[PRACTICE NOTE] The Hidden Tax on Pharma Commercial Performance.

How the gap between brand aspiration and brand delivery, reinforced by volume-led engagement, creates indifference, variability, and brand dissonance in life sciences

How is your brand really showing up to healthcare professionals? In a previous article, we explored how pharma’s hard-factor culture, optimized for scientific rigor and regulatory discipline, unintentionally marginalizes the human systems required for customer centricity to become how work actually gets done. This article examines what that design gap is costing the enterprise in commercial terms, and why the disconnect between brand aspiration and brand delivery has become a hidden tax on trust, preference, and long-term performance.

Pharma and life sciences organizations are built on aspiration. At their best, they aspire to advance science, improve patient outcomes, and earn the trust of healthcare professionals through rigor, evidence, and integrity. These aspirations are not abstract marketing claims. They are carefully constructed narratives supported by clinical data, peer-reviewed publications, global congress presence, and sustained investment in brand strategy. In an industry where credibility is existential, brand aspiration is treated as a serious enterprise asset.

Inside the organization, this aspiration is visible everywhere. It is reinforced in leadership town halls, brand planning decks, launch narratives, and immersive congress experiences designed to signal scientific leadership and partnership. Teams speak fluently about precision, trust, and patient centricity. From the inside, the brand feels intentional and well governed.

Yet when you step outside the corporate environment and into the lived working reality of HCPs, a different pattern often emerges. Not because the aspiration is flawed, but because the system responsible for delivering it has been optimized around volume rather than value. This is where the hidden tax begins.

How Volume Quietly Became the Proxy for Effectiveness

Over time, pharma commercial organizations have quietly coalesced around the volume of interactions as the dominant indicator of performance. Reach, frequency, call counts, impressions, and engagement volume have become the primary levers through which success is planned, measured, and rewarded. This made sense in an earlier era when awareness and access to information were the primary constraints on prescribing behavior. That world no longer exists.

HCPs today are time constrained, cognitively overloaded, and navigating increasingly complex clinical, administrative, and access environments. In this context, more interactions do not automatically create more value. In many cases, they add noise, effort, and fragmentation.

Yet commercial systems have been slow to adapt. Brand aspiration speaks of care partnerships, relevance, and trust, while brand delivery is governed by interaction quotas and activity targets. The organization claims to value helpfulness and precision, but optimizes for presence and coverage. This contradiction is structural, not philosophical. It is the point at which the aspiration–delivery gap begins to widen.

Where the Aspiration–Delivery Gap Is Actually Born

In most global pharma organizations, brand aspiration is developed centrally, while brand delivery is executed locally and functionally. Marketing teams optimize campaigns and message consistency. Medical affairs teams focus on scientific exchange. Sales teams focus on calls and coverage. Digital teams optimize platforms. Access and patient services teams focus on reimbursement and support. Each function operates with professionalism and good intent. Each is measured against its own objectives. What is rarely governed with equal rigor is how these functions come together in the lived experience of an HCP.

A physician may encounter an elegant narrative about partnership and precision at a major congress, only to struggle weeks later with a patient support program that feels administratively complex and poorly coordinated. A representative may deliver a thoughtful, clinically grounded conversation, followed by digital content that feel generic or poorly timed. None of these moments violate policy. None trigger compliance alarms. None feel dramatic enough to escalate.

Together, they reveal a widening gap between what the brand aspires to represent and how it is actually delivered. This is not a messaging problem. It is a design problem.

Where Indifference Quietly Takes Hold

Indifference in pharma commercial organizations is rarely intentional. Most organizations care deeply about healthcare professionals, patients, and the integrity of their brands. The people inside them work hard and often chose the industry precisely because they wanted to contribute to something meaningful.

Indifference takes hold not in intent, but in tolerance and the normalization of poor interactions. It emerges when variability in experience is observed but accepted as inevitable, an acceptance that "that's just the way it is in pharma".  When inconsistency across channels is acknowledged but framed as the cost of scale. When misalignment between aspiration and delivery is rationalized rather than treated as a quality failure. Over time, the organization becomes indifferent not to customers, but to the discipline required to close the gap between what it claims to value and what it consistently delivers.

This indifference isn't episodic, it is too often structural and systemic. It lives in habits and instincts, materializing in governance models that prioritize message approval over experience quality, and in operating models that reward activity rather than usefulness. A senior commercial leader once remarked that her organization had "become excellent at approving content and far less disciplined at evaluating whether that content actually helped anyone". The process was working. The experience was not.

Variability as the Definition of Poor Quality

In pharma, variability is treated as unacceptable in every domain where outcomes matter. Manufacturing organizations work relentlessly to reduce variability because patient safety depends on it. Clinical development teams design protocols to minimize variability because results depend on it. Quality systems exist precisely to ensure that standards are applied consistently, regardless of geography or individual judgment. Yet when it comes to brand and commercial experience, variability is often normalized.

One medical interaction may feel collaborative and insightful, while another feels scripted and transactional. One patient support experience may feel seamless, while another introduces friction and delay. One digital touchpoint may feel helpful, while another feels like an obstacle.

From the organization’s perspective, this variability is often invisible or excused. From the healthcare professional’s perspective, it is experienced as poor quality. Particularly in the context of their busy daily lives, clinicians do not interpret variability as nuance, they interpret it as unreliability. In a profession where reliability matters deeply, that perception carries weight.

How Poor Interactions Accumulate Without Complaint

What makes this dynamic particularly dangerous is that it rarely produces overt dissatisfaction. Healthcare professionals are pragmatic and adaptive. When interactions feel inconsistent, they rarely complain. They simply lower expectations and engage selectively.

A physician who once welcomed in-depth scientific dialogue may now prefer brief exchanges. A practice that once explored patient programs may now avoid them unless absolutely necessary. The brand is no longer experienced as a partner, but as a vendor whose usefulness varies by moment.This is how poor interaction quality accumulates quietly. The experience does not feel bad enough to protest. It simply fails to reinforce trust. At the level of lived reality, this erosion shows up in subtle ways:

• Engagement becomes transactional rather than collaborative

• Interactions are tolerated rather than welcomed

• Support programs are avoided unless there is no alternative

None of this triggers an alarm. All of it weakens the brand.

Brand Dissonance as the Rational Conclusion

Brand dissonance in pharma is not confusion about positioning. Healthcare professionals understand brand narratives and scientific differentiation. The dissonance comes from observing a mismatch between aspiration and lived experience. This disconnect is uniquely damaging in an industry that demands extraordinary rigor in science and manufacturing continues to tolerate imprecision in experience.

When a brand speaks about precision but delivers inconsistent experiences, clinicians notice. When partnership is emphasized but engagement feels fragmented and transactional, the contradiction is felt. When trust is asserted but reliability varies by channel or moment, engagement becomes conditional. HCPs are trained to assess consistency and reliability. Their own work depends on it. Brand dissonance is not an emotional reaction, it is professional judgment.

Moreover, in an industry that emphasizes trust still relies on activity metrics that say little about helpfulness or burden reduction. HCPs notice this gap immediately, even if they never articulate it explicitly. They do not question the molecule. They question whether the organization behind it applies the same discipline to how it engages as it does to what it develops. One clinician described it simply by saying that the science was always excellent, but the experience was unpredictable. That single word captures the problem.

Why the Shift From Volume to Value Is Now Urgent

Over time, the commercial consequences become visible. Brand investment delivers diminishing returns. Engagement becomes conditional. Preference weakens. The brand’s equity rests increasingly on scientific merit alone, unsupported by an experience that consistently reinforces it.

At this stage, many organizations respond by refining aspiration. They sharpen messaging and invest in new campaigns. Yet without redesigning delivery, the gap persists and often widens.What began as tolerated variability becomes a strategic risk to brand credibility, trust, and long-term relevance.

The hidden tax created by volume-led engagement is no longer sustainable. HCPs are rationing attention and disengaging selectively. Brands that continue to equate presence with value will see diminishing returns on even the most sophisticated commercial investments.  Closing the gap between brand aspiration and brand delivery now requires a fundamental shift in how effectiveness is defined. It requires moving:

• From volume of interactions to value of interactions

• From activity to helpfulness

• From reach to relevance

• From frequency to friction reduction

This is not a tactical adjustment. It is a strategic pivot. For pharma commercial leaders, the path forward is not to reduce engagement, but to elevate it.  It requires designing systems that prioritize interaction quality, consistency, and usefulness over sheer volume. It requires holding the organization accountable not just for how often it shows up, but for how reliably it delivers on its brand promise in every interaction. It requires treating variability in experience with the same seriousness as variability in science.

In a consumer-grade expectation environment, brand truth no longer lives in aspiration alone. It lives in what HCPs consistently experience when they are trying to do their jobs under pressure. Therefore, the most important question facing leaders today is not how visible their brand is, but how it shows up in the lives and workflows of customers.

Key Takeaways

• Brand aspiration without disciplined delivery creates risk. Credibility is judged through lived experience, not stated intent.

• Variability is the operational signal of poor experience quality. Inconsistency is not nuance. It is unreliability.

• Volume-led models quietly tax trust. Activity without usefulness accelerates indifference.

• Indifference is structural, not intentional.  It emerges when misalignment is tolerated rather than governed.

• The future belongs to brands that design for value, not visibility. Relevance beats reach.

Leadership Diagnostic Questions

• Where does our brand aspiration most visibly break down in delivery across congresses, field interactions, digital platforms, access processes, and patient services

• What experience variability have we normalized that we would never tolerate in science, manufacturing, or quality systems

• Are our success metrics rewarding the volume of interactions or the value those interactions create for healthcare professionals

• How much cognitive and operational work are we pushing onto clinicians to reconcile fragmented or inconsistent experiences

• Who is accountable for experience coherence end to end beyond functional performance and channel optimization

• If our commercial experience were held to the same standards as our science, where would it fail first

• Which high-volume activities persist today despite adding noise, friction, or dissonance rather than value

About

Wayne Simmons is the author of The Customer Excellence Enterprise. He is a global customer excellence and customer experience leader, a former Inc. 500 founder and CEO, and a founding faculty member of North America’s first master’s degree program in Customer Experience Management at Michigan State University. His work focuses on helping pharmaceutical and life sciences organizations embed customer-centricity, experience delivery, and commercial excellence into how their businesses actually operate. This article is part of Wayne’s ongoing Customer Excellence Insights series, exploring how brand, experience, and commercial strategy must evolve in the age of AI, Experiential Commerce, and rising consumer-grade expectations. For deeper perspective on customer-centric transformation, experience-led growth, and the future of marketing and CX, you can also follow his newsletter, The Customer-Centric Marketer.