Driving Influences for Change in Prescribing Practices: High vs. Low Threshold Speakers

In the world of pharmaceutical marketing, the job of a speaker is to influence healthcare professionals (HCPs) to make the right decisions on behalf of their patients. Yet great medical treatments don’t always advance because it’s right or because the advantages are obvious. It is because of an HCP’s threshold for change—not because of their beliefs, but how willing they are to go against the grain and drive new trends.

Here, I want to explore how these concepts play a role in the efforts of a product leader and how we can more effectively influence change when working with key opinion leaders (KOLs) or HCPs that have either low- or high-threshold personalities.

Speakers, KOLs, and clinicians come in all shapes and sizes, including low- versus high-threshold individuals. Credit goes to Malcolm Gladwell for helping me to better understand and build on these concepts for pharma. In the simplest sense, a high-threshold personality is more likely to let a crowd dictate his behavior whereas a low-threshold personality makes choices based on less influence by others.

HCPs are no different than speakers. I’ve worked with many doctors who were unwilling to adjust their own prescribing habits that might benefit their patients. Data have shown that even when there were clearly better methods available, they still wouldn’t consider them. Once, I was in the midst of a conversation between a KOL and a clinician discussing a newer medication for cardiovascular disease. The clinician was using a long available medication that, historically, had never shown long-term advantages for patients; however, a more recently approved and proven therapy had shown a revolutionary cardiovascular advantage for patients in a head-to-head trial.

The KOL challenged this clinician on his methods and it led to the clinician later confiding in me that he never wanted to speak to that man again. While the situation was uncomfortable, it was a lesson for me on 2 possible paths for physicians: the use of older medicines with less benefit and minimal side effects, or the use of newer medicines with significant benefits but less available long-term data. Conviction on one side spurned a feeling of disrespect and humiliation on the other. That clinician was low threshold—the type that’s not so easily influenced by others.

Another example of a low-threshold personality is my father, Bob Rehal, who continues to work as a pharmacist now for 63 years. At age 87, each day, like clockwork, he still drives himself to work. Growing up, I watched and admired him as I learned during our dinnertime conversations that this son of immigrants had blazed his own trail through college, pharmacy school, the army, as an entrepreneur, husband, and father.

For him, it really didn’t matter that the economy wasn’t good in the 1970s, he knew that there were customers to serve so he opened yet another pharmacy in the new community of Indian Hills in Sioux City, IA. Some thought he was crazy to do this in a dragging economy with interest rates at 18% to 20%, but he remained true to his vision for his life, his business, and his family. “When we opened the doors in the fall of 1977, there was a snowstorm; it was a bad day,” my dad recalled.

By age 80, in 2012, he closed that store—and another—combining those businesses. Yet it didn’t matter if others thought he was foolish, he just didn’t let others dictate how he did things. He followed his vision because he has a low threshold for being influenced by others. Now at age 87, he’s reaping the rewards of keeping his commitments, going the way of his own vision, and is one of the happiest people I know. I still want to be like him when I grow up.

Think about those individuals who speak on behalf of your products. Speaker dinner programs are likely a part of your tactical plan. Speaker programs have been a staple of the pharmaceutical and biotech industries for decades because they provide a forum for peers to connect with other peers in a social environment that leads to greater understanding of a therapeutic area.

High-threshold speakers tend to be more coachable and follow brand messaging. As a product manager or brand director, these are the individuals you may enjoy who are coachable within limits. As long as it falls within their beliefs, they’ll typically make changes and listen to your direction. But because they are rule followers, it can be seen as less authentic and more like they are acting as an agent of the organization—so it takes more time for attendees to build trust in them. This leads to them being less influential to others because their authenticity can be questioned. These speakers are usually really enjoyable; they’re very accommodating and rarely challenge what needs to be done. They aren’t the squeaky wheels.

Low-threshold speakers, however, are less influenced by what others think. They typically have strong visions and will follow their vision even when it’s not necessarily the cool thing to do. Since they don’t always follow the rules, they are viewed as more authentic agents by their peers and tend to have greater influence over decision making. They aren’t afraid to express their convictions. They usually get good results.

Pharma product managers and brand directors working with speakers tend to work best with one type or the other. It’s important to remember that there is a place for both types of speakers. We certainly need those who will follow the rules, yet we want and need authenticity to lead others. Personally, low-threshold speakers were always my favorites because I enjoy working with strong and talented individuals who will help get to the best version of what we seek. Then again, maybe it’s just because I love my dad.