Classroom Case Study: Drug Marketing.
What can designers offer in the face of a direct-to-consumer advertising ban?
By Brianna Sylver
"Effective May 15, 2006, Direct-To-Consumer (DTC) advertising by U.S. pharmaceutical companies is banned."
This was the scenario provided to the students of the Communication Design Workshop at the Institute of Design, IIT, at the start of Spring 2006 class. The scenario was fictitious. And today it still is. But Congressional FDA hearings conducted in the latter part of 2005 have the pharmaceutical industry on edge, anticipating how the advertising regulations regarding the use of branded communications will change over the next two years. Wanting to stay ahead of change and to demonstrate how applying a bit of creative thinking to a sticky situation can result in innovative solutions, the following question was posed to the class: "If pharmaceutical companies can no longer present branded promotions through traditional DTC advertising channels, how else might they continue to reach healthcare consumers?"
The following question was posed to the class: "If pharmaceutical companies can no longer present branded promotions through traditional DTC advertising channels, how else might they continue to reach healthcare consumers?"
The Brief: Project background and design parameters
Issues and concerns are abundant in this scenario. Every player—pharmaceutical companies, healthcare professionals, healthcare consumers, and the government—has a perspective regarding the value of DTC now, and the pros and cons of an environment in which DTC no longer exists.
For pharmaceutical companies, advertising budgets are directly tied to Research and Development (R&D) dollars. If they can't continue to deliver DTC communications, the possibility of even sustaining current funds allocated to their R&D efforts is at risk. And healthcare professionals recognize the tremendous value that bringing public awareness to seriously under-diagnosed, chronic conditions such as Type II diabetes, hypertension, depression, etc. has offered to a number of their patients. Yet, they are frustrated with the amount of precious patient time exhausted trying to combat hypochondriac tendencies...brought on by DTC exposure.
Healthcare consumers (i.e. patients) have become more accustomed to being active partners in their healthcare decisions. They want to educate themselves regarding their condition state, medication side effects, and treatment options. But in order to do that effectively, trusted and fully disclosed sources of content need to be available. And finally, the government is concerned that DTC marketing—specifically television advertising—gives unrealistic expectations of what a drug can do and how it can be used. Regulations, such as the Fair Balance Act, have sought to punish institutions that place more emphasis on a product's benefits than its risks, but many dollars must be spent on post-marketing surveillance in order to keep the industry regulated.
The situation is complicated. Banning DTC communications doesn't seem like the best method, but it's quite clear that new marketing approaches are needed. So with few restrictions and a world of design possibility, the students of the Institute of Design were tasked with discovering new ways in which to provide relevant and credible information to healthcare consumers about disease conditions under the "banned DTC" scenario.
We segmented the workshop class into four groups, each tasked with comprehensively understanding the point-of-view of one of the player groups potentially affected by the threat of a DTC ban.
The Process: How the class was organized
Two classes—co-requisites of one another—provided the foundation for the curriculum of the course. The content of the Visual Language class (7 weeks), taught by Bill Hill of MetaDesign, presented communication theory to the students, focusing on principles such as information architecture, user interface, content strategy and visual design; the Communication Workshop (a semester-long 15-week class), taught by me, provided the studio environment in which students were able to practice the principles of user research while integrating visual language theory into the context of the project.
Before the students could begin to design, they needed to understand the primary concerns regarding DTC of each of the players in this complicated equation (the aforementioned pharmaceutical companies, healthcare professionals, healthcare consumers, and government). So we segmented the workshop class into four groups, each tasked with comprehensively understanding the point-of-view of one of the player groups potentially affected by the threat of a DTC ban. Each student group conducted one-on-one interviews with experts, and performed a secondary research review in their respective area. The intention of the activity was to ensure that the class could cover a lot of ground quickly in learning about the existing pros and cons DTC advertising provided to each of the player groups. The class then leveraged their collective knowledge to ideate new approaches for the pharmaceutical companies to "market" their drugs, while fitting the criteria of being mutually beneficial and valuable to other players in the DTC equation.
To help direct the exploration, students were given a content area to focus on—diabetes—but they were told that solutions and strategies developed needed to extendable to other disease states as well.
A game such as this becomes a great teaching tool for nurse practitioners—often tasked with educating patients about their conditions, yet burden by the pressure to reduce face time with their patients in order to meet insurance demands.
The Results: Work from the students
The results of the project were fascinating, serving as great examples of how applying a little bit of design thinking to a sticky problem can result in the discovery of many previously overlooked opportunities. Concepts explored by the class ran the gamut, from games to new interactive platforms to in-office evaluation/education assessment software. And all of the solutions were targeted at incorporating the customer's point-of-view into their communication plans, providing value to the player groups, and lessening the "sales pitch" projected in the content.
Three solutions within the class stood out as approaches that best leveraged existing DTC marketing know-how, yet challenged the conventions enough to be deemed innovative.
A. SugarRemedi: An educational board game targeted at 40-60 year old, newly-diagnosed Type II diabetics. The intention of this game was to provide an entertaining platform for diabetics to learn, reflect on and share knowledge regarding their experiences in learning to live with diabetes.
B. Diabetes Dashboard: An in-office, Internet-based evaluation/education assessment software used by physicians working with patients inflicted with diabetes. The system collects information from patients prior to their doctor's appointment in effort to better target the education needs of patients, and ultimately, to optimize patient-physician communication.
C. Diabetes Wellness Competition: A virtual, online component to a "Biggest Loser"-type competition for diabetics with problems complying with their treatment regimens.
By understanding the needs and challenges of the different players in the DTC equation—pharmaceutical companies, healthcare professionals, healthcare consumers, and the government—the students were able to develop communication systems that leveraged user-centered design principles at their core. Concepts developed in the class strove to bring care-focus to the traditional DTC marketing techniques.
When first developing the disease-management education game, SugarRemedi, Min Ouyang surveyed the landscape of existing patient education games and found a gap: few disease-management games sought to create a collaborative environment in which patients could learn about their diseases and reflect on their experiences. "The research showed that people are likely to seek advice from other sources beyond their doctors," she says, "such as their immediate circles (family members and friends), DTC ads, and information found on the Internet" when making their healthcare decisions. Hence, SugarRemedi strives to be the interactive, entertaining gaming experience through which middle-aged diabetics can learn factual information regarding what diabetes is, and share experiences with their peers regarding how to live with and integrate diabetes into their lives.
The logic of the game is based on the metaphor of a diabetic needing to lower their blood sugar. Each player is given two "blood sugar bars" and ten "blood sugars" (five for each bar). The objective of the game is to lower your "blood sugar" by answering content category questions correctly. Strategy is involved when you jump your opponents, resulting in the transference of your blood sugars to them.
This is a new opportunity for pharmaceutical companies. The majority of the content that makes up this game is leveraged in existing DTC marketing channels—whether through print and TV ads or point-of-care brochures. But from a branding perspective, packaging the content in this manner has the promise of associating a memorable and positive experience to pharmaceutical-sponsored content that may otherwise be overlooked. In addition, a game such as this becomes a great teaching tool for nurse practitioners—often tasked with educating patients about their conditions, yet burden by the pressure to reduce face time with their patients in order to meet insurance demands. This solution assists the nurse practitioner in being able to deepen the education that s/he can impart to a patient, providing an educational experience to as many as 12 people at a time.
The game board of SugarRemedi is scalable and customizable to fit the education needs and playing experience of 2-12 players. Each content area corresponds to a different game board color.
Interlocking joints enable players to order the board however they wish, customizing the difficulty level of the game. To win, a player must answer at least one question in each of the content areas on the board in addition to depleting their "blood sugars." Consistent visual design of all game elements gives SugarRemedi a professional, cohesive look.
B. Diabetes Dashboard
When conducting user research for the class project, Chelsea Holzworth identified that "the most valuable resource for a diabetic patient was the doctor him/herself. Yet, unfortunately, the time that patients and doctors actually have to spend together is very limited." Hence, Chelsea developed the Diabetes Dashboard, an Internet-based evaluation/education assessment tool that aims to "enhance and maximize the value of the face time" that occurs between the patient and the physician during a normal office visit. The system tracks the current status of a patient's condition and knowledge of their disease, which ultimately reduces the amount of face time spent identifying the patients' current care needs, and results in a more quality and mutually-fulfilling care interaction.
When first diagnosed with diabetes, patients are asked to complete—prior to the doctor's appointment—the "Body Model Explorer" modules in the Diabetes Dashboard system. These modules use comparison education theory to provide the patient with an understanding of what they do or do not know about their condition. So, for instance, the patient might first be asked to show the system (i.e. the doctor) how diabetes impacts the circulatory system. Then the system displays the facts of how the circulatory system can really be potentially affected by diabetes. The system tracks what information the patient did not know, helping the doctor to deliver more targeted education to the patient in the valuable (and limited time) that they have to spend with one another.
Additionally, the online functionality of the system supports continued education, outside of the care interactions with a healthcare professional. From home, patients can access targeted information regarding exercise and diet, and use the system to track their insulin and treatments. When they return to the doctor, it's known what the current state of their condition is. So, instead of spending the first five minutes "getting up to speed," care and education can begin immediately.
This is yet another way that pharmaceutical companies can incorporate care-value into their marketing techniques. A system such as this understands specifically the education needs of a patient, delivering precisely what information is most relevant. Additionally, through positive association, the pharmaceutical companies are able to dissipate the distrust that is often projected by both physicians and patients towards the traditional marketing approaches of pharmaceutical companies.
The "Body Model Explorer" allows a patient to explore the different systems of the body and learn what effects diabetes will or can have on various organs and tissues. First patients are asked to show the system the parts of the body that can be affected by Diabetes.
The system then shows the patient how diabetes can affect the tissues and organs of their body. Information not known by the patient is tracked in the system and assists their healthcare professional care team in designing patient education sessions specifically targeted at their needs.
The "My Insulin" section allows a patient to view their insulin levels compared to normal blood sugar levels. This section outlines each patient's specific insulin tracking plan and warning signs to look out for.
The "My Exercise" section suggests ideal workout activities for each patient across four physical activity categories. It allows patients to update the site as their habits change and helps them to track progress and set goals.
C. Diabetes Wellness Competition
When designing the Diabetes Wellness Competition, Tina Ro's primary objective "was to design a service that would effect change in patients resistant to comply to their therapy." The Diabetes Wellness Competition is a virtual, online component to a "Biggest Loser," reality television-type competition for diabetics. It uses the fear, aggression and anxiety of competition and team synergy to motivate patients toward improved 'performance'," says Ro.
Tina notes that her biggest challenge in designing the virtual interface of the competition was "finding a good balance between the 'hard' and the 'soft.' The competition needed to kick patients into action," but she needed to make sure that competitive nature of the site didn't ultimately trigger a defensive reaction and result in people quitting the program.
This solution is interesting because it toggles the virtual and physical worlds, and is accessible to everyone. Neighbors and/or clinical teams can compete with one another against the highly publicized teams in the reality show—all while working towards the single goal of learning to better manage their diabetes to ward off the long-term complications of the illness.
This is another opportunity for the pharmaceutical companies to "market" their drugs, while providing tangible care value to their customers. From a marketing perspective, fewer dollars need to be spent to target a focused segment of individuals needing drugs and services to assist them in controlling the negative consequences of the diabetes disease. By sponsoring this site and/or events tied to it, pharmaceutical companies are not only helping their customers sustain and/or cure their condition, but they are also teaching and supporting their customers in learning to live with their condition.
The "Progress Graph" enables team members to track their performance in glucose control (HbA1c), diabetes knowledge test scores, and weight gain from baseline. The "Goals" section of the Diabetes Wellness Competition allows team members to help each other deal with the struggles of diabetes—the stress, depression, and resentment of having to deal with lifestyle changes (i.e. constraints on food, invasive injections, etc.).
Progress is tracked individually, within the team, and relative to the larger community. Members can access educational content—targeted based on their past performance—to assist them in accomplishing their goals. Suggestions for how to continue progressing forward are provided to each of the individuals participating in the competition.
Conclusions and reflections
The students in the class tackled an amazingly difficult problem with great sophistication. The concepts shared in this case study are only a taste of the effort taken by the students to fully understand, appreciate and design for the diverse needs and concerns of the various players threatened by a DTC ban scenario. From the perspective of Bill Hill and myself, we couldn't have asked for more.
Of course, there are things we would do differently the next time around: we would integrate the Visual Language and Communications more consistently, both over a 15 week period; We might use collaboration software to narrow the gap between time zones; And it was unanimously agreed (between the teachers and the students) that the class could have benefited from revisiting the initial scenario more frequently.
It was never the intention of the course for students to figure out the business models behind their proposed solutions (you can only accomplish so much in a 3 credit hour class), but in retrospect, if we had posed the question "Why is this interesting and valuable to the pharmaceutical companies? To healthcare professionals? To healthcare consumers? And to the government?" on a weekly basis, we could have possibly avoided some of the "lost in space" time experienced by the students. Still, some trial by fire was useful here.
I believe the outcomes of this class accomplished the goal of challenging the traditional approaches taken towards DTC advertising. A change in the U.S. DTC regulations threatens to change the landscape enough to force the pharmaceutical companies to explore non-conventional approaches. The students at the Institute of Design have simply started the ideation process of how pharmaceutical companies (and their marketing strategists) might take a more pro-active role in providing care value to patients, their families and their care providers.
Brianna is the founder of Sylver Consulting, a product innovation firm that assists organizations in finding opportunity sweet spots between their customers¹ needs, business objectives and innovation capabilities. In addition, she offers her expertise as an adjunct faculty professor at the Institute of Design, IIT in Chicago teaching courses in communication design and human factors. Her last article for Core77 was What does "Innovation" really mean? How to insure a success with your clients.