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Pharmaceutical Marketing as Mental Model Architecture

Insight and marketing functions at pharmaceutical companies are increasingly leveraging behavioral science, and this is a good thing. But there is a long way to go before the benefit matches the hype. Here are two problems I see:

1) It’s Hard to Nudge When You Don’t Own the Touchpoints

The hype of behavioral science is partly driven by the success of default effects used in contexts like population health initiatives, where choice architects tinker with some settings and trigger (or nudge) “better” behaviors without requiring any real deliberation by the user. (This is essentially what Richard Thaler won his Nobel Prize for, though in the context of retirement savings).

But unlike the healthcare organizations that run these population health initiatives, pharma marketers don’t own their customers’ choice context (e.g., electronic health record, HCP-patient conversation). They generally can’t create defaults for customers. And they can’t implement most of the nudges available to leaders in healthcare organizations. In short, pharma marketers can’t act directly as choice architects.

Instead, pharma marketers work upstream of choice architects, influencing HCPs and patients, not directly at the moment of choice, but at more amorphous “moments of consideration”. Pharma marketers have to focus upstream in a way that ensures their efforts trickle through to downstream choices that are made in a context they do not control. Pharma marketers are less choice architects than “mental model architects” – influencing, enhancing, and broadening the rich mental models that HCPs and patients bring into their moments of choice.

Mental models are an interrelated set of beliefs, often deeply entrenched, that represent a person’s understanding of how the world works. Mental models are the basis for a person’s predictions about what will happen in the world if they make a change. All mental models are incomplete, and all mental models are inaccurate to some extent.

As "mental model architects” pharma marketers need tools to help them identify and articulate the specific ways in which customers’ mental models may be incomplete or inaccurate.

Conversations about therapy should prompt customer consideration and indeed self-reflection on possible incompleteness or inaccuracies in their mental models. This is a more subtle craft than setting up defaults and other nudges.

2) Biases are the Wrong Unit of Analysis

The second problem emerges when marketers focus their behavioral science lens solely on “bias”. It’s easy to convince ourselves that HCPs have fallen prey to a cognitive illusion and that’s why they don’t prescribe our product. But the reality is that individual biases are rarely the only or even the most significant barrier to behavior change.

The emphasis on biases denies both the richness and incompleteness of the mental models that HCPs and patients bring into their moments of choice. Pharma marketers need to take biases as givens, and then identify and influence customers’ mental models.

For example, an HCP may not see the urgency for a new therapy because their mental model includes an incomplete or fuzzy representation of the therapy’s clinical trials - the HCP may not actually know the breadth of the patient population, or the magnitude of the relative risk reduction, or the quality of the evidence (e.g., head-to-head trial plus real-world evidence). They may not have concrete images or memories of patients who succeeded in the therapy. They may only have vague intuitions about the low likelihood of side effects. They may be unable to picture how they would explain the therapeutic benefit to a patient. And they may underestimate patient interest.

In short, an interconnected, but incomplete, set of intuitions may be the foundation of a mental model that leaves an HCP unimpressed with the opportunity a new therapy presents. If a new therapy really can bring value to patients’ lives, then marketers must help the customer update their mental model. We can reframe key details to make them more concrete, more complete, and more aligned with the true value of the new therapy.

The Role of Mental Model Architecture

How can pharma marketers pivot their role to that of mental model architects, and pivot their task toward influencing stakeholders’ mental models?

There are many rich disciplines within “behavioral science” that can give conceptual and methodological support for these pivots.

There is Cognitive Psychology, arguably the founding field of behavioral science with Daniel Kahneman himself starting his career as a cognitive psychologist. Yes, cognitive psychologists study biases, but they also study memory, attention, learning, skill development, problem-solving, habit formation, and concept formation – the bedrock of mental models.

There are also the applied fields of Human Factors and Naturalistic Decision Making where researchers have been conducting detailed studies of people’s mental models in different contexts for decades.

The behavioral science tools for pharma marketing are different than those for population health, consumer marketing, retirement planning, and digital technology. The tools extend beyond identifying biases and countering them with nudges.

The best marketing plans uncover sources of value. What part of that value is not well represented in your customers’ mental models? How can you influence those mental models? Those are the problems pharma marketers must solve for.

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