Another Day in Paradox: Here’s how we got the public to not hate pharma quite as much

To see what messages would get the public to not hate pharma so much, we’ve been running waves of message testing for the past year. We call it hit screening for messages, and we just finished Wave 3. Here’s how it works.

Just as drug screening involves testing many molecules to see which has the desired impact on a protein target and disease state, so can one test messages to see which ones resonate with an audience. Politicians do this all the time to see how a given phrase or policy idea lands with potential voters. Take a baseline measure of public perception (we use a polling service with access to millions of Americans from all demographics): how much do you blame pharma for your drug costs? How open are you to hearing from us? Show a video. Measure again. Ask what would make you trust us more. Run it on hundreds, then thousands of people. Plot it. Identify the best-performing strains from which to make new videos. Repeat. 

Our third round of data, generated in September, reveals that it’s possible to win people over. The video below walks through how we set up the experiments and which messages had the biggest impact on public opinion. I hope you’ll watch it, but first here’s some relevant context. 

The paradox we’re trying to resolve

The pharmaceutical industry has a serious reputation problem. Yes, we treat and cure diseases and make healthcare better every year. Our medicines go generic, unlike hospitals, and are society’s most cost effective way to help people get better and stay out of hospitals. And yet, we’re so hated that even Massachusetts Senators and Representatives go to Washington with proposals for how to throttle a key part of their home state’s economy. 

Can you imagine what it would take to get Iowa Senators to run on an anti-farmer platform? Texas stumps for oil. Michigan stumps for the car industry. But most of Massachusetts’s elected leaders at the federal level stomp on pharma. Why?

Because that’s what voters want. 

They blame the pharma industry for high drug prices that can make it hard for patients to get access. They also blame them for profiteering, charging the US more than other countries, pushing opioids, repackaging NIH discoveries for profit without doing any work, and for driving unnecessary uptake of all kinds of drugs with annoying DTC ads. Any one person likely believes some subset of all that, if not all of it. 

And with that anger and resentment comes all the encouragement for politicians to come up with policies that will ​“teach pharma a lesson” and put an end to those bad behaviors. That’s where we get proposals like the pill penalty, patent waivers, Most-Favored Nation (MFN), international reference pricing, tariffs on drugs, and proposals to ban DTC ads. 

If you are reading this thinking ​“but those are all good ideas,” please consider reading The Great American Drug Deal or taking Biotech Unveiled. If you recognize how all these policy ideas are flawed and will only gut innovation without actually lowering prices for patients in the US, then keep reading, because you see the problem.

Public anger at the drug industry is encouraging politicians to propose policies that set fire to innovation. And all of us in the innovation ecosystem are both distracted by the fires and obliged to constantly put those fires out. And not all our efforts to avert flawed policy are successful. Historically, drugs have had an average of 14 years on the market before generics functionally put an end to their profitability but in 2022 the IRA slashed that for non-orphan small molecules by allowing Medicare to price control them merely nine years after they launch. Our efforts to avert that policy failed. We have to keep fighting to hopefully someday get the EPIC bill passed which would change nine to 13, the same time that the IRA grants biologics. We might or might not achieve that. In the meantime, anti-pharma lawmakers are pushing for all drugs to get price controlled after nine years or even five years.

We can’t just keep trying to put the fires out. We have to get the public to understand that the affordability issues it’s concerned about are a function of insurance design and to urge for insurance reform, not price controls. To make that case, we need the public to trust pharma. 

It’s like we are battling a disease that causes many terrible symptoms. We can either keep trying to manage the symptoms or we can look instead to the origins of the disease and come up with a way to solve it at its root. And so that’s the essence of the Paradox campaign that we are running, trying to figure out how to engage with and win over the public to see the drug industry more favorably, to trust in us, to be more open to learning more, and to recognize that insurance plays a key role in affordability and that we are aligned with them in wishing to reform insurance and lower out-of-pocket costs.

Every preclinical investment today requires believing that defenders of innovation will avert the worst for at least 20 years, because that’s how long we need for that program to reach the market and generate a return on investment. Considering the current amount of public hatred aimed at the pharma industry and political vitriol, we need more than faith. We need to improve our industry’s standing with the public. 

Once we figure out the messages that work, we’ll switch to promoting those messages widely to see if we can shift public discourse and eventually see politicians change their proposals. The Paradox campaign is an insurance policy for every preclinical program we fund today whose NPV model optimistically presumes stable drug policy until at least 2045. All of us who understand the value of innovation and have a professional and personal stake in it (maybe that’s everyone) therefore have a stake in the success of the Paradox campaign.

I first proposed the Paradox campaign a year ago, here. Now a year on, we have data.

What the data say

The polished commercials our industry already runs, the innovation stories and the ones full of caring employees in lab coats, land in the no-effect zone. Well, almost no-effect – we also see that while industry ads may improve industry favorability, they also increase industry blame for pricing. They consistently fail to answer the question the public is actually asking: ​“Why are your medicines so expensive?”

The videos that broke out – ones that reduced blame and increased openness to pharma messaging – went straight at that question. 

• A scientist frustrated with the insurance companies that stand between the medicine she invented and the patients who need it. (11:58 in webinar)
• A narrator that says the quiet part out loud: pharma does well when you use its drugs; insurance does well when you don’t. (12:53)

Spots like these validated the anger and sought to redirect it. And only then did they make the case for innovation.

We also explored humor, to communicate the injustice of co-pays for people who’ve already paid their premiums. Picture a fire crew asking for your co-pay before they unroll the hose. (16:56)

And more recently we discovered something the original article didn’t predict: sequencing matters. Multiple videos in the right sequence had a bigger effect than any one video. 

If we show an insurance-reframe video first, then a traditional industry spot that performed poorly on its own begins to work. Stack three videos one after another, and agreement with ​“pharma companies are trying to help patients” moves from about 45% to 62%, before any optimization.

See for yourself: Watch the scientist video, then the industry spot that flopped on its own, then see what happens when you run them back to back. (14:20- to 16:20)

But the biggest movement came from adults 65 and older (23:14), the people who take the most medicines, vote most reliably, and anchor every Medicare pricing fight. If you wanted to pick one audience to move first, it would be this one.

With them, our videos reduced industry blame by 14 points. 

The thing nobody had tried

Our industry has run innovation ads for years. It has run insurance-and-PBM ads for years. It has never put them in the same 60 seconds. People have an infinite capacity for hate; they will happily hate insurers and still support price controls. The hard part, as I wrote last year, is getting them to love somebody in the system. And it turns out you start to earn that love by naming the real problem first.

Such message testing isn’t expensive. Most of our videos were prototyped using AI and cost under $1,000 to make (once we have the right messages, it will cost a lot more to promote them widely). But consider that even 1% of our industry’s DTC ad budget would be around $200 million a year, which we think would move the needle by a lot and maybe even condition the public to be more accepting of the usual industry ads that we spend the other 99% on. 

And feedback shows that people can smell AI and would prefer real people. So with more funding and experimentation, we’ll create content with real patients, real inventors, and real companies and promote it at a wide scale, with the goal of making the public both more receptive to industry voices and less receptive to policies that will harm us and the patients we serve.

Last year we asked you to join the campaign. This year we’re asking you to write. This campaign is rooted in storytelling that everyone from startup to pharma, scientist to banker, could contribute to. The lab is open to anyone. Send us a script, a sharp point, or a misconception you keep running into that nobody has answered well. Please note that you agree that your submission is provided voluntarily and without compensation, and that it may be used, adapted, or published publicly. In fact, we might just turn it into a video and put it in the next wave.

Got a great idea? Send it along to stories@​nopatientleftbehind.​org