January 31, 2008 
I was having an interesting discussion yesterday about how to solve a problem. The two opinions were whether there is a best answer or whether there are multiple best answers. It’s a great question.
Let’s frame it this way. Is there a message that is most likely to drive compliance for a group? I gave them the benefit of the doubt that they aren’t crazy enough to suggest that one message works generally with no segmentation. (McKinsey‘s article “Getting Patients To Take Their Medication” has some good research around creating segments and showing how some of the segments vary in what they want.)
The other person was presenting a case that they could do lots of research on linguistics and other topics and suggest one optimal message that would work across broad segments of the population. I was of the opposite opinion that a personalized message that had certain core research but varied by geography, condition, age, income, benefit type, prior interactions, etc. was better. And, that what is good today may change both generally and individually over time.
I would rather get all the micro-niches of people to their highest compliance and adherence level versus getting a better average across all group.
Basically, my position is that there are multiple optimal solutions to the problem not just one. It triggered a memory for me of when I first went to business school. In architecture school, design is somewhat subjective. (There are some logical rules such as the Fibonacci Sequence which serve as guiding principles of scale…for example.) We were taught to always bring three solutions to our initial presentations to let the judges decide which one we should push to finalize. We had to pick one for a deliverable, but it was always a tradeoff. In business school and the hard sciences, there is often only one answer that is valid. (1+1 always equals 2.)
But, for communications, marketing, and other things, it seems obvious to me that companies are best served by dynamic flexibility that allows them to bring multiple solutions to the market in parallel that adapt to different patients and change over time to respond to the market and the patient.
Here is a quick snapshot of the segmentation from the McKinsey report…
Enabling Healthy Decisions 
Great article – I agree the McKinsey study illustrates the differences which restrict the success of just one optimal message; because in fact there are as many messages as people, and people change over time.
Jean Lalonde
George,
I think you’re dead on with this one. A major problem of the medical infrastructure is that its messaging is about the same as one sees from the “Say No to Drugs” camp. Mainly, if we tell you to do it, you should automatically trust us and comply.
Meanwhile, in the real world, none of these messages are actually that clear, in so much as individual situations and the medical system’s understanding of conditions are constantly changing.
Zetia’s Enhance results have us questioning the validity of cholesterol as a meaningful metric– making those taking any of the cholesterol lowering medications due to “high cholesterol” (vs. previous coronary event) looking at surety of cost, and individually of side effects, without any real understanding of benefit.
Tailoring messages to meet the needs of individuals is where the system will have to go– it will be interesting to see docs and the healthcare infrastructure adopt to the changing market demands for personalized service.
George, that is a tough question to answer. You would think that telling a patient they are going to have a stroke or die if they do not take their medications would be enough incentive to drive compliance!
I think that tailored messaging is the most valid form of communication, and agree that flexibility and multiple solutions are needed to drive adherence. We have seen a dramatic increased length of therapy within our population with patient and caregiver created reminder messages. But this is obviously driven by the patient/caregiver and does not really answer problem.
Best,
Alex