MM+M Media Summit 2023 - Health Media and the Equity Conversation

Please welcome the panelists, Chad Godfried, CRO at MedicX Health, Casey Dickerson, who's the executive vice president engagement at Concentric, and doctor Gita Nayar, author of Dead Wrong and former CEO at Salesforce. Welcome. Welcome. Thank you for being here. And, so the task is to talk about health equity. So I thought that because we are gonna have different perspectives, in this panel, the first thing we should do is we should define the problem from everyone's perspective. Right? So we'll start with you, Chad. What is the problem with health equity from where you stand from? I get to go first on that? Yes. Okay. So the problem is, we have a system in pharma that is based off of return on investment, which really means, how do we get more patients to convert to brand at less cost? Cost being time, cost being money. And today, the pharma approach doesn't really fit the needs of the community. It's gonna take more of an investment than pharma has historically been willing to make to be able to address the issue of health inequity from a health media perspective. Okay. So I'm gonna switch a little bit to a doctor's perspective and then I'm gonna go back to KC. Gira, when you hear the words pharma is thinking more about a return on investment. As a physician, what is your first reaction to that? Sounds like pharma. Alright. Can you guys hear me? Can everyone hear me? First of all, I just wanna say thank you to Steve, Marnie, the Haymarket team for for having me here and and to everyone for being on the panel. Look, I think for health equity as a doctor, it's a whole different ballgame because we understand that the black and brown communities, the underserved communities, rural America is simply not their health care simply not accessible. Whether we're talking about information, whether we're talking about drugs, whether we're talking about access to doctors, health equity is an aspirational term for me as a physician. It simply does not exist. And the question is how do we make it exist? And in a post pandemic world, we should very clearly understand that we're only as strong as the weakest among us. Right? And that healthcare is very expensive, very costly, and often it is the underserved communities that are driving those costs because they simply don't have access or they're getting breast cancer instead of a mammogram. Right? And so that's the question. How do we make it equitable but actually also better for everyone? To me, the equity actually spreads very far for everyone when we focus on the weakest among us. Casey, can can you tell me how big is this problem? Like, what are we talking about? Because we when I say health equity, when I think about that, it seems like an academic word. Like, put it in practical terms. So to put it in practical terms, and I love that question. Thank you. And, again, thank you for allowing me to be here today. When I put it in practical terms, I look at statistics. I look at statistics that black women are less are more likely to die in childbirth. I look at Hispanic Americans are less likely to get the mental health support that they need. I look at it in terms of the number of doctors that are available within these communities that might speak in language these communities to allow these patients to have, an experience, an in language experience, an experience that allows them to communicate their needs that are personal to them in a way. But the impact is that the higher likelihood of health issues, going to a doctor later, so outcomes, and death, that is where the problem lies. So, Chad, you were saying that from a pharmaceutical standpoint Yeah. You know, obviously and I understand, by the way, there's gotta be a return on investment. Traditionally, how have pharma dealt with trying to solve those problems while at the same time getting that ROI? Well, it's funny because, you know, I I used to be a former pharma rep. And so pharma's made a lot of really good advancements over the years. Twenty five years ago, the way pharma addressed, you know, the the Latino community would be they would take cranes. Do you remember those? They would take those, make the the characters a little bit darker, and then just translate it to Spanish and say, we're addressing the issue. Today, right, they are doing a much better better, job of understanding that different communities have different needs. They need to be communicated differently. They need to be targeted to differently. And and the one place that they're missing is that they really don't understand the impact on on the way that people go to the doctor and consume health and how that takes time. And for me, if we, as a pharmaceutical industry, wanna better understand how to how to get better returns so that we can get more investment dollars back to the community, we really need to take a a look at understanding the impact of socioeconomics, the social determinants of health on not only targeting and messaging, but also on measurement. So throughout the continuum, we're not there yet, but we'll get there. And and are we not there yet because, as you said, it takes longer. So in any business, you want an ROI and you want results in the short run. We would all like to get the biggest return we can in the shortest amount of time. But pharma is increasingly competitive. Right? So we have more brands out there. We have more brands in smaller disease states that are more competitive. And if you wanna distinguish your brand from others out there, you better start looking at more than just mainstream targeting, mainstream messaging, and mainstream measurement. If you're only measuring using pharma data today and not looking at the at the consumer data, the the the the, you know, the the other the other attributes of consumer data, demographic data, you are gonna lose. Gira, it seems to me like you have pharma, who, for example, is creating and developing these solutions for patients that you are gonna have access to. Right? So you know these patients better, let's say, as a physician because you interact with them one on one. I agree. Keep going. Yeah. So what is missing from the interaction between you and your colleagues and pharma? Because it seems like if you are in the middle of that relationship, there's gotta be something that you and us can do to help. So I'm gonna try to be brief, but I have a lot to say here. Right? So so number one, what I'll say is we are operating in a world where physicians are burnt out, and there is a shortage. I'm a rheumatologist. There's, like, a handful handful of us in Miami, state of Florida, right, where we're both from. I didn't know you guys existed. I mean That's right. A lot of you guys were It's impossible to get a rheumatology consult. So I wanna set the backdrop that there's simply not enough doctors and there's simply not enough specialists in certain areas. Right? Now, I former chief medical officer of Salesforce, AT and T, I understand tech back and forth. I also understand clinical care and business back and forth. So what happened with the technology revolution is we came between the doctor and the patient. Right? Those computers over there, they were supposed to help us practice medicine. I think we all understand now they've set us back as practicing physicians, and we've really removed the joy of medicine. So that coupled with a global pandemic in a post pandemic world where now everyone is talking about artificial intelligence, I still see ads on TV from pharma telling my patients to ask me about a drug. Right? The latest therapeutic, the latest thing, da da da da. So here's where I would like to see pharma actually help me with the doctor patient relationship, which continues to be challenged for many, many reasons that have nothing to do with pharma. I don't have time to do what Juan is doing if I'm a practicing physician. Right? Full time practicing physician. I don't I can't learn social media. I'm not a marketing person. I can't be using patient engagement tools to text patients for appointments, etcetera. What I'd like to do is see pharma embrace a KOL strategy that sets all that up for me. Let me be the messenger. I'm the trusted voice. I also know my patients better than they do, like doctor Rivera mentioned. But it gives me the opportunity to improve the relationship and go directly through the KOL as opposed to direct to consumer, which actually confuses the conversation because then before my patient even sees me, they've told me what I should prescribe them. That is not fun to then explain why for this particular situation, this particular therapeutic is actually not the right choice. So I'm actually working against pharma in many, many situations. I'd love to see us flip that narrative. You know, it it's interesting something you said. Right? Patients are gonna tell you what you need to prescribe. Now that is a little bit difficult from another standpoint. When you think about the expansion of health care, there are companies out there, KC, that see access to health care as access to product, not access to doctors. You know, you have HIMSS, you have HERS. So our patients don't need us, really, to get whatever they, That's true. They need. Right? Or what if no. Whatever they need. Whatever they want. Correct. And And, you know, and I wanna and I and I'm just gonna say this as much as I'm very much a pro female leader. When I go to the mechanic, I know nothing about cars. Okay? My husband handles that. I'm very happy that he does. But it's like me going to the mechanic and saying, I think you should fix the carburetor. There's a sound, just fix the carburetor. Like I'm not even interested in the analysis. I'm not even giving the symptoms. Right? I've already come up with my diagnosis and my assessment and plan. Yep. And that's kind of the whole thing we go to medical school for for thirty years is to do that whole process. You bypass that because of a tweet you saw? Yeah. Somebody's gonna get hurt. And by the way, and before I bring Casey again, I'm gonna add, it's not only, the ads. It's not only the direct to consumer companies, but now most doctors are employed by hospitals who also have their own criteria of what you need to prescribe or what you can't prescribe. Casey, I wanted based on what Chad and Gita were, talking about, you have a lot of experience in the digital marketing, aspect of this relationship. What would you change to make this ecosystem better? Well, I'm listening, certainly. I think that the challenge with the current ecosystem is that, there is an opportunity to do better. There is an opportunity to do better targeting, but that is really difficult. I think in the mindset of pharmaceutical companies, you know, we go for the lowest hanging fruit. Right? So that starts with a mass strategy and then becoming more targeted. I do think that we could focus more on the disease but really helping patients understand the disease education, helping facilitate a conversation with their doctors. And then, I do think that we also have a role to play in really thinking about not just the data of who we're targeting, but the metrics coming out of the information that we're targeting. Because a lot of times, it's the data of who we're talking to, do we have the right looking person in our pharmaceutical ad, Is it in the right language? Right? But, I actually did a quick poll after a conversation with Gita earlier this week on with my team, and I said, has anybody seen the data come back from a pharmaceutical company that actually talks to the health benefits to a particular population beyond just a male and a female? And the answer was, I've never seen that data. But if we had that data and we could show that we were making an impact and that was part of the way that pharmaceutical companies were measuring themselves, I think that we would make additional strides, in moving the needle forward. I want to talk a little bit, Gidon. This is because of your book Dead Wrong about misinformation, disinformation. I mean, COVID just accelerated this to a tremendous, and at a tremendous pace. Where is this gonna end? Gosh. You know, I I would say that's up to us. That's up to everyone in this room. And, you know, I I wanna address the fact that mis- and disinformation have been around forever. It's timeless. Everyone here has heard from their aunt, their uncle, their grandparents about ginger, turmeric, how to have a boy versus a girl. Any of this resonating? Right? Everyone's got a biohack, like Juan mentioned before, for everything. The question is really what is the industry gonna do about it? Because here's the thing, mis and disinformation grows in the dark. So if we as an industry don't scale and start coming up with solutions, all the misfits out there, everyone with the political agenda, everyone selling a product, They're doing this really well because they have the technology and algorithms to do it. And healthcare has said marketing's cute, communication's cute, pharmacist, where's the ROI? This is the ROI. People have died. People have died during this pandemic. We can't reverse it. And it won't be our last pandemic, by the way. So as we think about the election, as we think about our communities, as we think about whether we even have a primary care doctor or not, this is truly the issue of our generation. And what happens next is truly up to us and how we take control of the situation, how we give every doctor the same platform you have won, how we get every doctor to partner whether it's with pharma, whether it's with regulatory agencies. Artificial intelligence could be used for good or for bad. Right? It's up to us. You know, so I see it from a media standpoint. I see it a little bit as a content war. You know, you have these individuals that are doing this on social media. They don't have any regulations. They can say whatever they want. Right? So I'm gonna ask you, Chad. One of the difficulties and I've worked with pharma on the TV side, and I have to be very honest. These are the most difficult segments to do. Because before you actually do this segment, you have a hundred rules of what you can say, what you can't say. And by the way, the other thing is by the time you end up with some segment, the executive producer of the show is saying, yeah, but that's boring. That's not gonna give me ratings. How do we I mean, if we're gonna compete in this content war, like, what do we do about that? Because it's Yeah. It's hard. Well, there there's a couple things. And the first is we we've gotta learn. Right? The number one thing is, watch the biohackers. Watch how these other people are communicating to the the the the mass market. Right? They're doing something that is gaining attention. I love I I wake up all the time at night, and the first thing I watch is an info commercial, you know, that that where you can get the Ronco Showtime girl. Set it and forget it. I'll never forget that because there's something about it that is really engaging. Why can't pharma I know we've got message constraints, but why can't we learn to be more engaging to to say the things and use the verbiage that engages people and makes them interested in what we're saying? The number two thing is where are these people being communicated to? Where are the people who are providing this information? Where are they where are they buying up media inventory? What are the channels that they're going after? Who are the people who are most, who are most likely to engage with that and then take an action with it? We need to meet them where people are, where people are spreading this disinformation, provide content that's meaningful in a place that is is where they're engaging. Go ahead. I'm already ready to piggyback on that because I do agree with you, but I don't know that I think that pharma can solve the misinformation problem. That said, I do think that there are very specific things that we can do. Number one, I think we have to punch above our weight in a incredibly regulated environment. Right? Because, you know, the misinformation, they don't have the regulations that we do. We know that we've got the FDA behind us. We've gotta do the right thing on behalf of these pharmaceutical companies because we want the messaging to be accurate and balanced. So we've gotta really punch above our weight. We've gotta focus on innovation. We've gotta have big ideas that's that, you know, focus on small pieces of data, small pieces of information, and really get the earned media so that our messages go viral. Now, that is the hardest thing to do, the number of clients that have come to me and said, can you make a viral campaign? And I, you know, shift in my chair and say, sure. But we need to be doing things that are bigger, that get disproportionate amounts of information, that highlight little pieces of information so that our messaging breaks through. We have to compete. We cannot displace. We cannot they're gonna always be there, and they're gonna become louder and louder. So we need our voices to show up differently and show up in exciting and entertaining ways. Right? We've got to be the most creative that we've ever done. I have I have an idea for pharma. You know? Why don't you why don't pharma take doctors like Gita and a group of influencers like that and spend a good amount of money for, battling that misinformation and putting in the money behind it to make sure that it's getting to all the social media, all the platforms out there. No. You know, because doctors can't do it on their own. Right. Like she was saying, like Gita was saying. Yeah. I sorry. Go ahead. Go ahead. I was gonna say, well, back to chat what Chad was saying, that is not necessarily where pharma's trying to get to on the revenue front. Right? They're focused on selling their drugs. We all have our jobs to do. So they may not invest the money in battling misinformation, but what we do do is we look at the influencers, be they KOLs or be they social media influencers. We bring them to the table. We use them to amplify our voices and to get the message out there. We are looking for partnerships. We want to know the very best doctors who have communities like the community that you have built because we know that you can have a more authentic conversation with our audiences. Well, it's it's more than that too. Right? It's all of that, but then it's for all the pharma people who are in the audience. Look, I and everybody here who's been calling on pharma, who's worked with pharma, you've all heard pharma say, let's I want something innovative. I want you to come back to me with something new. And as soon as you bring it back to them and it's new, they say, great. Where's the case study? That doesn't make any sense. So we need pharma to be more open to innovation too. Peter. I'll just comment. So first of all, one, I agree with you. They should totally do that. But I actually wrote a chapter about this, and everyone's gonna get a book, during lunch as I understand it. I I actually wrote a chapter on it because I I hear Casey and Chad saying, you know, pharma can't boil the ocean. Right? The industry has to boil the ocean. And there is a chapter, chapter eight on the Cleveland Clinic and how the Cleveland Clinic realized that their number one asset was their doctors, was their nurses, was their staff. Right? You don't have staff. You don't have a hospital. We were reminded of that during COVID. And they really, from a marketing perspective, head of marketing in Cleveland Clinic, he said, I'm gonna get all my doctors to be Juan Rivera. He put them on YouTube. He put them on social. He magnified their voices in a way that they didn't have to do anything. They just had to show up. He made them look nice. He gave them two minutes. Right? He didn't ask them to be marketers. He asked them just to be doctors, and then he did his part as the head of marketing. And then he partnered with YouTube. Right? And so I think we as an industry, we do. We have to think outside the box. And for pharma, I think you can solve the lane of mis and disinformation that leads to revenue. So you pick your drug. You pick your specialty. Listen, in rheumatology, we got mis and disinformation everywhere. Every specialty does. So there's a way for pharma to solve one piece of the pie and still get your revenue and still be a trusted partner to your KOLs. But then the provider, the payer system, everyone's got a role to play. Because when I talk to the insurance companies, value based care, value based care. Listen, no one's getting a mammogram if they don't know what a mammogram is. They're getting breast cancer instead. Right? So there's an opportunity for every stakeholder in this industry, and this is the undercurrent that we have ignored as we're focused on EHR optimization, artificial intelligence, staff burnout. Spoiler alert, it all leads back to mis and disinformation. Health care is a services business. People are looking for knowledge and answers to their questions. That's it. I I wanna go back to, something that, I think, Gita, you mentioned before. And, we as physicians are constantly having to talk to patients about different things that they hear on TV or whatever. But one of those, and I don't know if this has been your experience, one of the things we have to convince patients constantly is that pharma commercials are not as bad as they look. Because when you are watching the Super Bowl Yeah. And you're gonna take something for arthritis, but then you're gonna be impotent, and then you're gonna lose thirty pounds when you don't need to lose weight, and you're gonna lose your hair, and then your eye is gonna close, the patient comes to us and say, hey, I have arthritis, but I'm scared of this drug. And we have to convince them to take the drug. So there's already some of that happening. That could be amplified in a significant way because we're already doing it. Otherwise, these patients, after they started watching these commercials on TV, I'm telling you, everyone goes to their doctor saying, I don't wanna take the drug. But we convince them. That's right. And that is a conversation I have every day in my clinic at University of Miami in rheumatology because we give powerful, expensive drugs. And that is the number one conversation. I have a bottle of Tylenol that I keep out when I'm seeing patients, and I go through the side effects of Tylenol. And I say, how many times do you take Tylenol without doctor supervision? And, of course, the answer is like, oh, all the time when I have a headache, a backache, yada yada. And I see that's why you have me and that's why we check. We check your blood work. We're gonna check your kidneys. We're gonna know before anything happens with the side effects. But you know what? It's easier to take garlic and it's easier to buy the ten dollar vitamin at the store. So we are competing with that, and that's a great example for you guys and your revenue because compliance, adherence, that's what it's about in the farmer world. We've talked about this at length, and we talked about the type two d diabetes mark and the GLP ones. I worked with the GLP one that I could tell you I looked at the results. We talk about return on investment, right, and conversion rate. When it when a patient who goes to a doctor who's never written your drug and asks for a GLP one or another oral type two diabetic product, the chances of you as a physician writing that are next to zero if you haven't written that product in the last six months. So in the pharmaceutical world, if our job if if we if we wanted to continue to pretend that, in most diseases, asking the patient to go back and ask for a particular drug is gonna work, then then we're fooling ourselves. Spending a lot more time on giving patients the content that they need to drive them back to the physician to have a conversation about the disease and not the drug is a huge, huge marketing opportunity for most brands. Now there's some there's some, you know, indications where you can ask a doctor for a particular brand. You probably get it. But those are usually more wants than needs. But in those need based scenarios, you're gonna get much more pull through on, just driving the patient back to have an intelligent conversation. I will add, however, that, a patient that asks for a drug is thirty percent more likely to be adherent to that drug. Now I absolutely agree that the doctor needs to manage the conversation. They need to be the people responsible for actually looking at the blood work, prescribing the right medicine. But that thirty percent is going to be important when it comes to adherence. And so I do think that there's a little bit of, you know, balance to be had there. The big job is make the patient educated, get them to go into the doctor, help them have a reasonable conversations. In communities like we're talking about today, that's even harder to do because of their fears, preconceived notions, language barriers, etcetera. However, when we do get them there, if we want to have them be adherent, it is important that doctors understand they're more likely to do it if they are asking for something specific. So I think it's a little bit of, a bit of a balancing act. That may be true. But doctors, right, they patients are written drugs because they have access to them. And if you don't have access to the drug and you go to a doctor and say, please write this for me, and you go to the the pharmacy to fill it, you're gonna see the cost, and it's gonna be through the roof. So you're not gonna pick it up. You're gonna abandon it. So it's really important that we think that through. Excellent. I think we're running out of time. The the the last thing I'll say is I've thought about this actually more in the last two days than in the past months because it's you know, I've been doing other things. And one of the, things that come to mind is there are different stakeholders in this ecosystem and in this equation. You have pharma. They're, obviously, rightfully so, focusing on the return on investment. You have the media. The media is focused on ratings and advertising money. You have the doctors. The doctors and slash communicators are interested in patient care. They want to make sure that the patients are, well taken care of. Doctors are also interested in having some piece of the pie as well in this financially speaking. Let's let's talk about things that are also truth. Doctors are like, hey. I'm busy, and all of a sudden you want me to do this for free? So there's an aspect of that. And then there's the patient who is trying to absorb all of this information coming from, the different organizations and stakeholders. It seems to me like we are gonna start to we have to start to think, how do we align all these interests? Because, you know, when things don't get done, I'm seeing that it is because interests are just not aligned. So I'll let you finish, and then we'll say goodbye. So there is a regulatory component here. And I think we mentioned it earlier that even even in the social media world. Right? We've largely left it to the social media companies to self regulate. And we saw many in the medical establishment get slapped on the hand for spreading this and misinformation as physicians, as nurses. So I do think to have the alignment that will likely take regulation from all over, from all sectors. Right? From the pharmaceutical side, the technology side, the provider side, but it's time. You know, the surgeon general for the first time put out a warning for mis and disinformation just like smoking. So this is the time and this is the action and and not to get political as you talked about earlier, but mis and disinformation, it's on the ballot. It is on the ballot. Right? Because disinformation is actually when someone intentionally manipulates the masses for political gain, financial gain, or any gain. Right? And it it would be hard to say that this science has been very politicized. Science is science. That's the beauty of science. That's why so many of us are in it. So we need to take that out. We gotta take that piece out and that will come from regulation. Thank you. Thank you, all of you, for this wonderful conversation. Thank you. Thank you. Thank you.