Building Practitioner Relationships

Meeting with healthcare practitioners on their own “turf” is sure to help facilitate solid relationships and build loyalty.

By Dr. Gina Nick

A detailed understanding of the diverse healthcare practitioner market is necessary for devising the most effective and efficient marketing tactics. After all, healthcare does ac­count for 15% of the Gross National Product (GNP), and is growing at an increasing rate.

A careful analysis of the healthcare professions reveals a remarkable range of interests, talents and philo­sophies. First, there are the mainstream professionals, who are responsible for the care of the greatest number of people and for the astounding scientific progress made in the past century and continuing into the foreseeable future. These include MDs, DOs (Doctor of Osteopathic Medicine) and PhDs. Broken down further, this group also includes researchers, academics, orthodox practitioners and those who are reaching beyond traditional practices. What can be said of all of them is that their foundation is in science, defined by Aristotle as “systematic observation,” and based upon the methodologies of objective science.

These methodologies were established during the Renaissance and are held to this day. They rely on controlled and reproducible experiments, which include the fixation of all but a few variables and the statistical analysis of results to exclude all possible confounding factors and biases, most especially the placebo effect and the desire of participants for positive results. Either one of these influences can skew results by as much as 40%, rendering most results meaningless unless studies are controlled for these effects. There are several problems with this approach. First, it is expensive and time consuming. Secondly, controlling for these effects severely limits the range of interactions that can be studied objectively because it is only possible to deal with only a few variables at a time. Even the sophisticated statistical analyses now available—Kaplan-Meier regressions and analysis of covariance (ANCOVA)—are confounded by multiple variables. This is further encumbered by strict ethical standards requiring review by formal committees for all human experiments. A treatment proved to work cannot be withheld, while studying another treatment. Risks must be commensurate with anticipated benefits. Pregnant women cannot be studied except in the rarest of circumstances. And we need not even mention the army of tort lawyers ready to pounce upon even a hint of error.

Another significant hurdle in reaching this major segment of the healthcare market is arrogance. “Meet our standards or we are not interested,” is the message often conveyed by a majority of highly trained professionals in the medical field. In addition, medical professionals’ time is extremely limited in terms of their time. They do not have time to do all that is required, not only for patient care, but also in terms of keeping up on advances in their own field of expertise. There must be solid reasons for taking their time.

A further impediment to reaching this market is its economic structure and tradition. In contrast to other practitioners, it is considered unethical for physicians to profit from product sales. This is somewhat misty in its application, a fact that may need more emphasis, since there is a “mark-up,” if you will, for products like x-rays and chemotherapeutic drugs as they are “administered” by physicians. However, outright selling of oral products from a practice setting is forbidden.

Nevertheless, in part because of their wisdom and their dedication to service, healthcare practitioners are cautiously looking beyond their comfort zone for anything offering credible promise of benefit. These doctors are also human, and as much as they profess to be objective, they can be reached through other channels.

Examining the Channels

Nurses, physical therapists, occupational therapists and other “in-house” personnel are generally more malleable because they are not at the point of the spear, so to speak, and rely on the doctors both for direction and to absorb the liability. Pharmacists are strict scientists. Their concerns are more focused on issues such as toxicities, bioavailability of products and the risks of adverse drug and nutrient interactions.

Chiropractors, naturopathic doctors (NDs), homeopaths and others considered outside the pale of “orthodoxy” are more comfortable with less rigid evidence and more willing to deal in uncertainty, although you will find that some, particularly the DCs (Chiropractic Doctor), have been pushing hard for decades to be accepted by the orthodox community. In this effort, DCs are also likely to focus more narrowly on their specific area of musculoskeletal disorders, although they have a long tradition of involvement in nutraceuticals and no greater ethical constraints on profiting from them than homeopaths and NDs.

Finally, there are the paramedical practitioners such as massage therapists, who, although finding increasing acceptance from the “orthodox” community, are still considered ancillary and to a large extent superfluous. Only a few of these types of professionals and “in-house” adjuncts can expect to influence physician opinion. In fact, they are most likely to follow leads from their “superiors.”

So, the most direct approach will, in fact, be the most difficult; a strategy that will earn the scientific ear of the physicians and PhDs will bring the others in its wake. This strategy is medical science. Applying it to the nutraceuticals market requires significant changes, however, these changes are compatible with the differences in our “products.” As a general principle, nutraceuticals are as much stronger in the safety arena as they are weaker in the proven efficacy arena. This FDA approved strength is worth millions of dollars and years of time.

There is a way to get the medical community’s attention and it includes a strategy that has been used successfully by “Big Pharma” for decades. Slowly, this strategy is being adopted by large nu­traceutical companies because it promises the best and quickest return on investment. This strategy is known as peer-to-peer discussion groups or Natural Product Advisory Sessions‘ and it works like this: Physicians respected by their peers (perhaps a dozen or so) are invited to a somewhat informal discussion that includes food and wine. A moderator who is also a “thought leader” directs the discussion of a product, a clinical trial or a similar focused theme. The session at once becomes educational and advisory; the physicians (or pharmacists) become part of a select group that breeds loyalty and interest in the product. Because Big Pharma has already set the stage for this approach, it becomes immediately familiar and “orthodox.”

Such a session or series of sessions can be used to address a further barrier to gaining acceptance—the different scales of evaluation for our products. Most physicians are geared toward short-term gains in established conditions. This suits not only human impatience, but also the time scale imposed upon both the economics of FDA approval and the acceptance of new treatments by repeatedly successful clinical trials.

Nutraceuticals address illness from a very different approach—long-term gains through prevention and early intervention. A sea change in physicians’ concept of illness is required. Fortunately, this is happening as a natural result of the amazing success achieved thus far in dealing with acute conditions. The major goals of medicine are now dealing with chronic disease and cancer through prevention and early intervention. It seems our time has come.

It is increasingly being recognized that small gains over long time periods equal major improvements. Natural Product Advisory Sessions can address this topic from several perspectives. A purely educational session would address these simple facts, laying out several approaches to a solution. An advisory session could seek input from the physicians on the best way to demonstrate long-term preventive and health maintaining effects to their satis­faction. The product with the best clinical data could serve as a focus of discussion—How can we improve on our trial protocol? What primary endpoints are most convincing? What data already published can be used to substantiate the effectiveness of this (and other) products? Why are Europeans using so many more of these products than Americans?

Natural Product Advisory Sessions are available now at a very reasonable cost. They could form the vanguard of a new and “orthodox” scientific approach to nutraceuticals that easily extends into more formal courses within colleges and medical schools.

A substantial foundation for utilizing this new approach has recently been built. Medical schools opened their doors to complementary and alternative medicine (CAM) only a few years ago. Today, over half offer CAM courses. Medical schools are affiliated with colleges. There is no reason similar courses with reduced prerequisites could not find their way into un­dergraduate curricula as well. The same scientific approach will appeal to CAM students, who will welcome a firmer foundation in science and feel less alienated from the traditional medical community.

The practicing clinician still attends seminars, still reads the literature and still listens to salespeople (sometimes). A new commitment to “scientific” methodology demonstrated by using Big Pharma techniques is not only newsworthy, but will attract those practitioners seeking further progress in chronic disease and cancer, where prevention and early intervention for long-term gains hold the greatest promise for benefit. Approaching physicians on their own turf will open their ears to our products with, we can hope, an eagerness for this new direction. Acceptance by recognized medical journals, a goal requiring very strict adherence to orthodox medical science, will determine the quality of the new efforts.

It is the great safety of nutraceuticals that will earn approval of their long-term use in the hope, more than the proof, that they will improve long-term health. The peer-to-peer approach, while engaging the medical community anew in nutraceuticals, will not only demonstrate their safety but will also bring them into the fold. No longer outsiders, the barriers of both ignorance and of unwanted side effects can’t help but increase usage.

Computerized, cumulative medical records will eventually resolve the issue of effectiveness, but the time scale is decades. Efforts to establish data collection of the magnitude required to address this question must form a significant segment of the approach to validating our entry into the “orthodox” marketplace. This is an excellent subject for peer-to-peer discussions.

A focused approach on NDs and similar segments of the market can also be accomplished by peer-to-peer Natural Product Advisory Sessions. These will more effectively build on their already congenial foundation by addressing the very latest, innovative new raw materials and formulations. As the nutraceutical industry becomes more and more a part of medical “orthodoxy,” interest will grow and sales will follow.NW