Tuesday, 8 April 2014

The Black Death and Public Health

“What more can be said except that the cruelty of heaven (and perhaps in part of humankind as well) was such that between March and July, thanks to the force of the plague and the fear that led the healthy to abandon the sick, more than one hundred thousand people died within the walls of Florence… How many valiant men, lovely ladies and handsome youths whom even Galen, Hippocrates and Aesculapius would have judged to be in perfect health, dined with their family, companions and friends in the morning and then in the evening with their ancestors in the other world?”- Boccaccio, The Decameron.

Look around you. Wherever you’re reading this, whether in the office or on your phone, look at the people around you. Everyone alive and, hopefully, relatively healthy. Now look at 30-60% of them. Imagine them catching a disease, almost out of nowhere, and succumbing to a gruesome death as soon as one day later.

As macabre as this exercise may be, it barely begins to replicate the situation the people of medieval Europe found themselves in when the plague broke out in the mid-fourteenth century. There is almost no modern parallel that can allow us to emphasize with the horrors wrought by the Black Death, because it wasn’t just the disease itself that ran wild over Europe. Fear itself dominated the continent as this mysterious illness swept through and killed an estimated 100 – 125 million people.

That’s almost double the current population of the United Kingdom.

You were probably taught in school that the bubonic plague came to Europe’s shores by rats carrying infected fleas. It turns out that the rats are only part of the story.

During the development of a new train line through London, workers recently discovered a plague pit of bodies that were buried quickly sometime during the 1348 – 1350 outbreak. By studying the DNA of victims claimed by the Black Death and the makeup of the disease itself, two factors were established.

First, the victims were seriously malnourished. This does not only reflect the state of poverty many people in medieval London lived in, but also reflects the poor harvest suffered during an early fourteenth-century drought, coinciding with the childhood of many people who died during the plague. By being malnourished in childhood, the victims were more susceptible to the disease as adults.

Second, the strain of plague found on the victims is identical to the plague still found today (Y. pestis). Yes, if you didn’t know, we can still catch the Black Death, though thankfully modern antibiotics act as a shield protecting us. Click here (http://www.theguardian.com/lifeandstyle/2014/jan/31/i-caught-plague-from-my-cat) to read the story of one man who recently caught the plague from his cat.

According to the World Health Organization, “Streptomycin is the most effective antibiotic against Y. pestis and the drug of choice for treatment of plague, particularly the pneumonic form,” followed by Chloramphenicol, Tetracyclines, Sulfonamides, and Fluoroquinolones such as ciprofloxacin.  (http://www.who.int/csr/resources/publications/plague/whocdscsredc992b.pdf )


The identical nature of the plague helped to confirm several academics’ theory that the plague was not simply transferred via flea bite, but must have reached a pneumonic phase for it to travel so virulently and quickly as the Black Death did back in the Middle Ages.

It’s easy to dismiss the plague as something for historians to consider or as something that seems almost fictional, a disease for a world of magic and witches. But the Black Death is not nearly so far away us as that. For those of us who live and work in London, the recent discoveries serve as a reminder that we walk the same streets as those bodies found in the plague pit. And for everyone else, it reminds us that if we do not ensure that everyone has access to the same nutrition and sanitation security that we all deserve from childhood, then who knows when the next outbreak will spread?
This article was written by Alexandra Zaleski, Research Executive at Branding Science

For more information about the medieval plague, I highly recommend Rosemary Horrox’s book The Black Death, a compilation and translation of firsthand accounts from the fourteenth century.

Thursday, 3 April 2014

Brains, Brands and Sushi: Why Pharma need to focus on the emotive sell.

I read a startling statistic the other day that 95% of Brands launched actually fail.

Even more startling was the statistic that two thirds of drugs launched by the pharmaceutical industry fail to meet market impact expectations. Considering there are set to be 400 new drugs released in the next three years this is slightly worrying. Do the math. That’s around 266 potentially lifesaving drugs that will just fade into market obscurity…

So what on earth is going wrong?

Well, to answer that I guess we need to understand why those 5% of Brands that don’t fail, succeed.

It’s so easy to assume people will buy your product simply because you created it and it’s available.

It is also easy for the pharmaceutical industry to assume that customers will select their product for first line use because it happens to have the best clinical data out there. Wrong again. Let’s consider a scenario in the rheumatoid arthritis market where there is a clear market leader despite the fact that competitors also have comparable and in some cases, superior efficacy data. If we can’t explain a product’s use on rational reasons alone then there must be a less rational component.

And we often tell our pharmaceutical clients not to sell a product.

A product is functional. No-one loves toothpaste. They do, however, love Colgate because it promises to give them whiter teeth and fresher breath. And who wouldn’t want both of these things? This is the power of branding.

To understand why this love for Colgate over toothpaste is happening, let’s examine the brain. Because I don’t know if you are aware of this, but the brain controls everything we do. It’s the source of the majority of our behaviour and even though we are light years away from understanding exactly how it works, we have good enough technology at the moment to hazard a guess as to what might be going on.

You’re obviously objecting to my outlandish claim that you “love” Colgate.

But how outlandish is it really?

Using functional magnetic resonance imaging (fMRI) we can study the correlation between behaviour and increased activity in brain areas. By increased activity, I mean the assumption that more activity requires more energy therefore more oxygen is needed. It’s an indirect measure and requires extensive statistical analysis to make any sort of assumption. But for all intents and purposes, it’s a good place to start brain gazing.

So what’s happening when people view their favourite brands?

A study by Esch et al (2012) showed that the palladium (the part of the brain involved in emotional cognition) was positively correlated with viewing familiar brands. Translation: when we view brands we are familiar with, the emotional processing parts of our brain are activated. Moreover, when we view unfamiliar brands, the areas associated with linguistic encoding are comparably more active. Translation: whilst we use emotions to store and retrieve brand perceptions, we use our rational minds to evaluate novel brands.

What’s the relevance of this for the pharmaceutical industry?

Well, quite simply, customers are not solely evaluating brands on a rational basis. They aren’t weighing up the pros and cons every time they consider Colgate. The same way doctors aren’t weighing up the efficacy data every single time they prescribe treatments for an RA patient. Through positive experiences with the market leader they have developed a strong emotional attachment to the brand. So when it comes to writing a brand on that prescription letter, it is nearly always their favourite, and more importantly, it is rarely thought about.

What does storing brand perceptions in this way offer the individual?

There has long been a theory that brands might actually function as reward stimuli (Schaefer & Rotte, 2006). And when we do look at brand logos, studies have shown that brain activity increases in the essential component of the brain’s Reward Pathway: The striatum. It receives input from the Cerebral cortex and its outputs get fed into the basal ganglia system that is responsible for a variety of behaviours such as routine behaviours or ‘habits’ and cognition and emotions. Therefore, brand logos are enough to elicit a reward response that feeds into our perception of what we feel the brand offers us.

Furthermore, there is less activity in the brain areas associated with rational choice.

So if you are still with me after all this brain talk, then you’ll be starting to realise that perhaps there’s more to branding than simply conveying the overall benefits of a product.

And that engaging customers might be about more than just describing those benefits.

As our associate director, Anthony Rowbottom, likes to say: “If pharma tried to sell sushi they would describe it as cold, dead fish. That’s exactly what it is. But no-one is going to respond positively to that message.”

Pharma must stop thinking about their customers as cold, clinical doctors and stop selling their products as molecules and impersonal data. They need to appeal to the human in the white coat through the real life patient sat in their surgery opposite them, by describing how their product is providing a practical and emotional benefit for them both.

Think about this next time you are brushing your teeth…

This article was written by Sofia Fionda, Research Executive at Branding Science
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