The new Medicare prescription drug benefit presents major marketing challenges for both the competing drug plans and officials at CMS and SSA. While the feds must conduct a massive outreach campaign to educate 43 million Medicare beneficiaries about the complex program, the drug plan sponsors must market their plan designs, which vary widely in delivery, cost sharing, and formularies.

With over 2,000 drug plan options across the country and each beneficiary having to select among 40-50+ plan designs in their own regions, the marketing challenges are extraordinary. Add to this the intricate, anti-intuitive program design set up by Congress in the Medicare Modernization Act and how Part D handles the dual eligibles, low-income seniors, retirees with employer sponsored drug coverage, veterans, and others all differently - and, well, you have the makings of quite a mess.

Yet, the challenges don't end there. The Medicare population is not homogeneous, media stereotypes notwithstanding. Beneficiaries vary widely by income, assets, age, disability status, setting, ethnicity, and existing drug coverage. Almost 70 percent already have prescription drug coverage without Part D. Those without drug coverage are a diverse mix of rich and poor, healthy and sick, active and isolated, urban and rural. As a group, American seniors are one of the wealthiest cohorts in world history but among them, there are many low-income seniors struggling every day.

In terms of race and ethnicity, African Americans and Latinos make up 15 percent of Medicare's beneficiaries ages 65 and older and 27 percent of Medicare's under-65 disabled beneficiaries. However, while less than a third of white beneficiaries are sufficiently low in income to qualify for federal drug subsidies, over 60 percent of African Americans and Latinos on Medicare may qualify for the low-income subsidy. While a sizable majority of all Medicare beneficiaries have access to drug coverage without Part D, African American and Latino beneficiaries are more likely to have no drug coverage now. In addition, the vulnerable dual eligible population, with its 6.5 million souls, is disproportionately African American or Latino beneficiaries.

Traditional, television-centric marketing tactics are necessary but not sufficient to reach Medicare's diverse population and offer the benefits of Part D, particularly the substantial savings available through the low-income subsidy. To differentiate themselves in a crowded market and maximize both enrollment and retention, Medicare prescription drug plans need to adopt a more sophisticated, multi-facetted array of marketing tactics and mediums. Among them, viral or word-of-mouth marketing is essential. In addition to being extremely effective in situations like this, the costs and risks are low.

After an avalanche of federal money the past ten years, the National Institutes of Health (NIH) is under pressure to show results. This is no small feat given the enormous scientific challenges of cancer, heart disease, HIV, and other killers and disablers. And even though NIH's budget more than doubled in recent years, less than five percent of government health spending goes to research into causes, treatments, and cures.

In areas where NIH and the private research community is successful, we face another challenge - getting the results or evidence into practice. According to the Institute of Medicine, it takes an average of 17 years before a proven best practice is in wide spread use for the benefit of patients. In other words, patient care in 2005 is more often based on the best science as of 1988.

Our nation's investment in health services research - which covers how to get evidence to practice and improve access, quality, and cost effectiveness of our $1.8 trillion health system - is worse. It hovers around one percent of what we spend on NIH. Medicare and Medicaid waste more in a single day than what we spend in a year on trying to improve program performance for patients and taxpayers.

As the NIH works to demonstrate results for the taxpayers, we all need to recognize the symbiotic relationship between (a) basic and clinical research that creates new evidence and (b) health services research that shows us how to bring the evidence to the physician and patient. Right now our research system is like a auto manufacturer who spends all its money on engineering and testing new vehicles and virtually nothing on design, quality control, financing, cost management, distribution, training, sales, or marketing.

Of course, the researchers must deliver. To do this, NIH and ARHQ in particular should support more actionable research. To be actionable, research must be:

1. Timely: Better to have a good answer today than a perfect answer in a few years. All too often we allow analysis to be the enemy of action.

2. Decision Relevant: Enough of preaching to the choir and hunting for tenure. Researchers must connect with real-world decision makers and answer their questions. Other than the Nobel Prize, virtually all other forms of recognition for research have little or nothing to do with work that is actionable.

3. Translated: It's all about reaching decision makers and unfortunately most researchers are horrible communicators. What do you think, what do you know, what can you prove, what do you suspect? Say it in the context of decision makers and their challenges.

4. Disseminated: Peer reviewed journals are great. I enjoy reading many of them. But most decision makers do not. You're lucky if they read the abstract. Disseminate findings in new ways to reach decision makers. Multiple mediums must be used and, if necessary, created.

NIH's new Institutional Clinical and Translational Science Awards program is a great start in the right direction.