Modelling thoughts

Brands are here to stay - because consumers want them. Brands help people navigate the information boom with a sense of direction and trust in how they source their views and opinions.

But what about the healthcare sector? Do brands perform the same function? Are pharmaceutical brands here to stay because healthcare professionals (HCPs) want them? Do brands help HCPs navigate the information boom coming out of the pharmaceutical industry?

Brands do exist in both environments, but how are they different? What function does a brand perform in the consumer sector that it doesn't perform in the healthcare sector? Are they driven by the same thought and desire processes?

Brands should deliver
In a nutshell, consumers are driven to choose a particular brand because of emotions. They buy brands in waves, depending on current trends and marketing campaigns. Their decisions are subjective. For example, when in the fridge aisle of the supermarket, most consumers will choose one yoghurt brand over another on a recommendation, because they saw a television advert, they like the taste, the packaging is engaging, or perhaps because it is on special offer.

Imagine the same scenario with an HCP: a patient with osteoporosis enters the surgery. Will the doctor choose to prescribe the brand with the nicest packaging or because they know Mrs X's daughter took it and it was such a tasty syrup?

Perhaps they will choose the brand that is on special offer - prescribe this to a patient and next time they are ill, they'll get free treatment from the pharmaceutical company (Buy One Get One Free!)?

Obviously not.

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Why is health so different?
HCP brand decisions are objective. They base their brand decisions on evidence-based benefits to their patients. They buy the brand they trust, the brands which are supported by solid scientific data.

The healthcare system is different from the consumer world. The consumer is free in their brand choice; however, healthcare systems are bound by controls, regulations and ethical considerations.

The consumer's choice of yoghurt, or washing powder, brand does not have long lasting consequences; the consumer has no responsibilities besides fulfilling their desires at that moment. The HCP, on the other hand, has an enormous amount of responsibility.

They are faced with a serious problem, a disease he has to cure. Choosing the wrong brand could, in the worst case, result in death of the patient. His choice of brand has long lasting consequences.

Healthcare systems around Europe are changing rapidly as new controls are introduced and requirements become subject to change:

• Evidence-based outcomes

• Moves to generic prescribing

• Resource models, health technology appraisal, integrated care pathways, etc.

Healthcare marketing has become more efficient by adopting new techniques, but has it ensured it is keeping pace with rapidly and frequently changing health systems?

Health suppliers (in particular pharma companies) may need a better way to relate to health users to ensure they create and sustain competitive advantage.

Customer insight
Customer insight should be the engine of all brand focus and activity in consumer brands - it drives product development as brand development. Many companies claim to truly understand their customers, but is this always the case?

When conducting market research, the claims hierarchy often results in the traditional order of preference: efficacy, tolerability, safety, ease of use, etc. But how often does market research, asking what a health professional wants (or needs), result in the standard response of I would like a highly effective, clean, safe, easy-to-take medicine, please?

Such results could apply to any disease area or medicine and are clearly not of great use.

True customer insight - identifying what motivates the customer to appreciate value and change their ways - has become increasingly difficult as it has focused so long on the big money-spinning therapy areas, where the category may be saturated and new products can only get in the game by pushing competitors out.

Yet, times are changing and R&D efforts are taking marketers to fresh fields where the landscape is not mapped out and the lines of communication to the customer are not so clear, or not there at all.

The demand for customer insight skills is growing and there is a new marketing requirement beyond basic skills that identify not what customers think - but how customers think. This is what disease model marketing allows you to do.

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Disease models
If brands are built around customer insight, then, in health, customer insights revolve around disease models. A disease model is the simplified version of a disease that health professionals carry around in their heads.

It is a simple way of condensing the text book into a workable tool that allows them to do their job effectively and efficiently. By understanding the relevant disease model, it is easy to see how decisions are made, treatments are chosen, results are achieved, and patients get well - or perhaps do not.

Disease models are reproducible across target audiences and geographical areas, and are remarkably consistent in enabling health professionals to talk to one another without talking at cross purposes, as well as allowing them to agree to disagree if necessary.

These models work by providing the philosophy behind the therapy area (see figure 1 - right). For example, peptic ulcer disease is fundamentally related to acid - too much in the wrong place or at the wrong time - so the solutions are all acid related.

As a clinician, you think about neutralising the acid, defending against it, or turning it off. Doctors want to know how much acid control they are getting for their money and, if they decide to prescribe a medicine, how it will ultimately deliver the appropriate outcome (based on the disease model) - ie, the patient getting better.

Anxiety and depression are associated with levels of neurotransmitters, serotonin and noradrenaline, in the brain. Prior to the launch of Wyeth's Efexor in 1995, the disease model for depression was based solely on serotonin. However, subsequent developments highlighted that some of the newer combinations of noradrenaline and serotonin elicited a superior effect on depression, changing the disease model.This model evolution was necessary for serotonin and noradrenaline reuptake inhibitors to be successful.

In the field of asthma, Allen & Hanburys first long-acting beta agonist illustrated that the condition was also an inflamm-atory disease, a development which changed this disease model.

Disease models are often based on classes of drugs and how they work, not on individual brands. In cardiovascular disease (see figure 2 - right), a clinician will decide on the appropriate intervention based on the class of medicine they wish to use which satisfies their disease model.

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Driving insight
Part of the beauty of working with disease models is in understanding their very existence. It provides a way of talking and listening, which opens up debate, opinion and emotion with health professionals. You do not see this when they discuss the application of solutions, which is when they remain mostly dispassionate.

Hence, the first benefit is the sheer volume of feedback and enthusiasm associated with the subject. Secondly, the degree of consensus and varying points of view is a vital way to gauge how much satisfaction or need there is in the area.

Thirdly, the expectation levels and support for individual solutions is couched in commitment to a particular disease model, not just a validation of guidelines or protocols - so the degrees of commitment and loyalty are very apparent.

The customer insights which can be derived from this approach are often emotive and rational at the same time and are fundamental to treatment chosen at all levels. Most of all, they give clarity to how health professionals currently position brands and the reasons for it.

It's about how you think
Getting back to the customer is the greatest lesson we can take from the consumer brand marketers and the single biggest move we can make.

The relentless pursuit of customer insight Sudler and Hennessey has seen by our clients in consumer brands, such as Colgate Total, Actimel, Activia, Dove and Cow and Gate, convinced us to put customer insight at the centre of everything. We have put this disease model marketing into practice with many market-leading brands.

Over two-thirds of the brands we have worked on that have achieved market leadership have relied on disease model marketing.

So to a marketer, the challenge is a simple one - in what context do you think about the product that you work on?

Compared to competitors? Based on a point of differentiation that may, or may not, be meaningful to the prescriber?

For real success with your product, it must fit perfectly with the clinician's disease model. Going beyond the brand and understanding the insights that disease model marketing brings opens up a new way of seeing how health professionals work and what motivates them.

Make sure you truly understand how your customers think and not what they think.

The author
Dr Brian Kelly is managing director of Sudler & Hennessey's London office, part of a global healthcare communications firm