Can Medicine Compete with Big Wellness? Part 1

In part one of this conversation, I’m joined by Professor Graham Dowling; former professor of marketing at the Australian Graduate School of Management and Macquarie Graduate School of Management, branding expert, and my dad.

We talk about what “big wellness” actually means, how health has expanded from something purely physical into something mental, emotional and social, and why wellness marketing has become so powerful.

We also explore whether evidence-based medicine has a marketing problem, why science can struggle to compete with simple promises and emotional branding, and whether I may need to give my pharmacy degree back.

And we end with the question that leads us into part two:

How would you market medicine?

Maryanne Demasi. “From FDA to MHRA: are drug regulators for hire?”
The BMJ, 2022;377:o1538
DOI: 10.1136/bmj.o1538
Published: 29 June 2022

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Read more about this episode at Medication Clarity Clinic, Kate's own medication education and telehealth consulting site: https://medicationclarity.com.au

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Transcript

SPEAKER_01 0:01

And I asked you a question. What what question did I ask you last night?

SPEAKER_00 0:04

I asked you a question about is the wellness industry four times the size of the pharmaceutical industry.

SPEAKER_01 0:11

I asked you why it was or I told you that it was.

SPEAKER_00 0:13

You told me that it was and we didn't believe you. So uh I used my trusty Google AI research assistant to confirm that it is. And was I right? You were correct.

SPEAKER_01 0:27

Hear that everybody, I was right.

SPEAKER_00 0:29

But you weren't comparing like with like.

SPEAKER_01 0:32

You're listening to On the Moons, where we have conversations about hormones, midlife, and the moments that make us wonder, is it just me? I'm Kate. I'm a 48-year-old pharmacist and newly minted perimenopausal oversharer. This is where we talk openly about the changes we aren't prepared for, so we never have to feel alone in them again. I acknowledge the Camaregal people of the Eora Nation, the traditional custodians of the land which I am recording today. I pay my respects to elders past and present, and I extend that respect to all Aboriginal and Torres Strait Islander peoples listening. Always was, always will be, Aboriginal land. Hello friends. Today I am joined by someone very special, Professor Graeme Dowling. He's a former professor of marketing at the Australian Graduate School of Management and the Macquarie Graduate School of Management, where he taught MBA and PhD students about marketing, branding, and consumer behavior. He also happens to be my dad. In this first half of our conversation, we try to define what big wellness actually is, and why we talk about how healthcare has changed from being something we think about as purely physical to something that now touches almost every part of our lives, physically, mentally, emotionally, and socially. We also talk about how enormous the healthcare and wellness industry has become, why wellness marketing is so powerful, and whether evidence-based medicine has any hope of competing. And at one point, my dad suggests I may need to give back my pharmacy degree. So that's nice. This is part one of my conversation with Professor Graeme Down.

SPEAKER_00 2:30

The if you unpack the wellness industry broadly and you look at the pharmaceutical industry more broadly, the what I call traditional medicine industry is a fraction bigger than what you call the wellness industry.

SPEAKER_01 2:48

Are we calling traditional medicine? Is that what I'm calling evidence-based medicine or big pharma?

SPEAKER_00 2:53

You're calling, I'm calling traditional medicine the combination of doctors, big pharma, and healthy private health insurance. Now, the let me go to a backstory. Each person when they wake up in the morning might ask themselves one or three questions. And the question might be, I feel like a pickup, or I feel like a tone-up, or I feel seriously unwell. Now, if I feel like a pickup, then what I might do is I might go and spend some money on personal care and beauty. I might go for a wellness experience, I might have a yoga, do some yoga, sauna, go to some thermal springs, I might go to my private coach and have a sort of a mental health session. I might go for a run or go to the gym, or I might decide I'll do some healthy eating and nutrition and keep an eye on my weight. Now, all those things are combined into what's broadly known as the wellness industry. And that's a big industry, that's seven trillion US dollars a year approximately. Now, if my third question was I wake up and I feel seriously unwell, then I head towards a doctor and the doctor prescribes medicine, and then I claim it back on my personal personal health insurance. And if you add up all those bits, there's slightly more than what we've been calling the wellness industry.

SPEAKER_01 4:28

In your wellness industry, catch all, are you also including supplements and herbs and collagen powders and uh adjunct?

SPEAKER_00 4:40

Yes. Yeah, everything. Everything gets gets thrown in there.

SPEAKER_01 4:44

Are you including naturopaths and chiropractors and uh what I would can what I would call pseudoscience related? I'm struggling not to use the word health professional. In fact, I'm struggling to not to use the word health or professional in the same sentence as as those things, but are you also including those practitioners?

SPEAKER_00 5:06

Yes, all all that's jumbled up together. And so when you go looking at statistics um uh in a broad sense, either in Australia or around the world, what you get is a is a jumbled mess. And so it's a not a fair comparison in the sense of saying, you know, wellness dominates big pharma by about four. You need to come back to those three basic questions because every individual will dabble in each of the markets. So you go out and buy a pair of running shoes, you're playing around in the I'm pro in a preventative health type of market, you go and you buy some facial cleanser, you're going in the sort of an an indulgence market, you you're worried about um getting the flu and you go and have an injection, so you're now playing in the pharmaceutical market. So it's not as though they're three separate markets um appealing to three separate groups of people, it's a situation-dependent issue. So I wake up, how do I feel? And off I go to one of those three markets, or alternatively, I just go to work and put up with it.

SPEAKER_01 6:17

That that's very much your approach, I think. Um, but if there are definitely people though who wake up and feel unwell. So not there's a step up from feeling critically unwell when you just feel unwell. And instead of choosing to go to the doctor, they've they choose to go to an alternative practitioner.

SPEAKER_00 6:39

One of the reasons they'll do that is that they feel in more control. So if I'm a person that really wants to take control over my own life, I don't want to pass that responsibility on to a doctor in a medical center. The first thing I'm likely to do is I'll go off and I'll try whatever my friends are talking about and whatever I might have seen on some sort of a podcast. And when that that might alleviate the symptoms, but if it doesn't, then fairly soon I'll go back to the traditional uh medicine sort of uh practice.

SPEAKER_01 7:16

The wellness, big wellness's favorite catchphrase is that all of these, I'm not sure you might not have seen that there's a whole sort of brand of um they call themselves functional practitioners, which are sort of words together that don't mean anything, in my view. But their whole sort of mantra is that we're different to science-based medicine because we treat the root cause of the problem. That's their whole thing. So medicine treats symptoms, but we treat the root cause. And what I'm struggling to understand, what I'm struggling to reconcile in my own mind is how anybody wakes up feeling unwell and thinks instead of going to someone who I know has been regulated by a professional body who has been educated under a curriculum, a regulated curriculum at a educational institution, I will instead choose someone who has either educated themselves or or perhaps done an online course. Or I mean, I know that in Australia, naturopathy is a good example. Neitropathy you can do at a university. It's not it's not regulated, so it that just means that if I do it at one university and if I do it at a different one, the curriculum is different. Or I can do an online course, or I can just call myself a naturopath with no any kind of training whatsoever. How is it that people are making that choice and not what I would consider to be an evidence-based educational approach?

SPEAKER_00 8:52

That's a traditional series of choices that people have been making for thousands of years. Chinese medicine um sort of originated from this. A bunch of people decided that there were life forces flowing through a body, and if you were feeling unwell, you did something to change either the power or the direction of the life force through your body. There has been shaman, um, there have been quacks ever since recorded history started. And so people with deep cultural beliefs who've grown up generation after generation, where those ideas have been passed through the family are quite comfortable doing that. In the modern manifestation, uh people have decided, well, what I'll do is I'll create advertisements for myself and I'll put myself forward as the modern shaman, and you can trust me because I'm good looking and I speak well, and you don't have to go to those university people uh who you probably don't trust anyway, and these higher education people uh you know come to me first. I'm a low-risk alternative, up to a point, because people are ignorant about the risk they face when they're they're feeling unwell. And that market's existed for centuries and will continue to exist. So if you're in that market, you play on those superstitions and those fears. If you're outside that market, you wait until people become seriously ill, and then you pick them up oftentimes too late in their health history to do uh much good.

SPEAKER_01 10:35

So you agree that they're grifting, or do you think they truly believe?

SPEAKER_00 10:40

Uh some believe a lot more than others. Some are just thinking, well, here's the game. I'll play, I'll win. It's it's a bit like um taxing the stupid. Um cigarette excise, gambling excise, alcohol excise, this type of thing are really taxes on the stupid because people know if they overindulge in any of those um activities, harm follows. But the government may as well tax them. You you're not going to prevent that sort of behavior, so you may as well make money from it.

SPEAKER_01 11:18

The TGA have um issued a oh, I think they issued a fine, and I think she actually may have even done some jail time of a particular naturopath who was selling a very, very toxic product and people were becoming very unwell and dying anyway. So, I mean, that's a pretty cut-and-dry case. But the TJ had also in this same statement said that the convincing somebody to do something that then puts off or turns them off the actual evidence-based approach is also harm. So you can I suppose what they're saying is is that doing harm is harm, but also convincing somebody not to do something is also harm.

SPEAKER_00 12:06

Yep. I mean that's that's perfectly correct. My guess is that the case you've just uh outlined was uh the woman didn't know what she was selling was toxic at the beginning and probably got locked in to what she was doing as she learned more and more about the side effects of what she was doing and bailed out too late.

SPEAKER_01 12:28

I think you're being very generous there. I I think she was peddling this shit for a long time and the TGA finally caught up with it. But yeah.

SPEAKER_00 12:37

But I mean, there's also the issue of how reliable evidence-based based medicine is. Now, I'm an old scientist and it's very, very difficult to understand the evidence-based medicine because you've got to be competent in the methodology that's been used in order to uh generate the evidence. Specific example, you mentioned the TGA. During COVID, TGA signed off on the vaccines that were distributed to Australia. They did that without looking at the raw data from the pharmaceutical companies.

SPEAKER_01 13:16

How do you know that?

SPEAKER_00 13:17

Uh it's been written up in a British medical journal article that was highly critical of Australia's TGA uh for some of the practices uh uh and some of the people who were on the panels that that made these decisions.

SPEAKER_01 13:33

Do you have that? Can I link it in my show notes? Yeah. That article?

SPEAKER_00 13:37

By all by all means. It's a it's an extremely disturbing piece of evidence from a group of British scientists who had to use freedom of information requests in order to get the raw, well, the basic evidence from the TGA. To give you a specific example that I can remember, that 50% of the people on the panel who uh were comfortable with the vaccines being distributed in Australia and used in Australia had a financial conflict of interest with the drug companies. Now, that, as as one of the authors of this paper said, is a good example of institutional corruption. So you we've got to be really, really careful when we say that evidence-based medicine or evidence-based sociology or evidence-based anything is robust and valid and reliable because most people can't tell unless you're a practicing scientist, you have no idea.

SPEAKER_01 14:40

I don't know how my car works, but I understand that it does work, and I drive it, and I don't need to understand how my car works to drive it. For it from for me to enjoy driving around in my car, I don't need to understand how it works. Isn't it enough for me to know that somebody understands how it works? And for me to place my trust in the person who does understand how it works, and the and the regulator that said it was roadworthy enough to be sold to me for me to drive it. Is it not similar?

SPEAKER_00 15:09

Most people are comfortable with that because that's a convenient shortcut. Uh you can't understand every piece of technology you use. But let me give you another example in climate science. Climate science has some of the biggest and scariest and complicated and fascinating and mind-boggling climate models in the world. Now, these things have got sometimes more than a million lines of computer code. They run on some of the world's largest supercomputers, and literally only a few thousand people across the whole world understand how these things work. So for everybody else in the world, we either trust them or we don't. Now, if we trust them, those thousand people who do the coding, run the programs, what they call these spin them up and look at their forecasts and plot all their forecasts, etc., are pretty much like high priests. Just like religion. You either trust these characters or you don't. None of us have got the capacity to actually understand how these climate models work. We can look at what the CSIRO and the IPCC tell us and show us in their little diagrams about how this component talks to this component, talks to this component. But anybody who has coded software knows that there are bugs in the software. When you have more than a million lines of code, there are bugs in the software. Now, whether they're but they make a material difference, we don't know. But there was an old paper many, many years ago uh that had a in its title the butterfly effect. And this was a climate scientist from MIT. And what he was doing, he was running his climate model, and he got sick of putting in all the seed data at the beginning of each run down to about six or seven decimal points. Um instead of putting 11.6667849372, what he decided to do was he'd just chop off the last half dozen digits of the data that he put in. When he reran the models, he got completely different results. So sometimes these models are hypersensitive to the values of the input data put in. Well, if you've got a million lines of computer code and you've got thousands and thousands of data points running around this model, and we know they're super sensitive because they're highly complex and things interact with each other, you either trust these blokes or you don't.

SPEAKER_01 17:51

But what's the what's the alternative? So I can't understand it. I can't understand everything. I've got to place my trust in some people, and I'm hoping that in the thousand people that you're talking about all have degrees and PhDs and whatever from places that are reputable learning institutions, not I just reckon I've got an opinion on climate science and I can run a computer, which I feel is what happens in medicine is that in medicine we've got people who you also have to trust. And the alternative is a bunch of people who who don't have the background, who don't have what I would call a trustworthy background. Because otherwise, what else are you going to do? You can't you can't know everything.

SPEAKER_00 18:33

No. Well, see, scientists don't trust other scientists.

SPEAKER_01 18:36

And and that's excellent.

unknown 18:38

Yes.

SPEAKER_01 18:39

Well, we need that.

SPEAKER_00 18:40

Yes, but uh the scientists, the old good scientists who don't trust other scientists check what their colleagues do down to the finest detail before they're comfortable with their findings. Now that breeds humility amongst the scientific community. We don't make bold, strong statements about anything.

SPEAKER_01 19:02

Correct.

SPEAKER_00 19:03

So other people take a shortcut, and there's a a part of social science called willful blindness. And willful blindness is an idea that if you don't take the time to get yourself educated to a level where you're making a sensible decision, basically you're clueless and basically you're stupid. Now, many people with a a reasonable education should take the time to assess their risks about health and a whole series of other things that they believe from the media and they don't. And so periodically they're going to be caught out and make massive mistakes. In fact, in our university environment, there's an old there's a group of old professors like me who say that when a student comes to university that on day one they should all be given their degrees. The only requirement is they have to go to all the courses and sit the examinations and do reasonably well. Ten years after they graduate, they have to come back to the university and they've got to say how we use the degree. Now it doesn't have to be specifically in the field in which they got it, but they've got to prove to the old professors that they've benefited from that education and use that education. If they can't, they give the degree back. If the government and other people are going to invest an enormous amount of money in educating people, and then you don't use it, you become willfully blind to a whole series of issues from voting right through to healthcare, that you've been actually given the privilege of not being willfully blind for. So come back to uni and give me back your degree.

SPEAKER_01 20:47

I would say though, still that there's you you can educate yourself to a point, but at some point you have to trust somebody. So I can back to my car. I can educate myself enough to know that it's got four wheels and an engine, and I don't know, it needs oil and it needs petrol and what whatever it needs for me to keep it functional. But when something goes wrong with it, I really need to take it to somebody I trust who knows better than I do. And I would argue that in healthcare, yes, you have to know enough to know that you, you know, smoking is bad for you and that you need to keep yourself healthy and being obese is no good, and what a healthy diet is, like all of that. But at some point when something goes wrong internally, I have to go to somebody. And the way I choose somebody, what I I guess what I can't understand is the way people choose somebody. So when something's gone wrong, instead of thinking, I'm gonna choose this person because they've got a lot of experience and a degree and have been working in this field, oh no, actually I'm gonna go and choose this person over here who has just hung a plaque and said that there's a chakra that they can align, or there's a, you know, there's a vibe that they can.

SPEAKER_00 22:01

Okay.

SPEAKER_01 22:01

Fix.

SPEAKER_00 22:02

Here's a test for one of my students.

SPEAKER_01 22:05

Am I the student?

SPEAKER_00 22:06

Yeah. You you're sick. So it's extremely difficult to make an informed choice because everybody's got their plaques up on the wall that they've been qualified in in X and Y. So what you can do is you can pick one at random, go and get a diagnosis, and then the past fail part of the test is if you don't go and pick another one and get a second opinion and a third opinion, you've failed.

SPEAKER_01 22:33

So when you say pick a plaque, do you mean from the range of plaques all the way from grifting homeopathy over here to I've did m medicine and have practiced for 30 years in my field over here? So pick a pick a plaque of any anyone in between. Or do you mean pick three? Okay.

SPEAKER_00 22:56

If you had no limits on your time and no limits on your expense, you'd go and you'd pick up your basic statistics book, and your statistics book would say you've got a distribution of health providers. You don't know their quality. So take a random sample of those health providers and go and talk to each one.

SPEAKER_01 23:20

So I am going to say that you've used the word health provider, and that has already cut out all of those people in the wellness sphere. Because you cannot call yourself a health provider, in my opinion, if you have not done some kind of learning that means you are regulated with a professional body. So already, the way you've you've just explained it to me, if I've got a gastrointestinal issue, then I'm choosing from three gastrointestinal. So I guess I could be choosing from gastroenterologist, a dietitian, and a I don't know, something else.

SPEAKER_00 24:01

And a and a practitioner of Chinese medicine.

SPEAKER_01 24:04

And a practitioner of Chinese medicine, correct, because they are also opera. That's right. So I could I can choose from those three. Yeah.

SPEAKER_00 24:11

But you could you could choose um if you had unlimited time and and unlimited money, you could choose from a a very broad range of people. Um and so the whole notion of health uh during my lifetime has broadened considerably from things that affected me physically to things that affect me physically, mentally, socially, all sorts of things. It's yeah, the industry's just decided to redefine itself into a massive industry.

SPEAKER_01 24:44

And what to your point, what you were saying before was about, I think you you said something about speaking um uh confidently or definitively or something like that. And I think that that is something that the wellness space does really, really well. A wellness practitioner will say to somebody, I know exactly what's wrong with you, and I know exactly how to fix you. And if you take these three herbs and tonics and turn around three times and sound on your head, then that's going to fix whatever that ails you. Whereas medicine hasn't got that language, medicine's a lot more nuanced, and I wonder whether that lack of being so certain in the theory of decision making, there's been huge advances in the last 30 or 40 years, and one of the biases they've discovered is that people like to be like to feel confident about options.

SPEAKER_00 25:42

And so if somebody who is trustworthy says to me, I've got a clear-cut solution to a problem, and I'm not an old scientist who questions everything, then that resonates. And so as long as the wheels don't fall off in any other part of that um transaction, let me call it, I'll buy.

SPEAKER_01 26:09

And that makes sense. I mean, I see why that's soothing to people, but I feel like medicine has got. Well, here's a here's a question for you. You're a marketing professor. How would you market medicine? That was part one of my conversation with Professor Graeme Dowling, marketing professor, branding expert, and my dad. We've talked about what big wellness actually is, why wellness marketing is so powerful, and how health has become something much bigger than just the physical. And right as I ask Dad the question I really wanted him to answer, how would you market medicine? That's where we leave part one. In part two, we keep talking about whether science-based medicine can market itself better without becoming misleading or manipulative. And I also discover something genuinely alarming. Dad may have had an unexpected historical role in creating the very pharmacy supplement aisle that now causes me deep ethical discomfort. So please come back next week for part two. As always, you can find me on the socials, TikTok, Instagram, and Facebook at Prescribe or Pass or on YouTube. And if you want a one on one medication clarity appointment with me, go to medicationclarity.com.au and book in a time so we can have a chat. See you next time we get on the moans. Bye bye.