People, Not Populations
IDEA Pharma CEO, Mike Rea, on the importance of behavioral psychology in facilitating precision medicine.
People think they are making rational decisions regarding their health and the treatment of any health conditions, but they may be wrong. Indeed, it is common for people to wrongfully predict their own behavior. This doesn’t mean to say that people are naturally hypocritical. Instead, it simply reflects the fact that many of our behaviors are driven by unconscious stimuli or motivators. Therefore, in order to understand their patients better, the pharma industry need to concentrate more on the individual rather than the “market.” To this end, behavioral psychology can be invaluable.
A need for ‘people research’
According to IDEA Pharma CEO, Mike Rea, “Our markets are collections of individual people. People are made up of emotions, unconscious drivers of attitude and behavior, and a conscious, rational outside. If we can understand this at an individual level, we can understand markets, and develop ways to move markets.” It is, therefore, critical for businesses to have an understanding of the unconscious stimuli or motivators that can truly drive the behavior of each individual in their marketplace.
Some of the early ideas associated with behavioral psychology were exclusively focused on the understanding and modification of the behaviors of those with psychological problems. However, predicting behavior in general and identifying behavioral stimulus is highly useful and applicable to any study that involves people, and that includes consumer markets and patient groups within the pharma industry.
“We have a saying - that people research is more valuable than market research,” says Rea, referring to the views of his team at IDEA Pharma. Although population studies and clinical trials provide large amounts of data about the ‘what’ of behavior, they rarely answer the ‘why’ of the behavior, and consequently fail to include the actual motivators that can predict a desired behavior (i.e. medication adherence).
“It is easy for companies to forget that there is a massive difference between evidence at a population level, and a decision for an individual patient made prospectively,” explains Rea. “The fact that physicians are human, and not simple algorithmic robots, is at odds with the view taken by many pharma companies that just showing enough data will be enough to persuade.”
We have a saying - that people research is more valuable than market research. Although population studies and clinical trials provide large amounts of data about the ‘what’ of behavior, they rarely answer the ‘why’ of the behavior, and consequently fail to include the actual motivators that can predict a desired behavior (i.e. medication adherence).
Research has shown that, often, physicians don’t communicate what the drug is, what it is for, what its side-effects might be, how best to take it, and for how long. “In most cases, they communicate two of those five,” says Rea. “Patients sometimes only get one of these five, or a fraction of it.” With limited information cascaded down to the patient, pharma companies rely on clinical trial results to convince patients to change their behavior and adhere to their product. However, according to Rea, this is of little use.
The value of understanding patient and physician motivation
Within pharma, behavioral psychology can help gain a better understanding of what is important to patients. Market research can attempt to provide answers, but its results can be of little value if they can’t provide insights that translate to actual revenue. Instead, the real behavior of consumers, in actively responding to an advertising campaigns’ call-to-action and making a purchase, is what constitutes tangible income for a business. Pharma companies can apply behavioral psychology concepts in order to better understand the motivations that influence patients’ decisions regarding which pharmaceutical company to trust, purchase from, and be loyal to.
According to Rea, there are a number of factors that influence the personal opinions of both patients and physicians regarding medication and treatment plans.“We believe that the roots of behavior, and therefore decision-making, have a much greater influence than most physicians or payers acknowledge,” he states. He cites the example of how few rationally derived treatment guidelines are actually and absolutely followed by physicians. “Factors such as experience, expertise, trust, and familiarity must be playing a part in decision-making at the individual level, and patient by patient.”
From the studies conducted at IDEA Pharma, Rea has been able to observe how internal and unconscious factors can influence an individual’s opinions. “We have seen that physicians will make different decisions even between two ostensibly similar patients, based on parameters such as perceived optimism, or in one study we did, perceptions of ‘laziness’ by the patient,” he explains. Market researchers don’t always include such factors, like a physician’s personal judgment about a patient, in their population studies.
Additionally, although market research can identify the individually stated goals of patients and physicians, results don’t always reveal the true motivators that have led to those goals. “We have seen that in many or most cases, the goals of physician and patient are the most important predictor of the eventual treatment plan, and yet those goals are often interpolated from some deeply subconscious cues,” observes Rea.
Furthermore, although treatment planning is a shared activity between patient and physician, Rea points out that their goals might not be the same, and unconscious factors can continue to influence the achievement of either person’s goals. “The treatment goals are seldom shared between the physician and patient. A physician is balancing their own goals and the patient’s, often without knowing that they are doing so,” explains Rea.
Steps towards understanding patient motivations and behavior
According to Rea, “Understanding the psychology of decision-making is critical.” Pharma companies need to have an understanding of the concepts of behavioral psychology to aid in identifying and analyzing such factors, and consequently, predict patient behavior.
Rea suggests two basic steps towards understanding patient motivations that predict behavior. The first step involves acknowledging that pharma companies are dealing with collections of individual people. “Recognize that at every level – regulator, payer, physician, and patient, for example, not to mention every other individual involved such as nurses and carers – they are dealing with people,” he says.
Understanding motivations to seek treatment earlier, to arrive at a concordance with the physician on best treatment choice, and to optimize chances of success on treatment, could, for example, make more difference than a new drug that offers incremental benefit.
Step two is about seeking the answer to the question, “Do they know why they do what they do, and are they prepared to tell us?” The answer to this is critical because people tend to make decisions that aren’t solely rational. “For example,” explains Rea, “It can’t be tenable that an FDA panel can vote 11-4 on a drug, and that every one of those 15 was only looking at the evidence. Each of the 15 made an individual decision, based on their own feelings about the risk-benefit balance, on the confidence they have in the data, etc.” The context within which people decide might even be invisible to the individuals themselves. “Biases, prejudice and preferences are all swimming around the central question – subconscious rather than conscious and rational,” says Rea.
Encouraging behavior and retaining patients
Behavioral psychology can also be applied by pharma companies to entice and retain patients. “It is a tremendous opportunity to move from simply looking at what people need to looking at what people want,” says Rea, giving the example of how understanding patient motivation can impact the development and marketing of new drugs.
Getting to the core of what drives patients to act can have a dramatic impact on healthcare systems as well. “Understanding motivations to seek treatment earlier, to arrive at a concordance with the physician on best treatment choice, and to optimize chances of success on treatment, could, for example, make more difference than a new drug that offers incremental benefit,” says Rea. The potential cost-saving impact of influencing factors that motivate and increase the desire to prevent disease among patients are clear.
As pharma increasingly recognizes the opportunities of precision medicine, it increasingly has to understand that precision demands understanding what patients want to achieve for themselves, and not just on a simple ‘quality of life’ scale.
Rea also points out how behavioral psychology is key to developing better medication, specifically precision medicine. “As pharma increasingly recognizes the opportunities of precision medicine, it increasingly has to understand that precision demands understanding what patients want to achieve for themselves, and not just on a simple ‘quality of life’ scale,” he says. Precision medicine cannot rely on data from population studies and clinical trials and, according to Rea, “That means looking into opportunities for more human devices and diagnostics, and using more human endpoints in studies.”
People research matters
In an industry such as pharma, it is important to recognize that although the market is made up of people who supposedly make rational decisions; these people are actually unconsciously motivated by factors such as emotions, temperament, preferences, and personal opinions. It is equally important for pharma to identify and understand such motivating factors.
Population studies and clinical trials can reveal only half of the story about patients. In order to provide precision medicine, behavioral psychology must fill in the missing half. “Patient journeys, pain points, what ifs, micro-environments between patient and physician, and opportunities to persuade and tell stories - these are all places where people research matters more than market research, where opportunities come from understanding, not speculation,” explains Rea.
Overall, an understanding of behavioral psychology can aid pharma in identifying deep-seated motivations that may be invisible to both physicians and patients. Companies can then influence the treatment-related decision-making of physicians and the health-related decision-making of patients. Ultimately, this will equip pharma to provide enhanced quality and precision of care, encourage patients to use their products, retain them in trials or as customers, and add better value to business and patient care.
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