DTC's Next Chapter

Orchestra conductors may, at first, seem like an unlikely comparison for pharma marketers. After all, a conductor's job is to ensure that each instrument harmonizes with others within the section; that all the sections complement one another; and that the timing, tone, and pitch of each disparate part are flawlessly executed. But when one appreciates the challenges facing executives today in integrating all components into the marketing mix, the analogy seems appropriate.

Understandably, direct-to-consumer (DTC) advertising is only one movement in the composition. But faced with industry's increasing reliance on DTC to drive preference for the growing number of parity products, consumer marketers' biggest challenge-and opportunity-comes in leveraging the benefit of the whole marketing mix. In doing so, not only can they prompt patients to talk to their physicians, but they can actually influence that dialog, and, ultimately, affect how well patients adhere to and comply with the prescribed regimen.

To better understand those challenges, Pharmaceutical Executive convened a roundtable of esteemed DTC marketers responsible for some of the biggest and most effective consumer campaigns. The discussion revealed the struggle that integration poses to consumer marketers in advancing their craft. But it also highlighted how much these executives have learned since 1997-they are now focused on return on investment (ROI), they are moving slowly and smartly into new tactics and formats, and, by looking to their peers in consumer packaged goods, they have a much better understanding of their target audience. Here's a summary of that discussion.

Follow the Leader

In today's information age, consumers, not companies, are leading the integration effort. Patients are connecting the dots between ads they see on television, the magazine story with their favorite celebrity talking about a health issue, and the e-mail newsletter containing tips on heart health. In fact, patients have logically grouped those messages around a brand or disease, and marketers are struggling to keep up.

Quotables: On Brand Positioning

"What always happened, and still happens, is that professional agencies claim the territory of the physician's office and everything else is considered DTC," says Jim Sandino, former president of Lowe Consumer Healthcare, now president of the J. Sandino Group. "Yet the campaign for Accutane, which blurred those lines by putting simple branded devices inside dermatologists' offices, was a very effective tactic to extend DTC into physicians' consciousness and actually right into their office."

"At the end of the day, you need to put the patient together with the doctor to have that important dialog," says Frank Hone, executive vice-president, global business group, Healthworld Communications. "We have to help guide it. One way we've done that, in the direct response DTC campaign we developed for Avonex, was to include a question card for patients to bring to doctors, which guided the conversation to get the positive outcome we desire."

Inside Information. Andrew Schirmer (right) and Anne Devereux (left) share their insights on what makes DTC advertising tick.

Roundtable attendees agreed that the lack of a central marketing architect hampers program integration. "It's incumbent on clients to take that leadership position, to bring everyone together and make sure that everyone has an aligned strategy in bringing the brand to market," says Amy Niemann, vice-president of marketing for Barr Laboratories. "Not only the consumer and professional ad agencies, but all of the folks who are working on the business, whether it's interactive, public relations, or medical education."

Several participants noted that if clients don't drive or reward integration efforts, they simply don't happen. "We did a major product launch for a client last year, and there was all this talk about interagency integration," says Bill Drummy, chairman and CEO of Heartbeat Digital. "We had all the meetings and we did all the right things. Everyone agreed. But with the lead agency dictating the creative, none of it happened. There are very few clients that have the actual insight and the force of will to say to the agencies that they have to come up with a comprehensive campaign and stick to it."

Quotables: On Integration

It may be unrealistic to think that clients have a handle on how to best integrate agencies. More and more, partnerships seem the ideal answer, with companies and agencies trying new ways to bring around a brand-centric, versus a budget-centric, approach.

BBDO, for example, recently appointed Anne Devereux to the new role of chief integration officer. "Many of us from a holding company and large-agency perspective are creating integrated service networks inside the agencies, so the onus doesn't only fall on the client," says Devereux. "It's worth all the meetings and all the energy to break down those silos because you will see the results in the marketplace."

Small agencies have created their own networks as well, whether formal or on a project basis. Sandino says the latter approach was effective in creating and launching an integrated DTC campaign for Kremers Urban's omeprazole in less than three weeks.

Patient Care. Denise Strauss (left) stresses the importance of reaching patients with credible spokespeople. Frank Hone (below) discusses how to effectively create dialog between patients and physicians.

Next Stop: Persistence and Compliance

Integration efforts may also be the key to increasing and advancing persistence and compliance programs.

"You don't see any more than 10–15 percent of total media dollars spent on compliance and persistence," comments Michael Guarini, managing director of Ogilvy & Mather's healthcare practice. "For those programs, the industry is just adopting a lot of the standard consumer marketing tactics, like free trial offers or coupons."

Certainly, environmental forces will dictate that marketers increase their efforts in this area. "There will be intense pressure on price over the next couple of years," says Anthony Manson, senior vice-president, managing director, Sudler & Hennessey. "All companies are going to have to deal with that. All of a sudden, getting that repeat script may be a more viable way to grow the business than the acquisition part. So we may see changes in the pattern of spending in the next couple of years."

Quotables: Revamping the Brief Summary

Denise Strauss, director of marketing for Bayer Men's Health and Levitra, says new efforts will be more interactive. "The opportunity with compliance and persistence isn't as much with national broadcast media, but it's online and through customer relationship marketing. That's where we'll see an increase in investment with more product managers using those tools to grow loyalty and compliance."

Marketers should also focus on getting inside conversations between patients and doctors, where the greatest opportunity to change behavior lies. "Industry is extremely limited to incentivize physicians to give out patient support material," says Sandino. "On the other hand, the only patients who voluntarily enroll in compliance programs often need it least. So companies are only getting a small improvement in drop-off rate. It's analogous to everybody going after the two top quintiles of doctors. You need to get to the physicians in the next two quintiles down who are trying to grow their practice. Similarly, we need to get to the not-so-good patients in order to make a compliance program truly effective."

"This is where integration is going to be crucial," says Devereux. "Just look at the diagnosis process for a patient with high cholesterol. The doctor says, 'I'm going to put you on this exercise regiment, and if you can't get your numbers down, I'll give you this drug.' So despite all of the patient's best effort, he fails, gets Lipitor, and feels like a loser. What's his motivation to stay on the drug? Until we get into the doctor–patient dynamic, we're going to have a very hard time hitting the adherence issue on our own. That's why integration is the path of the future."

The Ins and Outs of Regulation. Anne Myers (left) and Louis Morris (right) talk about the various challenges and opportunities in working with FDA to create new formats for DTC communications.

New efforts show that to be true. Novartis' most recent "Take Action for Healthy Blood Pressure" campaign highlights integration with messages aimed at the public through an educational initiative and medical education for physicians, and thus creates conversation between patients and doctors using the same language. Also unique is the campaign's money-back guarantee, which drives patients to physicians' offices to get tested and increases compliance.

Untrademarked, Not Unbranded

In its recent guidance, FDA announced that pharma's help-seeking ads fall outside its purview. That statement has reinvigorated the discussion about unbranded advertising, but may not change companies' strategies.

Quotables: On Working Together

"Interest in unbranded advertising is diminishing," says Mitch Roberts, senior vice-president, group managing director, consumer operations for Cline Davis & Mann. "It's very difficult for clients to understand pouring money into unbranded efforts."

Indeed, DTC marketers often say that awareness is only valuable if it drives consumers to physicians to ask for brands by name.

"There's too much data that show that eight or nine out of 10 patients will get the drug they ask for," says Stuart Klein, president of the Quantum Group. "One of our key challenges is getting that often incomprehensible brand name on consumers' lips because, for the most part, in these parity categories, doctors will write whatever patients ask for."

Top Priorities. Anthony Manson (right) notes that pharmaceutical companies will direct more money toward persistence and compliance efforts. Stuart Klein (below) discusses the importance of brand awareness.

Therefore, marketers will continue to use unbranded advertising only when "you have something new to say from an educational standpoint, when it's the only product on the market, or the rare occasion that you do get a unique point of difference-those are the times when help-seeking is effective," says Ellen Fields, group account director at DDB.

Richard Czerniawski, managing partner of the Brand Development Network and keynote speaker at the roundtable, challenged that assumption: "If a company wants to have an ongoing dialog with patients, untrademarked advertising-which is anything but unbranded-can be very effective," says Czerniawski. "If people perceive that Viagra is weaker than Levitra and Cialis, I might want to go unbranded to get that dialog going."

One common advertising tactic to improve the ROI on help-seeking advertising is to link it with a branded reminder spot. "The only way we can make it work for Zocor, which is strong but still distant to Lipitor, is to link them to branded efforts," says Guarini. "Otherwise, we are driving 65 percent of new patient starts to Lipitor."

Quotables: On Corporate Branding

FDA did warn industry in its guidance against pushing the envelope on pairing disease awareness advertising and reminder ads too closely. "The FDA guidelines will open up new ways in how we use unbranded and branded communications," says Todd LaRoche, executive vice-president/managing director of creative at Palio Communications. "That's where you're going to see some changes."

One area under investigation is how corporate branding can be used in help-seeking advertising. "When Bob Dole did unbranded advertising for Viagra, you saw a little blue oval at the bottom," says Andrew Schirmer, executive vice-president and managing director for McCann HumanCare. "That was nice synergy, but it was happenstance. The reality is that the two brands can help each other, but that isn't viewed as an objective at the corporate level."

But change is slow, especially when it comes to trying new things. "DDMAC has always been interested in learning, and they are willing to experiment as long as it fits within the regulations," says Louis Morris, former acting director and branch chief of DDMAC, now president of Louis A. Morris & Associates. "But industry is fearful to approach FDA. When push comes to shove-and plenty of people are pushing, including ad agencies-companies don't want to engage in that kind of risk taking."

Speaking From Experience. Amy Niemann (left) discusses how agency–client integration can work. Richard Czerniawski (center) challenges assumption of help-seeking advertising. Jim Sandino (right) provides war stories from several DTC campaigns.

Yet Eli Lilly's Anne Myers, Strattera consumer marketing manager, says that is not acceptable. "We're all after the same goal-good patient care. If we can think of it that way, as having the same objective, we can get somewhere. If we continue to be afraid, we'll get nowhere."

Know Thy Audience

The roundtable discussion proved that some of the most important DTC lessons have been learned from the consumer packaged goods industry.

"DTC is getting a lot more people from other types of agencies into this category," says Millicent Badillo, senior vice-president, brand director for Cialis, Grey Worldwide. "They're saying, 'I don't know about molecules. But what's the insight here? Why do patients need the drug? Why is it different?'"

Indeed, consumer insight may be the key to making a brand resonate. "For the Lipitor work, we learned to understand how the target audience truly viewed themselves," says Devereux. "We spent time talking to baby boomers, and we also delved into the MacArthur Foundation Study that showed that baby boomers see themselves 10–15 years younger than they are.

"When the reality of disease collides with our perception of ourselves, that's when we start tuning out the messages. So featuring people who were cast to look young, healthy, and vibrant is much more aligned with how the audience sees themselves, even though it's not who they truly might be."

Quotables: On Fair Balance

Taking those campaigns to the next level means translating the insight into tactics. "Great tactics also come from really knowing who your consumers are, what they think, what they enjoy, where they work, where they play," says Strauss. "Then talking to them in their language, maybe through a spokesperson who is credible and who is a mentor. It also means reaching people in a venue and talking to them about a product or condition in a way that they haven't heard before."

But for many consumer marketing veterans, that is easier said than done. "It's hard to do work in this category that is successful and that is respected by the larger advertising community," says Schirmer. "And it is ridiculously hard to do both together. But the people sitting around this table have stuck with it-pushing on behalf of the client to make sure that it's successful; pushing for the patient, ensuring that it's clear; and pushing as craftsmen, making sure it's something we're proud of."