How Can Self-monitoring Best Support Behaviour Change?

3907691Some of today’s biggest public health challenges, such as obesity and  heart disease, can be linked to personal lifestyle decisions. Governments have tried tackling these issues with smoking bans and taxes on high-fat foods, with moderate success. However, personal health behaviour change is needed to make a significant, lasting impact. Can self-monitoring of health information be the answer?

Studies in diabetes, hypertension, medication compliance and weight loss have shown that patients who successfully self-monitor their activities and set personal goals enjoy improved health outcomes and better adherence to treatment 1-6. We now have an abundance of apps and wearable technology at our fingertips to comprehensively track numerous aspects of our lifestyle, analyse results and observe improvements over time. These self-monitoring tools can then be easily integrated into social health networks so that we can share experiences, track our progress against that of our peers, and give and receive advice on how to succeed.

It is estimated that there are more than 40,000 health and fitness apps available. But with this bewildering variety of choice, how can we know which ones will encourage lasting behaviour change?

Easy does it

The apps which make the process of data upload as effortless as possible for the end user are the ones most likely to catch on in the long-term. Devices that automatically record data and synchronise it with online analysis programmes in real time provide a seamless transition and are not hampered by general forgetfulness or lack of time.

Keep it simple

Health information needs to be engaging, and simple enough to be universally accessible. The average person is likely to find sorting the data that matters from what doesn’t time-consuming and intellectually daunting—in fact, many patients who have to actively monitor a condition like type II diabetes don’t always fully engage with self-monitoring for these very reasons.7

Be realistic

Establishing aspirational but realistic goals and providing reinforcing feedback can help bring self-monitoring systems to life and make them personally meaningful.  A recent study into self-monitoring to improve diabetes treatment found that the main concerns patients had with the system were disappointment with unmet expectations and difficulty fitting the programme into the demands of daily life. 1


Ideally, fitness or health tracking app developers should collaborate closely with specialist healthcare providers and device makers as well as social scientists who understand how to bring about behaviour change. Such cross-fertilisation could result in truly useful tools that track fitness alongside other health metrics, such as blood sugar levels or medication adherence.

CONTINUE THE CONVERSATION: Questions? Comments? You can contact the author directly at blog@ochww.com. Please allow 24 hours for response.

1.  Barlow J, et al. Self management approaches for people with chronic conditions: a review. Patient Education Counseling 2002;48:177–87.

2.  Benhamou PY. Improving diabetes management with electronic health records and patients’ health records. Diabetes Metab 2011;37(Suppl 4):S53–6.

3.  Dennis EA, et al. Weight gain prevention for college freshmen: comparing two social cognitive theory-based interventions with and without explicit self-regulation training. J Obes 2012;2012:803769.

4.  Parker R, et al. An electronic medication reminder, supported by a monitoring service, to improve medication compliance for elderly people living independently. J Telemed Telecare 2012;18:156–8.

5.  Ralston JD, et al. Patients’ experience with a diabetes support programme based on an interactive electronic medical record: qualitative study. BMJ 2004;328:1159.

6.  Wagner PJ, et al. Personal health records and hypertension control: a randomized trial. J Am Med Inform Assoc 2012;19:626–34.

7.  Choose Control Survey. Choosing to take control in type 2 diabetes. Available at: http://www.diabetes. org.uk/Documents/Reports/Choose_Control_report.pdf (Last accessed May 2013).

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Digital Trends Impacting US Healthcare – Infographic

In the past year, digital innovations have brought about new markets and channels for digital health interactions. This infographic is a visual mapping of the technologies and innovations which are already playing a key role in shaping the future of healthcare and the experiences and journeys which surround it.

Of course the ACA is affecting healthcare coverage, but it is also affecting our healthcare experiences by placing increased importance on and driving more frequent interactions with NPs, PAs, and Pharmacists. Additionally, more priority has shifted to consumers to educate themselves and take responsibility for their own health, especially when combined with our growing culture of social media and trust networks, and recent draft guidance from the FDA. Video remains hot, but the trending has shifted to the length of videos patients are consuming, increasing its relevance to pharmaceutical marketers. Mobile and tablets continue to grow rapidly, with and quantified self driving deeper engagement though apps, not just web. Last, but certainly not least, EHR is poised to enter the next phase of meaningful use, setting the stage for a platform shake-out as certification requirements evolve to provide more and deeper data sets to systems of connected health as providers continue to on-board.

Infographic of important technologies that impact digital healthcare marketing.

Infographic of important technologies that impact digital healthcare marketing.

Technology is evolving fast, and healthcare, believe it or not, is keeping pace and even leading the charge on many fronts. Spurred on by government mandates and initiatives, innovative organizations ranging from Google and Apple to Silicon Valley startups like Practice Fusion are quickly carrying the ball forward, sometimes struggling to keep pace with consumer expectations of today’s technology. It’s these digital healthcare innovations which have set the trends affecting us today, and will carry us forward to tomorrow.

CONTINUE THE CONVERSATION: Questions? Comments? You can contact the author directly at blog@ochww.com. Please allow 24 hours for response.

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Taking the Pulse…Tuning In to the New Patient Network

1741356 sA guest blog post from Craig Martin – Chief Executive Officer of Feinstein Kean Healthcare, an Ogilvy & Mather Company

Most of us are far too young to remember the early days of television. What I do recall from my childhood is that three networks owned the airwaves, large numbers of people followed a small number of notable programs, and the screen turned to fuzz at midnight. You made note of the TV Guide schedule, and you adjusted your schedule to the TV shows that interested you. The networks and the stars were in charge.

A lot has changed since then, obviously. There are now countless networks, and seemingly limitless numbers of shows. Reality television has made stars of “ordinary” people. And the digital age has made scheduled programming obsolete—the content follows you and adjusts to your life and device of choice, not the other way around.

Why wax nostalgic about the evolution of broadcast television? Because I believe a similarly dramatic transformation is under way in our field. The old channels and choices are fading to fuzz. A new era is dawning.

For years, healthcare PR relied on a few channels and reliable choices to reach, inform, and market to patients. On behalf of our clients, we used traditional media (earned and paid), events, celebrities and big disease education programs to build awareness and get patients to “talk to their doctors about…”

Today—as more of the burden of choice, comparison, and cost gets shifted to patients, as diseases become more and more categorized via genomic analysis and molecular diagnostics, as medical practice and health become more universally digitized, and physicians and pharma become more responsible for outcomes vs. treatments—the traditional big, broad-channel approaches are becoming less relevant and effective as a means of reaching more and more narrowly defined populations of patients.

These trends are leading to the establishment of entirely new channels and networks, made of up patients identified and aggregated virtually through the sharing of personal medical information and data. In other words, the audience is creating the network, and continually informing the programming through the data they share. Now, rather than casting a wide net via mass media and hoping a narrow audience will be watching, we will have ready-made networks, open 24/7, waiting if not demanding to be engaged. This opens up new frontiers for micro-targeted, real-time communication and measurable engagement, based almost exclusively on digital content and social influence.

Not long before the holidays we learned that Feinstein Kean Healthcare (FKH) and a select group of partners won a million-dollar government grant to develop a “patient-powered research network” for the multiple sclerosis community. This is an exciting development, but not because of the money. This new kind of network represents the leading edge of the transformation I’ve described, and we’re now right at the forefront as well.

In the days and months ahead, we’ll continue to evaluate the pace and progress of change, and work to assure that our thinking and services are aligned with where the world is headed. Naturally, we don’t want to get too far out ahead of the trend, but we must be informed and equipped to lead when the market is ready.

I believe, as this new era unfolds, we will find there are many exciting opportunities ahead for us to engage differently and far more meaningfully with patients.

Questions? Comments? You can contact the author directly at blog@ochww.com.
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The Parent Factor—How to be a Good Daughter and Pharma Marketer

Patient Doctor ThumbnailWhen my mother was recently diagnosed with COPD, I thought I could help her. We had worked on the gold-standard treatment for a decade, knew the data, the leading clinicians in the field and the course of the disease. However, knowing the answers is one thing, effectively communicating them to a parent is quite another.

Two main hurdles hadn’t occurred to me. Forgive my sweeping generalisations, but I think these may apply to a lot of people of her generation.

Firstly, she has entrenched, hierarchical viewpoints when it comes to receiving health information, namely:

  1. Whatever I say is of no consequence—I am not a medic, I’m her child.
  2. Whatever the nurse says is of no relevance—she is “insolent” and shares anecdotes about her own mother’s illness, which is “inappropriate.”
  3. Despite having a “machine” (MacBook Air), searching the web for relevant information, tools or support doesn’t occur to her.
  4. Whatever the doctor says is sacrosanct (hierarchy is everything), but she’s unlikely to remember it.

Secondly, obtaining an accurate account of what had been discussed during her many consultations was almost impossible. Precise questions such as, “Ask them to give you your FEV score” were met with vague responses: “They wouldn’t give it to me, they said they think it’s that thing—emphysema—they explained what the blood tests were for but I can’t remember what they said,” etc., etc.

Trying to interpret patchy feedback from the consultations was frustrating, especially when it was further confused by her misconceptions. At one stage, she said they thought it was asthma, but this was an assumption she had made because they had prescribed an inhaler which she equates with asthma. My mother is an intelligent woman—it’s just hard to listen and remember everything when you are scared and confused. And the more I speak with her, the more evident it is that she doesn’t understand the disease or the need for treatment: “I’m going to go back and find out just how long they expect me to use this medicine” and “What happens if I don’t take it?”

I spend my working week devising new, innovative ways of communicating health messages to patients—via the media, apps, crowd-sourcing communities, videos, Vine, Twitter—you name it, we’ve done it, but what I’ve learned from this personal experience is that sometimes there is no substitute for clear advice provided directly by an HCP.

What my mother needs is a consultation with a doctor in which he or she clearly explains:

  • The disease
  • The role of treatment
  • The consequences of nonadherence
  • The outlook

All could be covered in a short conversation, but this needs to be given by the doctor and backed up with written information.

My final thought is, wouldn’t it be great if there was a network of impartial adults—call them consultation buddies—available to accompany people to their healthcare consultations and take notes on their behalf? Not to aid diagnosis, but to aid understanding by capturing the relevant information in written form.

If anyone is interested in starting a consultation buddy business, call me!

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Don’t Be Fooled: The Core Tenets of Relationship Marketing Are Timeless

DartGoing back to basics on effective communication can lead to a big impact on your audience.

Pharmaceutical marketing at a glance seems unrecognizable compared to a few short years ago: technological advancements, big data, changing sales models, channel fragmentation, mobile marketing, social media…the list goes on. This constant sea of change is enough to overwhelm even the smartest marketers and strategists. Some marketers have followed the whims of change, prioritizing the latest marketing fads over a sound strategy. However, this reprioritization of communication efforts can lead to risky results. Pharmaceutical marketers will be best served by keeping their focus on the following fundamental marketing objective: getting the right message to the right audience at the right time.

Without a doubt, incorporating modern tactics and media channels can strengthen a campaign’s effectiveness, but the core communication objective should be tied to strategic objectives. In other words, the tail should not wag the proverbial dog. These core objectives should drive the decisions behind the channels, the content, the cadence, and the outcomes toward which a campaign is optimized.

The focus on fundamentals is essential across both patient and healthcare professional marketing campaigns. For example, with traditional patient support programs—which educate patients on their disease state, provide them with lifestyle tips, and empower them with condition management tools—the ultimate objective is to increase persistency and adherence. Rather than haphazardly building a program that randomly combines the latest marketing “it” channels, it is imperative to strategically consider the combination of tactics, channels, and content, at the right cadence to achieve the campaign’s goal: increasing adherence and persistency. While a campaign can and should incorporate channels both old and new, it should be the strategy that drives these decisions.

How to Focus on Fundamentals When Determining a Marketing Strategy

So, how can marketers effectively deliver communications in the ever-changing marketing reality? In the era of data integration and two-way marketing, we recommend using these three best practices to guide the process:

1)      Don’t be afraid to ask—so you can know what they are thinking: A behavioral survey can identify how targets would prefer to receive communications, such as by telephone, email or direct mail. Using this information, design a communication strategy that provides relevant information in the way(s) they want to receive it. By simply asking how an individual wants to be communicated with and by fulfilling that basic need, marketers can more successfully deliver the brand’s message and increase conversion.

2)      Observe, adjust, and make them feel special: With the phenomenal growth and availability of campaign response data, marketers have the opportunity to design and cater communications at the individual level. Creating customized communications and educational tools based on a target’s experience can ultimately lead to greater engagement and positive, impactful outcomes.

3)      Think like them—to understand what they need: As marketers, we measure success by driving impact and ultimately changing behavior. With the data at hand, we can now design and adjust strategies, all the while focusing on the brand’s fundamental goals. These metrics and objectives allow us, as marketers, to start thinking like our targets and asking questions that drive stronger campaigns:

A) What do our targets want and need?

B) How can we strategically design a program to meet these wants and needs?

C) How will we know if we met our targets’ wants and needs?

By remembering to follow these three steps when developing a CRM strategy, we can impact behavior by creating custom relationships based on trust, respect, and value…all by delivering the right message in the right way to the right person.

So while the marketing context, customers and channels have changed and will continue to change rapidly for the foreseeable future, we as marketers must keep our focus on our core, timeless tenets of good marketing: sending the right message at the right time and the right place. By applying some of these best practices, you should be well on your way to maintaining a sound strategy amongst the ever-changing marketing landscape.
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Is It “Health Insurance,” or Merely Prepaid Health Care?

PillThe Affordable Care Act’s (ACA) goal is to provide health insurance coverage to those without it now, and it uses 2 main mechanisms to do so. It penalizes individuals without insurance, thereby encouraging them to sign up for health insurance. (In order to support this effort, the law creates state insurance exchanges to offer health plans to consumers.) The law also penalizes employers (with 50 or more employees) that do not offer health insurance to their workers. So, these employers will either need to add insurance if they don’t currently offer it, or maintain or modify what they now offer to their employees…or else pay a fine.

As the ACA proceeds to full implementation, it’s probably polite to say that various “inconsistencies” in the law are emerging. While “self-pay” employers may still exercise some degree of freedom in adding, maintaining, or modifying their health insurance offerings, the law is determining many of the characteristics of health insurance offered to the public via health care exchanges.

It’s interesting to note that 2 key requirements of the law undermine the basics of insurance, which is defined simply as “coverage by contract whereby one party undertakes to indemnify or guarantee another against loss by a specified contingency or peril.”

The first requirement is that all beneficiaries pay essentially identical rates, regardless of their risk factors. One of the few recognitions of varied risk among the population, an individual’s age, is still subject to constraint (older people cannot be charged more than 3 times the premiums charged to younger people). The other requirement is that insurance companies should ignore individuals’ preexisting conditions when writing new policies. While this rule is popular—no one wants to deny health insurance coverage to a cancer survivor—it also could encourage people to wait until they are sick before they purchase insurance.

Additionally, the law’s definition of an insurance plan’s “essential health benefits” may also contribute to an unintended result: a small set of insurance offerings on health care exchanges that are all generally very expensive, due to the fact that the policies are required to cover many things. One possible effect on consumers is that they will pay higher premiums.

Let’s go back to employers. Year-over-year health care cost increases have recently moderated, but over the long term they have traditionally been higher than the rate of overall consumer inflation. Some employers may use the soon-to-be-created state exchanges as an opportunity to withdraw the health insurance they offer to their employees. Employers who still plan to offer health insurance will continue to scrutinize costs and seek ways to mitigate their increases. They may continue to restrict the breadth of offerings in their health plans (a trend that is opposite to the expansion of essential health benefits above). Another mechanism that works is to shift more costs to their employees in the form of higher premiums, copays, coinsurance and deductibles.

So, in the 2 areas that the ACA seeks to create new health insurance opportunities (state-based exchanges and newly regulated employer markets), the individual will most likely pay a greater share of costs and have a greater responsibility to evaluate his insurance policy as well as the health care interventions he receives.

What does this mean for marketing communications?

One question facing employers, employees, payers and consumers will be the role and importance of deductibles, copays, and coinsurance. These patient payments are essentially behavioral-change tools, encouraging the patient to “shop wisely” because he is spending his own money on health care. Will these mechanisms continue to work as they have in the past? It may depend on which segment of the market grows larger: the state-based exchanges or the employer-provided plans.

On the one hand, if the law is encouraging fewer, similar insurance offerings on state exchanges, it will hardly be easy for insurance companies to differentiate one policy from another. If the offerings from health plans become expensive and undifferentiated, with most of their benefits “prepaid” by premiums, how much impact will deductibles, copays, and coinsurance have? Would this also complicate manufacturers’ efforts to differentiate their products to insurers, providers, and patients/members?

On the other hand, if employers are restricting benefits in their heath plans and shifting more and more costs to employees, employees will be using more of their funds to pay for premiums, and there may be less left for deductibles, copays, and coinsurance. With fewer health care dollars available, the employee may respond more to the cost effects of those patient payments.

Readers, what will be the health plan implications for related drug and device issues such as tier placement, contracting terms, and pricing? What marketing efforts are still needed? And to whom should they be directed?


  1. Merriam-Webster. Definition of “insurance.” http://www.merriam-webster.com/dictionary/insurance. Accessed April 22, 2013.


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When Will Pharmaceutical Companies Embrace Behavioral Retargeting to Drive Adherence?

Shopping KeyPicture this: You visit a website, add something to your shopping cart, but abandon the transaction. Maybe you are distracted or decide to shop around to get the best deal.

The next day, you’re on a different website. Suddenly an ad pops up on your screen…for that item you had in the shopping cart the day before. In your mind you’re thinking, “Wow, maybe this ad is an omen that I should buy that item?”

You’ll be relieved to learn that the ad is not an omen. It’s just “behavioral retargeting,” one of the tools that a smart marketer is leveraging to capture your attention. They want you back at their site to complete the purchase.

Digital channels can leverage relevancy (based on action and exposure) to deliver highly motivating advertising. If it works well for consumer products, how would this work for pharmaceutical brands?

The Web as a Research Tool
The Internet is used by consumers to compare prices and features. What we find online often influences both online and offline purchasing decisions. In the early days of the Internet, consumers were leery of making significant purchases online and would compare prices on the web then go to a brick-and-mortar store to make their purchase. With improved mobile technology, consumers now see and touch products in stores, only to make the purchase online. Many consumers are now willing to make major purchases online.

The prescription drug buying process is different. Some consumers see advertising for lifestyle drugs on TV and in print, go online for additional information, and ask their doctor for a prescription. If their doctor agrees, they may receive a prescription. A pharmaceutical website for a prescription drug may play a role in initial patient-doctor discussion, but it can really play a much more significant role in influencing medication adherence.

Behavioral Retargeting to Influence Good Behavior
We see many prescription drugs with elaborate, multichannel medication adherence programs that often have minimal impact on the bottom line. The reasons for this are twofold.

  1. Programs that are dependent on patients signing up tend to have very limited reach against the patient base.
  2. They often attract patients who are adherent, so there is little opportunity to increase sales. We also see programs where enrollment is driven by activating a savings card—but too often patients are unaware they joined the program and don’t engage with the communications they receive.

What if we used behavioral retargeting to increase awareness of compliance programs? Imagine if retargeting didn’t just apply to shoes and baby clothes, but also encouraged medication adherence.

Behavioral retargeting provides the ability to extend reach and deliver highly relevant adherence messages contextually, then bring consumers back to your site for deeper content. It provides an additional channel to get key adherence messages to customers who might not sign up for a program.

Then again, even if we can do it, we may not want to deliver behavioral retargeting. After all, some patients have conditions that they’d rather keep private. They may not appreciate a reminder message from a pharma company that manifests as a banner ad on their favorite website. If this is the case, such issues can easily be addressed with a simple opt-out that prevents future retargeting from the ad server.

These days, behavioral retargeting is closely associated with advanced ecommerce websites. Looking forward, it will probably become another tool for communicating with patients and healthcare professionals. Before that happens, industry thought leaders need to think carefully about how patient health information is used and retargeted across different websites, channels, and platforms.

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SXSW 2013: Empty Information Calories

Cloud Image“We are drowning in information and starving for knowledge.”

– Rutherford D. Rogers, Deputy Librarian of Congress

I recently presented at SXSW, and while there attended a number of other talks and presentations. One, given by a Buddhist nun, made me think in a new way about what it is we do as healthcare communicators. We create a lot of materials and services for people to consume, in essence “feeding” them healthcare information—but are we feeding them well?

The presenter used the concept of cheap nutrition as a metaphor for the modern habit of consuming low-value, high-turnover products and services without ever feeling full or knowing why. Everything, according to her, has the potential to become fast food, easily consumed and without real nutritional value:  the things we own, the entertainment we watch, the achievements we rank and catalogue…all of it can be had in a low-cost, transactional way, and it is all empty calories, taken on board without consideration and without satisfaction. The more you eat, the hungrier you get. To be fulfilled, we need to do more than consume—we need to connect, and to engage. I’m not a Buddhist and I like fast food as much as the next person, but as a metaphor for information available on the Internet, especially healthcare information, “empty calories” is as good as any.

Patients and caregivers seeking knowledge find a sea of information, often without context or a frame of reference to know if it is good information or bad, relevant or irrelevant, connected to their immediate need or concern or not. The information is readily available, it is designed to be easily digested, and rarely if ever does it leave us feeling that we know all that we need to know about whatever it is that ails us or a loved one: we sit at a keyboard, finding bite-sized information nuggets, and eat and eat, and remain hungry nonetheless.

The nun was right. Gorging on information will never truly make us full; what we need is information we can use, that can guide our actions in a meaningful way. Knowledge requires that we pay attention in a way that consuming information does not. Knowledge comes through deep interaction, through a relationship between the knower and the thing known.

We are healthcare communicators—what sort of food are we creating? Do we push ourselves to ensure that information is more than just digestible, and even correct, but is also presented so that people want to, have to engage? Do we truly think about the end user and her needs or experiences? Do we create “disposable interactions” that just help feed a need for consumption rather than a need for usable knowledge? Helping people acquire knowledge is our job, not just giving them access to information. I challenge us all, then, to create more than the next informational Twinkie.

Check out OCHWW’s other SXSW 2013 blog posts:

SXSW 2013: Small Data in a World of Big Data

SXSW 2013: How Zombies Are Helping Us Get Fit

SXSW 2013: BIG Data and Personal Technology at SXSW

SXSW 2013: The Mobile Healthcare Revolution

SXSW 2013: Bad Behavior – the Saga of SXSW
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Experience-by-Proxy as a Medical Decision Making Tool

computerNow that patient-centered decision making is becoming a reality, it begs the question: are we, as patients, really prepared to make life-or-death decisions on our own behalf?

The biggest problem I have making many of the decisions I am faced with in everyday life, not just in health, is that I simply don’t know enough about the options I’m choosing between. I am fully capable of ordering a cup of coffee—I’ve had lots of different kinds of coffee, and on any given day can be trusted to order myself a latte or a grande or whatever.

But if you ask me something I really don’t know much about, either experientially or theoretically, I’m going to be at sea, metaphorically speaking. To reuse an example I wrote about recently, when my builder asked me if I would prefer for him to install flexible tubing instead of traditional pipes for a new sink, I really didn’t have any idea, at all. He’s the expert, so I asked him what he would do. And he did what anyone might do in that situation—he told me what was good and bad about each, but made it clear that, really, flexible tubing was the bomb. You’d be an idiot not to go with flexible tubing.

And it turns out, he’s wrong. It works fine, but the water tastes like rubber, so you have to let the tap run for about 30 seconds before you fill up a cup of water. Not a huge deal, but what happened is, he gave me advice based on what would work best for him; it’s a lot easier and faster to install flexible tubing, so why not suggest it to me? I mean, he did give me the options, and he told me the truth about each in terms of cost, durability…but he never really told me what it would be like to actually live with a sink that produced water that had flowed through, or worse, sat in, flexible tubing. It was a decision he had to execute—it was a decision I have to live with. There’s a really, really big difference.

This lack of context when making decisions is one of the key problems facing patients who are now tasked with the emerging paradigm of patient-centered decision making, that is, the job of making their own health care decisions. Patients lack the experiential knowledge of what it might be like to live with option A versus option B. Doctors and other health care providers, who are much more familiar with the choices being faced, really never live with the consequences of these decisions, they merely execute or observe them. Just like a plumber, their choices are based on their own interpretation of what is best for the patient, which is probably in some measure based on what makes most sense for them, given that they have to carry out the technical aspects of the decision. This is why we are moving towards patient-centered decision making in the first place, so that the patient can make decisions based on what he or she believes will be best for him or her, given their values, their situation, etc. But if we give patients the kinds of information that doctors use to make decisions, or the kinds of information my plumber gave me about ratings, durability, costs, etc, we’re only helping patients understand the consequences of their decisions from the point of view of someone who doesn’t have to live with them—we’re still not helping them understand what it will be like to live with the consequences of different decisions.

A lot of very important medical decisions are made only once by any given individual, so whereas I might have another sink put in some day and be able to make a second decision differently based on the experiences of the first decision I made, sink-wise—in the medical context, you pick your option and you live with it. We may be providing patients information about these decisions, but in many ways it’s hard to say that the decisions themselves are “informed.”

What we need, then, is some way to give patients a window into the possible futures that might exist for them, depending on which choice they make, which option they follow. Like the Ghost of Christmas Future, we need to have some way to show patients what their lives might be like with choice A, choice B, or no choice at all.

This is, in part, the theoretical underpinning of one of Ogilvy CommonHealth’s two South by Southwest (SXSW) core conversations taking place in Austin, TX, early in March.

One of the best tools for achieving this is video testimonial by patients who have been faced with similar choices, and who made one. These patients can talk from experience about what it is like to make such a decision, why they made it, and what it’s been like since then. Another patient may have made a different choice, and can talk about the consequences of that choice from their distinct point of view. And suddenly a patient who was choosing from medical options based on things like survival rates and risk-benefit can now make decisions based on the experiences of people like them, facing the same issues they faced; people living with the consequences of their choices, for better or worse. This we call “experience-by-proxy”—borrowed experience, which allows you to gain knowledge of a path followed before you follow it for yourself.

These experiences-by-proxy won’t necessarily help make the decision for you, but they can make your decision more grounded in reality. If you are unsure if you need a hip replacement, and watch several videos, one of which has a patient saying, “It changed my life, I have no idea why I waited so long,” and another of which says, “It was horrible, I should have waited longer, and here’s why…”, you may still have conflicting opinions. You may still want a better quality of life with a new hip, but fear the consequences of an operation that is never guaranteed to go right. You may still be on the fence…but at least now you have a clearer vision of what it would be like to live with the option to go forward with hip replacement, and to put a face and a life to the theoretical risk and benefit you considered earlier.

To learn more, go to http://schedule.sxsw.com/2013/events/event_IAP7391

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Fighting the Stigma of Mental Illness

Even with our medical knowledge of the neurobiologic causes of mental illness, prejudice and discrimination against people with mental illness is not decreasing (according to a study published by Indiana University and Columbia University).

The World Health Organization (WHO) reports that there are 450 million people worldwide who suffer with mental illness but fewer than half receive care (caused by limited resources and stigma). While the WHO is taking action, by assisting governments with better access to healthcare and training healthcare workers to recognize the signs of mental illness, the WHO cannot fight stigma alone.

Many people with mental health concerns hide their illness or decide not to seek help because of what others “think.” They are often plagued with shame and agonize over with whom to share (family, friends, colleagues) their diagnosis. Worst of all (in my opinion), people with mental illness often “self-stigmatize” (internalize the public’s perception) and limit the amount of success they think they can attain or deserve.

Could you imagine how different our lives and nations would be if society knew that Abraham Lincoln or Winston Churchill had a mental illness? Or worse, if these two men held themselves back because they felt they didn’t deserve to succeed?

Mental illness is no different than any other illness, but because it manifests in the characteristics that make us human, it is more difficult to understand and often feared. In some cultures, superstition also contributes to how people are treated or viewed among a productive society.

So what is the tie-in with why I picked this blog topic and Fast4wD Ogilvy? Fast4wD has been at the center of global communications for clinical research for the past 10 years. While our therapeutic area of expertise is broad, the majority of our business has fallen under CNS. In addition, since 2003, my career has coincidentally focused on mental health research. I say coincidental because several of my immediate family members and very close friends have struggled with these concerns. I’ve learned a lot through my personal and professional experiences, but the most heartbreaking learning I’ve had is that a double standard exists. From a scientific and medical professional perspective, the “support” is there (just look at the list below of common or well known disorders currently open on ClinicalTrials.gov), but the dialogue behind the scenes isn’t always very nice or compassionate when it affects the immediate business.

ClincalTrials.gov lists the following open clinical trials:

  • 2005 depression trials
  • 1505 anxiety disorder trials
  • 594 schizophrenia trials
  • 475 ADD and ADHD trials
  • 472 eating disorder trials
  • 351 post-traumatic stress disorder (PTSD) trials
  • 296 bipolar trials
  • 158 trials listed collectively for obsessive compulsive disorder (OCD), panic disorder and Tourette’s syndrome

As the National Alliance on Mental Illness (NAMI) says, “Stigma erodes confidence that mental disorders are real, treatable health conditions. We have allowed stigma and a now unwarranted sense of hopelessness to erect attitudinal, structural and financial barriers to effective treatment and recovery. It is time to take these barriers down.”

We can start by looking for ways to help make a change.

  • Be compassionate and be careful of what you say:
    • “Tard”
    • “Psycho”
    • “Did you take your meds today?”
    • “Just snap out of it!”
  • Participate in a nonprofit like NAMI at some level:
    • Memberships
    • Volunteering your time
    • Join fundraisers (walks, runs, etc.)

My challenge to you is to add to my list above of how we can help make a change. I want to hear from you.



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Also posted in Advocacy, behavior change, clinical trials, Health & Wellness, Healthcare Communications, Mental Health | Tagged , , , , , | Leave a comment