The additive problem: pharma is brilliant at adding and terrible at stopping

Pharma is brilliant at adding stuff. A new channel arrives and it joins the plan. A new tool gets approved and it sits alongside the old one. A new initiative lands from global and it goes on top of everything that already exists. Nobody takes anything away.

I have been working with pharma brands for over 30 years and cannot remember a single conversation that started with: “This is great, but what should we stop doing?”

This is not a resource problem, though it often gets framed as one. It is not a technology problem either, it’s a cultural one, and it shows up most visibly in the day-to-day reality of brand managers, who are expected to handle an ever-growing list of responsibilities while somehow also delivering customer engagement excellence.

PI changes, label updates, content approvals, campaign deadlines, the list goes on; and now someone is demanding an omnichannel plan by Q3. On top of everything else, with no additional resources. Without being told how or what this new request replaces in their workload and daily workflow.

Earlier this year we got some senior pharma professionals together and asked them to be honest with us about what the industry was getting wrong. One person put the additive problem better than I could: “We are so bad at saying here’s something we should stop doing. Instead we just add. It’s always additive, never replaced.”

The cost of accumulation

The additive problem is not just a workload issue. It has a direct commercial cost.

When brand teams are running to stand still, they do not have the space to think carefully about what they are actually trying to achieve with each customer interaction. They produce content because content needs to be produced by a certain date. They send emails because emails need to be sent. They tick the omnichannel box because the omnichannel box needs to be ticked.

The results are not subtle. According to 2025 Veeva Pulse Survey data, 77% of content created for field teams is rarely or never used. 80% of all content produced for HCPs never reaches them. 65% of pharma contacts are unsynchronised, meaning the email an HCP receives has no connection to the conversation they just had with a rep.

This is not a failure of ambition. Most brand teams I work with have excellent instincts and genuine care for their customers. It is a failure of capacity. When there is too much on the plate and nothing ever comes off it, everything suffers.

The compliance trap

There is a specific version of the additive problem that makes things worse. By the time a piece of content has cleared the approval process, the moment it was designed for has often passed. What started targeted becomes generic, what started timely becomes stale.

Brand managers know this intimately. They spend their careers navigating the gap between what they wanted to create and what they were allowed to publish. The result is a constant trade-off between speed and impact, and most of the time neither wins. I recently discussed with a brand manager about a “simple update” to their e-detail, and six months later, it’s still not live.

The answer is not to blame the approval process, it exists for good reason. The answer is to build content strategies that are designed with that constraint in mind from the start, rather than discovering it at the end.

What actually changes things

I want to be honest about this because the additive problem is genuinely difficult. It does not have a simple fix. It is embedded in how pharma organisations plan, resource, and measure themselves, and no single consultancy engagement is going to undo years and years of accumulated habit and institutional momentum.

But there are things a brand team can do within their current remit, without needing to change the culture or convince the whole organisation, that reduce the burden and improve customer engagement quality at the same time. They are not glamorous. They are not the things that get discussed at industry conferences. They are the basics that most teams either have not implemented properly or have never left the shelf and are just collecting digital dust.

Over the coming weeks, we are going to share what a group of senior pharma practitioners told us those things are. Not what we think. What the people doing this work every day said, in an honest room, when we asked them to tell us what actually moves the needle.

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James Harper is Founder and MD of twentyeightb, a field-first customer engagement excellence consultancy. twentyeightb has worked with more than 20 pharma companies across 15 years.