BMJ  2005;330 (28 May), doi:10.1136/bmj.330.7502.0-g

Editor's choice

Winning hearts and minds

When the furniture store Ikea first started selling a limited range of flat packed furniture that customers would buy from a warehouse, carry home, and assemble themselves, few could have predicted its phenomenal success. Equally surprising, for different reasons, was the success of the television series The Simpsons, initially considered a big risk by the Fox film corporation and now the longest running cartoon ever. Both are examples of clever market positioning. The trick, says an article in this month's Harvard Business Review, is to find out what your customers expect from you—and then shatter those expectations in ways that lift you above the crowd and create whole new markets.

With Ikea, "reverse positioning" meant stripping out features piled on by traditional furniture retailers, such as discounts and free delivery, and then throwing in unexpected new features to delight customers and build brand loyalty: crèche facilities for shoppers and funky household accessories. With The Simpsons, "breakaway positioning" meant mixing elements from different genres (children's cartoon and adult sitcom) to create a new concept with a non-ageing cast that can outlast and out-satire the rest.

If there's one group in urgent need of repositioning it is, as even its members acknowledge (p 1229), the pharmaceutical industry. In a recent survey, only a quarter of Americans said the industry was doing a good job, putting it on a par with the tobacco industry. When your customers see you as "manipulative, dark, menacing," you could be said to be losing the battle for hearts and minds. Does this matter? Apparently, yes. To justify their prices, drug companies are under increasing pressure to prove value for money, where "value" is about more than just the effectiveness of their drugs.

Two initiatives described in this week's journal could help improve the industry's image or help individual drug companies stand out from the crowd. The first is trial registration. A 20 year campaign is now gaining real momentum, thanks in part to the decision by the major journals to make public registration of trials a prerequisite for publication (p 1222). Drug companies have been closely involved in recent negotiations and should now, for their own sake as much as the public's, embrace this opportunity to show their commitment to greater transparency.

The second idea is more off the wall: that companies might offer a money back guarantee, not only if the drug doesn't work but also if it causes unacceptable adverse effects (p 1262). Unlikely as this may seem, it has already been tried. As pressure on companies increases, this may become an attractive positioning strategy.

Without (we hope) such an urgent image problem, the BMJ is also embarking on a cycle of work that will lead, if not to repositioning at least to a redesign. For this we need you. If you would like to take part in focus groups on the future of the BMJ, please contact us on editor{at}bmj.com. We expect an evolution, not a revolution, but who knows what you will come up with.