Wednesday, November 26, 2008

Do the Facts Matter?

Of Course They Do, Of Course They Don't
We receive, provide and use facts all the time. Facts inform our choices. Facts support our points of view. Facts help us find new facts.

Yet we see that facts matter little when it comes to risk and behavior. People can recite the facts but they smoke cigarettes, overeat, abuse drugs, don’t exercise, don’t take their medicine, and don’t wear motorcycle or bicycle helmets.

There are other circumstances where people just refuse to acknowledge a fact as fact. Have you noticed that some arguments are never won despite having solid, unassailable facts? If the facts don’t fit the person’s worldview or “frame,” as the cognitive linguist George Lakoff terms it, the facts bounce off like bullets shot at Superman’s chest. Your opponent deflects all the data while you get blue in the face.

Certainly there are internal and external forces at play. There may be inertia: “That’s the way we’ve always done things.” There may be no consequences: “Who’s going to notice, who’s going to care?” We may feel powerless: “I don’t have the resources, I don’t have the access.”

Still, we pump out what we think are compelling facts in the hope of persuading people to take some sort of desired action. That’s what prompted me to write this entry.

Another public health alarm was sounded this week with the release of a survey that said very nearly everyone (83 percent) at risk for type 2 diabetes in the US is not getting a simple blood glucose test or taking the appropriate actions as a result of their test. This joint effort between The National Changing Diabetes(R) Program, sponsored by Novo Nordisk, and Fleishman-Hillard points to some special concerns in Hispanic and African American populations. “Fifty six percent of Hispanics should be tested and 59 percent of African Americans are at risk for diabetes and should talk to their doctor about being tested.”

Dana Haza, senior director, National Changing Diabetes Program (NCDP), said, “This study clearly demonstrates the need for greater education and awareness, especially among people who are at risk.” And Martha Boudreau, president Mid-Atlantic, Fleishman-Hillard, added, “In working with our National Diabetes Goal partners to release this information and help create awareness about type 2 diabetes, we hope it will serve as a call to action for at-risk Americans to get tested and respond accordingly."

The NCDP is a very worthwhile initiative, don’t get me wrong. But if facts were all that mattered, we’d be done. Insight alone does not produce change. Those who came after Freud quickly discovered this truism. Indeed, a whole new genre of psychotherapy (cognitive) came to life based on the knowledge that knowledge doesn't bring change.

It’s the desire to change that brings change. To the at-risk person we must ask: “Why don’t you care, what don’t you understand, who might help you, what resources do you need, can you imagine what your future would look like if you changed?” Gaining these insights will help us place more effective calls for those desired actions.

Wednesday, November 19, 2008

Mind the Gap(s)

Ask Questions, Learn, Close the Loop
It was disturbing (but maybe not surprising) to read the findings of a Medco-sponsored survey this week. They found that over 60 percent of enrollees in Medicare Part D still did not understand the coverage gap – the so-called "doughnut hole" – where they must pay the full cost of their prescription medications. I said “still” because this plan went into effect in 2006. Most respondents didn’t understand the concept, didn’t know what counted toward the gap or at what point coverage resumed.

Woody Eisenberg, chief medical officer at Medco, said the Center for Medicare and Medicaid Services did “a fair job” in communicating what everyone expected to be a complex set of rules with multiple moving parts. There are, indeed, cases where fair or good is good enough but not here. Two years out, it’s painful to think that millions of people are not deriving the full benefit of such an important health program. This is one communications gap that must be closed.

There are plenty of other gaps like this one where great intentions fall short in the execution. And, there are other gaps that we leave open because we fail to close the loop. I’m sure we’ve all been there. We did all of the research and all of the planning. Then, we deployed the program and watched for outcomes. But how often have you really been involved in a post-mortem review and analysis of a program or a pitch? I’m not talking about a hallway conversation or a chat in a taxi cab. What was learned? What were the unintended consequences of our actions? What should be added or deleted to the next stage of the program? What else do we need to learn and from whom? Did we inform the internal and external teams that were part of the program success (or failure)? Did we provide adequate feedback to those involved? Whose performance should be celebrated and what steps should be taken to improve others? How did we manage our resources? Did we ask the people paying for all of this if they were happy?

There’s one more loop that we frequently fail to close. In business, where success is often founded on forming positive relationships, we are terrible at saying thank you. Win or lose, a thank you to staff, to vendors, to consultants, to anyone who had a stake in the effort is both the cheapest and richest expression one can offer.

Friday, November 14, 2008

Give Me an S, Give Me a C, Give me an…

The Necessity of Science Literacy
How do modern day snake oil salesmen make millions selling over the counter weight loss pills, arthritis cures and memory enhancers? Why have so many research projects become political footballs? Why do we risk losing our competitive edge in science and engineering? Two reasons, I think. We’ve allowed science to be devalued – denigrated, even. And, because science doesn’t occupy its proper place in the hierarchy of our society, our capacity to separate the good from the bad – the junk science from quality science – is at a frightfully low level.

Remember the first court case involving the arthritis drug Vioxx(R)? The jury awarded $253 million to the plaintiff. It was reported that the case for Merck, the manufacturer, was lost well before the conclusion of all the testimony. “We didn’t know what the heck they were talking about,” a juror told The Wall Street Journal. (In an NPR interview, plantiff's attorney Mark Lanier noted that Merck learned from this expensive lesson and communicated successfully with subsequent juries "in an everyday way.")

This isn’t just some isolated event or some trivial issue. We’re all hurt by the generally poor public understanding of science and our uneven ability to communicate it. In a New York Times piece on science literacy, Jon D. Miller, director of the Center for Biomedical Communications at the Northwestern University Medical School said, “People’s inability to understand basic scientific concepts undermines their ability to take part in the democratic process.”

There are, of course, bright spots. I’m on the Board of the Southern Connecticut Science and Engineering Foundation and we’re gearing up again for the annual science fair that we sponsor. Over the last seven years, the fair has grown from half a dozen student participants to about 120. And more schools are joining in. Still, it hits me each year that we have to struggle to get local press coverage. How about showing the same pride for the student scientists as we do our student athletes?

By the way, our need for judges has grown also. So, if you’re in the neighborhood this February and would like to help inspire some terrific young scientists and engineers, let me know!

Thursday, November 13, 2008

Let's Get a Little More Serious

Enhancing Corporate Reputation By Playing It Straight
I held a session on risk preparedness, issues management and crisis communications, last week in my Strategic Communication class. One of the truisms I talked about was how, so often, damage to reputation, morale, operations and financial performance is self-inflicted.

The pharmaceutical industry, unfortunately, serves as a prime example. In my view, some of the fights to differentiate products and gain market share have fanned the flames of antipathy toward the industry. DTC advertising has helped a number of brands become household names but these efforts have not always enhanced the public trust. We’re not making our best effort to properly set expectations or adequately communicate the balance between risk and benefit when animated characters or claymation body parts are used to sell medicines. I’m sure these ads test well in focus groups but this environment calls for a more serious approach to marketing and education.

This doesn’t mean that we can’t or shouldn’t be creative. We just need to redefine what creative means. The default definition of “creative” can’t be hosting big events or using celebrity spokespersons. It has to be more encompassing and it has to involve real analysis – a clear link to the needs of stakeholders.

Pfizer represents an interesting yin and yang on this subject. On the one side, they have Chantix(R), the smoking cessation product, with its ads using the tortoise and the hare to illustrate the importance of perseverance and compliance. But how seriously should we take the safety warnings when we see a petting zoo on TV? On the other side is the retooled Lipitor(R) campaign featuring an actual heart attack survivor who now takes the cholesterol reducer. If this guy is giving me the good and the bad, I’ll pay attention.

But what really interests me is the Company’s recently launched Medicine Safety Education web site. I don’t have any knowledge about how well this has been promoted, received or utilized, but this site looks like a good start in both communicating and collecting information on drug safety. And, beyond the attempt at putting safety in perspective, there’s another critical element – a step toward educating the public on risk perception. It’s a small but worthy – and creative – step toward rebuilding trust and reputation.