October 2008
	Semantics Are Everything Way back in undergraduate school, I encountered the concept of the Whorfian hypothesis. Google this term (I couldn’t do that at the University Of Pennsylvania in 1969; I had to learn it from a book!) and you will find that it is basically reflects the notion that the terminology and grammar a culture uses help determine the way we view the world. The example often used here is that Eskimos, who have some 20-odd words in their language to describe different kinds of snow, are caused by these language nuances to actually see different kinds of precipitation, where you and I would just say “snow” and view it all pretty much as the same white stuff. So what? In its own way, the pharmaceutical industry and the marketers and marketing researchers who work within it constitute a subculture with its own language, and the terminology those of us who are members of this subculture use every day helps determine the way we view things and thus the way we approach our jobs, customers, etc. Increasingly, some of the terminology we use is problematic, and I would like to suggest some changes I believe we should make. One of the first terms that started to bother me was Targeting, a term actively used by the industry and that I adopted and used quite extensively in the early ‘90s to help introduce micromarketing to the pharmaceutical industry. In pharmaceutical speak, targeting has always referred to the industry’s understandable desire to spend most of its promotional dollars on those doctors who have the most “prescribing opportunity,” which the industry conceives of as writing the most prescriptions in a drug class or treatment area in which one of its products competes. When I used the term, I always meant promoting to the right doctors, and always followed it with the other three Ts of micromarketing: Tailoring (modifying the message to meet the information needs and preferences of the individual physician to whom we were communicating), Tactical Implementation (communicating through the channels preferred by the physician or obtaining information) and most importantly, Total Customer Satisfaction. The industry, in general, missed the last three Ts, and used the concept of targeting to describe what amounted to bothering busy doctors more with repetitious promotional interventions. At the other end of the process, although I have hundreds of researchers working for most of the world’s major pharmaceutical companies, I am somewhat scandalized to note that, while we are often asked to conduct research related to sales force effectiveness, we are virtually never asked to conduct research on total customer satisfaction. Which takes me back to good old Whorf and raises the question as to which of us would want to be targets. This term has connotations that include lack of willingness, one-way communications and doing damage. In other words, it is about as far away from Seth Godin’s concept of permission marketing as it could possibly be. My recommendation here is to lose the term entirely, and focus on concepts, and terminology, more akin to “desired partners.” Whatever term we wind up using should encompass the notion that we will need the person’s permission to communicate with (not to!) him or her, and that this communication will take the form of a dialogue, rather than delivering a message. The next term that has come to bother me more in recent years is Reminder Detail. Quite simply, as our industry has run short on significantly new products to introduce to physicians and has largely run out of new things to say about existing products, we have legitimated the huge and historically increasing sales force by describing its activities as “keeping our products in front of the doctors.” Question: What doctors need to be reminded multiple times each year about our products? Those who have considered them and rejected them, or tried them and found them not worth including in their prescribing armamentarium, won’t be convinced by quick mention of the product name, features and benefits, so it’s not them. Those doctors who regularly use our product don’t need to be reminded, since they remind themselves every time they write a prescription for it, so it’s not them. Maybe that’s why many pharmaceutical companies have cut their sales forces giving reminder details by a relatively arbitrary 10 percent. I predict that further cuts, of greater size and significance, are soon to follow, and I think we should stop using the terminology reminder to justify annoying busy physicians who, not surprisingly, are joining the no-see list in increasing numbers. While we are at it, from a marketing researcher’s perspective I need to challenge the terminology Sales Force Effectiveness as it is currently used and monitored. More specifically, in the handbook I wrote a few years ago on the topic (If you don’t have one and would like to, just let me know ), I pointed out that the first step in the process of measuring SFE is getting agreement from all of your internal stakeholders about what you want the sales force to accomplish. First, let’s take off the table the terminology Sales, since as we all know the vast majority of the 90,000 or so pharmaceutical sales representatives in the field today are not in the business of taking orders, arranging payment and delivery, etc. What we are left with then, as we travel from drug company to drug company to discuss this concept and its measurement, is a hodgepodge of goals that range from increasing a key product’s quarterly market share in a territory to developing a long- term loyalty toward the sponsoring the company. Bizarrely, many of the questionnaires that I examine that purport to measure SFE contain items that look a lot more like “Does the doctor like the PSR” than “Is the PSR effective” in accomplishing the often unstated and un-agreed upon goals. In my mind, we can continue to use the term sales force effectiveness if and only if we define it and measure it against the goals we have set for this important communications channel. Otherwise, we might like to consider using terminology like Total Customer Satisfaction or some other phrase that better lines up with what we have in mind when we spend a few million dollars a year to track what the folks out in the field are doing. On a different topic, another term that does us a disservice, I believe, is Prescribing Decision. In the practice of most medical specialties, we need to understand, the vast majority of prescribing is not done by the physician reviewing in his or her mind all of the possible choices that could be made and carefully picking one. Rather, most physicians have developed a prescribing habit, i.e., a go-to drug for particular prescribing situations, and they don’t systematically review efficacy, side effects, dosages available, etc., every time they take out the prescription pad. And increasingly, these habits are being influenced by formularies, patient preferences, etc. There is not a lot of ponderous deciding still being done, and to believe that there is misdirects our promotional and marketing research efforts. Read How Doctors Think, and excellent and seminal book, and you will quickly come to see that treatment decisions for a particular patient are typically made with far less deliberation, and far more reflexively, than most pharmaceutical marketers believe. All of which calls into question the use of (Hold on to your hat, folks!) the term Pharmaceutical Marketing. Although this terminology is virtually sacred and is the phrase that most of us use at a cocktail party when describing what we do, it is problematic in several regards. First of all, from a commercial standpoint, we increasingly see our clients, with Johnson & Johnson being a key example, emphasizing other aspects of their overall health care business as their pharmaceutical product line becomes increasingly susceptible to generics. Diagnostics, surgical devices, vaccines, OTC products and other areas of health care are garnering increasing attention as the pharmaceutical profitability bucket dries up. From the physician and patient point of view, moreover, I believe that pharmaceutical marketing has significantly worsened our current regulatory and public relations situations. Millions of dollars of fines, and many consent decrees, have resulted from abusive marketing practices of the pharmaceutical industry, and January 2009 will bring significantly tighter restrictions as to what treats we can offer physicians, i.e., virtually nothing. Moreover, with politicians and others talking about a crisis in health care, the use of the term marketing seems a bit lacking in taste. And marketing is a term that deals with product choice, and does little to deal with important issues, such as patient persistence, that are major deterrents to both good patient health and product profitability. Again, to cut to the chase, I believe we should stop talking about pharmaceutical marketing and speak increasingly about health care communications. The latter terminology is far less inflammatory, and far more descriptive of what I believe our focus will be in the years to come. As an important aside, this terminology shift is also consistent with the Cluetrain Manifesto’s reminder that “Markets are conversations,” with those that occur among our customers being more genuine, and more important, than our messaging. Relatedly, as was described in last month’s Orange Pages module, the advent of mobile marketing, and more particularly the 3G iPhone, will enhance the ability of the various stakeholders in health care to have dialogues with one another. Influencing these dialogues and the social networking (arguably a better term than mobile marketing) that drives them will become increasingly important in our industry’s activities. In summary, I could go on pointing out terminology in our industry that I believe does us a disservice, and therefore should be reconsidered and, in many cases, replaced, to avoid ongoing confusion and adversity. But the more important point is to get you to consider, as Whorf held forth before most of us were born, the key role that words serve in determining the way we deal with the world. As you go through just one work day, consider each and every word you use that might have importance and think about whether that word and the meaning most people would take away from it is what you would intend. Interestingly, as you can tell from my examples above, some of the most important words to consider are those you and your colleagues use frequently and that everybody assumes they know the meaning of. The health care marketplace, as we all know, is changing substantially, and as we enter a new era, now is as good a time as any to clean house on outdated terminology. As you go through this process, please feel free to e-mail me with any key words or phrases you believe are worth discussion. There may well be another article on this topic as a result of your feedback! Richard B. Vanderveer, Ph.D. Group Chief Executive Officer GfK U.S. Healthcare Companies