The Scotch, the Doctor, and the Lesson I Almost Missed

It was a Friday afternoon in southwest Chicago. I was 25, working as a marketing researcher for Stuart Pharmaceuticals, and I had just finished an in-office interview with an internal medicine physician in his late 50s. The product I was there to talk about was Effersyllium, which was essentially identical to Metamucil in mechanism of action and marketed at the time as a laxative.

My flight home was at 5:30. It was 3:30. I was ready to go.

The doctor looked at me and said, "Son, you're never going to make it with traffic. Have a seat."

I sat.

He reached into the credenza behind him, pulled out a bottle of scotch and two glasses, poured, and then told me something I've thought about for the rest of my career.

He leaned back.

"Older people care about two things. One, are they sleeping enough? Two, are they having a bowel movement every day? They don't sleep well because they nod off during the day and don't remember it. And they don't eat enough to have a bowel movement every day. So instead of positioning this as a laxative, you should position this as a bulking agent for the elderly. It's perfect. It's non-systemic. It won't interfere with any of the other drugs they're on. And they'll feel like themselves again."

It clicked immediately. One of those moments where a physician with thirty years of clinical experience hands you an insight that reorganizes the whole problem in your head. I missed my flight. I didn't care.

The following week I wrote up my findings and presented the idea to senior management.

They rejected it. Too limiting, they said. Too narrow a segment.

Later that year, Metamucil launched its product as a bulking agent for the elderly. It became — and remains — the dominant player in the category. Metamucil is still marketed as a bulking agent, for exactly the reasons that doctor described to me over scotch on a Friday afternoon in Chicago.

Effersyllium? Long gone. A footnote in the pantheon of drugs no longer marketed.

I've thought about that afternoon a lot over the years, and I'll admit the part that stings isn't that management rejected the idea. It's that I brought them a story when I should have brought them an idea with greater personal conviction. I had been handed something rare — a fully-formed strategic insight from a clinician who understood his patients better than any focus group ever would — and I presented it like one interesting data point among the broader set of findings. I let it get weighed against the rest of the deck. Based on my track record with other products I'd helped position, I should have been more forceful, put it on the table and said, this is the answer. 

That's the lesson I carry from that afternoon in Chicago, and it has almost nothing to do with pharmaceuticals.

Sometimes an n of 1, from someone who truly understands the patient and the problem, is worth more than an n of 1,000 where the questions were answered perfunctorily. The trick is recognizing it when it's sitting across from you with a glass of scotch — and having the courage to carry it back to management.