Selling Drugs by Creating a Disease Category
How to brand a disease -- and sell a cure
By Carl Elliott, Special to CNN
October 11, 2010
Editor's note: Dr. Carl Elliott, an M.D. and Ph.D., is the author of
"White Coat, Black Hat: Adventures on the Dark Side of Medicine" (Beacon Press, 2010).
(CNN) -- If you want to understand the way prescription drugs are marketed today, have a look at the 1928 book, "Propaganda," by Edward Bernays, the father of public relations in America.
For Bernays, the public relations business was less about selling things than about creating the conditions for things to sell themselves. When Bernays was working as a salesman for Mozart pianos, for example, he did not simply place advertisements for pianos in newspapers. That would have been too obvious.
Instead, Bernays persuaded reporters to write about a new trend: Sophisticated people were putting aside a special room in the home for playing music. Once a person had a music room, Bernays believed, he would naturally think of buying a piano. As Bernays wrote, "It will come to him as his own idea."
Just as Bernays sold pianos by selling the music room, pharmaceutical marketers now sell drugs by selling the diseases that they treat. The buzzword is "disease branding."
To brand a disease is to shape its public perception in order to make it more palatable to potential patients. Panic disorder, reflux disease, erectile dysfunction, restless legs syndrome, bipolar disorder, overactive bladder, ADHD, premenstrual dysphoric disorder, even clinical depression: All these conditions were once regarded as rare until a marketing campaign transformed the brand.
Once a branded disease has achieved a degree of cultural legitimacy, there is no need to convince anyone that a drug to treat it is necessary. It will come to him as his own idea.
Disease branding works especially well for two kinds of conditions. The first is the shameful condition that can be destigmatized. For instance, when Pharmacia launched Detrol in the late 1990s, the condition the drug treated was known to doctors as "urge incontinence." Patients called it "accidentally peeing in my pants" and were embarrassed to bring it up with their physicians.
Pharmacia fixed the problem by rebranding the condition as "overactive bladder." Whereas "incontinence" suggested weakness and was associated mainly with elderly women, the phrase "overactive bladder" evoked a supercharged organ frantically working overtime.
To qualify for a diagnosis of "overactive bladder," patients did not actually have to lose bladder control." They simply needed to go to the bathroom a lot.
The vice president of Pharmacia, Neil Wolf, explained the branding strategy in a 2002 presentation called "Positioning Detrol: Creating a Disease." By creating the disease of "overactive bladder," Wolf claimed, Pharmacia created a market of 21 million potential patients.
Another good candidate for branding is a condition that can be plausibly portrayed as under-diagnosed. Branding such a condition assures potential patients that they are part of a large and credible community of sufferers. For example, in 1999, the FDA approved the antidepressant Paxil for the treatment of "social anxiety disorder," a condition previously known as "shyness."
In order to convince shy people they had social anxiety disorder, GlaxoSmithKline, the maker of Paxil, hired a PR firm called Cohn and Wolfe. Cohn and Wolfe put together a public awareness campaign called "Imagine being allergic to people," which was allegedly sponsored by a group called the "Social Anxiety Disorders Coalition."
GlaxoSmithKline also recruited celebrities like Ricky Williams, the NFL running back, and paid them to give interviews to the press about their own social anxiety disorder. Finally, they hired academic psychiatrists working on social anxiety disorder and sent them out on the lecture circuit in the top 25 media markets.
The results were remarkable. In the two years before Paxil was approved for social anxiety, there were only about 50 references to social anxiety disorder in the press. But in 1999, during the PR campaign, there were over a billion references.
Within two years Paxil had become the seventh most profitable drug in America, and Cohn and Wolfe had picked up an award for the best PR campaign of 1999. Today, social anxiety disorder, far from being rare, is often described as the third most common mental illness in the world.
It is hard to brand a disease without the help of physicians, of course. So drug companies typically recruit academic "thought leaders" to write and speak about any new conditions they are trying to introduce. It also helps if the physicians believe the branded condition is dangerous.
When AstraZeneca introduced Prilosec (and later Nexium) for heartburn, for example, it famously repositioned heartburn as "gastroesophageal reflux disease," or GERD. But it also commissioned research to demonstrate the devastating consequences of failing to treat it.
If all drugs were harmless, disease branding would be relatively harmless, too. But no drug is completely benign.
For example, Detrol can make elderly people delirious and may cause memory problems. Paxil is associated with sexual dysfunction and dependence. It also carries a black-box warning for suicide in children and adolescents. Side effects like these are a part of every drug. But they are never part of the brand.
The Rule of Law
CNN published an article on 12/23/08 concerning the agreement by the US Army to honor the US prisoners of war turned into slave laborers by the Nazis for being or "looking" Jewish. The article was available at the time at:
http://www.cnn.com/2008/US/12/23/slave.camp.honor/index.htmlIT is the best example I know of for enforcing rules of law withrespect to captured soldiers or combatants. All human beings arecapable of depraved behavior under stress--witness the famous Milhimeexperiments at Yale. It is the responsibility of leadership in ademocracy to insist upon the rule of law, not to seek ways to evade it.As we are beginning to learn from the partial records of the Guantanamofiasco, a government cannot afford to let the military, or thegovernment itself, set its own rules of conduct. I have no doubt thatthere are dozens of legitimate war criminals at Guantanamo. If I werethe king, I would throw those people off the top of the Empire StateBuilding one at a time and sell popcorn to the audience. Let's justmake sure we throw the right ones!But what about the poor guy who was just "waiting for a bus" when thewar came by. It seems to me, as a sideline observer and one who by anystandard is staunchly conservative on national security issues, that alot of these people were simply "guilty of being an Arab" at the wrongtime and place. Let's make damn sure that justice is served for theprisoners of Guantanamo who really committed no offense punishable byyears in prison without recourse to a judge. And let's make sure theserial bunglers who authorized or at least gave comfort to Abu Ghraib,Guantanamo--Rumsfield, Cheney, Gonzales and so forth-- are heldaccountable by history for disdaining the very virtues we Americanscherish--justice for all!Bob Sweeney
Effect Sizes and Measurement of Learning
What Is an Effect Size and Why Should You Care?
An effect size is a standardized measure of change over time. Trainers and educators continually wonder if the materials they use, the courses they teach, and the examples and behaviors they model actually produce any change. This generalization applies equally to any industry or profession--medicine, law, accounting, sales training, and so forth. How do we know if what we are doing has any effect?
Traditionally, educators have used such things as grade point averages, test result data points, GME or GMAT scores, and other so-called “standardized tests.” Surely, these outcomes mean something, but just what? And how much of a difference makes a difference?
Over time, the training profession has attempted to recognize the role of confounds, that is, factors other than the tests themselves that influence test results, and selection bias, who is included or excluded or who drops out in a testing process. As a result, the profession has adopted such techniques as Likert scales, multiple regression, multivariate analysis . . . and the list goes on. Each of these techniques aims to overcome some deficiency of traditional tests, but each in turn has its own shortcomings.
Experts in scientific and clinical research methods have invested a small fortune in time and money to create antidotes to test deficiencies. Just go on Evaluated Medline and examine the vast array of meta-analyses, odds ratio studies, research repositories, such as the Cochrane Collection, and quasi-analytic studies. These powerful approaches lend strength to outcome findings because they rely upon the power of large sample sizes and the collective benefit of multiple research techniques.
Unfortunately, the faculty in a residency or other clinical training program has neither the time nor the money to evaluate, select or employ such comprehensive tools. What can be done to arm the individual program director and his or her colleagues with a practical, yet feasible, method of evaluating test results?
The answer is the effect size measure. In fact, effect size techniques of one kind or another either directly or implicitly underlie the methods employed in meta-analysis and comparable large-scale research and testing methods. Here is what the term means and how it can work to help your teaching and testing practice:
An effect size compares the mean results of two or more “tests” relative to the amount of variance between or among these outcomes. In a very simple setting, suppose you pre-test the same group of residents on some element of content, and then post-test them on the same content a month later. You test the same people on the same materials. In each case, you obtain a mean result. In many, perhaps most, cases, we are left to ask ourselves what the difference in these mean results is telling us? Is a difference due to a real training influence or is it just chance? Can we estimate what the probability is that our outcome is just a random or chance result, as opposed to a real training benefit? The answer to this question is YES.
Well, like everything in testing, the answer is a qualified YES. As the professional statisticians will tell us, we are actually making the following assumptions about the test condition “from the get go”:
· The compared groups are part of the same population of test-takers, i.e., they are either the same people or the groups are samples from the same type of pool--residents, PAs in training, undergraduates, medical students, or some other pool with common properties.
· The normal amount of variance in this common population is stable.
We can think of variance as the spread or distribution of data points in testing outcomes. To keep it simple, a narrower spread or smaller variance indicates that the mean point in the data distribution is a better measure of a group’s average performance than would be the case with a wider spread. So, to measure testing effectiveness, we compare the difference in means to the “average variance” among or between the compared groups. The technical term for this average variance is the pooled standard deviation of the effect size measure. Here is a simplified version of the formula *:
Es = [M2-M1] divided by √ of [(V2 + V1)/2]
Where Es is the effect size; M2 and M1 are the mean, that is, average results of two group performances; and V2 and V1 are the variance calculations for each group. So, to get an effect size, we divide the difference in mean outcomes by the square root of the summed variances. That is a mouthful, but just think “mean difference adjusted for variance”!
Once we have an effect size outcome, what does the number actually indicate? Well, for starters, we sure hope the number is positive, since a negative number would mean that the training had a negative or harmful effect. More typically, the outcome will be a positive number in the range of 0.2 through 0.9; these values represent a continuum where the top end is highly favorable and the bottom end suggests lack of much impact. If we were to examine the outcomes of big clinical trials of treatments and large scale training programs, it would be typical for beneficial programs to have an effect size between 0.6 and 0.8. A much larger number would indicate an unexpectedly powerful result and might suggest a defect in the design of the training. For example, if you pre-tested a group with absolutely no knowledge of the test matter, then post-tested then after training, you could get numbers greater than 1.0. However, what would be the point of pre-testing a completely uninformed audience? No tool can overcome a poor or misguided training or testing design. So, let’s be sure we are making comparisons that make sense so that we can take comfort in the usefulness of our effect size measures.
The Challenger StatPak™ system will automatically calculate effect size measures as part of its reporting options. With these measures, you can achieve the following objectives:
· increase your confidence in the raw outcomes of testing
· report verifiable results to the ACGME, your university, and your program administration
· more comfortably assign remediation based on validation of test result deficiencies
· modify your training curriculum to compensate for content gaps uncovered via test results.
Viewing Effect Size Results
Since the Challenger StatPak™ system automatically calculates effect size measures, taking advantage of this advanced feature is merely a matter of looking at the numbers and knowing how to interpret them.
Challenger StatPak™ includes two types of effect size reporting. The Pre Test/Post Test type allows you to compare assessment results for your trainees during two time periods, the Pretest period and the Posttest period. The Group Comparison Effect Size (World) compares scores in your program to others in the Challenger system.
Both reports are easily accessible from our main reports page for subscribers with the Premium Reporting Package version of Challenger StatPak™.
Other Data Included in Effect Size Reports
Both types of Effect Size Report also include:
the mean: the average score on the tests
the standard deviation: a measure of the variability of the score distribution; smaller is better
the variance: the spread or distribution of scores
the confidence interval, assuming p<.05, that is the benchmark for Challenger is a 95% reliability that a test result or comparison is not a chance result.
the sample size: the number of assessments sampled
These values can help you determine whether or not the Effect Size number is useful; for example, comparing two radically different sample sizes will provide a less reliable result than comparing two similar ones. A group of scores with a wider variance is a less reliable indicator of performance than a group with a smaller variance.
Conclusions
The Challenger Program for Residencies™ is just a few years old. However, we already have one of the largest national pools of adult end users. In fact, there are over ten thousand “seats” occupied by residents, PAs and fellows in training with Challenger content and subject to evaluation in our reporting system. That is far larger than any corporate university, and approximates the scope of training pools for the military and large government organizations. Already, our client institutions are beginning to report training outcomes that were either unavailable in the past or not easily interpreted in terms of validated training effects. I will simply cite two examples:
The Family Medicine Residency Program at St. Anthony’s Hospital in Oklahoma City has replaced some of its traditional didactic curriculum with the Challenger content library for cognitive training of residents. Moreover, the faculty can now assign and verify compliance with instruction from remote locations when other commitments require their absence from campus.
The PA Training Program at Trevecca Nazarene University in Nashville reported a measurable effect size gain from use of Challenger content in PA training, measured as the success rate of their graduates on the PA National Certification Exam (PANCE). The initial test pass rate rose from 83% to 97% for the students who tested from this Program from 2005 to 2006.
For further discussion of the effect size methodology and how it might be applied to measure the benefits of your training program, you can e-mail or call me at:
Robert E. “Bob” Sweeney, PhD, MS
Chief Executive Officer
bobs@chall.com901-762-8425
The Culture of Technicalities
One continually troublesome issue in dissecting the pathology of commerce in medicine is what I call the "culture of technicalities". This is the mind set that comes to equate success, ethical behavior and legal justification with whether or not some tactical pretext or technicality can let the perpetrator justify or escape the consequences of something he knows or should know is wrong! If Merck wanted to sell Vioxx to the general public, then the ethical obligation was to disclose the potentially dangerous side effects of the drug in terms that the average television viewer could understand. It is not an adequate defense to argue, as their general counsel has been doing, that either such information was not "proven" scientifically or, in any case, should have been understood from the technical mumbo jumbo written on the pill bottle!.
I hear often a sense of wonderment that lawyers are frequently either the source or the shield for clearly unethical, quasi-legal or even illegal, activity. Elected officials are overwhelmingly members of the legal profession. General counsels for corporations and universities are by definition lawyers. Spokesmen for dignitaries are often lawyers. What is it about the legal profession that lends comfort to actions and actors who violate the rules of ethical behavior?
Here is where I think the problem arises. Lawyers by training are taught to find reasons to exonerate their clients. That is, they are required by the ethics of their profession to uncover justifications for behavior that others, including the general public, do or might perceive as "wrong". Many or most legal conflicts involve disputes where there is some truth on each side, but the lawyers are obligated to only represent one side. Moreover, each lawyer's writ is to employ technicalities to build a one-sided case for his or her client. This is the premise of legal engagement that underlies our common law legal tradition. It ensures that the lawyer has no conflict of interest and will exhaust all legal means to represent and defend his client. It is the context which makes commerce viable and is the single most conspicuous deficit in economies and societies that are ruled by oligarchy [post-Soviet Russia], tribal or traditional alliances [most of the Middle East], corruption [much of Africa], or terror [North Korea].
However, there is a downside to this culture of technicalities. The culture carries over into other aspects of our society and economy where the legal imperative is not or should not be the governing method of behavior. Public corporations have an obligation to do what is commercially "honest", not just what is technically legal. It is therefore shocking to find the general counsel for Hewlett Packard defending the use of spying and subterfuge within the corporation, on the basis of legal technicalities. It is unacceptable for the general counsel of Merck to justify the sale of Vioxx to an unsuspecting public when the company's scientific officers and leadership KNEW that the drug had a high risk side effect profile. The same type of defense peppers the arguments offered by Arthur Anderson for its shameful abandonment of duty in the Enron scandal. And, this is just exactly the same mentality that induced Bill Clinton, lawyer, to argue about the meaning of the word "is", and Mark Foley, another lawyer, to justify sexual advances to teenage pages by his own alleged molestation as a child.
CEOS and Presidents of corporations have an obligation to look past the technical defenses offered by their lawyers. The duty comes with the job. The legal team works for the CEO, not the other way around. Any corporation, particularly one in the public markets, has a responsibility to do so. In the past five years, the pharmaceutical and medical device industry has lost sight of this objective. The physician community and the general public will remain suspicious and skeptical until there is evidence of a change in the approach by corporate management to the ethics and probity of corporate behavior. The shareholder community and the public at large expects a culture of doing the right thing, not a culture of technicalities once the right thing has been abandoned or ignored.
Power and Validity in Pharmco Claims
One thing I did in my graduate school days was to take a lot of courses in statistics. Yes, I know that you are wondering: "Why?"
Simply put, my curiosity was piqued and I was determined to understand the basis of the "lies, damn lies and statistics" that are commonly quoted and thrown at the public as evidence for one claim or another. I took at least four or five courses in stat, including three courses in advanced stat in the internationally recognized Graduate Psychology Department at the University of Memphis. Of course, I cannot recall all the formulas and mathematical gyrations without looking back at a book, but I CAN recall some fairly straightforward principles I took with me. These principles serve as kind of an informal "BS detector" when I read or see claims made by politicians, advertisers, drug reps, and, yes, doctors and scientists [the majority of whom know as little as the rest of us about what constitutes a valid claim!].
Here they are:
(1) "Size Matters": It might seem obvious, but it is important that a LARGE enough sample size be in the test pool for a claim to be representative of what is true in the world at large. Obviously, if your pool contains 500 subjects, its outcome is more "powerful" than one with 50 subjects, all else being equal.
(2) Chance: Any formal study or research project sets what is called a probability threshold. You may see this characterized as what is called a "p" value. So, a hypothetical study may say that a given result is valid with "p<.05". What this means is that, for this study, there is a 5% chance that the allegedly valid result has been obtained by chance, that is, the finding is actually incorrect! this is called a False Positive result. Here is the take away message: ANY study has a p value of some amount or other. So, it is most important that we know what it is and recognize that the claim being made could be a random false for positive some percentage of the time less than the p value.
(3) Variance: Here is where it is important not to be misled by AVERAGE results. Any credible study should be able to report a "variance" value for any measure where it is also giving you the mean or average result. You can think of the variance value as a measure of the "spread" or distribution of the results. Lower variance means that the typical outcome for each subject in the test is closer to the average value than would be the case with a higher variance. I'll put it in every day terms for you: Let's suppose that you can take two medications and that both have the same average outcome: I'll say 80% of the time that each is effective for ten users. Which would you feel better about putting in your mouth--one that has this pattern of "percentage of the time effective" outcomes for its ten users:
70, 90, 60, 100, 80, 75, 85, 68, 92, 80, 80
or this one:
20, 80, 100, 60, 100, 60, 75, 90, 85, 95, 35.
Both have the same AVERAGE outcome of 80% effectiveness. But only a crap shooter would feel more comfortable with option number two if option number one is also available.
(4) Test dilution: This concept is a little bit more complex, but I will try to make an analogy. In any test study, there is a dilution of the validity of an outcome claimed, when the same subjects are used to conduct more than one test related to the same finding. The statistical logic is straightforward but esoteric. The short version is that there is a tradeoff between statistical validity and the number of tests we run on the same subjects. So, when an argument is made on behalf of some form of treatment, be sure to ask the claims maker about repeated testing of the same subjects. If you want to put them really on their heels, ask them if they made a "Bonferroni adjustment" in determining the outcomes.
(5) Conditional probabilities: Here we are talking about the validity of a claim made where the probability of one event is actually dependent on some other event(s). A classic example is the diagnosis and treatment of prostatic cancer in men. One variable is the rate at which this disease in one manifestation or another occurs in men as they age. The second variable is the accuracy with which it can be diagnosed by method "X". Let's suppose that your Uncle George goes to the doctor and gets a test result that says he has prostatic cancer. What is the likelihood that he actually has the disease? What should be done about it if we have a range of potential treatments that work some percentage of the time? Does it matter if most cases of prostatic cancer never become life-threatening in any case? The probabilities here are all interrelated and any claim that does not take the actual "base rates" of disease incidence and mortality or morbidity into account is NOT ACCURATE.
This is just a start. I could go on at great length, but then I'd be "teching stat" and that is not my objective. My goal is simply to play a constructive role in the never ending campaign to separate reasonable claims from what the lawyers call "puffery"-- more commonly referred to as malarkey!!
Bob Sweeney
Disclosure...An Ethical Concept for Physicians, Businessmen and Politicians
Two recent articles in the New York Times grabbed my attention. Both addressed the importance of fully disclosing the financial arrangements, both direct and indirect, between scientists, including research physicians, and industry. Both articles were spawned by conflicts of interest in the publication of research results. These conflicts range from failure to reveal that an author or reviewer was a paid consultant on a medication being reviewed; to an instance where a chest implant device was under review by a physician with an undisclosed partial ownership in the device manufacturer; to other cases where the authors involved failed to reveal that they were paid consultants to a distributor, although the particular medication being reviewed in their article was not the direct product for which they were being compensated.
Yet another topic of debate is the issue of whether participants in drug trials or other tests of efficacy are fully informed as to the financial interests of the scientists conducting the research. Obviously, such research criteria as selection bias, the effect size or power of the study, and the robustness of the findings are all subject to doubt if the folks running the tests have undisclosed economic interests in the given study findings.
The media highlights those cases where businessmen and politicans fail to honor their obligation to their constituents to disclose their actual and potential conflicts of interest. If Ken Lay, Jeff Skilling [both Enron] and Richard Scrushy [Healthsouth] had been forthcoming about the real financial status of their corporations, they might each have been fired for incompetency, but at least their character, if not their legal status, would not likely have been in question. If Tom DeLay had publicly disclosed his relatonship with Jack Abrahamoff and his efforts to salt the redistricting procedures for seats in Texas, he might have been subject to political criticism, but he would not be facing jail or huge legal bills now. In fact, the issue is a far larger one for politicians, since at least the formal part of business education exposes young business men and women to a theory of ethics. I find it perplexing, but perhaps revealing, that politicians as a group seem to lack any sense of ethics, although the vast majority of them are lawyers. That is food for another commentary, on another day.
Industry, that is, the drug and device companies, have an obligation to their shareholders to optimize the revenues they receive from marketing their products. The effectiveness of those products are subject to verification by formal means of testing which require participation, supervision and interpretation by experts in the relevant science, applicable fields of medicine, and the tools of advanced statistics. Unfortunately, how these expert skills are applied is beyond the capability of even the informed public to easily evaluate. For example, I doubt that more than a handful of even the well-educated realize that, with the normal p<.05 criterion for attributing effectiveness to a tested treatment, at least one time out of twenty a test or trial will generate what appears to be a valid effect purely by chance!!!! That is, even if the drug or device actually fails to be useful, there is a one in twenty chance that the results will incorrectly indicate that it is effective. For that reason, more than one or two tests and an adequate test subject pool size are both fundamental standards for truly valid conclusions from the testing process.
We rely upon and trust the judgments and endorsements provided by what amounts to a class of "high priests" in science and medicine to monitor and oversee these eccentricities of the testing process. The very least we can expect of the physicians and scientists we trust with our health and well-being is to let us know up front where their actual and POTENTIAL conflicts lie. It is not enough for an individual physician to assert personal integrity or to claim that he or she would never let money stand in the way of their impartial judgments. Plenty of evidence from experimental psychology shows us that time and again, and especially with respect to professionals imbued with expert knowledge, we are completey unaware of our biases and how easily they can be influenced or manipulated. In fact, industry capitalizes on the ignorance and hubris of the physician with the very materials they design and props they employ to promote their wares to them. Come with me to any medical assembly and you will see how easily this agenda is fulfilled.
The best antidote to all these real and potential conflicts of interest is "fresh air"--that is, disclosure. When the expert physician reveals his or her financial interests, he or she makes it possible for the "buyer"--that is, the patient or his agent--to decide for themself if they want to bear the risk that the expert is biased. That is a fair tradeoff for the prestige, compensation and social clout we accord the physician and the scientist in our society. It is a missing ingredient throughout the marketing side of the pharmaceutical and device industry, and it is our duty as an education company to support disclosure wherever and whenever possible.
Who Wants An Educational Program that Docs Actually Trust?
I was exchanging e-mail last week with Rick Bukata, the physician executive who owns and runs the Center for Medical Education [www.ceme.org]. Actually Rick is much more than a physician executive; he is the soul of his company. Everything his company stands for in terms of quality and honesty is a reflection of Rick and the 30 years or so he has been both a physician and a clinical educator.
I've known Rick since the early 1980s when I worked in the California contract medicine industry. He was the medical director of a community hospital emergency department. He had just started a small business creating and publishing medical abstracts to help emergency physicians update their cognitive knowldege of the standard of care. Now, Rick operates an international enterprise with live seminars, audio tapes and written publications. The audience is the full range of acute anc primary care clinical professionals. My company, Challenger Corporation [www.chall.com], is grateful that Rick permits us to exhibit and market our eleectronic physician education materials at his live seminars. When we can, we provide promotions for CEME courses on our web page and by direct mail. Rick's physician instructors also use some of our content in their lecutres and presentations.
Although both companies somewhat overlap in terms of their product offerings and are therefore competitors in principle, the truth is that our relationship is one of those rarities where the sum is greater than its parts. We each reflect and enhance the quality and reputation of the other, and benefit from doing so.
In the last 15 years, CEME's live seminars--high risk medicine, emergency medicine and family medicine boards review courses, primary care updates, continuing certification courses--have acquired a reputation for excellence, consistency, measurable benefit, and continuity unmatched by any other commercial live seminar network in the country. Why?
Here's why:
(1) Brand built by long-term consistency in faculty, sponsorships and outcomes.
(2) Offers backed by money-back guarantees and commitment to remediation for unsuccessful candidates.
(3) Investment in prestigious faculty with proven speaking and teaching skills.
(4) Integrity in each and every aspect of marketing, promotion and fulfillment--claims limited to what can be verified and delivered.
(5) Arms-length production and validation of the instructional content provided in the courses--sponsors cannot "salt the shaft" in terms of subject matter or subject matter interpretation.
(6) Avoidance of sponsorship relationships simply for short-term cash.
Come to think of it, my company stands for the same principles and we have gone about our brand building and development with the same ideals in mind.
What should this tell the drug and device industry about their sponsorship efforts? From my perspective, there is an untapped opportunity for the enlightened corporation that wants to build a long-term bond with the physician community. I am not suggesting that industry abandon its short-term, narrowly focused promotional efforts. Those things are directly related to the enormous pressures created by quarterly financial reports and public finances. But there is room and logic for a longer term strategy. Which firm will take the lead? Who really wants to be known as the standard setter for physician training and education? Who wants to be the "CEME" or "Challenger" of industry sponsored clinical content?
This kind of decision will not be made at the level of the product manager. That individual by necessity has to be focused on the short term and whatever specific drug, device or treatment modality he or she is reponsible for, this year. The visionary we are looking for is at the CEO, Chairman or Board level. I say "visionary", because the culture of the entire industry is aimed at narrow treatment approaches and short-term return. The focus I am suggesting will be broader, longer term [five to ten years] and outside the annual promotional budget. Next week, I will discuss some specific concepts that might work and what they might cost.
Bob Sweeney, PhD
CEO and President
An Educational Program that Docs Trust
I was exchanging e-mail last week with Rick Bukata, the physician executive who owns and runs the Center for Medical Education [www.ceme.org]. Actually Rick is much more than a physician executive; he is the soul of his company. Everything his company stands for in terms of quality and honesty is a reflection of Rick and the 30 years or so he has been both a physician and a clinical educator.
I've known Rick since the early 1980s when I worked in the California contract medicine industry. He was the Medical Director of the emergency department at at a hospital in Glendora, and had just begun creating and publishing medical abstracts to help emergency physicians update their cognitive knowldege of the standard of care. Now, Rick operates an international enterprise with live seminars, audio tapes and written publications. My company, Challenger Corporation, is graetful that Rick permits us to exhibit and market our eleectronic physician education materials at his live seminars. When we can, we provide promotions for CEME courses on our web page and by direct mail. Rick's physician instructors also use some of our content in their lecutres and presentations. Although both companies somewhat overlap in terms of their product offerings and are therefore competitors in principle, the truth is that this relationship is one of those rarities where the sum is greater thanits parts. We each reflect and enhance the quality and reputation of the other.
In the last 15 years, CEME's live seminars--high risk medicine, emergency medicine and family medicine boards review courses, primary care updates, continuing certification courses--have acquired a reputation for excellence, consistency, measurable benefit, and contintuity unmatched by any other commercial live seminar network in the country. Why?
Here's why:
(1) Brand built by long-term consistency in faculty, sponsorships and outcomes.
(2) Offers backed by money-back guarantees and commitment to remediation for unsuccessful candidates.
(3) Investment in prestigious faculty with proven speaking and teaching skills.
(4) Integrity in each and every aspect of marketing, promotion and fulfillment--claims limited to what can be verified and delivered.
(5) Arms-length production and validation of the instructional content provided in the courses--sponsors cannot "salt the shaft" in terms of subject matter or subject matter interpretation.
(6) Avoidance of sponsorship relationships simply for short-term cash.
Come to think of it, my company stands for the same principles and has gone about our brand building and development with the same ideals in mind.
What should this tell the drug and device industry about their sponsorship efforts? From my perspective, there is an untapped opportunity for the enlightened corporation that wants to build a long-term bond with the physician community. I am not suggesting that industry abandon its short-term, narrowly focused, or deliberately weighted promotional efforts. Those things are directly related to the enormous pressures created by quarterly financial reports and public finances. But there is room and logic for a longer term strategy. Which firm will take the lead? Who really wants to be known as the standard setter for physician training and education? Who wants to be the "CEME" or "Challenger" of industry sponsored clinical content?
