Muzeable Thinking

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Data, demand and influence – empowering people to manage their healthcare

Posted by on Nov 16th, 2016 in muzeable thinking | 0 comments

Muzeable Thinking No. 19 – posted by Tim Brooks 14th July 2016

A brief piece written with Kath Ludlow at Legend Engage on a subject we both feel passionately about. We also think we can help provide a few solutions.


As the world of advertising and advocacy continues to change, certain markets and categories are potentially changing exponentially. The grit in the oyster is clearly technology, or perhaps more accurately the data it generates. We are witnessing rapid changes in attitudes and behaviour – driven by, or better understood through, technology and big data.

One such market is healthcare. People have a growing expectation that they will stay well and healthy through an ability to treat minor conditions and increasingly a belief that medicine will deal with their more serious illnesses. But, businesses and health systems are still not maximising the opportunity to support the ambition.

Here at Legend Engage, we are always seeking fresh insights into consumer attitudes to healthcare and were particularly struck this month with this paper from Kantar Health, Edge of Insight: Health Activators – key influencers who drive healthcare decisions.

Here were our key outtakes…

Simply put, the paper focuses on how people make healthcare decisions now and the role of information and influence. The group at the heart of Kantar Health’s thesis are called Healthcare Activators… a cross-generational group that want to be proactive; feel the ‘system’ is about ‘sick care’ not healthcare; and their interactions with it are too rushed and lack a preventive, long-term angle. They want to do more but lack the knowledge [and face too much information] to make some of the decisions they need or want, to make.

This is clearly part of a much broader issue. The healthcare system is under immense pressure – driven by increasing demand [ageing populations et al] and finite resources. Kantar Health’s Health Activators are, in part, a reflection of this.

These issues are not going to go away – and in our role as an agency creating insights and marketing solutions for healthcare and pharmaceutical brands, we, also, cannot ignore them or underplay them when creating solutions or presenting insights findings.

To our mind, there are two fundamental components that current solutions fail to give enough weight to:

  1. We need to spend much more of our collective energy thinking about demand versus supply and how we can innovate to meet demand in a different manner. We will not solve the resource issues through operational efficiency alonebut we can massively alleviate them if we use behavioural understanding to change the relationship between people and the healthcare system. This could mean more information sources, more directed self-care, more focus on prevention, multiple points of support, deeper levels of personalisation [via wearable tech for example], more people-centred solutions and so on. Health Activators are an early-adopter group in this equation.
  2. We need to shift from paternalism to empowerment – and this will require a change in attitudes and treatment methods (professionals) and expectations (patients). This change will be challenging, but without enabling more responsibility for self-care – even within serious conditions – the system will eventually reach a state of atrophy.

Obviously, the solutions closest to our heart – and, to our mind, some of the least challenging to implement, involve digital ad social media.  A future-facing approach to data -including social media – is what’s needed to start to set the wheels in motion for change.

There is an ongoing – and in some cases important – debate about the ability of some social channels to deliver effective marketing campaigns. Butwhat we should stop debating is the ability of the data and its robust analysis to build a powerful engine to drive insight, understand influence and behaviour and inform strategy.

This is not theory – this is how we deliver deeper, smarter more actionable insights day in, day out for our clients. We:

  1. Understand a lot about what, how and why people behaviour the way they do without asking them artificial ‘research questions’. We can map how influence and behaviour work – in the real world, often in real time, to deliver actionable insight.
  2. Map demand – in a mechanistic sense, but also in an emotional sense. This can be used to build simple models and ‘experiments’ to change behaviour. Forget the rhetoric of ‘likes’ etc. Nudge and social/digital are a marriage made in heaven.
  3. Interrogate data sets – by expertly mashing together, bespoke, multiple data sets we can create unique actionable data points. This is the future.
  4. Act within regulations to get closer to people than ever before. We use highly anonymised data analysis to understand the world and create tightly targeted interactions in the form of campaigns and communication programmes that deliver industry-beating results.

Mapping and analysis to drive insight and understanding of behaviour and influence is available NOW – yet many healthcare and pharmaceutical companies and systems seem stuck in the headlights of change. The data’s there and people are sharing more than ever before, especially when it comes to their health – isn’t it time that brands started to listen and act?

Paternalism and the myth of homo-pharmaceuticus: why the ASA ruling on Nurofen is not very people-centred.

Posted by on Jul 14th, 2016 in muzeable thinking | 0 comments

Muzeable Thinking No. 18 – posted by Tim Brooks 14th July 2016


Paternalism and the myth of homo-pharmaceuticus: why the ASA ruling on Nurofen is not very people-centred.

By Tim Brooks and David Gray

The ASA’s ruling on Nurofen advertising is a setback for Nurofen/Reckitt Benckiser. It is also a fundamental body blow to the OTC industry. Now, and in the medium/long term.

But, the real denouement is that it is actually a small retrograde step in the broader approach to one of the bigger problems facing the world – the funding/management of our healthcare system. Against this issue a vibrant and effective self-medication market is not just ‘nice to have’ it’s ESSENTIAL.

And whilst the importance of the success or otherwise of a large pain brand is of no material importance, this broader issue really matters.


We are, and will continue to be, on the edge of a crisis. The developed world is caught between the rock of aging populations/technological healthcare advances and the hard place of finite resources.

In the UK prescription drug use continues to grow and service use – often unnecessary if you even take a cursory look at GP visits/A&E admissions data – is growing rapidly.

The system is run and organised by administrators, academics and healthcare professionals. They are almost blindly focused on their ‘day job’ – the supply side of the equation; efficiency, service delivery, resource management etc. We need to focus more resources on DEMAND.

For demand, we must continue to explore ‘nudge’ and service design, but in reality there is actually only one solution. A vibrant, effective and commercially attractive self-care market where manufacturers, brands and retailers/own label, are able to use unpleasant things like marketing and advertising to help people feel confident, empowered and better able to treat themselves.

We are fully aware that Nurofen’s marketing employs some smoke and mirrors in that they have a generic ingredient and they are presenting it to create a sense of difference. So, what?

We are not aware of any fundamental lies they tell in their presentation of the basic data around the performance of their product in specific pain situations. Both the MHRA and PAGB approved their approach. It is a perfectly good painkiller for joint/back pain. Its mode of action will [admittedly among other things] involve it basically treating the pain at its site.

For the record, we totally believe in regulation. We need it. The consumer needs it. Markets need it. But our approach to regulating medicine in the self-medication space is misguided.

It is driven by paternalism and an inherent belief that pharmaceutical companies don’t quite have our interests at heart. It [and most HCPs/regulators we’ve listened to/met] naively [stupidly!] believe that the route to solving the problem is information/education and a world filled with generic ingredients. A world where everyone knows what guaifenesin is. The myth of HOMO PHARMACEUTICUS is alive and well. The rational goes like this. ‘Surely if we present rational/technical data and choices to people they will make the right decisions.’ And pigs will fly. Just read any behavioural economics work of note – even if you choose not to fully believe that it is the answer to all our ills – and this approach disappears in a puff of smoke.

We don’t know who brought the complaints – a paltry 18 loud voices – not even worthy of the title ‘minority’. But it is almost certainly either HCPs or a scientifically minded ‘experts’ who understand the mode of action of an NSAID. Lucky them. They clearly feel that the average unscientific persons on the Clapham Omnibus need to be educated to see the error of their ignorance. It’s critical they are able to understand and make a rational, considered choice based on the data and act in their interests to buy the cheapest generic ibuprofen they can. Maybe…

The myth of homo-pharmaceuticus, like the myth of homo-economicis, is just that – a myth. People just don’t – and never will – work like this. And neither do they need to. It adds no value to our complicated, full to over-flowing lives.

Between us we have been involved in millions of pounds of research with real people in the area of self-medication. We have read and seen 100s millions £££ more of such data. Much of it is robust, insightful and relevant. This data is as useful in shaping our approach to healthcare as is any clinical trial. Yet, we ignore it.

So, for the record. Three fundamental things drive people’s self-selection of medical products selection in store.

  1. What symptoms [not ‘indications’] is it for?
  2. What benefit does it deliver? [What can I expect it to do for me?]
  3. Branding. Interestingly, even if someone buys own label/generic they use brands to navigate, to find things and to make choices. The decision to buy own label is almost entirely made before someone gets to the store.

Price and format and pack size are obviously important, but these three are key. All the extensive research we have seen highlights that ‘segmentation’ – targeting products at specific needs [e.g. specific products for headache or joint/back ache] is REALLY helpful to people who don’t understand or want, even need, to understand the technical attributes of an ‘ingredient’ [safety information notwithstanding]. HCPs can get as frustrated as they like about the logic gap in this…but, it’s behavioural and therefore they are wasting their breath.

So, the people centric, if not the clinical data, would on balance support the Nurofen approach. And again, given the way the OTC market works, own-label products are able to copy this and create a value/price alternative for people with the same segmentation. So the only ‘advantage’ a brand has is that it invests in advertising the product [a choice with risk, not an unfair advantage.] And against our need to drive the demand side of the healthcare conundrum if we make advertising of OTCs more and more unattractive the holistic situation can only get worse, not better. That’s ultimately a problem for all of us.

Further, we are seriously struggling to see how the person buying Nurofen Joint and Back is misled in a meaningful way by this advertising? The product is as good a treatment as there is available for their problem. Buying own label ibuprofen will not increase their comfort – given the placebo effect of branding it might even lessen it! They certainly wouldn’t be harmed. If manufacturers charge dramatically different prices for the same product it is a different debate. But not specifically an advertising one. Even here, brands will [rightly] get caught out in the long run if they do these things.

Conclusion. This ruling is a retrograde step. It has huge knock on effects and the ASA either doesn’t understand what it’s done, or it knows and is complicit in a paternalistic out-dated approach to the regulation of self-medication and the unhelpful ‘protection’ of ‘the consumer’. Shame on you ASA.

We need to do 2 things and do them fast.

  1. Put people’s actual behaviour at the heart of our approach to regulation/self-care. And, unless meaningful numbers of people are going to be seriously harmed… base policy and interpretation of regulation on this real behaviour.
  2. Within a clear regulatory framework change the balance between paternalism and empowerment in healthcare. We need to experiment to drive OTC demand and rightly or wrongly ONLY brands will ever have the commercial self-interest to drive this. This doesn’t need any ‘de-regulation’, just a more 21st century interpretation of the current regulations.

Let’s stop trying to make the system work for a mythical species – homo-pharmaceuticus – and make it work for real people. Nurofen Joint and Back is a small part of this equation. If it’s a good idea it will flourish and the result is more people will treat pain. If it’s not… it will wither and disappear. In the meantime, nobody would have been hurt and the fact they don’t understand prostaglandin synthesis is not a meaningful gap in their lives.


About the authors: Tim Brooks runs Muzeable a healthcare strategy consultancy and is a non-Executive Director of Creative Leap.

David Gray is CEO of Creative Leap, one of Europe’s leading healthcare branding and creative agencies.

Tim and David have worked together and in healthcare for far too long.

‘Don’t just do something – SIT THERE!!’ On Romans; Michelin chefs and festina lente.

Posted by on Apr 28th, 2015 in muzeable thinking | 0 comments

Muzeable Thinking No. 17 – posted by Tim Brooks 28th April 2015

‘We have all the time in the World…[1]Well… actually, we don’t. We have too little time and too much to do. A symptom of the modern business world is far too much on the corporate to do list with diminishing resources and usually, if you’re paying attention, a nagging sense that we might not be doing the right things anyway. Sadly, it creates a permanent sense of hyper-urgency.

Massimo Batura is a 3 star Michelin chef. I’ve never been, but his restaurant, sounds amazing, original, innovative and most importantly… delicious. He was a guest chef during the BBC’s latest series of Masterchef™. At one point he summed up his philosophy with the Latin phrase – Festina Lente – make haste slowly. To solve challenges/problems you need to [paraphrase]:

‘Think very slowly, then execute at great pace.’

Wow. This is my/Muzeable’s long held philosophy and the Romans had it covered off all the time. Now I can answer the question ‘what have the Romans ever done for us?’

It goes with my other favourite stock phrase… ‘Don’t just do something… STAND THERE!!’[2] I prefer to sit.

The point is that 99% of my time in business has been spent in a world dominated by the need for IMMEDIATE ACTION @ GREAT SPEED… think fast, act fast – just do it, but do it yesterday. Occasionally wrapped up in a bit of filo-panic and drizzled with a well reduced, desperation-jus.

The result… well, it often leads to sub-standard solutions, almost-ideas [great ideas watered down too soon by the need to launch it – now], half-baked investments and poor execution.

There is a self-justification recipe. Pretty much every new CEO says something along the lines of:

‘I need to make an impact and fast. So, I will lock down my strategy asap and then I’ll create momentum by making lots of decisions [large and small] very fast. As long as I get c. 65% of them right – we’ll be ok.’

This feeds into the typical ‘three year leader-model’. Year 1. Sort out the problems [sometimes blaming the past]. 2. Have a full year of doing landing the new plan 3. Live [or die] by it. Then move on.

All understandable [and too cynical I know], but the problem is that FAST in this environment often [usually] = short termism. A ‘Pot Noodle[3]’ not strategic refined dining.

The new reality is that the challenges in almost every market or category are huge and complex. ‘Wicked problems’ as The Rotman School of Management[4] described them. Quick action orientated approaches to big spaghetti problems is increasingly becoming like sticking tails on donkeys with a blindfold on – your experience means you have a vague idea on where to stick it, but it is ultimately an act of faith, or more likely hope.

Some problems or strategies just need a bit more festina lente!

The relentless need for speed also impacts on our attitude to risk… at 100 mph most of us will struggle to add additional risk to our already break-neck risk-benefit equation… so we play safe. This magnifies our short termism, repeating models that are ‘ok’ etc. rather than building real improvements.

All this without getting on to the huge issues caused by the potential conflict between the personal agendas/career development [risk aversion] of the employee [especially senior ones] vs the doing what’s actually best for the business [intelligent risk] and its potential for failure and personal consequences.

It is accepted that in keeping this to a page this is an over-simplification. Possibly, maybe.

The answer? The need to drive stuff fast will never go away. We must do that. But when we come to the big ticket items; the strategic conundrums; the long term growth agenda; real innovation… we MUST train ourselves to THINK SLOWLY, before ACTING FAST. Once you have an edge you can exploit it – ruthlessly – but find the edge first.

Leaders must work harder to create the space and time for rigour and the protection to enable the unthinkable to be thunk.

All the Kahneman[5] et al models of thinking and behaviour re-enforce this.

Muzeable is called Muzeable for just this reason. It’s in the name; to muse – to reflect and think more deeply on big problems – then to make the output usable. It was founded on the naïve desire to find a few more tortoises in business and to work on a few more ‘don’t just do something, sit there’ projects.

Organisations must learn to stop and think and, even briefly, to muse if they are really committed to sorting the big stuff out. Then you can do some rapid and ruthless execution.

This is rarer than you’d imagine. In fact, I’ve almost never seen it – too much personal risk and too many boxes to tick. When on earth are you going to find the time to do it!

My hope? That you will all embrace the delicious and occasionally frightening sensation of festina lente soon. It might just grab you by your taste buds.


[1] Lyrics Hal David, Music John Barry. 1969 James Bond film: ‘On Her Majesty’s Secret Service’

[2] From many sources, this is from p75 ‘Wait’ Frank Partnoy – a common Doctors adage attributed to Dr Justin Graham

[3] No offence meant. Pot Noodle is a fab brand with a clear role in delivering tasty convenience to busy lives.

[4] We recommend their journal Rotman Management as required reading.

[5] Daniel Kahneman ‘Thinking Fast and Slow’ – read it if you haven’t already.

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