Can You Market Medicine Without Losing Trust? Part 2

In Part 2 of my conversation with my dad, former marketing professor Graham Dowling, we turn to a deceptively difficult question: how do you market medicine?

We talk about the decline of trust in medicine and mainstream media, why people often struggle to interpret numbers and risk, and how the same data can appear to tell very different stories depending on how it is analysed or presented.

We also explore an uncomfortable tension inside community pharmacy: tightly regulated medicines are supplied from the dispensary, while wellness products with far weaker evidence are sold only metres away often borrowing credibility from the pharmacist and the pharmacy itself.

Along the way, we discuss “costless opinions,” misleading polls and why the way a question is framed can shape the answer.

Transcript

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SPEAKER_01 0:00

You're listening to On the Moons, where we have conversations about hormones, midlife, and the moments that make us wonder, is it just me? I'm Kate. I'm a 48-year-old pharmacist and newly minted perimenopausal oversharer. This is where we talk openly about the changes we aren't prepared for, so we never have to feel alone in them again. I acknowledge the Camaragle people of the Iora Nation, the traditional custodians of the land which I am recording today. I pay my respects to elders past and present, and I extend that respect to all Aboriginal and Torres Strait Islander peoples listening. Always was, always will be, Aboriginal Land. Hello friends. Welcome back to On the Moans. This is part two of my conversation with my dad, Professor Graeme Dowling, former professor of marketing. At the end of last episode, I left him with what I thought was a reasonably simple question. How do you market medicine? From there, we get into trust, numbers, opinion, and the uneasy relationship between the dispensary and the wellness aisle at the front of the pharmacy. We also talk about why data does not always speak for itself and how the way you ask a question can shape the answer you receive. Let's get into it. You've got to market it to be competitive against wellness. Don't forget wellness is coming to you barefoot and glowing from the kitchen with shiny skin and 28-year-old abs and you know emotive language.

SPEAKER_02 1:46

If I could answer it off the top of my head, I'd be a multimillionaire. Oh, get on it then. Yeah, I mean, that's uh a question that's w w what we call a slow question. That's some that's a that's a deep question that needs unpacking. And the way the place you'd start is you'd start asking people whether or not they trust medicine and what are the situations that send somebody to a doctor rather than send somebody to a naturopath. And so there'd be there's the evidence probably exists um on the internet somewhere, and somebody's probably done the study. But medicine like science um has been degrading and like teaching and like the police, etc., has had reputation degradation over the last 10 or 20 years because there's been a number of foul-ups, and people have lost confidence and lost a bit of trust in those professions. So when you look at the image of professions that's periodically done by the Roy Morgan Research Institute, you get teachers and doctors towards the top, you get politicians and newscar salesmen right down the bottom, you get federal judges and lawyers towards the middle. But no nobody anymore, no institution, no single profession is a stand is standout trustworthy.

SPEAKER_01 3:21

I feel like the paramedics always do quite well.

SPEAKER_02 3:24

Yeah, the paramedics get you right when you actually need them in the middle of an emergency. And the NRMA insurance company years ago used to run an absolutely fabulous um advertising campaign for their road service, which was exactly the same as a paramedic. You break down in the middle of the harbour bridge, and the advertisement said something along the NRMA will come and grab you, and the four NRMA letters changed into H E L P.

SPEAKER_00 3:53

Yeah, yeah.

SPEAKER_02 3:53

And it was absolutely fantastic. So every now and again you'll see uh uh companies via their advertising agencies know exactly what the trigger is and know exactly what the emotion is.

SPEAKER_01 4:06

You need to turn your mind then to how we can win back this game of trust, I oh, you know, with the with the big monas. And then and the other thing I was just thinking of when you were talking then was i if there's a screw up in medicine. So there's a screw up in the hospital, or somebody dies in a hospital, there's uh they used to call them RCA, they now call them does they used to call them a root cause analysis, they now call them I think of the London Protocol. Anyway, basically looking back over the every decision that was made. And you know, that you're familiar with the Swiss cheese effect, you know, the holes all line up and anyway. So they do that. But when somebody dies in naturopathic land, nobody you don't hear about it. You don't like somebody's somebody has died because they haven't done the evidence-based thing, the science-based thing, they've gone down the alternative-based route, but it's not ever as publicized. So we've got um a diff we've got different standards.

SPEAKER_02 5:10

Yeah, they're not a publicly funded institution or perceived to be a publicly funded institution, and they're not an easy target for people like the ABC and and SBS.

SPEAKER_01 5:21

Why?

SPEAKER_02 5:23

Why are they not an easy target? Ah, well, if you look at journalism, journalism's lost its reputation too, the old-fashioned type of journalism. I was looking a couple of nights ago on on the news, and w I think it was the ABC or the SBS, what they'd done is they were interviewing a woman who'd had who lived in a rural community who had had nine embryo transplants or something before she fell pregnant, and they were using her as an example of the poor state of rural health.

SPEAKER_00 6:03

How?

SPEAKER_02 6:03

Exactly. How? What was the link? So the story was here there was no link to me, but the the story was here's this woman, here's her story. Now, what we can do is we can infer from that that there's not enough funding going to dermatologists and people in various subspecialties in the rural healthcare system. And so here again, you've got a single case that's got absolutely nothing to do with the bigger problem that's winding up on the national news. And nobody has lined up the ABC or the or SBS and said, look, this is actually horrible journalism. Because when you sit and actually think about it, uh the relationship between the bleeding heart that you've got um on the news and the problem that you're trying to describe down here is so tenuous that you're just filling up news time.

SPEAKER_01 7:04

Have you seen um there's the causation, correlation is not causation? There's a graph of the um, there's a graph of ice cream sales that increases, you know, over the year, ice cream sales increase at various different months and then decrease. And it describes perfectly um shark attacks and shark attacks. And so therefore, ice cream causes shark attacks. That's the same kind of thinking. Just just because it's been correlated doesn't mean it's actually been caused by that thing.

SPEAKER_02 7:39

Well, just on that one. That's a statistics 101 problem. Anyone who goes to university and does any statistics course bumps into correlations don't uh imply causation. Let me give you a slightly different example that that's a bit more fun.

SPEAKER_01 7:54

More fun than ice creams and sharks.

SPEAKER_02 7:56

Oh, yes, yes, yes. There's this notion of big data. All our transactions in a supermarket, all our financial transactions, et cetera, wind up in a database, and the data analysts go scurrying through the database looking for patterns, uh, causal patterns between clusters of variables, etc. Years ago in Piedmont, uh, where we had a home unit, there was a Chinese restaurant directly opposite our local supermarket. And if you were standing outside the Chinese restaurant at lunchtime, what you noticed is a big tourist bus turned up, and the pe uh a whole bunch of Chinese tourists came out of the restaurant. Most of the men went into the bus, most of the women walked across the road into the supermarket. 15 minutes later, the women came out of the supermarket with as much baby formula as they could actually carry. And they hopped back onto the bus, and that afternoon they flew out of Mascot Airport back to China. Now, I'm a data analyst sitting in Melbourne, and I noticed that that Piemont supermarket has a massive amount of baby formula being sold during the week. So my assumption is there are a huge number of babies in Piemont.

SPEAKER_01 9:20

Or that eating Chinese for lunch means you get pregnant. Um possibly. Because you eat Chinese for lunch and then you've got to go across the road and buy baby formula.

SPEAKER_02 9:30

Yes, but see, the data analysts wouldn't know that. They would just pick up the sales figure because the Chinese were using cash. They were also getting rid of their uh their cash. Now it turns out in in Piemont, as a demographic, there are actually more dogs than children.

SPEAKER_00 9:46

Yeah, yeah.

SPEAKER_02 9:47

So it's really easy not to understand the data that you're analysing, uh, let alone just because things correlate with each other. Um there's no sort of causal model, there's no law of nature basically sitting beside this. And so many people have been caught out uh making what is really stupid assumptions off the back of data, they actually don't understand how accurate it is, how it's been collected, where it's been collected, and how it's been analysed, which comes back to this basic notion of when you're presented with evidence, you're willfully blind if you don't do the Ronald Reagan, which is trust but verify.

SPEAKER_01 10:29

I did a post, I did a reel on TikTok and Instagram that did um it did well, it got about, I don't know, 900,000 views. And it was basically I said, alcohol is not good for your brain. So not really anything that nobody doesn't know. The amount that you drink increases increases your your risk of dementia. So whatever your personal risk is, and then adding alcohol to it increases increases the risk. And the number of people in the comments that said my grandma never drank and died of uh died of dementia when she was 80, or my granddad drank every day and lived to 110 sharp as attack. The fact that people didn't understand, even the population, it was a population study, so didn't understand that one your story is not in in statistical terms, your story is what we call a large sample of one. Yes.

SPEAKER_02 11:26

And it's almost completely meaningless.

SPEAKER_01 11:29

But it's not meaningless to you, so it informs your belief about you.

SPEAKER_02 11:35

Yep, that's exactly right. And so as people, our intuition isn't good relative to statistical evidence. So there's always a fight between numbers and intuition. And education can overcome that partly, but education can't overcome that completely. And one of the biggest areas where some of the biggest damage occurs is in the assessment of risk. And so there are some notable academics around the world who have written books in terms of how you present numbers to help people understand the risks they face. And during the COVID pandemic, it it was fascinating because you could look at some of the data that was appearing on the COVID-live websites, and if you're a statistician, you could infer what your individual risk was of getting COVID. And that came from the basic numbers that were being published in an aggregate sense, but it was also conditioned by your lifestyle. If you were an old person living at home by yourself and had your groceries delivered to the front door, then your risk of catching COVID was extremely low because your interaction with other people with your natural lifestyle was very, very low. If you're a health worker who was doing a shift in the hospital and a shift in the aged care facility and did one shift a week down at the airport and shopped at Kohl's and had a large family, your your risk was skyrocketing simply because of your lifestyle. So governments got that wrong because they looked, they they looked at the population as a whole rather than segments of the population, and the public health regulations closed down everybody because that was the only thing they could do. So the low-risk people suffered because they were helping the high-risk people. And a lot of people were comfortable with that because they said that's part of the social contract. A lot of people got very cranky about that because their uh individual rights were being infringed. Now, how a government treads the path between that is really difficult, and that's why you don't want to be a politician in the middle of a pandemic. Or anytime. And that's why you really need to be careful about saying Scott Morrison was terrific or Scott Morrison was an idiot, because for some people he was both or either. So our intuition about evidence is often not the same from the personal side with the statistical side. So this stuff is actually complicated, and you need people who can explain it in simple terms to people. And this is why the risk literature is enormously complicated, but when it's simplified, people can get the hang of it. But most of the journalists have never read it. Uh, many of the medical practitioners are are only partially familiar with it. And advertising agencies and people like that who know about it can manipulate it very, very easily.

SPEAKER_01 14:47

So personally, how do we how do we think about this little problem that I have, which is, well, I guess this is this is a problem for all community pharmacies, which is that there is a an assumed level of trust placed in the fact that the pharmacist has gone to a d uh done a degree and gone to a university and then done their training and then been registered with APRA. So they're a registered health professional. There's a dispensary full of TGA listed, sometimes PBS funded medicines out the back that are prescription only that have come from another registered health professional, as in a doctor has prescribed it to this person. And then sitting out the front is a whole bunch of wellness. The wellness, in my view, is now borrowing authority from the dispensary and from the pharmacist. Worse, though, is that it's a commercial business. So for the pharmacist pharmacy to be able to offer a range of different services that people come to expect, like vaccines or even just health advice or whatever it is for free, because we're the only health professional that you can actually walk in and speak to for free. They need to maintain a viable business, which is selling the wellness supplements that I'm gonna say don't have the same body of evidence behind them as the blood pressure medication that's sitting right behind it.

SPEAKER_02 16:21

What do you do? Well, the first thing you do is you shoot your father because many, many, many years ago, one of my early consulting assignments was to a retail pharmacy group. And one of the things we discussed was how you make a pharmacy more commercially viable and how you broaden the product range. Now Dad! Yes, exactly. Sorry. Uh this all happened before you became a pharmacist. After we the family had invested in your pharmacy education.

SPEAKER_01 16:53

Do I have to give my degree back?

SPEAKER_02 16:55

No, but um had you become a pharmacist, I probably wouldn't have taken the consulting job. But think about it, and you've described it perfectly. I walk into a pharmacy, and the first conditioning I get is rubbish, not pharmacy. Now, who's to blame for that?

SPEAKER_01 17:13

It was you, apparently.

SPEAKER_02 17:15

Well, yes, but then people followed my my advice and the advice of other marketers.

SPEAKER_01 17:20

Hang on, do I understand that you are now responsible for price line, which is basically like uh it it not I'm not even gonna call it a pharmacy. In fact, some price lines don't even have a dispensary.

SPEAKER_02 17:30

Well, this was 30 or 40 years ago, and uh it's sort of ballooned a bit uh since since we were talking about it. And we weren't trying to protect the pharmacists, what we were trying to do is to make the pharmaceutic, you know, the pharmaceutical chain actually uh more viable. Yeah. Yeah, but yeah, basically profitable. But when you think about it from a strictly only pharmacy image uh point of view, that's got to be the dumbest retail environment that you've ever seen. What you should have is the you know, the pharmaceuticals up the front. And if people after they fill these scripts, etc., then they can go down the back and play with the beauty products and and everything else. But what retailers know is uh that the way that you capture people is you you put that stuff at the front. And it's exact it's a similar sort of principle to uh supermarkets. The stuff that you buy on a regular basis is down the back, so you've got to pass the biscuits and pass every and the chocolates, etc., until you can get to the milk and the meat and whatever it is that you buy on a regular basis down the back. That's by design, that's not by default. So there's a tension between make money as a commercial pharmacist, and there's a tension bit uh the and the other part of the tension is I want a credible image for you know uh my part of the health industry.

SPEAKER_01 19:05

So the place where I'm working has uh owned, is co-owned, so it's it's co-owned by a pharmacist and another pharmacist who's also a naturopath. And so they have quite a wellness um push, like a supplements, alternative medicines kind of push. And they have what they call training, and again, I'm using that word quite wrongly because on the uh the the rep for one of the the supplement lines, the company will come and shout everybody breakfast. This is like back in the days when you could get your drug company to come and take your doctors out for lunch or dinner or whatever it was, and they told them about their new thing. Well, they've stopped that now. You can't you can't go out with a drug company if you're a doctor and get any kind of benefit or remuneration from the from the company, but pharmacy still can. So we go down to the cafe and the rep buys us all breakfast and then she talks to us about the new product, and you can ask questions. And I went to one and it was about collagen. So they were talking about the new collagen product, and they had two or three different lines of collagen, and one was for skin and hair, and one was for joints, and one was for whole body, and she's explaining, you know, their their amazing collagen line. And I say, How does the collagen know to go to your skin and your hair in this jar? But in this jar it knows just to go to your joints, but in this jar it knows to go to your whole body, which I would think also includes your skin and your hair and your nails. And I was not praised for asking such questions, but I would think a legitimate question.

SPEAKER_02 20:43

Just you're praised by your father because you asked a sensible question. And it's sort of obvious that if you change the colour and put them in a different style bottle and change the label, then people think, oh, I've got my problem over here, I'll I'll buy this one. And that's just all retailing.

SPEAKER_00 21:02

Yeah.

SPEAKER_02 21:02

That's retailing 101.

SPEAKER_00 21:04

Yeah.

SPEAKER_02 21:04

Um, and when the reps come in and they talk to people and they give people a little bit more confidence about selling it, that's part of the you know, the commercial business-to-business sales process.

SPEAKER_01 21:17

Of course, but I don't want to be a part of that because that doesn't sit well with me ethically.

unknown 21:21

No.

SPEAKER_02 21:21

Well, you've got two options. You can be cranky or you can just say, well, resign.

SPEAKER_01 21:26

No, no.

SPEAKER_02 21:27

Or you can just say, if they buy this stuff up the front, it doesn't stop them buying my pharmaceuticals down the back because they've got a script for my stuff. And it doesn't matter what they buy in the front of the store, they're still going to buy my stuff at the back of the store.

SPEAKER_01 21:41

Well, how I reconciled it with myself was that I thought I won't recommend it. So if somebody comes in and says, I've got a sore knee, do you think this collagen for joints is going to help? I'm not going to say, I'm not going to regurgitate the spiel that was given to me by the rep, but what I What I could say is, I'm not sure. I don't, I don't know about that product. I can but I can tell you that if you have a sore knee, an anti-inflammatory may help you. But if it's ongoing, you need to see somebody about what's actually causing it. But I'm not going to actively be promoting it.

SPEAKER_02 22:16

But if you own the pharmacy, what you might say is, listen, I think they're all pretty much the same. So why don't you buy the cheapest jar?

SPEAKER_01 22:23

Yes.

SPEAKER_02 22:23

And your customer will think, wow, I've saved a bit of money. That's terrific. I'm beginning to trust you more.

SPEAKER_01 22:28

Yeah, exactly. Exactly. And I understand that I'm sitting on a very high horse of not having to pay staff, not having to keep the pharmacy shop open. It's not my livelihood. I understand that it's easy for me to have an opinion like a yeah, you know, a high ethical moral ground on this one because I'm not in the position of having to do all of those other things. But I just find it very challenging.

SPEAKER_02 22:49

Well, think about the background question to the example that you've just given. You've got what marketers call a costless opinion. Now, a costless opinion is a market researcher comes up to you and basically says, Listen, do you think climate change is important? And you say yes. And because it costs you nothing to say yes. But if a marketer comes up to you and says, Listen, are you prepared to pay 50% more on your electricity account so that the electricity people give you green energy? That's not a costless opinion. That's going to cost you 50% of your electricity bill or whatever. So lots of market research surveys ask people questions about things that don't cost them anything. So the socially desirable response is to say yes. Well, if you base your business model on that or you base your political campaign on that, then when people actually have to pay for things, their um actions are actually quite different.

SPEAKER_01 23:53

So again Isn't that called putting your money where your mouth is?

SPEAKER_02 23:56

Exactly. But it's also part of the evidence base because you'll see people come up with, we've done a survey and it says that people want this or that people hate this or something's going on. Tim DeVinny and I did a study years ago in the area of social reputation. One of the big uh recruiting companies published a study that said most young people now want their the company they work for to have a good social reputation. And the research we'd been doing said that that was basically blather. Or not to be politically correct, that was bullshit. So what we did was we designed three sets of questions and put the same group of people in front of the computer. And the first group of questions was if you're going to work for a company, which of the following 15 issues is important? Please rate them from not important to very important. Salary, superannuation, social reputation of the company, potential to work with the senior people, potential for overseas travel, etc. So out of the list of 15 criteria, we gave people 14 out of the 15 were rated either very or extremely important. The next screen came up on the computer, and the current and the question was: pick any company around the world that you'd actually like to work for and write their name in this space here. And so you could pick Apple, you could pick Salvation Army, you could pick whatever, didn't matter. You just put a company in you wanted to work for. The next part of the question was out of those 15 criteria we've given you before, which three of those criteria were important in terms of working for your most ideal company? So they pick three. Pick contract A or contract B. So we gave them 15 sets of two contracts, and they picked either A or B. Now, statistically, what we could do with the third question is we could work out the relative importance of each of those 15 criteria, which we did. The second question basically said out of the 15, which were the three most important? And the first question, where there was no consequence, there was no cost, everything was important. So sure enough, the recruiting company survey was based on the first set of questions. But as soon as we adjusted that slightly with the same group of people and the same computer at the same time, they changed their minds. Social reputation was important in the first set of questions, social reputation disappeared completely in the second set of questions. Social reputation occurred in the third set of questions, but only as a tiebreaker. If the two contracts were perceived as almost identical, the company with the better social reputation, you know, you wanted to work for it. Now, intuitively, the third question made eminent sense because you're not going to substitute the social reputation of a company for an extra $100,000.

SPEAKER_00 27:25

No.

SPEAKER_02 27:25

Or a better superannuation benefit or the potential of going with a boss overseas on a six month months thing. So without understanding without looking at the questionnaire, without understanding the science behind the evidence, it's really, really easy to dupe people. And any decent survey researcher can design a set of questions to get you pretty much the answer to whatever question you like. Even nuclear power, I can design a set of questions that will give you 60% of the local community are happy to have a small nuclear power plant built 15 kilometers down the road. And I can, if you want me to get at 60% of people who don't want that, I'll design pretty much the same set of questions, but I'll ask them in a slightly different order and I'll ask a few extra questions to make sure that I get the majority of people to say no, we don't want it down there. So again, it's this whole business of I'm given evidence and I'm willfully blind if I don't ask for the questionnaire and then sit down and think about how the heck did they get that result?

SPEAKER_01 28:35

That was so interesting. I loved that chat. I did, I really love that chat. He's laughing at me, but I actually really did. And what I want to do, so I'm just putting it out there now, what I would like to do towards the end of the week, because we're going to be here for another couple of days, is I want to think more specifically about how we can rebrand, let's just call it medicine, but it can be traditional medicine? No, that's not let's call it let's call it evidence-based medicine. But let's even pretend we're opening a practice. Let's say we're opening a practice, and how we would market it to be as shiny and trustworthy and I don't know, desirable as any of the big wellness stuff. Let's do it. Let's let's solve this problem. What did you promise me I would become a multimillionaire if we can solve this problem?

SPEAKER_02 29:35

If you become a multimillionaire, then I want to be in your will rather than you can be in my will.

SPEAKER_01 29:42

Professor Graeme Dowling, you're a hoot. Speak to you next time. Bye.

SPEAKER_02 29:46

Bye-bye.

SPEAKER_01 29:52

That was part two of my conversation with Professor Graeme Dowling. What stayed with me from this discussion is that trust is much easier to lose than it is to rebuild. Medicine does not always communicate uncertainty well. The media can reduce complicated evidence to a single headline. Data can be analyzed, framed, or presented in ways that lead people towards very different conclusions. But that does not mean all claims are equally reliable. And it does not mean that a product sitting inside a pharmacy has automatically earned the same authority as the medicines supplied from the dispensary. And that distinction matters because pharmacies do not simply sell products. They sell reassurance, credibility, and access to a trusted health professional. So perhaps the question is not whether pharmacists can legally sell a product, it's whether the product deserves to borrow the pharmacist's authority. And when we are presented with a confident opinion, a dramatic statistic, or a persuasive poll, it's worth asking, who designed the question? How was the data analysed? And what does the person giving the opinion stand to lose if they are wrong? As always, you can follow me on Instagram, TikTok, and Facebook at Prescribe or Pass. Or watch my YouTube channel On the Moans. Or follow me on LinkedIn, Kate Thomas, Medication Clarity. And if you'd like a one-on-one appointment with me, head to www.medicationclarity.com.au and book in a time that suits you. Thanks for listening to On the Moans. If this conversation made you think, please share it with someone who you think will enjoy it. And I'll see you in the next episode. Bye bye.