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Pharmaceutical Manufacturing and Packing Sourcer

Style and Substance

Design and patient behaviour are inherently linked, and several elements come into the design process when developing a new user-driven device such as a prefilled syringe, encompassing adherence, branding and safety. People in our design office admittedly, at times, exhibit a split personality. The techno-gadget-engineering-geek side of us may be fascinated by some engineering marvel or microscopic manufacturing detail in a product or package we have come across. But at the same time, our humanistic, people-first, usability-centred design side will lament over that item’s unfortunately missed opportunity to combine that technical expertise with an understanding of the realworld needs and behaviours of people.

Accordingly, the phrase ‘well-engineered but not welldesigned’ comes up often in our conversations. While we find products that exemplify this thought in all types of consumer and professional areas, nowhere does it surface more often than in our reviews of medical products.

In 2012 it is no longer appropriate to just make a product that works technically. Products need to work with people, and unless people are considered from the start as a critical component in the equation, the product will not be optimised. That’s a lost opportunity for the product, for the brand, and – more importantly in the field of healthcare – a lost opportunity for maintaining and improving people’s health.

The Definition of Design

‘Design’ used to mean aesthetics – the look and style of an item – but not any more. Investigations that our design office conducted in the mid-2000s showed that its meaning was already in flux. People were associating design not with visual aspects of a product or package, but with its function. In making that transition, design has gained some new respect, and is thankfully no longer considered superficial.

Encompassing ease of use, product performance and, importantly, personal meaning, design is no longer an option, something ‘nice to have’; it is essential.

That said, there is still a lot to be done. In the pharma industry the power of design to affect a patient’s attitudes and behaviours remains woefully misunderstood, underappreciated and underutilised. In the face of today’s well-informed consumers, the large number of drug choices available and an unprecedented number of brand-name drugs with patents either recently expired or about to expire, design in many cases may be the only competitive edge.

Imagine two different briefs. One calls for the team to create a package for a prefilled syringe. The second calls for them to address user behaviour, conceive ways to improve adherence through the package, and ultimately enhance the entire brand experience. The first is much more common, but the second opens up an array of opportunities.

In practice, the three components of the second version of the brief – user behaviour, adherence to the regimen, and brand experience – are tightly interwoven.

Effect on Behaviour

The first glance at a package registers a series of important messages in the mind of the patient, setting expectations before any written words are read or any doctor’s or nurse’s words are spoken. These impressions can have both positive and adverse effects.

For instance, the willingness to take medication as directed when at home, or to carry it when travelling so that it is accessible when needed, becomes an important factor. A package or dispensing device that looks intimidating can discourage the user and act as a depressing or demotivating daily reminder.

This by no means implies that the seriousness of the malady should not be recognised, but a daily reminder for people we are trying to help can negatively affect long term adherence, with a detrimental effect on the ultimate effectiveness of the medication.

The dial and calendar formats that birth control pills have been packaged in for decades serve as a good example of packaging designed to help the patient with their regimen. However, due to the distinctive nature of the packaging, users may be discouraged from carrying them with them or leaving them in a place where others could possibly see them. Design clearly affects behaviour.

Design and Adherence

Generally speaking, ‘compliance’ refers to a patient’s performance in following a drug regimen or treatment, while ‘adherence’ encompasses compliance combined with factors that may be beyond the patient’s control. While many people use the two terms interchangeably, adherence is generally considered to be more politically correct – it does not place blame solely on the patient.

Continuing with the birth control example, compliance issues such as forgetting to take a pill can cause a degree of uncertainty. What should be the next step? The ability to provide accurate instructions for next steps lies in the hands of the healthcare providers, further missteps constituting an adherence issue. Missing pills, throwing away the unused remainder of the pack, and waiting for the next four-week cycle to come around before starting up again are reasons why users drop off the birth control regimen and look to other methods – even if those methods can be less dependable.

Adherence would therefore involve more than the ability of a primary package to protect the contents; it should also enable patients to take their medication easily and properly. The package needs to take into account a wide range of patient abilities and their willingness to understand and properly use that medication. Physically, the design can also enable (or disable) a patient’s ability to dispense the medication when needed.

Design and Brand Experience

A brand is not simply about a logo, trademark or colour palette. Brands are defined by a person’s experience using products portraying that brand’s moniker. Brand equity and product quality have always gone hand-in-hand. However, the situation today is quite different. In the past the speed at which brand attributes and individual experiences were communicated occurred at a snail’s pace; performance reports could take months or even years. Today, we seem to know within nanoseconds of a product’s launch whether a product works or not – buy or don’t buy, five stars or one. We’re not relying on a company’s ads or marketing efforts as the source for our information – people are talking to each other through social media platforms.

Exceed Expectations

Established brands are not able to rest on their laurels; exceeding expectations has become a minimum requirement. We’ve seen new products coming from well-established companies that can have a lifespan measured in minutes once negative reviews go viral, where new brands can come to prominence seemingly out of nowhere, creating a threat to established brands.

Many competitive products provide similar performance, so competition in pharmaceuticals can be tough. This is compounded by the fact that benefits of a drug are not always immediate or tangible, and differences may never be detectable to the user.

In terms of competition, pharmaceutical manufacturers are being confronted with the reality that the number of patents that have expired in the past few months or are due to expire within the next two years represent more than $70 billion in annual sales.

This should be a call to action. Companies about to lose their patent protection can maintain equity through design, focusing on many user touch-points, and should think beyond the medication itself. At the same time, manufacturers of generic drugs can sway new customers away from established brands with more than just lower costs, and even leapfrog those brands completely.

Case Study

UCB recently spent more than a decade developing a biologic medication that effectively treats the symptoms of rheumatoid arthritis. A major benefit would be that patients could care for themselves at home, self-injecting two prefilled syringes every four weeks.

Understandably, the challenge for the prefilled syringe designer was that the patient would have significant difficulty operating a traditional syringe. Those syringes, whose basic construction had remained unchanged for decades, were developed from a manufacturers’ point of view – an example of a device that is well-engineered but not well-designed. A small finger flange, square edges and a small thumb pad on the plunger left much to be desired by patients with strength and dexterity problems.

The design team set out to address patient behaviour, improve adherence and enhance the brand experience. At the outset the syringe was to be co-branded with a brand known primarily for a line of kitchen tools ‘designed for everyone’, used to accommodating people with challenges such as arthritis. Many arthritis patients are familiar with the brand for that reason, and in initial discussions welcomed the thought of it being involved in developing a medical device.

As a first step in the syringe project, patients with rheumatoid arthritis were located and consulted. Prior to the involvement of the design team, hundreds of rheumatoid arthritis patients took part in clinical tests during the development of the syringe. The design team took a more personal approach, visiting a comparatively small number of patients in their homes. The new prefilled syringe would be designed with those individuals in mind. These patients were treated as contributors to the design effort – not as ‘subjects’ but as people who could help.

Throughout the project, an iterative process was employed, keeping in continuous contact with patient-advisors. Early on, rough models were made and tested using both quantitative and qualitative methods to evaluate them in regard to both biomechanics and perception.

Biomechanically it was possible to design a syringe that empowered patients – in a sense, making them ‘stronger’. Rheumatoid arthritis patients are able to exert almost 50 per cent more force on the new syringe than the traditional version. This was the result of a design that embodies a soft rubberised thumb pad that reduces slippage, a finger flange that accommodates three fingers underneath not two, and smooth rounded shapes that eliminated square edges and pressure points.

In conjunction with the physical benefits, perceptions and willingness to inject were also key considerations. The design team developed a list of 19 attributes that the new syringe should exemplify. They included qualities such as approachability, comfort, ease of control and ease to inject. Using techniques from the field of cognitive psychology, patients reported their impressions both before using it, and after injecting with the new design.

We’re Getting There

Although a patient’s attitudes and behaviours are on the critical path to success, the ability of design to influence the efficacy of a medication is often not considered by the people initiating a packaging project. Yet attention to design can have huge impact in the field of healthcare. In the prefilled syringe example, the design team was aware from the start that the package could have a significant impact on patient behaviour, adherence and brand equity. While a medication can work wonders, it can only do so when a patient complies with the regimen.

Design has the power to create a meaningful user experience that does not only differentiate a brand – it can also improve health. Every touch-point in the user experience can help; even the packaging can help make a patient feel better.

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Dan Formosa is a founding member of Smart Design, a firm based on the idea that design is about people, not things. With a background in product design, he holds a Masters and a PhD in Ergonomics and Biomechanics. Dan was a member of the design team that developed IBM’s first personal computer. In 1980 he helped establish Smart Design to explore ways in which design can positively impact people’s lives. He frequently lectures on the changing role of design, physical and psychological aspects of design, gender and social responsibility.
Dan Formosa
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