A Good Idea That Won’t Work

It seems no matter how many times companies try to understand why patients do what they do, they cannot bring themselves to admit that changing a patient’s behavior is the most difficult nut to crack. We mention this after we read a post on the FiercePharma which stated;

“The gap between drug efficacy in clinical trials and drug effectiveness in the real world has been a conundrum in pharma for years. Sanofi believes one of the keys to closing that gap is patient behavior. So, it’s created a behavioral science advisory board to beef up its knowledge and practice, and it’s hired Dr. Bernard Hamelin as head of medical evidence generation to manage its implementation.

Recently, the Paris-based pharma held a press briefing to talk about the importance of behavioral science and Sanofi’s progress in the field. As Sanofi noted in the session, while 50% of health outcomes are determined by patient behavior, most physicians aren’t well-trained to deal with that part of treatment.”

Although the post did not specifically mention patients with diabetes it would make sense that Sanofi (NYSE: SNY) is interested in that area. More specifically they are seeking the same Holy Grail that everyone is seeking; getting patients to take their meds as they are prescribed. The one twist to this age-old problem is that Sanofi seems to think if physicians had a better understanding of the impact of patient behavior then they could do something.

We’re not sure we agree with that twist given that most physicians understand patients for whatever reason are not always adherent with their prescribed therapy regimen. And let’s be honest physicians, the majority anyway, do not have the time nor are they paid to educate their patients as to why they need to be therapy compliant. Even if they had the time and were compensated we’re not sure this would make a difference.

The problem is once the patient leaves the office and gets out in the real world, real world events interfere with the message that their physician delivered. And let’s be honest all the education in the world does not consider things like what these medications cost. What we have said consistently is education gives the patient the how to it does not provide the want to. Patients are not robots who can programmed they are humans and humans do not always do what they should be doing.

Listen everyone knows that smoking cigarettes is not healthy, yet millions of people still smoke. Same with eating, everyone knows it’s not a good idea to eat McDonald’s or Lou Malnati’s pizza everyday but given the obesity epidemic people don’t always eat what’s “good” for them. Add exercise to this list and countless other well-established behaviors that can positively impact outcomes.

The harsh reality that no one seems capable of accepting is that changing patient behavior is a good idea that just doesn’t work. Yes, these efforts are noble but also futile.

Until the patient has the WANT TO, the desire, motivation whatever you want to call it, all the education in the world won’t mean a thing. Two things must change. First, these companies need to stop running into what basically is a brick wall. Accept the fact that changing patient behavior just doesn’t work. Second, change the paradigm or as we like to call it change the patient experience. Give these patients a reason to get motivated and become engaged with their diabetes.

One of the reasons we missed why the FreeStyle Libre has surpassed its shortcomings, i.e. no alarms, no smartphone connectivity, etc. Is we weren’t practicing what we have been preaching. The Libre changes the patient experience and not just because it does not require a finger stick calibration. The Libre puts the patient in control allowing them to get their levels on their terms. While alarms can be lifesaving they as we have stated and experienced can be annoying. The Libre may not be as accurate as the Dexcom (NASDAQ: DXCM) system, it may not have all the bells and whistles Dexcom has but the fact is patients are very comfortable and seem to love it.

In the real-world Libre users are doing exactly what Dexcom users did, that is learning to trust their device. Once they feel comfortable they will not wait for the FDA to tell them it’s ok to dose their insulin based on what their device says. This is because patients are human and humans besides being impatient don’t always follow the rules. They do not need for the FDA to tell them doing this is ok as they are living with diabetes every day.

Listen you don’t an advanced degree to figure out why participants in a clinical trial see better outcomes then when the drug or device gets out in the real world. These patients have mommy watching over them, helping them and doing the things that Mom’s do. But as Momma Kliff said once we got home from college; “You’re in the real world now kid, an adult so while I’ll be here to help and listen it’s your life now.”

We suspect that one reason companies want to change behavior rather than changing the patient experience is it’s theoretically cheaper. If patient behavior could be changed and patients got the want to on their own these companies will make more money. However, changing the patient experience means getting away from their comfort zones. And let’s be honest these companies don’t do very well when they get out of their comfort zones.

To us part of changing the patient experience is not just making drugs and devices more patient friendly, i.e. CGM that does not require a fingerstick calibration or a pre-filled insulin cartridge for an insulin pump. Changing the experience to us anyway means changing the motivational tools used, i.e. giving the patient a financial interest in achieving better outcomes or at minimum giving them something, anything that they can personally touch and/or feel.

This is why auto insurance companies will give discounts when drivers allow the company to track their driving habits. The driver is willing to exchange personal information, effectually giving up some of their privacy, in exchange for saving money. The same goes for diabetes. We do not expect companies just to give away money based on self-reported outcomes, that would be foolish and ill-advised. However, should the patient agree to share this information, have it independently verified what is wrong with giving them a lower co-payment or discount on their health insurance premium.

Is not the goal to achieve better patient outcomes? Does not everyone win here? The patient obviously wins but so too do the drug and device companies as they will sell more stuff. Payors also win as they won’t be paying for emergency room visits or complications that come from poorly controlled diabetes. The government also wins for the same reasons.

Yet, no one seems to get this. All these efforts at behavior change will need up like Harry the hamster on that wheel to nowhere. Behavior is a good idea unfortunately it just doesn’t work.