Media Mix Town Meeting 2001: Much Ado About Media

The unprecedented proliferation of new digital and traditional media vehicles is surpassed only by the continued growth of pharma marketing budgets and promotional spending. The combination of the two has generated an industry stir-among product managers, their agency partners, and publishers-about what constitutes the optimal media mix for today's pharma brands.

Pharmaceutical Executive's sixth annual Media Mix Town Meeting gathered together more than 70 industry insiders to share perspectives about the needs of pharmaceutical brands. Although the afternoon's discussion touched on topics such as agency-client relationships, the value of public relations, and the downturn in medical journal advertising, everyone agreed that, whatever the media, the agency, or the mix, brand strategy is paramount. According to Cavan Redmond, a "client-side" guest who pulled no punches in his challenge to the audience of agency marketers, journal publishers, and market researchers, agencies had better do their homework, because they don't own brand strategy-companies do.

Redmond, senior vice-president of global strategic marketing at Wyeth-Ayerst and Town Meeting keynoter, summed up the challenges to the industry and its brands: "As pharma companies in a highly regulated environment, we have to address a broad group of people-physicians, healthcare payers, and patients-with different needs. How do we get there?

Drivers of Change

"That's where agencies have a new challenge-to help clients understand how to address those needs and to measure the results of their efforts. I don't think we've figured that out as a group yet, because so much has changed in the last few years; there are so many things that simply didn't exist before. Five years ago, the Internet wasn't a major driver of scientific information for brands or therapeutic categories. Now, it's a significant driver, but I don't know if it will help my brand deliver the data today. That's what we need the experts for."

Indeed, the combination of a vast audience and rapidly changing technology means that state-of-the-art marketing is a nebulous concept. Marketers need to re-educate themselves continually to seize new opportunities, minimize risk, and recognize the key drivers of change that affect brand strategy.

Once upon a time, agencies spearheaded clients' brand strategies. Ahead of the tactical curve in their creativity and knowledge of emerging media, they led the design and positioning of most pharma brands. According to Redmond, agencies need to abandon that myth before they lose further ground with clients. Today, brand teams are the real owners of brand strategies, and they want their agencies to learn rather than lead and to translate that knowledge into relevant tactics that yield measurable results. But how do you measure those results? By sales? Brand awareness? Long-term relationship building and customer loyalty? Return on investment (ROI)?

The Wake-Up Call

In debating that question, audience members, panelists, and PE editors uncovered two problems. First, without a clear definition of ROI from clients, no one has identified tools that measure the relative value of medium versus medium, technology versus technology, or the optimal mix of the two. Second, and perhaps more important, agencies are simply not listening to clients.

Beyond that, the discussion resembled a turf battle in which marketers championed their specialties, publishers promoted their vehicles, and researchers defended their data.

No discussion of optimal media selection or blending would be meaningful without mention of the impact of the technological revolution. Both panelists and audience members agreed that, for the most part, the days when "media" meant journals are all but over. However, today's definition of media is still in development, depending on whom you ask and on whether the industry defines itself as marketing-driven or sales-driven.

Media Versus New Media

"Through the early '90s, we heard that we were going to have to get rid of all the sales reps, because e-commerce and everything else were going to do away with them," said Redmond. "The number of details required to launch a drug now can hit 200,000-300,000 for the first three to six months. If you said that in 1993, everybody would have said, 'No way, that era is gone.' We're in the midst of a major evolution in technology that we're blending with a mix-whether journals or advertising, I don't know. But we're all struggling with the best way to reach patients or doctors with our messages in a very crowded marketplace."

Ed Goble, CEO of Goble & Associates, noting that 30 percent of his agency's business is interactive, characterized that medium's limitations: "Interactive media has to be combined with traditional media. We do e-detailing, we do surveys online, we use journals, we use mail, we use telemarketing-all those things to get into the new echelon of media. Without traditional media, interactive vehicles can't stand alone. But journal advertising probably could. If you look at a third-tier brand that's off patent or soon to go off patent, and you want to bring it back but have no detail support, you might be able to reinforce its use with existing customers and keep the brand going. I don't think that's true with electronic media."

Inevitably, the discussion turned to medical journal advertising, which sustained major losses during the past few years. Gaurav Kapoor, managing associate of the New England Consulting Group, recommended advice gleaned from other industries: "We keep coming back to the consumer packaged goods industry, because they have some of the strongest brands in the world-blockbuster brands-and a lot of marketing dollars have moved away from traditional advertising media or mass media to consumer and trade promotion. So it's not just that journal advertising will be replaced by interactive advertising. It's a matter of where the total marketing dollars will go to build a whole, strong brand."

The Journal Debate

Cindy Clark, vice-president of business development at MedCases, said her company's data show that journal advertising simply does not fulfill doctors' need for more evidence-based brand messages: "We just finished a study of high-prescribing cardiologists, who ranked the top 12 sources of information on pharmaceuticals. On the bottom was journal advertising. On the top were peer-reviewed scientific articles. And in the middle were case-based education, sales rep visits, and dinner meetings."

That generated a heated response from veteran marketer Harry Sweeney, chairman and CEO of Dorland Sweeney Jones: "Has anybody in this room ever seen a study that asked, 'Do you love advertising?' Have you ever seen advertising ranked that way? That it was ranked at the bottom of the list doesn't tell us anything. You have to look at outcomes of readership studies. Nobody's going to admit in public that they read the advertising."

Sympathizing with publishers, Sweeney suggested that brand managers are too often pushed by their companies to avoid journal advertising, which he described as a proven medium. "But that's the organizing discipline within their own corporations," he says. "If they were told, 'You will treat this journal or this set of journals the same as your detail force. You may not go out of those books,' you would see a very different mindset in product management."

If pharma defines itself as sales-driven, then the growing crop of sales force-trained brand and product managers is a welcome trend. But if the industry characterizes itself as marketing-driven, that trend might reinforce the notion that agencies have a more complicated job than they used to.

The New Product Manager

Koberstein pointed out that companies' decision making about media buying and determining desired outcomes is climbing up the hierarchy. "It's not just a product manager 'here today, gone tomorrow,' as I've heard many people say. Now product managers are people with a long-term vision that work through the whole continuum of product development and marketing. As agencies, you'll be dealing with that kind of consistency versus the helter-skelter 'who can you get by the collar to sign off on this' way of doing business in the past."

That means agencies had better seriously consider what clients want-whether they agree or disagree-before making recommendations. Product managers may not have a marketer's familiarity with media, but they have a sophisticated and valuable understanding of the brand that is unparalleled on the agency side.

So if decisions are made at a higher level and brand management is gaining depth, what's keeping clients from clearly defining their branding expectations? The discussion ran in several directions, eventually pointing to a reasonable answer.

"I truly don't believe that brand managers are looking at each piece of media and slicing and dicing without asking, 'What's it going to give me?'" said Redmond. "Return on investment is important, but we're also looking at the whole picture. If I have a sales force going out, but I'm doing nothing else, I know I'm not getting enough information there. So maybe the way I need to measure my ROI for a certain medium will be very different from how I measured it in the past. I believe we will have those tools as we go forward, but I don't think we're there yet."

Kathryn Metcalfe, executive vice-president and managing director of healthcare at Cohn & Wolfe, suggested that measuring ROI becomes more difficult when companies demand more integrated campaigns. "As we invite more agencies and groups to the table, as we all go out and do our respective activities, it becomes a real challenge to ask, 'Who's responsible for what, and what really moved the needle on this or that initiative?' That's where agencies and others have had to really look for new tools, measurements, and guidelines, and we'll have to continue to do that. That's always been a challenge in public relations, one for which we've been testing and trying to come up with new measures. But one of the other outcomes of having more and more people at the table is that the role of product managers has to change. They have to be able to handle more and more complex views and opinions, and that makes it much more challenging."

Marcia Frederick, corporate communications supervisor at inChord Communications, challenged the panel with a particularly pointed question: "Do you see pharma companies bringing on their PR partners before they bring on their advertising partners?" All heads turned to Redmond for his perspective.

What About PR?

"We tend to identify a program's core attributes and then decide who we need at the table," he says. "I don't care if someone is with a PR agency or an ad agency or a medical communications agency. It's just not something that keeps me awake at night. What does keep me awake at night is: Are all three of those programs going to have the same message at the same time and have the level of quality that I expect?"

Redmond added that companies pay agencies to handle contentious situations and to work with conflicting views until they come to a consensus. His ideal team is full of strong personalities and people from different agencies who would argue about what's best for the brand. Once he's picked the right people, he doesn't think twice about his allocations to PR or journals or other activities. "That doesn't drive me," he claimed. "What drives me is: Did I get everybody there with the same information at the same time, and are they on the same team? That teamwork will be critical in the future. It's no different than the first time you get marketing and medical people together-when you realize that they have entirely different points of view, and you must be able to bridge that and let them understand each other's world."

That philosophy, to which other global pharma companies also subscribe, makes the best of an environment in which clients are unclear about the results they want and in which their agencies-biased in favor of their own specialties-are trying to help them figure that out.

Although everyone agreed that the definition of "media" has changed over the years, there was little agreement among participants about that definition. For most of the audience and panel, "media" meant advertising vehicles. To some, however, it meant "the media," as in "the press." The chasm between the two schools was almost tangible in the room as the discussion-at times adversarial-avoided mentioning the value of media coverage in building pharma brands. So Koberstein raised the issue, asking if public relations was getting "a fair shot these days."

Media Versus "the Media"

"Everybody knows that an ad is run by a company and that it is information about a product," said Teri Cox, senior managing partner at Cox Communications Partners and president of the Healthcare Businesswomen's Association. "But it's perceived, just by its nature, as self-serving, whereas PR can be more subtle."

Metcalfe added that, despite the increase in the DTC advertising spend to get messages directly to patients, PR is poorly understood by product managers and by the industry in general, which marginalizes PR professionals as crisis handlers or press announcement coordinators.

She continued, "We're seeing public relations play a very effective role in the prelaunch phase and in conditioning the marketplace, where you clearly have more latitude, and also in advocacy, where you can mobilize large groups of patients. But we're also seeing companies, particularly in the biotech and specialty pharma areas, turn to PR when they don't have the dollars to spend on DTC and they need to reach key audiences very quickly."

Cox reiterated that, in tandem with advertising, much of PR's value is in building credibility for manufacturers through the work-and, if they're lucky, the voice-of organizations such as patient advocacy groups, research institutions, and professional medical societies.

"Then," she added, "you also have the human-interest element of the patients and the caregivers involved-how a drug or a therapeutic regimen changed someone's life or improved a child's outcome when it looked dismal. But, again, having the third-party distance in the message and the stories out there in print, on television, on radio, and in the alternative media as well as the mainstream media really helps drive the important messages home to the right audiences."

Redmond summed up the discussion by adding that a mix of both public relations and traditional media is essential for launching and sustaining major brands. "The goal is to provide everybody with accurate information and to do it very quickly," he said. "You can't do that with your ad or medical education agency if you don't also have somebody who knows how to handle reporters and how to place your message into context. As a brand manager, you use PR to handle the proverbial crises or issues that arise and to convey the positive information that comes up when somebody wants to know: 'Do you have a breakthrough cancer drug or transplant drug? How's it going to affect me?' And patients really do want to know."

To describe the environment into which a brand is launched, Koberstein used the term "therapeutic culture," meaning:

• the unique realm created by interested parties in a particular therapeutic category-patients, caregivers, healthcare providers, and advocates

• the market-unmet patient need, brand competition, threat of generic competition, level of research, and level of awareness

• the media-level of interest, influence of professional- and consumer-targeted vehicles, and applicability of technology to relevant audiences

• the opportunity offered by the combination of those factors.

The Therapeutic Culture

Although therapeutic categories have a lot in common, therapeutic cultures may not. The distinction is crucial to emerging brands, those preparing for launch, and those bracing for either brand or generic competition.

Making the most of a therapeutic culture in the context of constant change is a big part of building a strong brand. But that is much easier said than done, especially in an era of targeted medicine, when patients and their caregivers often know more about a specific disease than their doctors do.

"The therapeutic culture isn't a homogeneous group," said Metcalfe. "Not only are you looking at different geographical bases, you're also looking at patients with different stages of disease. So to reach those who are newly diagnosed, you may use one particular medium; for those more severely affected, you'll use another. You also need to reach people with chronic conditions. There's no single right answer for reaching all patients; you have to be really specific and careful in those communications."

Building on that and returning to the media mix, Alan Topin, CEO of Topin & Associates, addressed message delivery to pharma's most important audience-healthcare providers. "Certainly, the information in a science piece must be communicated differently than in a traditional consumer piece," he said. "We have gatekeepers in this industry, and that changes the rules. In fact, doctors have their own gatekeeper-managed care. Lastly, we are sales rep-driven. Years ago, they used to say, 'Advertising is what you do when you can't talk face to face.' In this industry, you have the opportunity to talk face-to-face, even if for only 50 seconds outside the sample cabinet."

To Ed Goble, the face-to-face detail is still the most important vehicle for message delivery to doctors, although even that is undergoing significant change. "There are several things out there-e-detailing, e-commerce, the Internet, intranets-that give us opportunities for even better reach. They may not be as tried and true as the standards, but I don't think the standards are going away, either. There are pressures for product managers to try out new areas. But there are always opportunities with audited data and specific information we have about individual physicians that justify spending a little more per hit.

"In no way, though, should that spending come out of the traditional media budget. You cannot get a sale unless you have awareness, and awareness is generated best and most cheaply by media. There are other ways to attract people now, but they shouldn't replace the basic media."

The afternoon's discussion yielded no consensus about the definition of a successful pharma branding campaign. It generated no model for the industry to follow when allocating funds among the many promotional activities. Yet, at the end of the day, it was obvious that the optimal blend is a phantom to be chased by a collaboration of researchers, brand managers, marketers, and PR professionals. And those collaborators will have to pay extremely close attention to the real change drivers-their customers. Whether the relationship is between agency and client or between manufacturer and customer, technology can spontaneously drive change as well as be used to drive change by those who embrace it. But embracing technology requires a creative effort to develop accurate and effective measurement tools to determine the relative value of various marketing efforts and media vehicles.

Tomorrow's Pharma Brand

In the meantime, lack of measurement means that the true definition of a successful pharma brand remains elusive, as does a meaningful definition of ROI. Is a brand simply a product with the largest sustained market share, or is it a name that builds loyalty for its manufacturer's pipeline long after its market share has evaporated? Maybe the ultimate pharma brand is one that actually creates its own therapeutic culture, defining itself by fulfilling its targeted unmet need and fostering the kind of collaboration among marketers and pharma companies that will ultimately sustain the growth of the industry as a whole.