What are IDEAs made of: Audiences

Mike Rea

IDEA Pharma

Following down the path of influence for even one respiratory tract infection (RTI) antibiotic prescribing decision can be a Poirot-like exercise. From the chest physician, her peers, her opinion leaders (and the guidelines they wrote together), to the PCP, the nurse, the pharmacist, the payer, the infectious disease specialist, the microbiologist, the medical journalist who supported the last review paper on the subject, all the way to the patient (and his mum), understanding exactly who chose the brand that the patient eventually took home is not easy (or perhaps even possible). That isn't a pyramid of influence, more like Murder On The Orient Express.

This is somewhat inconvenient for most of us. It would be much easier if we knew whom to spend our time persuading of the general excellence of our product.

Traditionally, the industry has relied upon latter-day Moses figures known as 'opinion leaders' (or their other denominations: KOLs, KEEs) to carry the tablets of stone to the masses. However, there are a couple of problems right there. 1) Opinion leaders may not actually influence opinion, and 2) they may not represent opinion very well.

This could be a problem.

Back in the olden days (let's call it the 80s), a wise old man, widely respected in his field (please excuse the seemingly sexist appellation - I had to choose one gender…), would stand up at the World Congress, and deliver a view on the best choice of product for a given situation that everyone then went away and followed blindly.

Except… that's not what happened. Even then, if you put 10 'opinion leaders' around a table, and gave them a patient history, they'd make 10 different decisions. This (by the rather obvious way) has not changed. So, what those delegates at the World Congress were doing was exercising judgement - listening to arguments and then coming to their own decisions. Were they influenced? Probably. Was their opinion led? To some extent, possibly. KOLs are often in the position of a local music critic - those around them may well follow some of their advice, but many will never even hear it, especially those further afield. (Believe me, I am a music critic in my spare time, and can't even persuade my wife to read the reviews…) The chances of your local PCP having been directly influenced by, or even aware of, the recommendations of an anti-hypertensive 'KOL' are vanishingly small.

"The chances of your local PCP having been directly influenced by, or even aware of, the recommendations of an anti-hypertensive 'KOL' are vanishingly small."

(To the second caveat: if you are currently using 'KOLs' in advisory meetings, do stop and ask yourself whether they have been very good at representing the collective views of practising physicians, or whether they are more likely to simply give you their own intuition. If the former, you've been lucky.)

What was true then, and is even more true now, is that the 'audience' for a pharmaceutical product is enormously complex. There are patterns, of course, and hierarchies - it is a racing certainty, for example, that some opinions count for more than others, especially in pre-launch.

So, when you develop the idea of your product, whom do you develop it against?

Several methodologies have a different 'primary customer', and in some corporations this is 'the patient', or 'the prescriber', and the others are conveniently ignored. That is the height of ignorance (speaking literally, of course…). If a proposition does not work for all the audiences that matter, it is of no value. For example, a proposition developed against a patient that carries no value to the prescriber or the payer is a self-evidently useless proposition, unless you want the patient to pay directly. (I say 'self evidently', although it wasn't so self-evident to one of the largest companies in the business, who tried it for a few years - now they have fortunately abandoned that idea…)

There are problems associated with this inconvenient truth - conducting market research and running advisory meetings, for example, could become remarkably expensive and time consuming if a change in the process is not implemented to recognise it. However, there is a simple opportunity if you flip the problem. Come up with the ideas first and test for alignment through all the relevant audiences (the way that most other industries do it - just in case you didn't want to go first…). That way respects the complexity of the audience construct, and doesn't deny the opinions of everyone who may be involved in writing a prescription for your new drug. The world today won't allow you to focus on one audience type to the exclusion of all others - they all read the same Internet.

About the author:

Mike Rea is a Principal with IDEA Pharma, who enjoys taking a look outside the industry to learn how it can think differently. For direct enquiries he can be contacted on mike.rea@ideapharma.com and for more information on IDEA Pharma please see http://www.ideapharma.com/what/default.htm.

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