Hive Health

As Helen and I drove down the M6 in the rain yesterday, something struck me…..

In 1996, I travelled – I had no email, no mobile phone – my family got a postcard every couple of weeks

In 1997, I started at university – they gave us a clunky email that resembled an MS-DOS screen – we thought it was great

In 2000, I did a PGCE – for the first time I used the internet for research – my paper on health education for behaviour change was largely in debt to online publications

Here we are in 2009, not a huge number of years later, and Helen and I were driving down the M6 after meeting the Head of the Pharmacy School at Keele University. What he showed us was mind blowing!

They have developed the virtual patient – an avatar called Shirley who walks up to the pharmacy counter, coughs, snuffles and waits for you to start the conversation. Depending on what you, as the pharmacist, chose to say or do, Shirley will respond. The prototype is using text input, but the future masterpiece version will use voice recognition.  It’s ingenious and totally captivating!

The consultation scenario that Shirley demonstrates is based on a decision tree algorithm – an interlinking set of questions, answers and decision points that dictate what Shirley will say and do. These algorithms are incredibly complex to build, we know, because we have just completed our first set for the alli launch that has been used to train pharmacists across the land. We’re very proud of the work we’ve done so far, but I can’t help wanting to take scenario training to the next level.

I had a conversation with a man who works with us sometimes, Dan. He recently stopped smoking with the help of nicotine replacement therapy. I too have banished the need to smoke. I didn’t do it with NRT though – I tried that a few years ago and fell off the wagon too soon. I have also tried tablets, but misread the label and got the dosing wrong in the first week.

I was kidding myself both times. To tackle an addiction physiologically you need to be 100% committed. That’s tough, especially when you don’t feel all that addicted in the first place. Hence the behavioural support programmes that accompany smoking cessation products.

Maybe you think you enjoy smoking, but know that in the main you are insensibly compelled to do it. The truth is, cigarettes are nice, but so fiendishly addictive that most people develop a mutually abusive relationship with them. That’s when you notice the downsides.

When it’s time to get serious, call on the wise. Attend a reliable support group. NHS, Allen Carr, NRT support plans will help you make your decision.  Of course, simply attending these sessions/ reading the literature will remind you that smoking doesn’t do it for you. Not one cigarette nor a million will make you a better person.

It is a horrible, angry feeling, a ciggie craving. I experienced it for many years. Then I took a closer look. It’s not just a nicotine request. A craving is an unheard demand from childhood. It’s an oral fixation. It’s the left hand feeling left out when the right hand holds a drink. It’s a simple desire to tune out for ten minutes. A habit that shrinks as the weeks go on.

Of course, there are certain benefits to smoking. It gives you Time Out, staves off hunger, is proven to enhance short term memory, etc. Considering the price of being a smoker, I can do without those things. If you can’t, make a plan to compensate. 

Nobody should be surprised that obesity has overtaken smoking as a cause of death. Smoking is not a natural urge. Sleeping or eating is. Babies, rabbits, budgies, will all attack you for food. Light a fag and they scatter.

It’s okay to want to smoke a little bit, here and there. But if you’ve been addicted before, you must avoid forever. Keep reminding yourself of what makes sense, and you’ll be fine.

Something seems to come over us when we write an ad brief, my planner friend reminded me this morning. It’s the way we do our best to cram everything about the product/condition/patient into one ad. We forget completely how we as consumers interact with ads; forget that below-the-line materials are on this earth only to communicate the underlying support for the product story.

I had a quick browse of OK! yesterday afternoon (dermatology research). The ads in there are graphic and simple. Their feel and message happened to me automatically, without conscious decision. Clarins just stepped right on in there. Bang, I was Gucci’d. But that’s a good thing. I didn’t have to waste time and delve into reams of body copy to know what it is these brands were trying to say to me. The same thing they were saying in their first, second, 500^th print ad. One-dimensional, loud and clear. Intent – a quick reminder of high-end status. (Plus a little eye candy for the logo lover.)

We’d hardly dream of addressing healthcare professionals this way, because we seem to feel we need a myriad of reasons to excuse ourselves. The disease area needs innovating, here’s why, here’s how we help, here’s the whole deal in microscopic detail. Certainly, HCPs need this information – but a brand ad just can’t and shouldn’t carry all of it. Instead, we must communicate quickly the offer/ position in the one elegant wrapper of a creative idea or perhaps like Gucci, a proud identity. To keep our messages simple we can use a separate, successive approach – that’s why we often roll things out in campaigns.

However, healthcare is a major area of research and advancement and that’s why drugs and services are constantly turning over. Research shows that a small amount of inner detail is appreciated by HCPs, so we have room for a couple of clear sentences in our work. OK, our clients are not Gucci, but we can still learn from such brands. Manufacturing processes kept to the label, leather ageing techniques communicated in store, deals kept to a business-to-business environment, and endorsement happens via PR. The ad is left to communicate the feel of the brand as simply and elegantly as possible. Isn’t what really sticks in our heads the stuff we don’t have to think about too much?

To build upon this and make it relevant to our proposition here at Hive. Using the ad to communicate an element of the story, and the whole mix to contribute to a bigger idea which exists outside and above that of the ad concept seems to us to be a better way, and should provide not just a brand feel but a story and richness that contributes to a truer more in depth relationship.

So POM to P switches are 25 years old, but for me everything changed in 2002 with the publication of the list by a RPSGB led working group of potential candidates for reclassification from POM to P. At the time there was talk of an avalanche of switches coming through the system, the industry got itself all expectant, the pharmacy profession was nervously excited and everyone prepared themselves for the new era.

So what happened? Despite all the positive hype, it hasn’t quite worked out as hoped for, either for the industry or the profession. Certainly the avalanche never arrived, and I doubt now it ever will.

I think if you asked industry executives, hand on heart, has switching been commercially successful, so far most would admit it hasn’t. If we believe POM to P has a role to play in the future of treatment management, and that pharmacy has a key role to play in diagnosing and managing conditions – both of which I passionately believe in – we really need pharmacists to start proving that they believe it too.

I have no doubt that for a host of conditions and ailments, the best place to treat and manage (and even diagnose) is in the pharmacy. Some 30 per cent of GP consultations are for minor or self-limiting conditions, most of which are in areas that pharmacists are either well or sometimes better equipped to deal with.

Couple this with the fact that our healthcare system has disenfranchised so many people and that vast tracts of patients/consumers are increasingly looking to their high street clinician – the pharmacist. One begins to wonder how it could go wrong.

I run a communications agency and over the years I’ve worked on a host of switches. I’ve spent a great deal of time talking to pharmacists about their role, their attitudes to conditions and treatments, and most importantly how they interact with their customers.

We develop training and tools to support pharmacy knowledge, and to help create a positive dialogue with customers around a condition or treatment. We also spend a great deal of time talking to the pharmaceutical industry about how to support pharmacy – so I do see things from both the industry’s as well as the profession’s side.

As far as the industry is concerned, innovation drives growth. Generic proliferation and own-brand competition mean that you can’t sit still. POM to P switching provides a huge area for innovation. It’s a ready-made pipeline of proven products for key conditions and it can breathe extended life into brands coming off patent.

With the new community pharmacy contracts and the evolution of pharmacists into service providers, the case to move more chronic care into pharmacy is compelling. Diagnose simple and even not-so-simple conditions, and the management of complex conditions follows closely behind. Whether pharmacists acknowledges it or not, the industry believes that the high street has a vital role to play in the future health management of the nation.

There is no doubt that the pharmaceutical industry produces fantastic support for pharmacy. The quality of support that exists for POM to P switches keeps getting better and better. The extent of investment in pharmacy for launches is now greater than I’ve ever seen. And it’s not unrecognised. Pharmacists acknowledge it openly. So why is it so difficult to get lift-off with a new POM-P medicine?

We acknowledge that the industry believes in pharmacy, but I believe, more importantly, that consumers believe in pharmacy too. So who is missing from this picture?

In truth, no one. Industry, consumers and the profession are passionately committed to an extended role for pharmacists. So it’s a perfect storm then? Sadly not. Because whilst the profession is supportive, there is a latent caution that affects launches so overtly that it brings to question whether switching is a viable long-term option.

From conversations with pharmacists this new world seems exciting, but quite daunting too. Diagnosis, long-term management, counselling, guidance, advice… all words that to a greater or lesser degree create nervousness. This new way has an impact on the way pharmacists operate – much more front of counter, the visible face in the store, more time intensive. So who sorts out the prescriptions? Who does the things that keep pharmacists so busy normally? Are they really able to diagnose? It’s a brand new world, and for many a scary one.

In reality switches should be the ideal conduit for this transition. The regulatory framework around switching is rigorous, designed to protect all, often to the detriment of efficacy. The products switched invariably fulfil a clear consumer need, and driving new people into pharmacy for new solutions should be good for all.

Consumers are open. They too like innovation, they want better treatments, to be able to quickly fix problems, get an appointment on their terms.

Sure it’s true that they are not yet used to more complex discussions with pharmacists. They feel a bit uncomfortable, unsure – but that’s easy enough to fix, isn’t it? Professionals, on the high street, ready to put people at ease? Perhaps the truth is that pharmacists aren’t used to these sorts of discussions either or just scared to have them.

The traditional role of symptom management will never disappear, but with the competitive environment the industry operates in being unsustainable without innovation, the truth is that without pharmacy engaging with POM to P switching and supporting it as a category, the industry will have to change tack. It cannot afford for innovation to go unrewarded in terms of sales.

This brings me to a final conundrum. I regularly hear cynicism from the profession that POM to P switches are just a route to GSL, and that pharmacists are being ‘used’. There is a truth that brands switched from P to GSL see improved sales performance, but for me it’s just a natural extension of life cycle.

An established brand with a profile for broader access, one that doesn’t need the time commitment from pharmacists, should be GSL. It’s not some conspiracy; it’s just a business reality. I worry that if pharmacy does not start to properly support POM to P switches, their cynical worrying becomes a self- fulfilling prophecy.

Pharmacists must demonstrate that they believe they are the rightful place for condition treatment and management to exist. This is so important, because once this true partnership is in place, the value of the consultation and improved experience for consumers will not only enhance their view of pharmacy as a solution, it will radically change the industry’s view. Why switch to GSL a brand where the role of a pharmacist is so intrinsic to the consumer’s experience?

This post also features in this months Pharmacy Magazine supplement reviewing 25 years of POM to P.