POLICY: The Industry Veteran on negative advertising, the ethics of clinicians, and is THCB more boring than the Democratic Convention?

The Industry Veteran is back and on fine form, picking up the ball on a piece of crossed out editorial about my least favorite American politician, and running it into the realms of whether the Democrats are right (as Jones the Policy Wonk suspects) to take the milquetoast route, and whether marketing to doctors needs to be different than to other clinicians.

"Theocratic fascist?" I love it. Now those are the terms and the tone I expect to see on a blog. If I wanted neuterizing, backpedalling, vague ambiguity and maudlin sentiment ("hope," "we can do better," "a government as good as its people") I’d watch the Democratic convention.

This leads directly to my opening rant. The Democrats apparently believe that aggressive Bush bashing will repel the "persuadable" 20% of the electorate and, for that reason, most of their carefully orchiectomized speeches have been as energizing as 20mg of Valium. Two reasons make me think they’re making a bad mistake.

Let me start by recalling two, well established facts of voting behavior in this country: (1) voting participation varies directly with socio-economic status and; (2) only half of eligible voters go to the polls. This means that non-voting prevails among the lower two-thirds of the economic ladder that constitutes the Democrats’ social base. Election victories by Democrats, therefore, owe more to mobilizing voting among this base than to persuading the half-assed/undecideds. Democratic non-voters need a reason or reasons to vote. Platitudes about a shining city on a hill, restoring opportunity to America or giving us security with peace don’t cut it. A candidate who lacks personal magnetism, together with the lachrymose sentimentality that Democrats have been shoveling out all week, produce responses ranging from indifference to cynicism and distrust, none of which provides lapsed Democrats with an incentive to vote.

My second argument for sharper, more abusive language contradicts the pollsters’ assertion that negative campaigning and personal attacks merely turn off voters. Pharmaceutical research that I have conducted over many years with physicians and consumers leads me to suspect that the Democrats are receiving some bad advice. When asked how they feel about ads and other promotions that slam a competitor’s product, physicians and consumers typically give the socially correct response by saying that they disdain it. Further probing beneath this response indicates a different, more complicated process at work. Both physicians and laymen disparage negative or critical promotions that lack specificity because the course of action suggested by such communication (i.e., buy our product rather than the competitor’s) does not follow logically. As a result, test audiences believe that promotions full of "empty abuse" insult their intelligence. Physicians, for example, want to see the results of published studies, together with tables, charts and a condensed version of the supporting data. Consumers seek their own forms of corroborating evidence, and this varies according to the product, the market segment and several other factors. Given a rationale that effectively informs their selection process, physicians and consumers actually welcome a sharply stated conclusion: the other guy’s product is less effective and more poorly tolerated than ours. In short, go ahead and call John Ashcroft a theocratic fascist after first discussing the draconian features of the Patriot Act. Call George Bush an arrogant dope, a plutocrat and a lying scumbag after first discussing, well, any of his policies. Hey, if a longtime Republican operative such as David Gergen thinks the Democrats wasted a big opportunity by going soft on Bush, I think he may know something.

Second rant. I mentioned in a previous posting that I completed a study earlier this year involving the policies and practices of Big Pharma companies relative to the OIG/PhRMA guidelines for promoting to healthcare professionals. (OIG is the Office of the Inspector General at the Department of Health and Human Services; PhRMA is the Pharmaceutical Research and Manufacturers Association, Big Pharma’s trade lobby.) In response to exposes over the past few years that featured "dine-n-dash" and paid vacations in Aruba, these two organizations each issued guidelines to specify acceptable and prohibited practices for pharmaceutical companies promoting their products to physicians and other professionals. We first assessed the policies and monitoring processes used by the largest pharmaceutical companies for assuring compliance with these guidelines. Then we analyzed their actual promotional practices out in the field. Suffice it to say that while the overall level of bribery and bribery-in-kind has diminished slightly or has become less overt, the levels of compliance vary among the companies and nearly all reflect major disparities between policy and practice.

More recently a client asked us to make a similar assessment among diagnostic device companies. We found that while compliance differences also exist among these competitors, such differences are smaller than among the pharma companies and, more importantly, the general level of bribery and bribery-in-kind is also far lower. This reduced level of baksheesh became evident early in the study, so we spent a good deal of time and effort trying to account for it. While any complex social behavior usually results from multiple factors, there is a principal reason why fewer payoffs, involving lesser amounts, occur in the diagnostics business. Stripped to its essentials, the promotion of diagnostics involves a far smaller number and proportion of office-based physicians who would demand such gratuities. Very often the decision-makers who select/recommend diagnostic products are clinical chemists, diabetes nurse educators, microbiologists and other non-physicians. Some decision-makers are purchasing agents for hospital and other buying groups. Their product selections must provide strict cost justifications that leave little room for the subjective preferences subject to gratuities. Once again, our princes with stethoscopes, these Mafiosi doctori and purveyors of the Hippocratic myth, have dipped their beaks into the underground economy of healthcare to raise the costs and lower the ethical standards.

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