Last month I enjoyed the opportunity to attend and speak at the European Society of Gynaecology (ESG) 2019 conference in Vienna.
At this year’s conference, a number of topics were covered. These included contraception and fertility, sexuality and ethics, and menopause and endocrinology. Gynaecologists presented conclusions from studies, delegates discussed and debated best practices, and consensus statements were shared on specific therapies. A number of pharmaceutical companies also took the stage to showcase their innovations.
I came away from the conference reflecting on three particular points:
The fear of hormone extends across different areas, e.g., menopause, with women often choosing treatments only to avoid hormonal preparations. This area was surfaced in many of the talks at the conference, for example by Professor Johannes Bitzer of the University of Basel, who used the phrase “Hormonophobia” to describe the phenomenon. He argued that the global media had had a significant role to play in many women disregarding methods with favourable benefit/risk profiles and raised the issue about helping women make more informed decisions regarding their needs.
We have also seen this pattern in much of our research. In our recent 7-country study on contraception, for instance, we found that 40% of women, in the age group 18-60 years, strongly agreed that they were concerned about the effects of hormonal contraceptives on their bodies and minds.
It was also interesting to note the number of innovations presented at the conference with a focus on safety. One particularly intriguing new class of drugs introduced was NEST™, or ‘Native Estrogen acting Selectively in Tissues’.
NESTs™ have some similarities to other classes in terms of their tissue selectivity and, based on data presented at the conference, seem to have a favourable side effect profile compared to other oestrogens. This includes a reduced VTE risk profile, lower breast stimulation and a low risk of drug-drug interactions.
The pharmaceutical company Mithra made presentations at the conference about their compound Estetrol (E4), the first in the NEST™ class. Estretol is the key ingredient in three of Mithra’s products: Estelle®, a 5th generation oral contraceptive, PeriNestaTM, a complete oral treatment for perimenopause and Donesta®, a next generation hormone therapy for VMS in menopause. These products are currently in development, with Estelle® notably having recently successfully finished its Phase III clinical study in Europe and Russia and USA and Canada.
Another company introducing a product in this area was Exeltis who, in 2018, received acceptance from the FDA for the filing of Slinda® a Drospirenone-only oral contraceptive . Drospirenone is a synthetic progestin which is believed to reduce the cardiovascular risk associated with other Combined Hormonal Contraceptives (CHCs). It also is shown to contribute to an improved bleeding profile and shows no decrease in efficacy in the case of a missed pill.
As one of the ‘Opening Lectures’ of the conference, the chief of divisional medicine at University Hospitals Cleveland Medical Center, Sheryl Kingsberg, introduced the topic of female Hypoactive Sexual Desire Disorder (HSDD) labelling this, ‘a significant area of unmet medical need’. This theme prevailed throughout the conference, with other talks discussing the disorder and debating the role of certain therapies for its treatment.
In the talk by Sherly Kingsberg, and during a subsequent symposium led by Rosella Nappi of The University of Pavia, we learned specifically about the RECONNECT study, a programme designed to evaluate the efficacy of bremelanotide (BMT) in the treatment of the disorder among premenopausal women. In this study, women using BMT were shown to have significantly increased scores on FSFI-D vs placebo, indicating an increase in desire, and a significantly reduced score of FSDS-DAO vs placebo, indicating a reduction in distress linked to low desire. BMT was also associated with an increase in secondary outcomes relating to FSFI total score as well as individual domains such as arousal.
This topic of HSDD among postmenopausal women was also discussed widely at the conference, specifically regarding the role of androgen therapy in its treatment. Nick Panay, Secretary General of the International Menopause Society, for example, delivered the first international consensus statement on the use of this therapy in this cohort of patients. This consensus specifically stated that, “Testosterone can be effective at improving sexual wellbeing for postmenopausal women with HSDD” and that, “benefits include improved sexual desire, function and pleasure, together with reduced concerns and distress about sex”.
 Insight Dojo, 7 Country contraception survey, June 2019, n = 719
Author: Daniel Rayner, Senior Associate at Insight Dojo.
We encounter multiple situations in medicine where drugs, therapies or devices are saved as a ‘last resort’ despite the fact that early use could improve patient outcomes. Often, this is not a considered treatment decision, but is instead based on a broader heuristic such as ‘saving the best for last’. One example of this is antibiotics.
Antibiotic resistance is one of the most pressing issues facing the global community. In a recent statement, former UK Chief Medical Officer Sally Davies claimed that antibiotic resistance “could kill humanity before climate change does”. When new antibiotics that can help fight resistance are developed, it is of the upmost importance that they are used in the most appropriate and effective manner. However, fear of resistance often leads physicians to save new antibiotics as a ‘last resort’, vetoing potential opportunities to provide appropriate care by selectively using the drugs earlier.
Our client has developed a pioneering new antibiotic for the treatment of highly resistant hospital infections and came to Insight Dojo for help positioning this product in the European markets. The problem posed was a difficult one – how can we ensure appropriate early use of a drug to improve patient outcomes rather than letting it be saved as a very last resort? Antibiotic treatment decisions occur in situations of low information and high pressure, where doctors are faced with clear and rapid patient deterioration, so solving this problem required an understanding of highly expert decision making.
Components of the solution
Our solution to encourage appropriate early use had four components; elements that we believe are applicable across multiple therapy areas.
Whilst this particular example pertains to antibiotics, the approach we took is not limited to this treatment area. From women’s health to oncology, Insight Dojo have created similar solutions to answer complex problems. In this case, we developed a multi-faceted design using techniques including ‘naturalistic’ qualitative research, quantitative research based on hospital stratification, non-conscious methods, and machine learning. As in all our projects, to ensure that our insights were implemented within the client’s overall business strategy, we carried out cross-functional working and learning sessions with insights managers, brand leads, the medical team, and even the CEO.
Author: Vivek Banerji, Founder of Insight Dojo
(reading time: 5 mins)
Most new products launched fail. Even successful ones build their share over many years. This is a story of a product that became the market leader with an 18% market share within a year. It was based on a strategy underpinned by insights developed through the combinatorial power of ethnography, psychology and machine learning. Furthermore, it grew the market along with another brand by 20%.
For context, the product was a natural treatment for HPV, a viral infection passed through skin-to-skin contact. It is detected at a Pap smear test. Positive tests mean that women have the infection or cervical lesions have begun to form. Women then enter long periods of tests, either ‘waiting and seeing’ or getting treated. For treatment, there are natural products and/or surgery. The license to market the product in the country of interest was acquired from another company.
In this blog, we have summarised certain lessons on insights used for rapid impact. We presented the story at the ESOMAR Congress 2019, and the detailed article can be downloaded from the link below: https://ana.esomar.org/documents/rapid-impact
So what was the secret to such rapid sales and growth?
1. Conviction that insight is central to substantial business impact
The first time we were briefed by the client’s senior team, the country head of business said to us, “Let’s show our partners what a big difference distinctive insights can make to a launch.” That set the tone of the entire project. In subsequent problem solving sessions, the ambitious overarching question was “How do we develop the strategy and tactics to gain market leadership? ” This was based on a hypothesis that women are suffering in this condition without a product that met their unmet need. The framing of the overarching question translated to a searching mindset. This encouraged each team member to actively seek opportunities to add value to the women and physicians throughout the research.
2. Combinatorial power of multiple insights approaches - ethnography, depth interviews, quantitative research, psychology, and machine learning - to develop launch effective actions
Ethnography revealed the extent of anxiety and suffering that the women experienced, and often how they misinterpreted what the doctor said, e.g., the doctor would say “It’s easy to catch” and that would cue, “So it must be easy to pass on?” This was used to develop a tool to improve the doctor–patient conversation. The quantitative research helped us spot a specific group that saw real value in natural treatments. A machine learning algorithm identified the most defining characteristics of such women in a manner that was superior to traditional regression approaches due to certain non-linear patterns in the data. These insights are being used to inform their digital marketing, and to help doctors understand who would value the treatment. One of the important predictors was “locus of control” - a construct related to self-efficacy that the psychologist in our team introduced. The entire launch communication for physicians and patients was based on the insights from the different methods.
Having the same individuals who were adept at business problem solving, and hands-on in multiple technical areas, e.g., moderating ethnography and running machine learning algorithms, accelerated the development of effective insights.
3. Seamless and cross-functional working amongst client and agency members
Every product launch involves decisions to be taken by different internal functions (e.g., marketing, sales, medical, regulatory), and working with supporting agencies. Seamless working makes the process efficient and improves the quality of the decisions. This was the approach adopted for the project. For instance, the client and our team learnt about the new therapy, its mechanism of action, and all the science and evidence, simultaneously rather than the client holding a separate briefing for us. Each problem solving session had members from the marketing, sales, medical team, and the agency members. One of the best indicators of seamlessness in working is when the source of powerful insights and recommended actions could be any member of the client and agency teams. Such was the nature of the collaboration.
4. Women at the heart of the work
The entire strategy and insights plan was conceived to keep the woman at the heart of the work. Both the ethnography and the quantitative research was designed to reveal their journey with the condition, the unmet needs, the emotions they experienced, the different coping mechanisms, and the interactions with healthcare professionals.
5. Courage to selectively use insights to pursue a vision-led strategy
The vision for this product was to serve the women’s unmet need. Whilst we conducted our in-depth interviews with physicians, we learnt there are varied mental models and practices about the condition. It would have been quite tempting to optimise the launch plans and communication to different groups of physicians. Instead, our client decided to take a leadership position and based the entire strategy on what women really wanted. A simple illustration is that physicians were concerned about “abnormal lesions” whilst women were anxious about “freedom from HPV”. The brand was developed around the latter aspect.
Author: Zoé Duhaldeborde, Associate at Insight Dojo
(reading time: 5 mins)
Ideas. Seemingly effortless; yet when prompted for them, we often draw a blank. What many of us don’t realise is that no person creates without inspiration; that an idea is in fact a chance intersection between other ideas and personal knowledge. But how can you increase the likelihood of this chance intersection? The answer is simple: cross-pollinate knowledge and immerse yourself in many disciplines whilst being attentive to yourself and the world around you. Listen to music. Read a book. Expose yourself to other ideas and let yourself be inspired.
In light of this, for personal inspiration, the Insight Dojo team recently visited the ‘In Real Life’ exhibition at the Tate Modern. The exhibition brings together works of art by Olafur Eliasson, who aims to increase viewers’ self-awareness and appreciation for their environment. Eliasson’s specialty is cross-pollination: his work is a perfect fusion of mathematics, science and art. His exhibition prompted three key insights on how to spark ideas.
Towards the start of the exhibition was a small room suspended in darkness. Upon entrance, we were immediately surrounded by musky, damp smells and the sound of rushing water. At one-second intervals, bright-white light would flash, revealing a water fountain in the centre of the room that appeared frozen in time. Interestingly, each flash of light would capture the water falling in a unique conformation; and each unique conformation would look different depending on one’s viewpoint. It occurred to us that this artwork may represent the nature of ideas. Specifically, the flashes of light may symbolise the spontaneity of ideas. The afterimage of the fountain once each flash of light ended may represent the lasting impact of good ideas. And, most importantly, the infinitely unique conformations of falling water may symbolise that to spark original ideas, we must shift our perspectives and see things differently.
Big Bang Fountain, 2014, Tate Modern, London.
But what does it mean to shift perspectives? Shifting perspectives involves not only understanding another point of view but embracing it as your own. It follows whilst we can shift perspectives using our imaginations, physical experiences catalyse the process by allowing us to take direct ownership of a viewpoint. For example, we may easily imagine what the Big Bang Fountain looks like from across the room. However, physically moving to that standpoint, we can engage directly in a new sensory experience and view things from a new perspective. Visceral experiences like this broaden our personal knowledge, which is in turn essential for sparking ideas.
Later in the exhibition, we entered a vast room. Projected onto a wall were our shadows: numerous, overlapping and colourful. Interestingly, when stood within certain proximities of one another, we noticed our shadows would intersect to become a different colour; but when stood alone, this could not occur. In a similar way, we realised that to spark a unique idea, we must collaborate with others, as this increases the likelihood of knowledge and creativity intersecting to yield insight. Furthermore, collaboration must be so seamless that we assume a collective group identity, allowing us to internalise and develop our teammates’ ideas.
Your uncertain shadow (colour), 2010, Studio Olafur Eliasson.
Towards the end of the exhibition was an expansive pin-wall collaged with thought-provoking texts, data and images. One section of the wall, for example, showcased visual data on climate change, whilst another section explored the nature of emotions. Strikingly, visitors were captivated by this wall, as it presented unfamiliar perspectives and bold ideas. To help provoke thought within the Insight Dojo team, could we do something similar? In subsequent discussions, we decided to introduce our own pin-wall that would span our office and surround us with ideas that have influence us. Inspired by Eliasson, we would decorate this wall with visual content that was interesting or meaningful to each team member in the hope of inspiring creativity, encouraging cross-pollination and promoting originality.
Pin-wall, Tate Modern, London.
A concluding note
Ideas are certainly spontaneous; but they don’t come from thin air. By shifting our perspectives, pooling shared knowledge and cross-pollinating ideas, we can inspire our own insights. In the words of Anais Lin: “my ideas usually come not at my desk writing, but in the midst of living”.
(reading time: 3 mins)
Which of these four dresses is the best quality? Please choose one, before reading on.
How did you decide? What was your mental process? How well do you think you could explain how your brain came to that decision?
If we were asking this question to respondents in a market research study, one might reasonably expect to obtain more or less the same number of people choosing each dress, since they are all identical. However when Richard Nisbett & Timothy Wilson conducted this experiment in the 1970s, the results were quite different - they found a systematic tendency to choose the rightmost dress.
What was even more surprising was that when they were asked, participants denied that the position of the dress had influenced their decision. Instead people cited impossible reasons for their choices, such as the quality of the garment.
Nisbett and Wilson took this as strong evidence to support their theory that ‘there may be little or no direct introspective access to higher order cognitive processes’. In other words that we are unable to tell how our own minds make decisions.
Although this experiment has received criticism (c.f. Newell & Shanks, 2014), it has been widely influential in the fields of psychology and market research. Nisbett & Wilson’s research forms the starting point for much of what is known today about whether we can access the underlying mental processes that guide our behaviour.
For marketers wanting to understand consumer behaviour, this research presents a well-known problem, illustrated by David Ogilvy’s quote: “The trouble with market research is that people don't think what they feel, don't say what they think and don't do what they say". Given the limitations of self-report measures such as interviews and questionnaires, what can researchers do to improve the quality of insight?
In addition to traditional market research techniques, there is now a diverse array of alternative methods available such as neuroimaging and implicit testing. Research designs that use a combination of tried and trusted methods, together with these newer techniques, can be highly effective.
Insight Dojo is pioneering the use of a new methodology called mouse tracking. This method involves recording consenting participants’ mouse movements as they choose between an array of options on a screen. By measuring differences in the ‘trajectories’ of mouse movement, we can gain an understanding of underlying mental processes and latent biases. This allows us to gain a deeper layer of understanding about consumer behaviour.
The MouseTracker (Freeman & Ambady, 2010) is at the forefront of a shift in cognitive psychology from the use of outcome-based measures such as reaction time, towards approaches that measure ‘response dynamics’. Thought does not occur in discrete steps, but as a mixture of grey areas that compete and coalesce, and update, right until the final behaviour occurs (for more, see ‘The Continuity of Mind’ by Michael Spivey, 2008). The data provided by the MouseTracker gives a window into these grey areas.
At Insight Dojo, we have found that the MouseTracker can add incremental value to our research, without disrupting tried and trusted methods. Much of the value comes from using it in the context of information provided by traditional market research methods. Including MouseTracker tasks in our qualitative research has given us richer insight in three key business areas: segmenting customers, identifying the competitive set for a product, and determining the latent motivations and barriers for a product's adoption.
We will be presenting our work on developing the commercial use of the MouseTracker at the ESOMAR Fusion conference in Dublin, in November 2018. Come and find out how it has influenced the strategy for a Europe-wide product launch, and how it is improving the value of the work we do – without breaking any eggs.
Insight Dojo will be introducing the MouseTracker at ESOMAR Fusion 2018 in Dublin this November.
For more about ESOMAR Fusion 2018: https://www.esomar.org/events/2018/fusion-2018/fusion-2018-programme#date20181115
Freeman, J. B., & Ambady, N. (2010). MouseTracker: Software for studying real-time mental processing using a computer mouse-tracking method. Behavior Research Methods, 42(1), 226-241.
Newell, B. R., & Shanks, D. R. (2014). Unconscious influences on decision making: A critical review. Behavioral and Brain Sciences, 37(1), 1-19.
Nisbett, R. E., & Wilson, T. D. (1977). Telling more than we can know: Verbal reports on mental processes. Psychological review, 84(3), 231.
Spivey, M. (2008). The Continuity of Mind. Oxford: Oxford University Press.
The subjective nature of reality
On 18th January 2017, newly inaugurated US President Donald Trump blasted news channel NBC for claiming that the returning of jobs to the US by large companies including Ford and Lockheed Martin was nothing to do with his election. Trump disputed this, branding NBC’s report as “Fake News”. However, a wealth of industry evidence suggested that the job return was set in motion long before Trump’s presidency. Whilst many attribute Mr Trump’s behaviour to a brash attempt to boost his own appeal, these “Fake News” claims may in fact represent a more interesting aspect of psychology.
We encounter vast amounts of complex, unstructured information, and making coherent sense of this can be extremely difficult. As a result, we construct small-scale, simplified representations of reality called ‘mental models’. According to Morgan et al. (2002), mental models are “personal, internal representations of the world, which individuals use to reason, make decisions and guide behaviour”. Our mental models can be a confusing mix of legitimate, biased and even completely incorrect concepts, and vary a lot based on our social contexts.
The year is coming to an end, and we’ve been reviewing the ideas that influenced us in 2015. One of the more profound experiences was applying the framework of posttraumatic growth to help healthcare companies design patient support programmes, and presenting our work at the ESOMAR Global Qualitative conference in Paris. What made the experience poignant was that the conference took place in the immediate wake of the terror attack in Paris. The attendees were deeply affected by that traumatic event, and the ideas expressed seemed to have broader relevance. This is a shorter version of our ESOMAR article, the link of which is given at the end of the blog along with other references.
Our inspiration for the work was an ex-colleague and friend, Jennifer Goodman Linn, who died of a rare form of cancer four years ago. One of the things that was remarkable about her story was the complete transformation that she went through during her illness. With her husband, David, she started a movement called “cycle for survival” that raised over 75 million dollars for cancer research in the last few years. She also started a motivational training company called “You Fearless” through which she inspired many individuals and groups to overcome their fears and accomplish more. This is an exceptional example of posttraumatic growth.
THE IDEA OF POSTTRAUMATIC GROWTH
The idea of posttraumatic growth is relatively new in the field of positive psychology. According to Tedeschi and Calhoun, who coined the term, “Posttraumatic growth is the experience of positive changes that occur as a result of the struggle with highly challenging life crises.” A lot of research on this topic has been done in the context of events that lead to trauma such as a terror attack, the death of a relative, the divorce of parents, a brutal attack or an illness.Our attempt was to use that general construct to shed light on the possible path to transformation of patients with chronic pain.
APPLICATION TO CHRONIC PAIN
Chronic pain is a traumatic event. The onset often comes as a surprise. The diagnosis is difficult involving patients visiting many doctors without getting clarity about their condition, and feeling misunderstood. The pain is ever present and alters daily activities resulting huge emotional and psychological impact. To exacerbate things further, the side effects of pain relief medication can be really strong.
To understand the experience of pain as a trauma, and the facilitators and barriers for the growth journey for chronic pain sufferers, we conducted ethnographic work in the UK, Spain, Germany and Italy. We supported our primary qualitative work by desk research of academic literature.
THE PROCESS OF GROWTH
There are many intricate details about the process of growth in the literature, but certain aspects that were particularly salient for us are given below:
The following quote from an interviewee in our research, a classical dancer, brings these points to life, “For a classical dancer, the most awful scenario would be not to be able to move as you did before. That was my nightmare and that’s what I had to deal with... I started realizing that I thought I was my wits, I thought I was my physicality…And, all of that kind of left. I had to find my essence. Who was I then? What was my essence if I couldn’t count on those two things? I hadn’t realized that I depended on those two things…I realized that my essence was deeper. Slowly and surely I became grateful.“
In general, growth manifests itself in a variety of ways – better relationships, new careers, a feeling of greater empowerment, but at the heart of it is a connection to a deeper sense of purpose and the prioritisation of one’s life accordingly. For instance, the classical dancer went through an internal transformation, and found that her purpose was to be a positive catalyst in other people’s lives.
We found certain common facilitators of growth that helped us identify ways to strengthen existing patient support programmes.
HOW HEALTHCARE COMPANIES CAN DESIGN BETTER PATIENT PROGRAMMES
Five themes to improve the design of patient support programmes emerged from our exploratory work. By systematically including these aspects, healthcare companies can enable better emotional coping, and tap into the latent potential of patients to grow.
We will continue to work on posttraumatic growth and more broadly on patient-centricity for healthcare organisations, and would be happy to collaborate with people who are interested.
We hope 2016 is fantastic for you.
Happy New Year!
Last year, I was conducting a patient immersion session with a client team. The videos from the ethnographic work portrayed the suffering of the patients, and the extent to which their lives had been disrupted by their health condition. Most members of the cross-functional team were completely absorbed in the experience, and were feeling a little low. All of a sudden, a member from the marketing team beamed at the entire group and said, “Our target segments are happy, confident and optimistic“ as if he wasn’t seeing what was transpiring right in front of his eyes. In his mind, the segments described in a black and white manner in the original presentation, were frozen. It occurred to me that in marketing we are often guilty of such behaviour where we get stuck on a framework, technique, or concept that blocks us from getting real insight, and this can lead our business in the wrong direction especially in a world that is rapidly changing. Conversely, when we can be truly mindful in the way we approach insights, our capacity to observe, empathise, and ultimately understand people heightens dramatically. We are on a path to discovering something new, and we develop products and experiences that satisfy a genuine need.
So how can we become mindful, and be sensitive to what is actually happening? How do we ensure that our actions are grounded in true insight? This requires constant practice. Given below are five ideas that I have found helpful:
When the speakers' guidelines begin with "you cannot bore or offend the paying audience" and "you can speak without slides", one can expect the the conference to be different from the usual. We are delighted to have been invited to the IIeX 2015 in Amsterdam where we'll speak about the role of art, mindfulness and positive psychology in making insights more human and innovation engaging. Please follow the link (http://iiex-eu.insightinnovation.org/) and read the synopsis for more details. The event features new thinking in the insights industry, and we're looking forward to sharing our ideas and learning about the latest developments in a range of topics - cognitive neuroscience and behavioural economics applications, social networks, the emergence of new technologies, big data and others. The format is highly interactive. We are hoping to see many of you there.
What is the essence of Insight Dojo?
It is the art of insight development for change. What drives people to change is a big topic, and needs to be addressed separately. In this blog, I will write about the practice of insight development as an art, and why it matters.
Picasso's Bull has been in the news in the last two months after The New York Times carried an article on how Apple uses it to teach design. Interestingly, the birth of Insight Dojo was inspired by the same work of art early last year. The actual idea of the company had been building up slowly over a decade. Yet, revisiting Picasso’s abstraction gave me the epiphany that insight development is an art - my art, and that realisation compelled me to create Insight Dojo.