What's Taking So Long?

Pharma's relationship to digital marketing is as puzzling as a suitor who can't bring himself to pop the question. If he knows he's going to do it, why all the foot-dragging?

"Companies are looking for someone to do it for them," says Michael McLinden, a partner at Mc|K, a healthcare advertising agency. "They want someone to say: 'This is how you build a virtual relationship with a patient; this is how you build a virtual relationship with a physician; this is how you make these relationships work for your brand.'" (see "Michael McLinden, Mc/K Healthcare").

Problem is, as many a shy suitor has discovered, if you wait too long, you might loose the prize altogether.

"Pharma risks being left behind unless it recognizes the need for specialized sales forces and increased use of the Internet as a customer information resource," states a recent study, "Reaching Doctors and Patients Through New Digital Media," by the eHealthInsight series.

The report goes on to say that while there's been a growth in physician and patient Web sites, there is a need to move forward from the traditional company Web site and actively engage with customers—physicians and consumers alike. "Social media and blogging forums are potential opportunities. And mediums such as podcasts and live video-detailing are currently underutilized."

So what's holding pharma back? To find out, Pharmaceutical Executive's Agency Confidential tracked down digital marketing expert, Lisa Flaiz. Flaiz is vice president, group director and national pharma practice lead with the Philadelphia office of Avenue A | Razorfish, an interactive marketing and technology services company. We grilled her on what the future holds for pharma online.

Agency Confidential: Pharma is finally going digital is a statement being bandied about these days. And yet the 2007 industry spend numbers tell an entirely different story. What's really going on?

Lisa Flaiz: The tracking isn't sophisticated enough to pick up on what people are spending on big content-integration sponsorships: what people are spending on search. A lot of dollars are not being reported. Nonetheless, from a trend perspective, when you hear a statement like that and then see the spend numbers actually going down, it is a little concerning.

Still, you have to consider the big picture. In the pharma space in general, DTC spend, no matter what channel we're talking about, is going down. So, I think, part of the trend is following an industry pattern and not necessarily a channel pattern, if you will.

The other problem with the statement is that the marketing mix models are not sophisticated enough to keep up with newly available channels. So when marketers are trying to make decisions about where to spend their money, and how to allocate their budget, they have a really hard time with decision support tools that say, "Move your money online." The models aren't there yet. Thank God there are people like Rex Briggs who continue to evolve and push that space.

Who is Rex Briggs? He's one of the analytic gurus in the arena who has really pioneered some of the ways that we begin to measure return on investment and, in fact, he's recently begun to evangelize the term ROMO, return on marketing objective.

What's the difference between ROI and ROMO? Return on marketing objective allows you to look at very specific E-performance indicators aligned with your goals, with your objective. It doesn't always have to be a hard, lifted script-type of number because your objective could be something completely different.

Do you mean engagement, and driving physicians and patients to the Web? Absolutely, and what you're also starting to see now is a trend toward marketers believing that a brand can be established online. That's a really, really slow evolution in pharma.

What would establishing a brand online entail? At one time the emotional engagement, or the big idea, happened off-line, primarily on television. But today the big idea can happen on any channel, and every channel has the ability to engage your customers emotionally. There used to be an argument that TV was sight, and sound, and movement. And it was the only medium that could touch all three senses. Well, that's not true anymore. All this stuff—the engagement—can happen online, and, it can happen in a long form. Thank God, because who's got the time to tell the full story about a pharma brand in 30 or 60 seconds? You need that long form.

What would the long form look like? Every channel is becoming action-enabled now. It helps to lead your customer down a funnel, along that customer communication journey, if you will, to the point where they're ready to take an action. Your brand can stand for something. And you can have that experience happen online now. That's what you're starting to see marketers understand.

Is brand building online catching on? Marketers have come a long way in the number of years I've been working in the pharma online space. Things have changed dramatically. Back when I started, my client was basically an IT guy. He didn't have a marketing bone in his body. Now the Internet is an integrative part of the marketing mix. It's not an afterthought. There are people on the brand team that have experience with online marketing, maybe not expertise, but at least exposure and experience. Clients will come to you and say, "I know what I need to do. I understand approach, but..." They are not as far along as they are with some of the off-line tried-and-true tactics. It still takes lots of pushing, of saying, "Alright, I get your challenge. Here's the solution we recommend." And then there's a lot of discussion. We work together. We work collaboratively with the other agency. Then we partner with the client, and eventually we come to something that we consider a strategy and hopefully an integrated program, as opposed to a tactic. You can't build a Web site and call that a strategy, that's a tactic.

How can nontraditional media and cutting-edge technology extend the reach and frequency of traditional marketing? We're in a pharma world right now where the overall effectiveness of the sales force has declined dramatically for various reasons. There's a real need to start looking at alternative channels for reaching position. I think there are plenty of companies out there who are doing that really well—companies that focus on E-detailing, companies that focus on hand-held marketing, and companies that focus on kiosks at conventions, and things like that. What's really needed is to work with an agency that has a command of physicians' habits when it comes to information-gathering and consuming media, and who also has kind of a deep familiarity with those various channels. Then the sales force can be complemented when you find its effectiveness is declining every day. In many cases a hurdle in the pharma space is the heritage of being a sales organization. Some pharma companies have a hard time getting their heads around what marketing a drug looks like without sales. A forward-thinking agency is needed to push you along and show you what an integrated communication plan to a physician could look like, and to help pursue new venues for getting messages out to them.

What does social networking look like in the pharma industry? We're starting to see people dip their toes in, and folks getting a little bolder with it, which is nice. So social networking is a really interesting place. Of course, the trouble everybody has is there's no such thing as guidance or governance for it, yet. But in Internet marketing or digital marketing, et al, I think FDA is not going to go too far. It's unlikely they will take a proactive stance in regulating the use of emerging technology or social media. Being the FDA suggests they'll take a wait-and-watch approach.

Hopefully, what pharma companies are doing right now is working on some sort of corporate guidance around how they're going to play in the social media space. Inconsistency is what's going to call attention to the industry and get us in trouble.

Are there sponsored social media sites? Gardasil has a page on Facebook. I love that. And there are plenty of online communities around particular disease states that are now being generated within popular social networking sites like MySpace.com. So you are starting to see them. But you have to treat it like you do any other promotional channel. You have to make sure that your information is balanced; that you're transparent; that you're adhering to the commercial regulations that apply to any other channel. It has to go through your medical, legal, and regulatory review. You have to file it, with the FDA, upon first use. So pharma companies really need to understand how they're engaged in these media. You have to find the appropriate resources to put toward managing, say, a blog or any of these newer channels, and that takes a cultural shift. That's going to take some companies being bold.

Johnson & Johnson's BabyCenter comes to mind. Is that an example of what you're referring to? The BabyCenter was well ahead of its time. That's social marketing before we knew about it. It's a wonderful site. The thing you need to remember as marketers, pharma or not, is that connected users are shaping your brand right now. This is how your brand is going to be defined, and, as a marketer, you want to have some control over how your brand is used.

So the Internet is not just a direct response medium anymore? Certainly not. It's no longer a one-way messaging medium to the marketplace. It's becoming a two-way dialogue with customers.

Has the prospect of losing control of the message online been a stumbling block for pharma? It is both the beauty and the curse of it. You have to let go and be willing to cede some of that control over to the consumer. What you can do, however, to keep some of that control is to manage the distribution of your content. You can't think of your Web site or the Internet as just a destination tactic anymore. It's really about distribution. If you get your word out there and distribute it through whatever—YouTube, Google, video, syndicated content—the better chance you have of becoming part of and having that conversation based on the credible, accurate, and balanced information that you provide as a company.

Are some distribution vehicles better than others for pharma brands? Video is going to be a huge opportunity for pharma. It's not realized yet because pharma hasn't realized they have to take on the role of content creator. They have to start producing video. We're not talking about 60-second commercials; we're talking about long form video now. What you're going to see is marketers having the same entrepreneurial spirit that Proctor & Gamble had in the 1930 swhen it created the soap opera. They are the ones that are going to really leverage this video opportunity. It's going to become episodic. We're not going to see 60 seconds; we're going to see serial programming.

Are there any current examples of this serial video pharma marketing? You might find some examples with the media companies, or some of the publishers out there. There are syndicated video that allow for custom sponsorships and some custom advertising. You're starting to see some pharmas take advantage of those from a third-party perspective, but I'm not personally aware of any kind of episodic video that's the kind of thing I'm talking about. I could be missing something. Centocor did a two-hour feature film last year. It was called INNERSTATE. I don't really think that's a sign of things to come, but it was pretty cool.

There seems to be a real craving on the part of patients for real information, not hype. Do you think that is true? Patients want to hear the real story: It's like, "Don't tell me about relative side effects. Tell me about the side effects to being an actual patient." The modern, branded opportunity is one in which marketers can supply compelling content that's entertaining but also engages the viewers with their brand's core values. And it's not about putting a 30-second or 50-second spot online. It's exploiting the opportunities of the Web. It's aligning the content and the format with the behaviors of that audience and creating something of value. Technology executives know they're on to something when Google shows up as a competitor. So back in February when Google jumped into the online health information market, which is the Google Health data, some of the other companies out there—Health Central and Revolution Health, and other newcomers to the market—probably got a little nervous. Anyone would be nervous if they thought Google was going to swallow them up.

Not everybody's figured out how they want to serve users. They haven't quite figured out their business model. But a lot of them are focusing on community, I can tell you that.

You mean patient-disease communities? It's about finding ways to create consumer advisers, if you will, or consumer online opinion leaders. They're trying to find a way to harness the power of community. They're getting people with like-minded values in the same place. I often point to the MS category as a model of the right type of relationship marketing. All the drug companies that sponsor those sites do a great job. MS is a small population. When you look at where the best communities online are right now, it's small populations. It's hemophilia, it's rheumatoid arthritis, it's MS. It's rare diseases and specialty physician populations.

It's funny because a lot of times people think, "Oh, can I really use the Internet to reach my audience? My audience is so small. I'm not heart disease; I'm not depression; I'm not cholesterol; I'm not one of these big GERD-type categories." But that's the community role. The real heavy players are in these smaller communities, these smaller populations scream opportunity for community. You only have 2,000 people? Get them online.

Do you have any future predictions? I think the next thing is for pharmaceutical companies to hold or sponsor dedicated blogs directly. So you brand a blog that discusses the appropriate use of a product. This is no different than what they do now when you call their 800 number. The next step is establishing a dialogue between consumers and a company's medical experts that creates an opportunity for the industry to dispel some of the mistrust that's built up in the public's perception. I hope there are some folks out there who think we're going to a place where the next step is that we can have some sort of open dialogue with our constituents. And, you know, it's not going to happen in 2008. Open forums are still very, very scary. People bring up adverse events all the time. People bring up off-label issues. But I feel as long as there's a plan, people are trained in it, and you know how to handle it, someone's going have to take that wild leap of faith.