Hive Health

The 2004 “Choosing health through pharmacy” programme envisages that by 2015, pharmacy will be our first stop for health matters. Pharmacists will be qualified to identify disease risk factors, suggest the appropriate treatment steps and refer practitioners when necessary.Going hand in hand with this is the increasing switch of prescription-only-medicines (POMs) to P status – medicines that can be provided by a pharmacist without the need for a doctor’s script. This is good for the drugs bill and so far, good for patients – with a pretty clean slate for switches so far in terms of safety.

Mixed reactions come from pharmacy itself, however. On paper the industry are largely positive but seem reluctant to practice on real life customers. This is not the proactive response that government and industry had hoped for.

Some believe it is too much, too soon, to expect pharmacists to accomplish a GP consulting approach. The first and biggest hurdle may be acceptance. To quote a pharmacist I recently spoke to: “If I had wanted to be a GP I would have become one”.

But the cost of switches must be recouped. So are we doing something wrong? Pharmacists know that switch products have met stringent risk-benefit criteria – I believe so. They value the training on offer – yes. Should we be more aggressive – less trusting of their professional instincts, less patient?

I don’t think a macho upbringing makes strong people. So we need to think hard about support. While the NHS is the main driver of change, we cannot expect that our responsibilities end with branded training. Instead, we’re going to need to co-create opportunities with government and pharmacy to build the secure, confident community practitioners of the future. Watch this space.

Freerice.com is a new interactive charity site that donates free rice for every word you know the definition for. It’s highly addictive, improving our vocabulary, is free and donates rice to the 3^rd world as part of the UNs bid to end world hunger. It donated 1billion grains in its first month. It generates revenue to do this through ads on the site. Its genius. Have a go and donate some rice.

Those of us on the industry side of healthcare may dismiss today’s news as another headline doing damage to an industry that delivers benefit to millions. But in claiming “The difference in improvement between patients taking placebos and patients taking anti-depressants is not very great”, lead researcher Professor Irving Kirsch raises some undeniably challenging questions.

For one thing, the “effect” is not limited to mental health trials. One RCT in patients with acute duodenal ulcer (Lanza et al. 1994) consisted of three treatment arms: the then-new drug lansoprazole (Zoton/ Pravacid), an older drug, ranitidine (Zantac) and placebo. As per experimental law, the 44 patients receiving placebo had the same diagnosis as the other patients and were examined alongside them. After two weeks about a third of the placebo patients were healed, and after four weeks just under half of them were healed.

Here’s another in angina: (Boissel et al 1986) 35 patients with severely limited functional status were treated for 6 months only with placebo and short-acting nitroglycerin. The placebo dosage was blindly titrated over this time until an “optimal” response was seen. Twenty seven of the 35 patients showed substantial improvements over this period. Overall the number of angina attacks dropped from 10.3 to 2.4 a week with a corresponding decrease in nitroglycerin tablets used. It seems unlikely that these people would have simply gotten better had they stayed at home and had no treatment. But, with inert treatment in a clinical trial, they did get better.

Let’s not forget that a placebo isn’t necessarily a tablet. In two studies (Cobb et al, NEJM 1959. Dimond et al, J of Cardio. 1960) surgeons were only informed once in the operating room which patients were to have a complete internal-mammary artery operation, and which were to receive sham surgery. Both studies showed that most of the patients were much better after “surgery” regardless of whether they had actually received it or not.

These examples of a high response rate in a placebo arm are not uncommon. For centuries, it has been known that sick people frequently get better when administered an inert intervention by a healer or medicine man. It’s hard to account for the substantial improvement in these patients.

Increasingly, the term “placebo effect” has been a dismissive one, given to justify a response that cannot really be understood. To me, it seems that at some point the role of the patient’s ‘mind-over-illness’ must be considered. Indeed, the word “placebo” is being challenged by medical anthropologists, who ask how placebos, an inert substance by definition, can have any effect at all. If it does something, it is not inert. There must be something else at play driving this change.

Daniel Moerman in his excellent book Meaning, medicine, and the “placebo effect”, suggests a very different approach to this problem. He uses the term “Meaning response” and defines this as “the psychological and physiological effects of meaning in the treatment of illness”. The meaning response can be applied to most of the results traditionally attributed to placebo effect. As a definition it gathers the elements of the non-physiological into treatment success, aiming at a better understanding of this phenomenon.

Once you acknowledge that treatment ‘meaning’ exists alongside mode of action and plays a role, it’s only a short distance to another important realisation. This is directly relevant to us: by understanding meaning in the eyes of the end user, we can feed this insight into the HCP strategy. Adapting and optimising our communications can only help drive a better brand experience, a better consultation and perhaps better outcomes.

What do you think?

I have been ‘doing’ billable healthcare digital for 14 years. In the beginning there were video presentations, online Q&A sessions and clinical summary downloads; more recently, a wealth of Flash-enabled tools. To date it’s been pretty easy to repurpose content or repackage it as a digital thing and sell it as exactly that – a thing, a tactical item, a separate channel for delivering traditional content. “A better mousetrap” as Ian would say.

The digital gold rush has produced an interesting response in the healthcare agency world. First, we have learned to bolt Shockwave Flash capability onto an existing production function. We expanded our in-house capability to do this, or outsourced to those talented Shockwave Flash savvy freelancers/e-lancers available locally or globally.

The second reaction is more radical. Agencies have been set up to focus purely on the digital channel, merging a healthcare marketing background with the ability to talk to internal and external audiences entirely through online means.

We’re responding to the rise of what we know as web 2.0 (every evolution must be named!). The success of brands such as Google, Facebook, eBay, YouTube have forced the agency world to find ways of incorporating the Web 2.0 experience into our healthcare approach. It appears no longer acceptable to consider “digital” as remote from the strategic process, interactive paper that crops up when useful. We must use its real advantages: to assist brands not only with functional delivery, but emotional answers and even a service offer.

It strikes me that an uptake of “real digital” in healthcare, and the correct use of its communication opportunities, calls for agencies to evolve and not necessarily clients. For years I sat with numerous agencies and moaned about the slow adoption of digital in healthcare. Over time I started to see how the digital evolution meant an entirely new strategic process. Forget the production bolt-ons, our work now is a total re-think from the earliest stages of brand planning. That’s when we will see brand values such as ‘community building’ being agreed on and more importantly, delivered.