Pinpointing the Persuaders

By

Archibald A. Anderson

Vice President of Sales for ROI²

Talk, talk, talk; it’s a marketer’s double-edged sword: “What are they saying about my product and how can I influence it?”  That discussion goes on despite the enormous sums of money marketers spend on promotion and education and despite long-term clinical relationships that companies develop with leading researchers, teaching institutions, and professional associations.  Product adoption decisions still take place during moments of casual conversation between trusted colleagues when marketers and their messages are not present.

That personal communications network is a critical part of the adoption decision process because most physicians are just like everyone else and don’t adopt new products until they have some personal verification that they work.  That approval frequently comes from colleagues in conference hallways, over dinner, at lunch, or on the golf course.  And some have more clout than others.  Local opinion leaders, whether pharma companies know who they are or not, influence a product’s – and the company’s – success.

Most people, including doctors, don’t want to stick their necks out to make a decision that might be wrong, so they look to someone whom they respect and whose decisions have a track record of success.  It’s the same with physicians and their decisions to adopt new products.

Marketers intuitively understand this.  If they only could identify the influence networks and the physicians who shape others’ opinions, they could create programs that harness that back channel of influence to achieve their product’s market expectations.

There is a way.  Product adoption rates among physicians can be described in a bell curve.  (See “Product Adoption Distribution”, page 22.)  They fall into segments as follows:

Innovators (3 percent). The first segment consists of physicians known as innovators, who have a high tolerance for risk.  They are the ones who participate in clinical trials.  They do not have great influence with other physicians, because they are know as risk takers in their embrace of the new.

 Early adopters (14 percent).  The second segment of physicians, known as early adopters are the certified opinion leaders.  They are well regarded by their peers because of the careful and deliberate way they make decisions.  Having earned status among their peers, they exert decisive influence over them.

 Early majority (34 percent). The third segment, the early majority, are risk averse and look for support among opinion leaders before they make adoption decisions. 

Late majority (4 percent).  The fourth segment – the late majority – adopt at a slower rate than the early majority.  They begin to adopt only after the early majority has integrated new products into normal practice.

Resisters (15 percent). The last segment will stalwartly resist any change to their practice

Identifying the Leaders

Companies have often tried to identify the all-important opinion leaders.  Past methods were useful but limited.  Though able to identify some leaders, they could not determine the influence relationships between leaders and their followers.  Now there is a way to accurately identify peer-selected opinion leaders and the networks of physicians they influence. 

Marketers send a survey to a list of high-prescriber physicians-pharma’s standard targets-requesting the names of physicians they know and with whom they discuss the treatment of a specific condition, as well as those whose work they follow through journals, meetings, and other forums.  A business intelligence system sorts the entered responses into interrelated groups of opinion leaders and network followers.

Product managers (PMs) can present influence data through maps with identifying vectors of influence and in text with “influence cascades.”  Such maps can be segmented by district, region, and territory.  Their uses for marketing and sales managers are broad and significant.

Influence data allows sales forces to target physicians who will have the most impact on the product adoption.  It also gives sales reps the knowledge they need to organize events that include physicians who know each other and are thus more comfortable attending dinners, grand rounds, and other meetings together.  That data also can be the basis for identifying prospects for local advisory boards and speakers.

The influence data can also serve as the platform on which marketers build programs such as advocacy development.  Sales reps can invite opinion leaders to meetings designed to present a product’s clinical premise and to identify those who embrace it.  They can also invite them to become speakers, advocates, and clinical trial researchers. 

Opinion leaders who do not embrace a therapy’s clinical premise present an opportunity for more ongoing communication to minimize objections and to bring them closer to adoption.  Nothing is more flattering than attention.  Leaders outside of the circle need more attention and information to bring them to a clearer understanding of the product.

Powerful Peers

Two careful studies, both published in the Journal of the American Medical Association (JAMA), showed the effects of opinion leader-delivered information on the adoption of new practices compared with others.  In both studies, the opinion leader intervention proved significantly more effective than traditional methods. 

In “Opinion Leaders vs. Audit and Feedback to Implement Practice Guidelines” (JAMA, 1991), the authors wrote: 

“A randomized controlled trial with 76 physicians in 16 community hospitals evaluated audit and feedback and local opinion leader education as methods of encouraging compliance with a guideline for the management of women with a previous Caesarean section. The guidelines recommended clinical actions to increase trial of labor and vaginal birth rates.  After 24 months…rates in the audit and feedback group were no different from those in the control group, but rates were 46 percent and 85 percent higher, respectively, among physicians educated by opinion leader.” 

In “Effect of Local Medical Opinion Leaders on Quality of Care for Acute Myocardial Infarction (AMI)” (JAMA, 1998), the authors used a validated survey to identify opinion leaders at 20 experimental hospitals who influenced peers through small and large group discussions, informal consultations, and revisions of protocols and clinical pathways.  The goal was to increase the treatment of AMI with aspirin and beta-blockers.  The article concludes, “Working with opinion leaders and providing performance feedback can accelerate adoption of some beneficial AMI therapies.”

One might assume that physicians were anxiously looking for every new way to improve treatment of their patients.  In principal, “yes”, but in practice, it is more ambiguous.  Physicians are busy and getting busier.  The time they have to study and learn about new practices is limited.  And, in most cases, effective choices are already available.  So the incentive to change comes infrequently and meets some resistance. Yet, studies show that even desirable, acknowledged improvements in healthcare are effectively communicated to physicians through channels that they trust: their privately acknowledged leaders.

The application of that concept to pharma product marketing is direct.  Some companies are already using it. 

One company ha s a new chronic obstructive pulmonary disease (COPD) medication that has advantages over existing products.  It is both fast-acting and long-lasting, while competing drugs usually have only one of those attributes.  The company also has some promising compounds in development for both asthma and COPD. 

The company’s goals are to:

·         Identify the local opinion leaders and networks among core of high-prescribing pulmonologists.

·         Identify the national opinion leader who local opinion leaders follow through journals and national meetings.

·         Identify the research centers and researchers which the local pulmonologists consider leaders in asthma and COPD

By surveying a target group of pulmonologists, the company was able to identify the key influence relationships among local physicians, the national opinion leaders and their followers, and the leading researchers and research institutes that might affect their business.  The company can now

·         Develop programs to communicate its product’s position to the opinion leaders

·         Recruit opinion leaders as advocates for speaker programs

·         Manage sales force effectiveness

·         Integrate opinion leaders as advocates into local communications programs targeted at physicians who selected the opinion leaders

·         Use national opinion leaders effectively within local influence groups

·         Develop target research centers and researchers for continuing product development.

That scenario has been repeated at several companies with slight variations that reflect the specific nature of each therapy.  A company with cancer treatment that includes radiation will include a question identifying the preferred treatment centers to which targeted oncologists send their patients.  The data will help them understand which treatment centers to target for supporting educational programs.  Another company wants to identify local and national opinion leaders and their referral networks.  In each case, the company will identify the influence unit most likely to help drive its business.

In another instance, marketers of an established product with a successful sales record needed to find ways to reach farther into the middle levels of the physician universe.  The therapy has a strong and active consultant group in place.  In that case, the method was applied in reverse.   The consultants received questionnaires, then provided the names of physicians within their influence.  With that data the company implemented programs similar to those described above.

The program’s results are frequently surprising.  The targeted physician list always consists of high prescribers.  The opinion leaders identified by those high prescribers are sometimes NOT high prescribers, and a significant number are unknown to the company.  The reality is that some of the most influential physicians are not high prescribers and the old methods fail to identify them.  Finding those opinion leaders and the relationships they influence can provide a significant competitive advantage. 

PMs can integrate such influence information into other marketing data to create a powerful marketing tool.  The challenge is not just to capture the loyalty of physicians but also to keep it, despite other companies’ communications efforts.  Integrating that knowledge into other data and tracking it over time to measure successes and failures puts and maintains a pharma company in a leadership position. 

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