The doorman fallacy in life sciences

If you work in marketing or commercial strategy and you don’t know Rory Sutherland yet, do yourself a favour. Stop reading this, go to YouTube, and spend an hour with the Vice Chairman of Ogilvy UK. The man is one of the sharpest thinkers in marketing today. He is fast, funny, contrarian, and annoyingly right about many things.

We came across one of his recent talks last week (his 2026 predictions), and it made us think. Not because he was talking about pharma. He wasn’t. He was talking about doormen, self-checkout tills, and the Royal Mail. But we believe that every single argument he made could have been written about our industry.

Give us a few minutes of your time. Promised it will be worth it.

The Doorman Fallacy

Sutherland describes a classic consulting trick that he calls the “Doorman Fallacy”. It goes like this:

A consultant enters a hotel and asks: “How much do you pay your doorman?” The hotel provides a low six-figure salary. The consultant then defines the doorman’s role as “opening the door,” replaces him with an automatic door mechanism, claims the full cost savings, and walks away.

Five years later, the hotel’s rack rate has collapsed. Homeless people are sleeping in the entrance. The most loyal guests have left. But the consultant who pocketed a share of the “savings” is long gone. Nobody held them accountable for the value they destroyed. They were rewarded for the cost they cut.

Because this is what the consultant conveniently ignored: a doorman doesn’t just open doors. He hails taxis. He recognises regular guests by name. He provides security. He signals status. He is the first experience of the hotel.

Sound familiar?

The Life Sciences Version

Now replace “doorman” with “sales rep” and “hotel” with “pharma company.”

For the past decade, our industry has been on a mission to reduce its dependence on field forces. Don’t get us wrong, there can be many valid reasons. We’re not black and white thinkers. Some we can think of: life-cycle stage, access restrictions, HCP preferences, cost pressure, competition, or the sheer inefficiency of the traditional model. Nobody is arguing that we should return to the days when reps were the only channel.

But here’s what’s happened in practice. The business case for digital channels was often, under the surface, built the same way the consultant built the case against the doorman. Define the rep’s role narrowly (deliver key messages, drive prescriptions), then show that an email sequence or a self-service portal can do the same thing at a fraction of the cost. Claim the savings. Move on.

Nobody measures the value that walked out the door with that rep. The trust built during off-script conversations. The nurse that was trained on injection technique because the rep noticed she was struggling. The KOL relationship that opened a clinical trial site. The early warning when a competitor was gaining traction in a key account.

We defined the rep as someone who opens doors. Then we replaced them with an automatic mechanism. And now we’re wondering why the engagement rate is falling.

The 0.5% vs. 30% Problem

Sutherland shares another brilliant story about an online travel agent. The entire organisation was obsessed with maximising online conversion. Then someone pointed out the obvious: a website visitor converts at about 0.5%. Anyone who picks up the phone converts at 30%.

The rational response? Invest in making the phone number more visible. The actual response in most organisations? Hide the phone number, because phone calls are expensive.

This is the same logic driving pharma’s channel strategy. We know that a well-timed, relevant conversation with a knowledgeable human being is the highest-converting interaction in HCP engagement. We’ve always known it. And yet, sometimes the industry's strategic direction seems to move away from it. Not because it doesn’t work, but because it’s harder to scale and harder to fit on a spreadsheet.

The people who made the case for digital channels claimed credit for the cost savings. Nobody held them responsible for the drop in HCP engagement scores, the decline in share of voice, or the growing indifference of physicians who now receive a hundred emails a week from companies they can’t tell apart.

Your Postman Problem

Rory also tells a Royal Mail story that should be required reading for every commercial excellence leader in pharma.

Royal Mail invested heavily in operational efficiency: faster sorting, more reliable on-time delivery. The result? Zero impact on brand perception. None. They then discovered something remarkable: there was no correlation between service reliability in an area and how much people liked the brand.

What actually determined whether people valued Royal Mail? Whether they liked their postman. Literally. If your postman knew you were on holiday and left the package on the back porch, you thought the entire organisation was brilliant. If your postman was rude, no amount of operational excellence could save the brand.

Now think about your own organisation. How much are you investing in content engines, CRM platforms, omnichannel orchestration, and AI-driven personalisation? And how much are you investing in the quality, capability, and empowerment of the human beings who actually interact with your customers?

Most pharma companies can tell you their email open rates to two decimal places. Very few can tell you whether their HCPs actually like and trust the people they interact with. And yet that second metric, the one nobody measures, is almost certainly a stronger predictor of prescribing behaviour, clinical trial recruitment, and long-term brand loyalty than anything sitting in your marketing dashboard.

The Quantification Bias

This brings us to what he calls the quantification bias, or the silent engine behind most of what’s going wrong.

What you can measure quickly becomes more important than vastly more important things that are either hard to measure or slow to reveal themselves. Click-through rates are easy. Trust is hard. Email opens are instant. Lifetime HCP value takes years. Channel cost-per-contact is on every dashboard. The value of a spontaneous conversation about an unmet patient need is on nobody’s.

And because the things that matter most can’t be measured quickly, they get systematically deprioritised. Not because anyone decided they don’t matter. But because the people who cut costs can prove their impact on a quarterly basis, while the people who build relationships can’t prove theirs until everyone’s moved on to the next role.

This is the asymmetry that Sutherland describes: you can claim credit for any reduction in cost, but you’re never held accountable for any destruction of value.

Phase 1, Phase 2, Phase 3

Sutherland uses the history of the electric motor as an analogy for how businesses adopt new technology, and it maps perfectly onto pharma’s digital journey.

Phase 1 → You replace the old thing with the new thing. Factories replaced the big steam engine with a big electric motor. The gains were trivial. In pharma, this is replacing face-to-face interactions with digital channels: same messages, same approach, just cheaper delivery. Most companies are here. It’s the Doorman Fallacy in action.

Phase 2 → You use the new technology to do the existing thing better. Factories used electric motors to improve the efficiency of their existing production lines. In pharma, this is omnichannel orchestration: sequencing emails, webinars, and rep visits into coordinated journeys. Better than Phase 1, but still built on the same brand-centric foundations.

Phase 3 → You reinvent the entire process around the unique capabilities of the new technology. Factories realised that, unlike small steam engines, small electric motors are excellent. Every machine could have its own motor, run independently, and be placed wherever it made sense. This changed everything. In pharma, Phase 3 would mean fundamentally rearchitecting HCP engagement around what digital and AI can uniquely enable. Not replacing the human, but redesigning the entire model so humans do what humans do best and technology does the rest.

Almost no one in the life sciences is in Phase 3. And you can’t get there by optimising Phase 1.

The Real Question

The industry talks endlessly about becoming customer-centric. But customer-centricity isn’t a digital strategy. It’s not an omnichannel platform. It’s not an AI-powered email engine.

Customer-centricity starts with a brutally honest question: what does the HCP actually experience when they interact with us? Not what does our journey map say. Not what our CRM reports. What does it actually feel like to be on the receiving end of our engagement model?

If the honest answer is “impersonal, repetitive, and indistinguishable from every other company”, then no amount of channel orchestration will fix it. You’ve got a foundation problem, not a technology problem.

Sutherland’s closing advice to marketers applies just as powerfully to life sciences commercial teams: don’t sell what you do, sell how you think. The real value isn’t in the campaigns you run or the channels you activate. It’s in the customer-first lens that prevents the rest of the organisation from making decisions that are operationally rational but humanly stupid.

Like firing the doorman.