Marketing

Reinhold Angelmar, professor of marketing at INSEAD, describes how empowered patients can become allies of the pharma industry.

Reinhold Angelmar, professor of marketing at INSEAD, describes how empowered patients can become allies of the pharma industry.

Arthur Higgins, chairman of the board at Bayer Schering and EFPIA president, has declared that Patients empowerment lies at the basis of a modern, sustainable health care system. Reinhold Angelmar, professor of marketing at INSEAD, shares that view, emphasizing that this means giving patients more control over health decisions.

Indeed, patients do affect which medicines come to market. This starts in clinical research, where patients participate in clinical trials. More dramatically, several years ago a vociferous patent lobby in the US, supported by the press, resulted in defense funding earmarked for the star wars missile defense program being diverted to breast cancer research.

Patient pressure

Patient organizations are now more deeply involved in clinical trials, and commonly advise companies on trial design as well as facilitate recruitment into trials, something that is particularly effective for rare diseases, says Angelmar.

In the HIV/AIDS area, patient pressure has expedited regulatory approval times, and patients have directly influenced market access. Angelmar gives the example of Lucentis (for wet macular degeneration) in the UK, which received limited support from a NICE appraisal. This was substantially modified after patient organizations protested, resulting in wider market access.

Patients are increasingly powerful, and increasingly allies of the pharmaceutical industry, he points out. Once a medicine is in the market, patients have a role in what brands are prescribed as well as being pivotal in treatment compliance and persistence. 

Patient models

Angelmar defines a number of models for healthcare interventions, ranging from the God in the white coat model (where patients put themselves totally in the hands of the physician) to the paternalistic model (the physician responds to patient statements about their condition) to the propose-dispose model. In this model, the patient calls the shots, explains Angelmar.

Essentially, the patient uses the physician as an expert, evaluates what the physician says, and decides on the best course of action. There are, however, models that empower patients even further.

In the partnership model, patients and physicians share decisions. Some patients may be very well informed via the Internet and just want the doctor to prescribe what they have already selected; others might be autonomous and manage their health entirely outside the healthcare system.

Patients take control

Which model is best? A difficult question, according to Angelmar, but there is serious academic support for the autonomous patient model. Indeed, it is enabled by new technologies, especially genetic testing, now available cheaply via the Internet.

Patients increasingly want to take control, and he refers to research in Germany showing that a majority of patients only take medication after trying natural remedies. Some prefer to try non-prescription medicines before consulting a physician.

Patients have access to a vast range of information sources. In the US, cancer patients mostly go first to the Internet, and 66% of online users search for prescription drug information. Not surprisingly, such activities are strongly influenced by the medical conditions patients have. The overall picture is broadly comparable in the EU, says Angelmar, except that there is less information online about prescription drugs.

Impact on drug usage

Other research, he reports, shows that most patients request drugs with which they have had good experiences, but that this is positively associated with more symptomatic conditions. It extends beyond the prescription; many patients continue to take medications after the physician has stopped prescribing them.

This illustrates that patients can affect drug usage more than physicians. Angelmar relates that patients rate news stories about drugs more highly than physicians, resulting in bigger than expected impacts on market shares. Sharing prescription medications further impact usage; some 40% of people in one study did this.

Threat or opportunity?

Patient empowerment is therefore being driven by many new factors, and we could see it as a threat or an opportunity. It really is a threat, says Angelmar, to the traditional push model of marketing, which centers on physicians. We could move to a push-pull model, he says, in which we try to get patients to request treatments more often.

However, health outcomes are really the goal, so pharmaceutical companies need to develop special expertise in understanding patient needs, which will enable much better interactions with payers.

This is the patient-centric model, which parallels what is happening in the consumer goods market. However, implementing the model may be tricky in the EU for regulatory reasons, leading to major asymmetries in the way companies interact with patients globally.