The Patient Orientation Quiz

Hello all.It's been a few months since my last column, but I have a great excuse... I've been really, really busy.Anyway, the kind and insistent people at eyeforpharma have asked me if I could pick up where I left off and I'm quite happy to do so.

In these intervening months, my general level of astonishment at the hesitancy of the pharma industry to take adherence more seriously has not significantly declined. At a time when pharma is under the greatest revenue pressure in the industry's history, a time when traditional ways of increasing revenues (read "hire more sales reps") are off the table, it is mind-numbingly evident that the industry should focus on addressing some of the hundreds of billions of dollars lost to non-adherence, particularly when the ways of doing so are very much on the table and staunchly supported by the very authorities that increasingly clamp down on promotional efforts towards physicians.

That's not to say that nothing is happening.  In the US, adherence spending has a tendency to follow Moore's law and double every 12 to 18 months, but Europe remains far, far behind, with a few notable exceptions.

I know that I'm being provocative, and a number of executives have protested by citing their efforts: a program here, a program there, a lot of words about how they're changing the disease, or putting patients at the center of all that they do.  I really do applaud the efforts they're making.  However, I'm still going to prod and ask, really, to what degree their companies are patient-centric.

I'm not talking about their personal motivations.  Despite the increasingly common tendency of the general public to consider the pharmaceutical industry as made up of greedy, unethical scoundrels, I've always found that the personal motivations of the many, many executives I've worked with have been noble.  I think most pharmaceutical executives genuinely want to help people live better, healthier, more fruitful lives and are justly proud of their work.

However, when you group people together into large corporations, the corporations end up with an incorporeal mind of their own and the question here is, to what degree does your company "think" first about patients.

There is, of course, the "vision thing" (to quote H. W. Bush).  It is ethically clear that pharma should put patients first, there's no argument about that.  There is also, though, the fact that these days, putting patients first will help increase adherence which is, once again, the best lever for results (see above).

As an example: just a couple of days ago a friend of mine who is a fund manager (disclosure: way, way back, I actually began my career on Wall Street) asked me which pharma companies' stocks I would recommend.  He knew how to run the analysis, he knew how to analyse pipelines and ratios and charts, he knew the financial ropes better than I do, but his question was about strategy - which companies had the best long term strategies.  He thought that the rest -  pielines and the like - were already discounted into the price.  My response was simply that these days it's all about which companies actually have a coherent patient-oriented strategy.  I won't say which companies I mentioned favorably and which I was less enthusiastic about, but suffice it to say that I told him I see enormous differences and only a few truly innovative companies in this respect.  He plans on acting on this.

So, where does your company fall?  I propose the following quiz.  Who amongst us hasn't done one of these magazine quizzes while waiting in the doctor's office?  Why not have one about patient orientation?

1.       Does your corporate mission statement mention patients?

a.      Yes

b.      No

2.       You have the opportunity to put into place a patient support program that will cost €200,000.  You have calculated that it should raise adherence for 1,000 patients from an MPR of 0.6 to 0.7, bringing increased revenues of €1 million.   What do you do?

a.       Do it

b.      Can't do it, I have no budget allocated for patient support

c.       Don't do it... and what's MPR?

3.       If your answer was b or c to the above question, skip ahead, otherwise... you have just learned that you can not restrict the above program to your patients.  The increase in cost is 20% and your competitors' products will also benefit.  What do you do?

a.       No problem, the ROI is still highly postive, it's good for patients and we want to position ourselves as patient innovators

b.      I'll try to push it through, but my management won't like it

c.       No way I'm going to spend a penny that could benefit my competitors

4.       What about if this program were done via an industry consortium with yourselves and your competitors in this field?

a.       This changes nothing, and we don't want to be seen as being left out.

b.      We would try at least to have a position of leadership within the consortium

c.       There's even less of a reason to do it... if one of our competitors invests in adherence and therefore helps us inadvertently, why should we invest?

5.       Estimate the relative size of your corporate spending for promotion (including sales force) vs patient support / adherence.  For this question, funds simply granted to patient associations don't count

a.       80/20

b.      90/10

c.       Higher than 90/10

6.       Does your company systematically take into account adherence levels when doing analysis for product marketing plans?

a.       Yes

b.      We try, but it's not a formal part of the planning process

c.       No

7.       Is it easy for everyone in marketing and in medical to access information about patient adherence levels for your products in their markets?

a.       Yes, the company regularly tracks this information and provides it

b.      We have some information, but it's not systematic

c.       No

8.       You know the effects of your products according to your clinical trials.  Do you know the effects on a patient that is at 80% or 50% compliant?

a.       Yes

b.      We have some idea

c.       No

9.       While it is difficult to engage directly with patients in Europe, it is possible to track what is being said on the web.  Does your company do this?

a.       Yes, we have regular reports on "buzz" and themes showing up and get information from patient sites

b.      We don't have regular reports, but we do try to pay attention and patient remarks form the web show up in internal presentations

c.       No

10.   To what degree do you regularly help prescribers to deal with their patients beyond the provision of medication?

a.       We regularly offer tools, guidance, educational materials both to prescribers and to other HCPs (such as nurses) to help them deal with patients

b.      We provide some assistance, but the vast majority of our promotion is about the products

c.       Whatever support we provide is primarily a way to position ourselves with prescribers, our promotion is fundamentally product-specific


Don't give yourself any points for question 1, regardless of your answer... this quiz is about what you do, not what you say.

For the other questions, give yourselves 2 points for every "a", 1 point for every "b" and 0 points for every "c".

I've worked in one capacity or another with something like forty pharma companies over the past few years, including every one of the top 20.  Inside Europe, I bet that the average score is between 3 and 5 on this (out of a potential 18).  I'm willing to bet that within five years it will be 15 or 16.

Where is your company ?

Kevin Dolgin is an independent consultant and President of Observia, a French company providing patient compliance programs. Kevin is also Associate Professor of Marketing at the Sorbonne Graduate Business School.

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