In his latest PharmaBoardroom piece, John Singer looks at Biogen’s marketing campaign for its new Alzheimer’s drug, extending and linking the controversy to the grander strategic themes reshaping the ‘drug market’ as a whole, including the impact of the internet on cognitive change, the unmet need for a different premise for “strategy” itself, and the call for new economic thinking.
Using direct-to-consumer marketing to create demand for prescription drugs sits at the centre of the discursive war the pharmaceutical industry as a whole is fighting with the world around the “value-based pricing” of its products. Despite the great supporting trunk of the industry’s worldview being crosscut with amazing speed and efficiency, drug companies continue to take refuge in a remnant context, a view of identify and approach that no longer fits with the digital age.
For more than a century, most Western companies have been working under a Fordist model of mass production and consumption, where industrial capitalism positions ‘promote-and-push product’ squarely at the centre of commerce. The purpose put into the machine is managing brand.
It’s an entrenched mode of being.
This is a premise of strategy that, up until recently, achieved a sort of benign balance in the friction between contending interests of market and consumer and government. And there’s an entire industry subsystem — of marketing and media advisors, stock analysts, media companies, business schools, digital platforms and advertising and public relations agencies that comprise a nearly $300 billion economy in its own right — whose revenue models, and the professional fates of executives, are still wed to preserving it.
The calcification runs thick, depositing layers of decomposing market theory across mindsets. And as one of the largest advertisers in the overall marketplace, pharmaceutical companies are also affected by the same sort of arterial hardening that keeps the Industrial Age alive and well, its brand managers and leadership teams kinetically-trapped in a belief system that no longer fits a new reality.
The late critic Hugh Kenner called this “patterned energy.”
When Everyone is Swimming in the Shallows
“When Memory Fades” is a disease awareness campaign from Biogen that narrates the story of Jane, a 76-year-old woman who has been diagnosed with mild cognitive impairment due to Alzheimer’s disease. The campaign – a standard companion piece for all pharmaceutical marketing plans, regardless of disease or business category — was created by T Brand, the New York Times’ branded content studio, its digital business unit that “crafts stories that help brands make an impact in the world.”
“When Memory Fades” urges readers to follow Jane’s example in overcoming the stigma associated with cognitive decline and fear of a diagnosis of Alzheimer’s. It includes an online survey that asks questions regarding a person’s cognitive health, and which critics say stokes fear that signs of normal age-related mental decline (like forgetting a word or getting lost) could be indicative of dementia. Even when a person answers that they ‘never’ have symptoms of cognitive decline, the ‘user experience’ of the quiz was intentionally designed to still recommend that a person talks to their doctor if “cognitive screening may be right for you.”
Biogen’s campaign targeting consumers’ concerns over what could be a chance occurrence is drawing criticism from some who see it as a predatory manoeuvre to promote the company’s USD 56,000-per-year treatment that’s embroiled in controversy and concern over its clinical worth.
“I don’t like it,” Matthew Schrag, M.D., an assistant professor of neurology at Vanderbilt University Medical Center, said in an interview in FiercePharma. “Those questions are not based on any legitimate tool to identify mild cognitive impairment, even though it looks that way.”
Operate under the assumption that psychic disintegration – mild cognitive impairment – is a hallmark of our brains on digital, of life as smartphone, where fragmented, dispersed living is wreaking havoc on our neural networks.
“When it comes to the quality of our thoughts and judgments, the amount of information a communication medium supplies is less important than the way the medium presents the information and the way, in turn, our minds take it in,” writes Nicholas Carr, author of The Shallows, the first book that really took stock of the cognitive and cultural consequences of the internet.
“The brain’s capacity is not unlimited. The passageway from perception to understanding is narrow. It takes patience and concentration to evaluate new information — to gauge its accuracy, to weigh its relevance and worth, to put it into context — and the Internet, by design, subverts patience and concentration. When the brain is overloaded by stimuli, as it usually is when we’re peering into a network-connected computer screen, attention splinters, thinking becomes superficial, and memory suffers. We become less reflective and more impulsive. Far from enhancing human intelligence, I argue, the Internet degrades it.”
“Digital” technologies enable amazing lateral speeds, and it is rewiring the mental circuitry of 8 billion people into something other than it was. Concentration and attention are no longer a given; they have to be strategized.
The entire world, it seems, could theoretically talk to their doctor about getting screened for cognitive change.
The Boulder Problem
In Greek mythology, Sisyphus was the cunning king of Corinth who was punished in Hades by having to repeatedly roll a huge boulder up a hill, only to have it roll down again as soon as he had brought it to the summit. The central concern of the myth is what Albert Camus called “the absurd.” Camus claimed there is a fundamental conflict between what we want from the universe, and what we find.
The reputation of Pharma as a heroic industry has collapsed because drug companies have not managed the impact of promotional tonnage over decades, of carpet-bombing its operating environment with drug promotion
Which is to say the problem that’s arrived for the ‘drug market’ is that its marketing is showing. An Industrial-Age approach to business no longer fits with a world that “works” with a different orientation, through ecosystems, and that the path to fitting strategically in a changed context starts with an ecological sensibility, by understanding how to create and communicate with systems thinking (i.e., the ‘Amazon Way’ of strategy).
The reputation of Pharma as a heroic industry has collapsed because drug companies have not managed the impact of promotional tonnage over decades, of carpet-bombing its operating environment with drug promotion; they now spend more on advertising than many health systems, states and entire countries spend on public health. (For a state-by-state look, see the Trust for America’s Health breakdown here.)
The strategic effect of focusing on narrow, short-term interests is to perpetuate the long-term chaos and baffling stagnation in healthcare, deepen the structural stalemate, negate the industry’s credibility about “affordability” of drugs and challenge common sense.
Yet, blaming Biogen (or the FDA) for performing according to the feedback loops misses the bigger story, the Main Drift keeping the multi-dimensional dysfunctionality intact and defended by all corners: it’s the premise of strategy itself that needs a new vantage point, a different vision, where the thing to recognize, reorganize and reorient is a USD 4 trillion health economy in the United States that currently rewards the production of inputs, not the production of health. The aim for new thinking should be for something qualitatively different, more imaginative strategically, more systemically transformative.
Outcomes happen at a system level. The locus of market innovation should be the same.
John G. Singer is the Executive Director of Blue Spoon Consulting , a global leader in strategy and innovation at a system level. Blue Spoon was the first to apply system thinking to solve complex market access and integration challenges in the pharmaceutical industry. He does not have a financial relationship with any company mentioned.