their hundreds of products have their own site (see Bristol Myers Squibb’s site) – pages upon pages of scientific analysis, contra-indications etc. Doctors use the web more and more to run their practices; the web is living up to it’s promise of being the information hub of this industry.
The best place to get frequency of exposure for a drug is still magazines. They are reading it, they can’t miss the ad. There are literally hundreds of magazines you could place ads in. From high-coverage, more expensive ones like The Journal of the Australian Medical Association, to obscure ones with a specialized focus and following, like Opthamology Times. And many of your targets read the international mags, like The British Medical Journal and the Journal of American Medical Association. If you’re a global business, it’s often cost effective to use these.
But do decent, thought-provoking, memorable ads will you? Bad puns and irrelevant images are so common in this industry it’s simply embarrassing. They come from weak briefs and badly trained creatives. I blame the incest-like relationship between the claimed specialist ad agencies and their clients. If you haven’t seen anything good for ages, would you wonder if anything better was possible?
If you are going to get past the reception filter, you better have something in it that is either funny or very ‘important’ like a big move forward in efficacy. But it’s best if it’s so funny it goes on their wall for a month or two.
As they only get about one piece relevant to medicine a day, and most of them are boring, there’s real scope to work this vehicle. I get about 10 pieces a day from relevant sources. The average Journo about 57 according to a recent study by the Financial Review – surely the Doctors can probably cope with a lot more than one? Pharmacists are a bit busier with 2 or 3 a day, but this is obviously an area under worked by the industry.
Don’t forget to work staff as well as doctors. The receptionist and nurses are powerful influencers. And keep in mind the hierarchy. The head of practice wants to be seen as more important than the junior partner doctor….
Hire/Train Your Reps Well
If your people are going to be at the coal-face, treat them with the respect they deserve. Give them a great answer to every hairy question and more background information than any doctor they are ever going to meet. Make sure you hire bright, qualified reps (Degree Nurses, Marketing Grads). Dummies will be cut to bits. Good looking with it, if you want them to be seen for a second time.
Presentation tools; power point etc.
Nothing more powerful in a meeting than a quick, to-the-point presentation so your troops don’t have to appear to be doing the hard sell. Rarer than it should be. It’s just murder getting the meetings and being humiliated…
Reminder toys etc.
All the Doctors I interviewed for this article complained about the poor standard of current give-aways. They hate pens, caps, pads and dinky stuff. They want scales or disposable gloves or something else that’s practical. Reception and the front office are as important as the surgery. Phones, charts, reminder stickers, patient’s details pads, credit card machines, etc. If they are useful they’ll hang around, pushing your product.
Print is still the vehicle most companies put major effort into, for good reason. It hangs around in the filing cabinets. It can be handed across the desk during a consultation. The market believes it is scientific, so it responds well to scientific-looking information, close typed, long-winded. But it is also very influenced by emotion. They are after all only human, so where you aim ostensibly at the patient, remember all the Doctors have to read the brochures, as well as the PI. (Prescribing Indicators.), because the patient is very likely to ask how to pronounce something on page four…What I’m saying is go for the dramatic issues in the glossy stuff, that you know they will read (the Doctors apparently love the little 3-4 page mini-magazines people are doing at the moment) and back it up with ugly badly type-set stuff to make the whole thing seem ‘scientifically’ more credible.
Should you contemplate Pharmaceuticals as a career? Yes. Pharmaceuticals are a great industry for a clever marketer – they’ll understand your scientific approach, your desire for best practice. And they have the money to make your projects really sing.
But it’s a complicated market. On the one hand, such important causes. On the other, gross inefficiency. I have to say, it was hard to decide what to say in this article. The scientific market researcher in me said, tell it like it was said to you. And what have I done in the process? I’ve alienated every Doctor and Pharmacy company I might ever contemplate going near. But the article is due. And it’s almost time I let a media rep buy my morning tea…