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All things Pharma

Does your call strategy engage or annoy?

THE 4 PILLARS OF PRODUCT CAMPAIGNS Many drugs are promoted in many ways. As a customer, I see some companies focussing on issues on cost-effectiveness, some on issues of evidence. Some will come in on aspects of the cheapest treatment available. Whatever the strategy it seems universal for companies to come with ‘key messages’ which are apparently ‘conveyed’ to me as a customer. These key messages will be blended with product USPs, key features and benefits and a corresponding ‘stack’ of clinical papers. But what are the underlying ‘commonality’ that I see coming through various representatives, companies and the products that they promote?
1. THE POST-HOC FALLACY When I play roulette (I do fancy the occasional flutter) I like betting on patterns of numbers that have come up on neighbouring roulette tables! Why? Because I tried this one night and it worked! (let’s just say I won a fair bit) Clearly I am exhibiting flawed reasoning; this is what we call posthoc fallacy. Just because one event follows another doesn’t mean that there is a causal link. This is why I often look very closely at absolute risk reduction of an event over and above that caused by placebo. Because if your drug improves stress urge incontinence by a significant amount, but not really much more than placebo, then the causal link may not be the drug but something else that is occurring during the process of seeing a patient, listening to their problem, measuring physical signs and symptoms and putting a pen to pad to prescribe them some blue smarties. Most pharma companies need to employ post-hoc arguments otherwise the increased well being is not attributable to the patient! Think about pleiotropic effects of statins or ACE Inhibitors. They are very much post-hoc arguments. We gave the patient a statin, and something else great happened that has nothing to do with cholesterol lowering. So this was due to the drug. I am not saying that there is anything wrong with post-hoc arguments. But I always advocate the causal link – at least in observation if not understood mechanistically. Let’s not forget that the customer too is guilty of post-hoc fallacy. “Oh I prescribed your drug in Edith and she felt really sick. I am not using that product again”. I am sure you have all heard this many times. Patients get better and worse whilst on numerous drugs. It is usually post-hoc fallacy when claims are made in general terms after 1 observation. So be sure to tell your GP this the next time he tries that on you! Furthermore, when something ‘good’ seems to follow the use of your drug I would advise you to be armed with 2 facts – how repeatable are the results of this phenomena and by what mechanism(s) do they occur?
2. ARGUMENT FROM AUTHORITY (Key Opinion Leaders, KOLs) When you see a famous footballer in an advert for razor blades or a voluptuous blonde in an advert for a premium lager one has to ask – what makes that celebrity an authority on that product? The answer is usually nothing. So endorsement is not authoritarian argument. But it seems, is just as effective. Pharma companies do not play into the hands of celebrity endorsement (except when advertising disease awareness campaigns to the public) but certainly use authoritarian views. So specialists in certain disease areas will ‘advocate’ the use or employment of certain strategies in treatment of disease. (I myself have spoken at numerous meetings as a KOL). As a customer, this is a very persuasive form of endorsement. However one must always be sensitive to varying and opposing opinions from leaders within a field. Inevitably pharma companies will use KOLs who advocate a course of argument which either endorses their product or (sometimes more effectual) promotes a treatment strategy that is conducive to the company’s strategy. Use your KOLs wisely. Remember different opinions come from different KOLs. Meetings where a KOL is seen to present company-logo slides with little or no passion for the disease probably does more harm than good. Also beware KOLs who seem happy to promote any product any day – whilst promoting treatment of a disease may be acceptable across pharma-speaker meetings, promoting products as the weather changes is not something you want to associate your budget with. If all else fails, the hell with it – wheel out your celebrity!
3. THE SLIPPERY SLOPE ARGUMENT I think this tactic annoys me the most but I hear it everywhere I go. If you don’t treat your infection right first time, the 2nd will come and when it does it will be much worst than the first, and this means it will need more drugs which will mean it will be more expensive which means your budget will be far worse than before. Hence – use our drug 1st line in all your patients. Absolute rubbish! The slippery slope advocate argues that one thing will surely lead to another without stating why that will happen. There may be legitimate cause for stating aspects of the slippery slope argument, particularly when there is evidence to back it up (ie MRSA prevention). But to reframe microcosm events as a worldwide game of dominoes is a superficial tactic. There are many ‘stop points’ to a so-called ‘downhill slide’.
4. THE FALSE DILEMMA ARGUMENT Very commonly employed this false dilemma argument. It goes like this:

  • Either you have A or B. If you don’t want A – you must chose B
  • Either you have an expensive heating bill OR you install double glazing and save money
  • Either you have uncontrolled asthma OR you have them well controlled on our inhaler.
  • Either you have patients non-compliant with their diabetes medication and worsen their HbA1c OR you put them on our once daily preparation and have them reach target.

These are actually well formed arguments. They often follow logical cause and effect. However there are three precise problems with some of these arguments

  1. The alternative offered by your company is posed as the only solution available for rectifying the problem. False – there may be many other routes / products / solutions that can be taken
  2. The alternative offered will solve the problem. False – the problems may be due to other circumstances and nothing to do with once daily dosing or inhaler technique. I don’t think a single GP will believe all his uncontrolled asthmatics can be controlled by swapping them onto a single product. I certainly don’t believe it.
  3. The problem may not be a problem – the heating bill may not be expensive. Yes spending a fortune may reduce the heating bill but by how much? And will it be less than the cost of the double glazing? And what problems may be caused by ill-fitted double glazing, or a COX-2 inhibitor that causes stroke or an antidepressant that is cardiotoxic . . .

The false dilemma argument is not necessarily a bad one. But too many representatives are pushing too many products with this ‘quick sell’ argument. Pharma should be more tacit than this. This is why I have drawn a parallel to the double glazing argument (did you feel a bit repugnant of this analogy – I hope so – because your job is nothing like that of a ‘salesperson’ in the usual context of the word. So don’t resort to their tactics). If you are using the false dilemma argument too quick too often you won’t need me in this article to tell you that it’s not a wise move . . . the response from your customers will speak for themselves.

OMAR ALI is the Formulary Development Pharmacist for Surrey and Sussex Healthcare NHS Trust and is a PCT Formulary Adviser to 2 PCTs. He is a lecturer on the MSc on Pharmacy Practice at Portsmouth University and is also an adviser to three Drugs and Therapeutics Committees in the South of England. Omar is a National Speaker in the UK (cardiovascular, diabetes, mental health) and is an Executive Board Member for the National Obesity Forum. He can be reached directly on ‘alipha@aol.com’
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