Delivering new insights for product managers by studying the patient's symptom presentation: by assessing the patient's presentation of symptoms in the physician's office, product managers can gather fact-based background information that can provide answers to questions arising during the product lifecycle, which will ultimately lead to successful pharmaceutical marketing.

Product managers searching for information and insights in product development and marketing planning are increasingly turning to a pharmaceutical marketing research method, called patient experience or treatment mapping, as a key source of "fact-based" background information. By using this method, product managers can gain key insights and depth of understanding that is needed for nearly any type of marketing research initiative.

Product managers use primary marketing research during the various stages of the product lifecycle to answer specific questions (Table I) such as:

* Does the product fill a niche?

* How will this product be used and will it change the way physicians treat patients?

* Who is likely to prescribe and be prescribed the drug?

* How can the product message best be communicated?

For each of these marketing research initiatives, a product manager can take three approaches: (1) The product manager can enter into the process without preconceived ideas or biases (pure exploratory research), (2) he or she can start the process with a well-defined set of a priori assumptions with the goal of validating or invalidating each initiative (confirmatory research), or (3) the product manager can begin with a deep understanding of the market from the perspective of the target audience and use this knowledge to guide the marketing research process. Of these approaches, only the third provides a focus and balance between the most actionable results and the most efficient use of resources.

The product manager who does not have years of category experience must vehemently research and understand the target audience. Even the most experienced product manager must be vigilant for changing attitudes, perceptions, and treatment approaches in medical categories. Mapping the patient's presentation of symptoms can quickly bring new product managers up to speed, and allow experienced managers to gain insight into how specific market events have changed the overall mindset of providers and patients.

Defining the Starting Path in the Patient Experience Map

A key objective in most marketing research initiatives involves understanding how physicians treat different patient "types" and how (or if) these should be addressed in developing marketing materials. Mapping research is no exception. If it is not clear where a particular treatment path should be started, it will be difficult to determine where to go. Therefore, much time is spent in the early part of the mapping research discussing patient origin, diagnoses, and treatment initiation.

An example of the merits of this approach is found in understanding how physicians categorize patients. Many clinical trials and other research initiatives are built around the concept that patients will have mild, moderate, and severe forms of any given condition. As such, in most marketing research interviews and surveys, physicians are often asked, "How do you treat your mild patients?" but are not provided the actual definition of "mild" or how severity is determined. Does the term refer to symptom severity? Extent of condition? Previous therapies? Comorbid conditions? Treatment history and response?

More importantly, do these categories drive prescribing? In conducting mapping studies, physicians, when asked about these categories of patients, often present a "chicken-and-egg" paradox. Not only do such categories as "mild" or "moderate" have little clinical meaning, but they are often defined based on the treatments prescribed. The following dialogue illustrates this point:

Moderator: "Doctor, how do you treat mild and severe patients?"

Physician: "I treat mild patients with a nonsteroidal anti-inflammatory drug and severe patients with a disease modifier."

Moderator: "What are the key differences between mild and severe patients?"

Physician: "Mild patients only require a nonsteroidal anti-inflammatory drug, but severe patients require a disease modifier."

Without identifying which actionable and meaningful categories exist, it is difficult to know where to begin mapping patients' treatment pathway. However, a distinction exists between naturalistic versus artificial categorization. In the seminal book, Women, Fire and Other Dangerous Things, author George Lakoff argues that all human beings are hardwired to categorize items in their environment. These categories are organized into archetypes, so when one thinks of the category, he or she has readily-established rules and assumptions about members of the category. For example, when thinking of a chair, one pictures four legs, a raised seat and a back. An object that fits these rules can be called a chair. However, if this object has no back, it is a stool.

Forming cognitive categories simplifies and expands the processing capabilities of the mind and allows individuals to achieve higher-order thought. However, how one categorizes his or her environment is highly individualized and is often based on everyday experiences. An advantage of mapping is that product managers can understand how physicians categorize patients in meaningful ways that affect their behavior, rather than having them react to categories that may be understandable but become artificial in their daily practice and do not drive their actual prescribing decisions.

Cartography 101

The mapping methodology is often divided into at least two phases of research: (1) exploration and (2) validation (Table II). Each phase involves individual in-depth interviews. Phase 1 is a bottom-up exploration of the market and market dynamics that affect the decisions of the target audience. Phase 2 validates the findings from phase 1 using a top-down approach to critiquing the outlined maps.

In exploring the treatment of patients with a specific condition, phase 1 is used to gain insight into several key objectives: What language do physicians use when talking about the condition, their patients, and the treatment options? What is the treatment progression from early symptom appearance, through condition remission or resolution? What meaningful differences exist among groups of patients, given different treatment paths? Where do clinical experience and established treatment guidelines cross? What is the interaction among members of the treatment team (including referral practices)?

During the phase 1 interviews, physicians' comments are outlined on a poster board, and each physician builds his or her own treatment map. It provides both the physician and moderator a means of reacting to various aspects of the map as it is being developed, and is further useful in the validation of the information provided.

The validation of physicians' maps involves two techniques. The first is to have physicians compare the map that they have generated with the records of actual patients. Using the poster board map, specific patients can be traced through the map from origination (acquisition and diagnosis) through resolution (treatment). Physicians can compare what they do "in theory" with what they do "in practice," by reading patient charts and recording the history of treatment from the first presentation to current status. This method for validating each physician's treatment map also provides a means of identifying "exceptions" and alternative treatment paths. Given time constraints, this validation can begin late in phase 1, but is often continued and expanded in phase 2.

In phase 2, the phase 1 data are synthesized into composite treatment maps and shown to physicians during a second round of interviews to provide a top-down validation of the data. Physicians are "walked through" the synthesized maps developed in phase 1 and are asked to critique and alter the maps based on their own experience. Between interviews, maps are refined, so that by the end of the process, the treatment map has been finalized.

Exploring the Map

Once the treatment map has been validated, research can proceed in a number of directions. The two most common follow-up phases involve determining the placement of a new product entry and sizing of the market. The advantage of waiting for a third phase before addressing either of these issues is that by the time respondents are shown the treatment maps in this phase, the maps have been validated by their peers and much more time can be spent on in-depth, insight discussion rather than on refining the maps.

When investigating the affect of a new product entry, respondents are "walked through" the finalized treatment map and are asked to comment on its accuracy. As the treatment map has already gone through a validation phase, corrections typically involve exceptions and special circumstances. Respondents are then shown a product profile and asked to address benefits, concerns, or areas to be clarified. Respondents are further asked to place the product in the treatment map with the moderator probing as to the reasons for the particular placement, affect on competitive agents, as well as reasons for not placing the product earlier, later, or in alternative branches of the map.

Sizing the Map