Opinion: It's All Relative

We are living in a post-Vioxx world where DTC can no longer exclusively mean direct-to-consumer advertising (DTCA). Today it must mean DTCC—direct-to-consumer communications.

Peter J. Pitts

Why? Because reform, while presented as voluntary, is in actuality being driven by the winds of the perfect storm—the 2004 presidential election season, the emergence of drug importation as a populist political issue, the Medicare Modernization Act, and drug safety (as personified through the issues of clinical trial transparency and Vioxx). A grand slam of highly charged issues made it not only possible, but also predictable that the media—and, as night follows day, politicians—would begin portraying Big Pharma as the new Big Tobacco. And DTC, being as it is the most public face of the industry, found itself squarely in the bull's-eye of pundit satire and political outrage.

It was into this arena that PhRMA launched its voluntary Guiding Principles for DTC. And this long delayed document needed to be more than a transitory inoculation against the DTC desperados in Washington and their allies in Congress. It needed to make a difference.

Winston Churchill said, "Americans always try to do the right thing—after they have tried everything else." If the pharmaceutical industry wants to change its image—from salesmen to scientists—on the Hill and in homes nationwide, it's time for Big Pharma to turn from pyrrhic victories to long-term strategies. And, in this respect, the new DTC guidelines, even though voluntary, are an important step in the right direction.

Today there is a new pharmaceutical Theory of Relativity: R3=DTCC. Now, in order for you to understand the elegant physics, allow me to first explain the three "Rs" of pharmaceutical DTC communications.

The three "Rs" are derived from PhRMA's 15 Guiding Principles. The first "R" is for reaffirm. Eleven of the fifteen principles fall into this category. In essence, they say that pharmaceutical companies will follow the rules and guidances set forth by FDA—and that every new ad will be submitted for review. I can already hear the groans from DDMAC.

The second "R" stands for redeploy. Guiding Principle number 10 calls for the de facto banishment of reminder ads, resulting in the need to redeploy the dollars and tactics previously handled by these obnoxious little billboards. While there are many strong and potent arguments as to why drug ads truly advance the public health—by destigmatizing diseases (such as depression), reinvigorating doctor-patient conversations, assisting in compliance, and uncovering previously undiagnosed conditions earlier in the disease process—there are no good arguments for why reminder ads, in any way, advance the public health.

Other things that will need to be redeployed, according to Guiding Principle number 13, are television ads that discuss lasting erections and satisfying experiences. Currently, those ads are limited to adult viewing hours, whatever that means. Seriously, folks, will primetime television featuring programming about sex be any better or worse without commercial breaks featuring advertising about sex? While most average Americans probably agree that banishing erectile dysfunction advertising from family viewing hours is a good thing, they were all already probably too busy doing something else—like watching Desperate Housewives and Family Guy—to notice.

The third, final, and most important "R" is rethink. It is here that the rubber really meets the road. This is the hard "R," the "R" that challenges the pharmaceutical marketing mind. The "R" that demands a redefinition of long-term thinking from the end of the quarter to the end of the quarter century.

Consider number three: "DTC television and print advertising which is designed to market a prescription drug should also be designed to responsibly educate the consumer about the medicine and, where appropriate, the condition for which it may be prescribed." Also number 14: "Companies are encouraged to promote health and disease awareness as part of their DTC advertising."

The operative phrase here is, "promote health and disease awareness."

While the passive-voice wording of these principles makes the overall effect more, well, passive, the main thrust of principles three and 14 are clear: less undisguised selling and more on-purpose education. It's an important first step in the campaign to reposition the industry from being assailed as hucksters to healthcare heroes.

If we are to view these guiding principles as a roadmap (as they are being promoted), then we must expect energetic battles between brand teams and their agencies, both advertising and public relations, over new ways to sell through education. Part of the answer is a shift to longer-term strategies, because educating about a disease means accepting the mantle of teacher. The teacher becomes the expert, and the expert gets the business—but not in the same truncated time frame that a hard sell produces.

Promoting health and disease awareness also means a fundamental shift in the marketing mix. Advertising is a wonderful brand builder but it's not nearly as potent a brain builder. That's traditionally been the job of public relations.

Which brings me to direct-to-consumer communications, DTCC. Direct-to-consumer communications means selling the brand as well as stimulating the brain. It means new strategies and tactics. And it means that the time is forever gone when a pharmaceutical CEO can speak about "responsible promotion" while turning a blind eye to the actual tactics being used on the air and in the doctor's office to meet aggressive quotas and keep the Street happy.

DTCC isn't just about selling. It's about saving lives and saving our healthcare system. It's about improving disease awareness and defeating non-compliance, which is estimated to cost our healthcare system billions of dollars a year in increased emergency room visits, unnecessary surgeries, expensive hospital stays, and lost productivity. Understandable and accessible information (in the form of DTCC that employs leveraged learning strategies and incorporates both brain and branded messages) also helps with our national crisis of embarrassingly low health literacy.

Successful DTCC requires a reaffirmation of responsibility, a redeployment and reassessment of resources and—the toughest "R" of all—the ability and willingness to rethink the roles of the many tools in the pharmaceutical marketing armamentarium. R3= DTCC.

Will this be difficult? You betcha. But like Tom Hanks said in A League of Their Own, "If it was easy, anyone could do it."

Peter J. Pitts is SVP at Manning, Selvage & Lee, and a senior fellow at the Pacific Research Institute. He can be reached at peter.pitts@mslpr.com