Evolution E 908 D DTCPM Sept 2011

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The Source For DTC Leaders

P E R S P E C T I V E S
Vol. 10, No. 3

September 2011

In This Issue
Nami Choe

Bruce Rooke

Partner, Senior Director,
Consulting with Ogilvy
Healthworld

Chief Creative Officer at
GSW Worldwide

Marketers have the opportunity to modernize DTC,
improving both campaign ROI and consumer reach

Branded vs. Unbranded:
Evaluating Tactics to
Reach Digital Consumers
Rx Non-Adherence:
The Silent Epidemic
Find Digital Consumers
In a Sea of Mass Media
Reinvent DTC Marketing
To Meet Demand in an
Anywhere Health World

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Source: GfK MRI Fall 2010/Spring 2011; Dash is a publisher-defined prototype; comScore,
July 2011 (Parade Partners [E], DashRecipes [E], Parade Health [E])

Editor’s Desk.................................................................................................................4
DTC in Brief...............................................................................................................6, 8
Spending Review.......................................................................................................10
Branded vs. Undbranded Digital Tactics: Reaching and Converting
Relevant Consumers..................................................................................................12

A series from Crossix RxMarketMetrics

P E R S P E C T I V E S

September 2011 Vol. 10, No. 3
Viable Content
Sources

Optimizing ROI through Integrated Marketing...................................................17

Nami Choe, partner, senior director, consulting with Ogilvy Healthworld
It’s Time ‘DTC’ Stood for Something Else.............................................................20

Bruce Rooke, chief creative officer at GSW Worldwide
Medication Non-Adherence: The Health Care Industry’s Silent Epidemic......22

Todd Steffes, vice president at FICO
Finding Digital Consumers in a Sea of Mass Media............................................26

Doug Zabor, executive vice president, and Qi Jiang, vice president of marketing science,
with Phoenix Marketing International

Memo to Digital Pharma Marketers: Don’t Overlook Viable
Content Sources.........................................................................................................32

Tanayia Washington, insights & analytics manager at CONTEXTWEB

Relationship
Marketing

What a Wonderful World it Would Be: Developing Relationship
Marketing Programs..................................................................................................36

Louis Winokur, director of analytics at DKI
Anywhere Health: Reinventing Healthcare Marketing in a
Connected World.......................................................................................................41

Jim Walker, director of emerging trends at Cadient Group
Promises and Perils: The Social Stock Market......................................................44

Jane Chin, Ph.D., author, online authority & former pharma R&D/medical affairs
Marketing and Media Movers.................................................................................48

An update on DTC personnel and company changes within the industry

Contributors’ Page....................................................................................................49

A closer look at the contributors to this issue of DTC Perspectives
Advertiser Index and Resource Center..................................................................49
Eye on the Hill: The Debt Ceiling is Just the Tip of the Iceberg.......................50

Jim Davidson reports on what to expect in the coming year from Washington
Perspectives on Books: Never Say Die: The Myth and Marketing of
The New Old Age......................................................................................................52

Social
Stock
Market

Reviewed by Robert Ehrlich of DTC Perspectives, Inc.
DTC Perspectives Editorial: The Uncertainty of Healthcare Continues...........54

Miss an issue, or want to order one from our archives?
Please visit our website www.dtcperspectives.com to view recent
issues of DTC Perspectives magazine, or call Debra Sander at
(973) 973-239-2051 to purchase previous issues.

44
DTC Perspectives • September 2011 |

Good Signs Ahead

fter periods of decline, DTC spending appears to be rebounding in the
first half of 2011, reaching $2.16 billion. Data from The Nielsen Company shows that to be a healthy increase over the prior year, up 7.6
percent. While several big name brands will be going off patent in the next few
years (including Lipitor, Plavix and Cymbalta), DTC Perspectives believes that
spending by new brands entering the market will counter such losses. Thus,
DTC levels will likely grow once again.
Marketers today understand how crucial DTC can be to a brand’s success;
consumers expect brands to be involved with the conversation. With new channels and methods for reaching and engaging consumers continually emerging,
marketers are embarking upon some very exciting times. DTC marketing is on
the cusp of an evolution that will break the current standards for communicating with patients. As Bruce Rooke, chief creative officer with GSW Worldwide,
discusses in his article, “DTC is due for some big innovation. … We have the
chance – and responsibility – to respond to the changing landscape with a whole
new vocabulary of action.” (Rooke’s article begins on page 20.)
In this era of constant change, marketers have the opportunity to re-invent
how they promote their brand – from a campaign’s creative and messaging
to how the brand engages with consumers to determining the optimal media
mix. However, improvements made to DTC campaigns would be fruitless if
they were not properly measured and appropriately adjusted when needed. As
advancements in analytics also develop, marketers can more accurately evaluate campaigns and channels to optimize ROI. “Marketers are continuing to
unlock data analytics’ potential in optimizing investment real-time and in a
more targeted way,” detailed Nami Choe, partner, senior director, consulting
with Ogilvy Healthworld. Choe’s article (beginning on page 17) explains “as
we look to the future, with data becoming more available and tracking more
sophisticated, there are opportunities for marketers to understand the impact
of” their marketing efforts.

Progressing to the next level
With the plethora of opportunities created, jumping into the new frontier of
DTC marketing can seem like a daunting undertaking. However, our industry
must push forward to remain relevant and set new benchmarks for DTC. It is
with this goal that we have designed our upcoming fall conference, Marketing to
the Digital Consumer: Pharma Best Practices Present and Future. We hope that you
will join us Oct. 12-13, learning how you can improve current campaigns and
plan for upcoming initiatives in the future marketplace. We will also be inducting our 2011 Hall of Fame class, featuring progressive industry members: Mark
Bard of the Digital Health Coalition, Bill Drummy of Heartbeat Ideas, Joan
Mikardos of Sanofi-Aventis, and Nancy Phelan of Pfizer.
Sincerely,

Jennifer Haug

4 | DTC Perspectives • September 2011

P E R S P E C T I V E S
Robert Ehrlich
Chairman and CEO
DTC Perspectives, Inc.
Christine Franklin
VP, Marketing and Sales
Jennifer Haug
Editor / Design Coordinator
Matt Yavorski
Sales Associate
Molly Diemel
Marketing and Production .
Associate
Debra Sander
Office Coordinator
Scott Ehrlich
President
MDPA Division
Amanda Ehrlich
Director, Publishing
MDPA Division
Debra Rennert
Creative Director
James Ticchio
Art Director
Direct Media Advertising

DTC Perspectives is Published Quarterly By:
DTC Perspectives, Inc.
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Verona, NJ 07044
Phone # 1-973-239-2051
Postmaster: Please send address changes to the above.
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No part of this publication may be reproduced in
any form unless given permission by the publisher.

We have a thing
for ears…

At Beacon, it’s all about you...
■ Your brand: we’ll listen to what you have to say
■ Your business: we’ll understand, because we’ve
been there too…in professional, managed markets,
DTC, oncology, and interactive
■ Your budget: we’ll be transparent and avoid surprises
■ Your success: our experienced professionals are ready
to focus on you
Call Adrienne Lee at 908.781.2600 and tell her what
Beacon can do for you or check out our Web site.

It’s all about you.

beaconhc.com

I N

B R I E F

Facebook Policy Change in Effect,
Some Pharmas Shut Down Pages
As Facebook’s policy change requiring the comments feature
to be enabled on most pages went into effect mid-August, some
pharmaceutical companies have decided to close out their pages.
According to a Washington Post report, companies are concerned
with what the open-commenting policy could lead to. Combining
a lack of FDA guidance on social media best practices with concerns about adverse event reporting (AER) and off-label claims,
companies have had to choose between shutting down their pages
or establishing a plan for continual monitoring of Wall comments.
With many of the companies having joined Facebook within the last year and half, the Post explained that some have
chosen to closely monitor their pages themselves or via a third party rather than turning away. Pfizer and Sanofi each told
the newspaper that they plan to keep their pages online, noting that such engagement and feedback they have garnered
outweighs concerns. While currently uncertain of its potential impact, Amgen and Novo Nordisk have decided to simply
“monitor the situation.”
Meanwhile, AstraZeneca, maker of depression treatment Seroquel XR, opted to close its “Take on Depression” page;
Johnson & Johnson also followed suit by shutting down four of its pages – two devoted to ADHD, as well as rheumatoid
arthritis and psoriasis. Johnson & Johnson manufacturers the respective treatments of Concerta, Simponi and Remicade,
and Stelara. As with all pages, marketers can remove any posted comment from their Wall. Pages devoted to Rx products
can still disable the commenting feature entirely.

Rep. Quayle Meets with WKPS Executives
To Discuss Delivery of Health Information
Congressman Ben Quayle (R-Ariz.) met with executives from Wolters Kluwer Pharma Solutions (WKPS) in late
August to discuss the current state of health information in America. The first-term Congressman and son of former
vice president Dan Quayle is eager to learn more about how industry can improve the delivery of health information
and safety. He was treated to a presentation about health information technology by WKPS executives, including joint
presidents Bob Jansen and Michelle Woker, members of the healthcare analytics team, including Cathy Betz, vice president of government affairs, and the company’s Arizona lobbyists,
TriAdvocates.
“One of the things we shared with Congressman Quayle is
our conviction that preserving good access to health information
is vitally important to America’s health as a country,” said Bob
Jansen, president of Wolters Kluwer Pharma Solutions’ healthcare
analytics business in a news release. “The Congressman also shares
the conviction that transparent and actionable health information is
in the best interest of public health.”
WKPS is a leading provider of scientific information and anaRep. Ben Quayle (center) met with WKPS’ Bob Jansen, president
lytics to pharma/healthcare professionals. While the firm is curand chief commercial officer, and Michelle Woker, president and
chief operating officer, to discuss improvements of today’s delivery rently seeking a buyer, they plan to continue as a leader in the
health information space.
of health information.

6 | DTC Perspectives • September 2011

Now…the Science of Sampling
Meets the Science of Medicine

SSI Brings Its 34 Years of Sampling Leadership to Healthcare, with the Broad Reach
and Precise Targeting to Optimize Your Patient, Caregiver and Physician Research!
Your market research drives your most critical business decisions. And the quality of your research depends
on the quality of your sample. That’s why companies around the globe, including 48 of the top 50 market
research ﬁrms, trust their most important projects to SSI. Now, SSI is bringing the scientiﬁc rigor that made us
the world’s sampling leader for 34 years to healthcare, with our new access to patients, caregivers, physicians
and allied health professionals. You beneﬁt from:
• Wide reach across key therapeutic categories, including metabolic
syndrome, respiratory ailments, mental health, lifestyle treatments and more
• Real-time dynamic proﬁling to identify and engage precise segments
• Advanced quality processes—from digital ﬁngerprinting to third-party
database matches—to ensure data integrity
• A full range of online and ofﬂine modes—Web, phone, mobile and mixed
access—to optimize reach

You wouldn’t build your products on anything less than solid science—and neither would we. Experience
the difference sampling science can make in the accuracy of your research. Contact Chris DeAngelis at
203-567-7220 or Chris_DeAngelis@surveysampling.com.
Pure Science
info@surveysampling.com | surveysampling.com

I N

B R I E F

Botox Receives FDA Approval
For Seventh Medical Treatment
The FDA has granted Allergan’s Botox approval for the treatment of “urinary incontinence in people with neurologic conditions such as spinal cord injury and multiple sclerosis
who have overactivity of the bladder,” the agency announced in a news release. As
reported by The New York Times’ blogger, Duff Wilson, this is the seventh medical
condition for which Botox has been authorized to treat since premiering in 2002 as a
cosmetic treatment.
According to the FDA, the Botox injection will relax the bladder, resulting in an
“increase in its storage capacity and a decrease in urinary incontinence” for up to 10
months. Company spokeswoman, Caroline Van Hove, told the Times that Botox has
been studied for more than 100 medical conditions, referring to the drug as “a pipeline in a vial.” She added that Allergan is also seeking approval for idiopathic urinary
incontinence.
Other Botox indications include treatment for: hyperhidrosis, chronic migraine headaches, and certain muscle stiffness
and contractions. Global sales for the multi-use drug were approximately $1.5 billion in 2010. Seamus Fernandez, an analyst with Leerink Swann, predicts sales in the region of $40 million for the current bladder treatment and $210 million for
the broader label by 2017, according to a Reuters report.

Lilly Diabetes Collaborates on
Type I and II Awareness Efforts
To further diabetes awareness and support, Eli Lilly has partnered with the American Diabetes Association (ADA) and
award-winning actor/comedian Anthony Anderson on a type 2 diabetes effort; and Disney and Denise Jonas, mother of
Nick from the Jonas Brothers, for a type 1 diabetes initiative. (Nick Jonas has worked with Bayer Diabetes Care in the
fight against juvenile diabetes.)
Continuing its successful Fearless African-American Connected and Empowered (F.A.C.E.) Diabetes campaign, Eli
Lilly teamed with Anthony Anderson on their most recent effort. Anderson, a paid spokesperson, travelled with the pharmaceutical giant in events “around the United States to raise awareness of the type 2 diabetes epidemic among African
Americans, a population disproportionately affected by the disease. In fact, according to the [ADA], African Americans are
1.8 times more likely to have diabetes than non-Hispanic whites,” Eli Lilly & Co. explained in a news release. The most
recent event took the “Law & Order” actor to the 14th annual Victory Over Diabetes, a free event hosted by the ADA in
Atlanta.
Moving over to Lilly Diabetes’ type 1 efforts, this campaign will target parents and caregivers whose loved ones have
been diagnosed with the condition. Hosted under the Parenting section on Disney’s Family.com website, visitors can
view informational videos and articles, and connect with other caregivers. Disney Publishing Worldwide will also provide doctor’s offices with custom children’s books geared to various ages and life-stages with diabetes. Additionally, the
partnership has created the Once Upon a Time contest featuring Denise Jonas. Families
can submit a story, poem or essay about their child’s experience with type 1 diabetes.
Selected by an independent panel of judges, the winner will receive a family trip for four
to the 2012 Friends For Life, an annual international conference devoted to children with
the condition.

8 | DTC Perspectives • September 2011

e
h

Patient-Centric Marketing Via
Specialty Point-of-Care Networks

Action
and
Compliance:
Patient-Centric
Marketing
Patient-Centric
via M
94% ofNetworks
patients
are Sp
Acquisition:
Specialty
Point-of-Care
Specialty
Point-of-C

Awareness:
Millions of patients are
watching each month
1

51% of patients are
asking their HCP
2

TARGETED
MEDIA ROI
MEASURABLE

MEASURABLE ROI

Action
and Acquisition:
Awareness:

✔ ROI Guarantee

51% patients
of patients
1 million
areare
✔asking
Proven
Results
their
HCP
watching
each
month

Action and Acquisition:

purchasing products
immediately
3

MEASURABLE
ROI LIFT
PROVEN SALES

Action and
Compliance:
Acquisition:

✔ State-of-the-art Technology

51% of patients are
51%
94%
of patients
of patients
are are
✔ HCP
Advanced asking
Reporting
asking their
purchasing
their HCP
products
immediately
1. Monthly Affidavits, 2010. 2. Deibler Consulting, 2008. 3. Audits & Surveys Worldwide, 2001

ContextMedia owns and
operates a portfolio of the
largest condition-specific
in-office digital networks

For more information, contact:
Shradha Agarwal,
Chief Marketing Officer
312.239.6656
shradha.a@contextmediainc.com

R E V I E W
DTC Spending Showing Healthy Signs of Growth at 7.6% in First Half
Five New Brands/Treatment Indications Rank among Top 20 Spenders
Brand

Manufacturer

Lipitor

Pfizer

Cymbalta (Pain)

Lilly USA

Uloric

Takeda Pharmaceuticals

Cialis

Lilly USA

Celebrex

Pfizer

Abilify

Bristol-Myers/Otsuka America

Seroquel XR

AstraZeneca

Pristiq

Pfizer

1H 2010

1H 2011

$ Change

% Change

$141,059,869

$144,924,859

$3,864,990

2.7%

$72,541,275

N/A

$244,590

$72,269,377

$72,024,787

29447.2%

$93,285,343

$71,352,468

-$21,932,875

-23.5%

$66,677,970

N/A

$71,729,538

$63,926,868

-$7,802,670

-10.9%

$62,028,290

N/A

$77,197,469

$61,367,844

-$15,829,625

-20.5%

Lyrica

Pfizer

$61,278,288

$59,598,520

-$1,679,768

-2.7%

Cymbalta (Depression)

Lilly USA

$84,570,291

$56,488,760

-$28,081,531

-33.2%

Viagra

Pfizer

$44,489,842

$55,443,355

$10,953,513

24.6%

Advair Diskus (Asthma)

GlaxoSmithKline

$80,361,827

$51,455,379

-$28,906,448

-36.0%

Plavix

Sanofi-Aventis/Bristol-Myers

$67,918,130

$50,100,266

-$17,817,864

-26.2%

Chantix

Pfizer

$63,458,544

$49,592,955

-$13,865,589

-21.8%

Enbrel

Amgen/Pfizer

$4,502,295

$48,351,033

$43,848,738

973.9%

Advair Diskus (COPD)

GlaxoSmithKline

$55,954,049

$46,280,597

-$9,673,452

-17.3%

Niaspan

Abbott Laboratories

$5,085,769

$42,912,129

$37,826,360

743.8%

Boniva

Genentech/Roche

$36,121,712

$42,671,928

$6,550,216

18.1%

Vimovo

AstraZeneca

$40,800,076

N/A

Beyaz

Bayer HealthCare

$39,360,372

N/A

$887,257,556

$1,198,144,321

$310,886,765

35.0%

$2,010,966,227

$2,163,414,680

$152,448,453

7.6%

Total Spending for Top 20 Brands
Total Pharma Spending

Television Sees Slight Increase in DTC Promotions
Magazine Segment Gains Market Share
1%

Media Type
65% Television
29% Magazine

29%
65%

5% Newspaper
1% Radio

0% Outdoor
Total Pharma
Spending

Note: Excludes
Internet Advertising

1H 2010

1H 2011

$ Change

% Change

$1,345,251,695

$1,401,769,069

$56,517,374

4.2%

$547,455,629

$624,932,017

$77,476,388

14.2%

$92,678,960

$117,297,547

$24,618,587

26.6%

$23,663,848

$18,468,477

-$5,195,371

-22.0%

$1,916,095

$947,570

-$968,525

-50.5%

$2,010,966,227

$2,163,414,680

$152,448,453

7.6%

Source:The Nielsen Company for DTC Perspectives
Nielsen Monitor-Plus is the leader in innovative advertising information services and tracks advertising activity across 18 media types.
For more information, send an e-mail to Marisa Grimes at Marisa.Grimes@nielsen.com.

10 | DTC Perspectives • September 2011

His healthcare decisions are influenced by
much more than a visit to his physician.
While physician advice and
prescribing greatly influence
patients, it’s not just physicians
that impact patient behavior.
Patients’ treatment decisions
are also influenced by
information they learn from
other sources, including
patient education programs
and advertising.
By utilizing the most
comprehensive view of patient
behavior and characteristics –
both healthcare- and
consumer-related – SDI can
identify the best venues for
reaching patients and crafting
the most relevant messages.
SDI leads the industry in
providing empirical,
patient-level data to inform
and improve advertising
strategies. We provide insight
on patients’:
•
•
•
•

Media preferences
Advertisement exposure
Behavior post-exposure
Attributes and demographics
To learn more, please call
Melissa Leonhauser at
1-800-982-5613 or
visit:www.sdihealth.com/influence

Crossix RxMarketMetrics Series

Branded Versus
Unbranded Digital Tactics
What to expect in reaching relevant
consumers and converting to brand
An examination of Rx-based benchmarks for branded and unbranded digital tactics demonstrates unique
advantages and disadvantages offered by each. Pharma marketers can leverage the strengths and mitigate
the weaknesses of branded and unbranded tactics by understanding which strategic goals each type of tactic
can best support.

% of Audience

ed digital tactics supports this hypothesis and uncovers
ampaign planning involves analyzing the tradeoffs
actionable insights into when each should be used along the
between marketing approaches. In pharmaceuticals,
continuum of prospect identification, consumer engagement
these decisions grow more complex when choosand conversion to brand use.
ing not just between channels, but also between branded or
unbranded communications. Marketing decisions become
Benchmarking quality
even murkier considering regulatory compliance requirements
Crossix RxMarketMetrics sheds light on performance difand legal approvals – especially, though not exclusively, with
ferences between branded and unbranded tactics using meanbranded messages. Unbranded messages can often be underingful norms that can help guide brand teams in their planning
taken at a lower cost because of the less stringent fair balance
efforts. RxMarketMetrics generates these market norms by
requirements. This results in messages that can be
conveyed in fewer pages, shorter television time,
Figure 1: Percentage of Audience Treating in Category
or smaller display space.
Of course, an unbranded message is typically
80%
not as powerful in driving direct conversion benefit (new patient starts) to a brand. Branded messages drive the product ethos to patients while
58%
57%
unbranded messages serve to increase disease
60%
awareness and education. While unbranded messaging can grow the size of the market, branded
messaging is necessary to increase a brand’s share
40%
of new patient starts.
The decision as to when and where to use
branded versus unbranded communication can
be challenging in the ever-evolving realm of
20%
digital marketing. Cost considerations aside, one
would hypothesize that branded tactics executed
digitally would more effectively generate conver0%
sion to a prescription while unbranded tactics
Audience Treating in Category
would hit a wider audience to raise disease or
Branded
Unbranded
category awareness and drive a qualified audiSource: Crossix RxMarketMetrics March 2011.
ence. A meta analysis of branded versus unbrandTM

12 | DTC Perspectives • September 2011

BRANDED VS. UNBRANDED

Audience vs. prospects

Figure 2: Percentage of Prospects Treating in Category
vs. Existing Patients
80%

60%
% of Audience

aggregating hundreds of actual Rx matchback
analyses over a broad range of media tactics,
brands and therapeutic categories. RxMarketMetrics measures the quality of engaged consumers
through the metric Percentage of Audience Treating
in Category. Audience Treating in Category includes
both existing patients on a specific brand as well as
prospects treating with a competitive therapy. Percentage of Audience Treating in Category is a measure
of how well a tactic attracts a relevant audience
likely interested in a brand’s message and, thus,
likely to engage.

53%
46%

40%

A comparison of quality of engaged audiences
20%
between branded and unbranded tactics across
channels demonstrates meaningful differences in
Rx profile. The median branded tactic generates a
similar share of a qualified audience as the median
0%
unbranded tactic. (See Figure 1.) However, by
drilling down and looking at only those not existing patients (candidates for conversion), further
insights emerge.
Analysis of the Percentage of Prospects Treating in
Category demonstrates that unbranded tactics drive more qualified prospects than branded tactics. The median unbranded
tactic generates seven percentage points more qualified prospects than the median branded tactic. The lower level generated from branded tactics is driven by the fact that branded
tactics often attract existing patients treating on the branded
Rx, whereas unbranded drives higher proportion of prospects.
(See Figure 2.)
Based on the median rates, unbranded tactics more effectively drive qualified prospects than branded tactics. However,
this does not necessarily mean that the audience converts at the
same rate as branded. Despite generating a higher rate of Prospects Treating in Category, typical unbranded audiences may not
start at the same point in their treatment decision-making pro-

11%
5%
Prospects Treating in Category
Branded

Unbranded

Existing Patients

Source: Crossix RxMarketMetricsTM March 2011.

cess as branded audiences, with implications on effectiveness of
further education and brand-specific messaging.

Branded vs. unbranded conversion
Percentage of Total Conversion Benefit (net of control) quantifies
the time to conversion to a brand Rx realized on a monthly
basis. An examination of two digital tactics, search and website, demonstrates the differences in time to conversion
between audiences engaged with branded tactics and those
engaged with unbranded tactics. In addition to differences
between branded and unbranded tactics in time to conversion,
differences also emerge in absolute conversion rates as well as
the size and scalability of the engaged audience. Among the
top 20 percent of programs, branded tactics drive 1.2x higher

About Crossix RxMarketMetrics
Prescription drug information drawn from Crossix RxMarketMetrics™, market benchmarks for performance of patient
adherence and consumer marketing activities based on thousands of actual Rx analyses including more than 600 consumer
marketing tactics across a broad range of therapeutic categories.
Campaigns included in RxMarketMetrics aggregated for the chronic, lifestyle and specialty/biologic markets and derived
from actual anonymized and aggregated results of consumer marketing campaigns for dozens of leading pharmaceutical
brands ranging from direct response (DR) to general awareness and branding campaigns (GA), and multi-channel, from Web
to Print to TV.
Normative Rx-based measures include conversion rates and curves, retention rates and curves, and Rx patient profiles specific to the market, channel and tactic. Benchmarks are further broken down by campaign specifics, such as purpose, level of
branding, creative, offer type, response channel and fulfillment stream.

DTC Perspectives • September 2011 |

BRANDED VS. UNBRANDED
Figure 3: Percentage of Total Conversion Benefit – Search

% of Total Conversion Benefit

100%

75%

50%

25%

Unbranded

5
Month

Branded
Source: Crossix RxMarketMetricsTM March 2011.

Figure 4: Percentage of Total Conversion Benefit – Website

% of Total Conversion Benefit

100%

75%

50%

25%

Unbranded

5
Month

Branded
Source: Crossix RxMarketMetricsTM March 2011.

rates of conversion than unbranded tactics. Sometimes branded
communication elements follow unbranded campaigns, potentially mitigating an even larger difference.
Looking at a six month horizon, we see that the benefit
from branded search shows more quickly with 45 percent of
benefit achieved in just the first month versus 38 percent for

14 | DTC Perspectives • September 2011

unbranded. Unbranded search share of benefit continues to track comparably with branded search through the six months, although
at a slightly lower level. (See Figure 3.) An
even larger first month variance appears
when examining branded and unbranded
websites.
Branded websites achieve nearly threefifths of the total conversion benefit in just
the first month. It takes unbranded websites
nearly four months to achieve the same share
of benefit – by which point branded websites
have realized over 90 percent of the benefit. (See Figure 4.) A script-in-hand effect
can partially explain this rapid realization of
conversion through both search and branded
websites, wherein visitors to the branded site
have recently received their first Rx and then
proceed to research the product before visiting the pharmacy.

Acting on this information
Brands and agencies typically view
unbranded tactics as a means of casting a
wide net to raise disease awareness, educate
potential patients and grow the size of the
market. RxMarketMetrics demonstrates that
unbranded tactics executed digitally can serve
as a powerful way to attract prospects treating in category. However, these individuals
convert more slowly and need further support by branded messages to continue to
move the potential customer from a prospect
to a patient. In considering unbranded campaigns, the lower cost of media, the reduced
regulatory constraints in messaging, and the
broader appeal to higher volume of qualified prospects (wider net) should be weighed
against slower time to conversion and lower
conversion than a similar branded campaign.
The product lifecycle and market share will
often play a major role in considering these
alternatives. Ongoing, granular Rx analysis
of tactics can inform on in-market campaign
performance in near real time.

This is a fourth installment of an ongoing series on Rx market metrics
of various consumer marketing activities. For more information, see the
Crossix RxMarketMetrics™ website (www.rxmarketmetrics.com),
from Crossix Solutions Inc., an Rx-based consumer analytics company
(www.crossix.com).

your
remedy

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Marketing to the
Digital Consumer

A DTC Perspectives Inc.
Conference

Pharma Best Practices Present and Future
October 12–13, 2011 • Crowne Plaza, Fairfield, NJ
As.technology.provides.exciting.new.possibilities,.Digital.DTC.
Marketing.must.push.forward,.mitigating.risks.while.maximizing.potential.gains..Learn.how.to.improve.current.campaigns.
while.planning.for.future.initiatives..Hear.from.25-plus.progressive.speakers.streamlined.over.two.days:
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Todd Kolm
Christopher D. Johnson,
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Consumer Brand
Channel Strategy,
Director, AstraZeneca
US Primary Care Consumer
Portfolio, Pfizer Inc

With expert input and analysis by
conference co-chairs…

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Author, online authority
and formerly pharma
R&D/Medical Affairs

Matt Giegerich
Chairman & CEO,
Ogilvy CommonHealth
Worldwide

Mark Bard
Executive Director and
Co-Founder, Digital
Health Coalition

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Sr VP, Prophesee,
Initiative USA

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Optimizing ROI
Through
Integrated
Marketing
Optimal ROI is best achieved when the interactions between marketing channels and campaign tactics work
together to increase overall marketing effectiveness. Pharma marketers should focus on three key steps when
measuring integrated campaign ROI: audience type, channel mix, and timing.
by

Nami Choe

onsumers’ preferences and modes of communication
are diversifying exponentially faster than most contemporary marketers can nimbly adapt. By the time marketers collectively acknowledge and begin to understand a new
advent in the industry, another innovation emerges to transform the landscape yet again. (Marketers were still attempting to unlock mobile’s potential when tablets and new social
media platforms like Foursquare marched into the forum.)
In these circumstances, particularly against the backdrop of
heightened economic pressures, the integrated marketing
approach has regained prominence in industry dialogue with
natural reason. Brands are seeking more structured frameworks
for determining the optimal marketing and media mix.

Marketers must be diligent and fastidious in
their measurement planning to avoid common
pitfalls that inadvertently compromise the
fundamentals of integrated marketing.
The rapidly increasing number of tactics in the media
toolbox yields a complex menu for marketers to select from,
boosting the demand for data-driven analyses and predictive
models to ensure that the final plan will derive the maximum
ROI possible. However, campaign measurement remains
relatively nascent with respect to cross-channel algorithms for

quantifying synergies generated from various media combinations and investment scenarios. Marketers must be diligent and
fastidious in their measurement planning to avoid common
pitfalls that inadvertently compromise the fundamentals of
integrated marketing.
Frequent fluctuations and tightening of budget constraints
during the campaign development process have generated understandable hesitation to commit to marketing plans
without comprehending how each tactic will contribute to
bottom-line sales and ROI. Internal and agency analytics teams
often collaborate to model multiple investment scenarios to
compare the potential returns associated with various media
mixes.
The challenge with designing predictive models for integrated marketing efforts, though, has been the lack of crosschannel benchmarks to inform assumptions for lift and return.
Traditionally, third-party vendors specialized in the measurement of a single medium, so most historical data points pertain
to a channel’s independent efficacy, regardless of its relationship with other campaign elements in the consumer’s overall
experience with a brand. Research vendors are making significant strides toward centralizing data to expand their breadth
of cross-channel measurement, but a solid and universally
accepted methodology has yet to be introduced. As a result,
the inputs and assumptions for predictive ROI models do not
always account for potential synergies derived from multiple
channels and their cadences.
DTC Perspectives • September 2011 |

OPTIMIZING ROI
ment and optimization
plans can be an efficient
process that uncovers data
gaps, minimizes tactical
issues and ultimately keeps
all partners aligned with
marketing goals.
Measurement requirements should focus
on enabling tracking
consumer engagement
across multiple channels. While legal parameters
might limit the granularity
at which consumer activities may be tracked, generic
source coding can be leveraged to identify user paths
and link disparate data
sources. Ideally, marketers
should also consider formal
Media Mix Modeling (an
econometric model which
Ogilvy CommonHealth Worldwide’s overall framework for planning, implementing, executing and sustaining
determines revenue contricampaign measurement.
bution per tactic/program
that accounts for overall
marketing efforts, seasonality and conversion lag times), which
At the eventual step of minimizing costs to maximize the
requires substantial campaign setup prior to launch, but can
ROI output, channels and touches thereby risk omission withcorrelate media exposures/engagement to conversions without
out the model reflecting the opportunity from its relationship
instruments for direct attribution (e.g., source codes and tagwith other media. In other words, the channels are evaluated,
ging).
However, as with any model, it requires marketers to
mixed and matched as independent entities – contrary to the
let
ample
time for the campaign to make an impact and gather
underlying principles of integrated marketing. Rather than
enough data. Given the need for some level of patience, Media
wait for third-party vendors to release blinded benchmarks
Mix Modeling is still a particularly attractive solution for meato improve media mix assumptions, marketers should focus
suring DTC campaigns where bridging between consumer
on building their internal repository of cross-channel results
media
exposure to actual Rx or product adoption remains a
through robust measurement planning that truly reflects the
large gap.
integration for which their plans strive.
Document key hypotheses/tests in the measureEstablish measurement plans
ment plan, and allow sufficient time for data to accrue
Commence measurement planning before creative
for statistically significant findings. Data is becoming
development to ensure that all tactics are tracked propincreasingly more accessible in real-time, allowing for prompt
erly. Defining tracking requirements upfront ensures sufficient
in-market optimizations. However, eagerness to optimize has
time for creative partners and vendors to assist with maximizalso led to premature reactions. Adequate sample size is critical
ing visibility into campaign dynamics. Measurement is too
to statistical integrity but is often overlooked when marketers
often an afterthought upon the program’s completion, when
observe trends only directionally. Rash and frequent optimiit is too late to implement the appropriate tracking instruments
zations risk dismantling the test plan and might inadvertently
to address key questions.
inhibit learnings at the end of the campaign.
The most challenging part of this process is agreeing upon
Identify connections
campaign and tactical objectives. Once key stakeholders are
Identify key performance indicators (KPIs) that
in agreement, the measurement plan becomes less of a burden
are aligned with how consumers actually engage with
and less time consuming on the analyst without going back
each channel and across channels. When marketers hold
and forth with vendors and marketers. When approached with
all tactics against the same objective, the measurement plan
discipline and structure, translating objectives into measure-

18 | DTC Perspectives • September 2011

OPTIMIZING ROI
grows unnecessarily complex and results in channels being
held against unrealistic expectations. The overall objective
of a campaign might be to increase sales, but evaluating all
individual tactics against driving sales would be to overlook
that each channel drives different consumer behaviors toward
conversion. In general, certain tactics are further down the
consumers’ consideration paths and thus produce more direct
attributions to revenue. A common example is the comparison between print and SEM. When marketers attempt to hold
print and SEM against the same objective of driving sales,
print typically yields an apparently lower return, prompting
stakeholders to reduce print investment. Instead, the integrated
marketing perspective would suggest that print heightens
awareness and prompts consumer research via SEM.
Focus investment on the select channels that are
truly relevant to the target audience and brand category. Some marketers have misinterpreted integrated marketing
as the requirement to create “surround sound” by positioning
the brand in every possible channel – to check all of the primary media boxes, including TV, print, digital banners, SEM
and social media. However, ROI generally diminishes when
resources are spent unnecessarily or thinly. The measurement
plan also becomes unfocused, as noise from superfluous media
muddles and detracts from evaluating the tactics that were truly
influential to the target audience.

These are exciting times for analytics. Marketers are
continuing to unlock data analytics’ potential in optimizing
investment real-time and in a more targeted way. First step
of successful integration is through the data planning phase
and using data to understand how consumers engage across
most relevant channels. However, as we look to the future,
with data becoming more available and tracking more sophisticated, there are opportunities for marketers to understand
the impact of pulsing versus continued exposure of marketing
efforts.
More research is needed in order to understand how timing
affects the relationship among channels. In addition, further
understanding is needed in integrating the marketing efforts
of different audience types: healthcare professional, patient/
prospect, and pharmacist. Optimal ROI is reached only when
marketers successfully understand and coordinate the relationship of three key factors: audience type, channel mix, and timing. And it will be the appropriate use and analysis of data that
will enable marketers to achieve this. DTC
Nami Choe is partner, senior director, consulting with Ogilvy
Healthworld. Ogilvy Healthworld is an innovative full service marketing agency and a part of Ogilvy CommonHealth Worldwide. Choe
can be reached by telephone at 212-237-4789 or by e-mail at Nami.
Choe@ogilvy.com.

REACH THE RIGHT DTC MARKETERS
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Value-added packages available for 4 time advertisers.
Opportunity for integrated presence through DTC Perspectives magazine, our website,
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DTC Perspectives • September 2011 |

It’s Time “DTC”
Stood for
Something Else
Effective brands are now built on what they do for consumers, rather than what they are. Thus, DTC is
due for some big innovation. By redefining DTC, marketers can truly realize the potential of DTC to
responsibly change consumer healthcare and deliver the coveted: improved outcomes.
by

Bruce Rooke

f change is the Grandmother of Invention (after all, who
do you think begot Necessity?), then the current world
of DTC is like ladies night at the nursing home. There’s a
huge mosh pit of change all around us:
• Almost 75 percent of the biggest DTC spenders will go
generic by the end of 2013. Think about it: Lipitor, Crestor, Plavix, Cymbalta, Viagra, Advair, Boniva, etc. (IMS,
2010)
• There’s been a dramatic shift from mass media to targeted
audience, (e.g., a 23 percent swing from network to cable,
MM&M 2010)
• And, miracle of all miracles, there’s finally a government
agency that admits DTC plays a beneficial role in both
public health and in lowering healthcare costs (The Congressional Budget Committee, May 2011)
Which means DTC is due for some big invention.
In fact, it’d be a shame if we just stood there and kept putting out the same Beauty and the Beast formula of a diseasestricken patient magically transformed into a walking grin,
interrupted by 32 seconds of fake doctor-patient interaction
while fair balance is read. We have the chance – and responsibility – to respond to the changing landscape with a whole
new vocabulary of action.

20 | DTC Perspectives • September 2011

What DTC could mean
“Direct to Consumer” says what it is and where it plays.
But effective brands today are built on what they do than what
they are. So imagine if DTC stood for:

D = Do. Do something for consumers beyond disseminating information. Don’t just stand there at the pulpit and
preach. Add value to your communications by adding utility
to your media. A mobile app (“mHealth”) that empowers a
consumer to do something about their disease, or their care,
can be much more effective in building your brand. Some
other good examples:
1) Is an app that alerts me to when my epinephrine pen
needs replacing worth more than another print ad? It
shows that the brand is actively
engaged in my life, proving its
understanding – not just passively
claiming it.
2) T h e A l l e r g y M a n a g e r a p p ( f r o m
Omnaris) gives sufferers an allergy
forecast in their area, along with
information on Omnaris. (But
don’t cheat. Your app has to
be more than just the mobile
version of your website.)

REDEFINE DTC
3) GoMeals (from Sanofi-Aventis) instantly
guides diabetics in
the real world to
what they should eat,
where they can eat,
and helps them watch
what they eat.
4) The Tamiflu campaign* for Roche
where, beyond the
“Happy Feet” dancing penguins, we
gave consumers a
simple mnemonic
to tell the difference
between cold and flu – the F.A.C.T.S. of flu: Fever,
Aches, Chills, Tiredness, and Sudden Symptoms. It gave
caregivers a free diagnostic tool that made them, well,
better caregivers. That’s doing, not just telling.

T = Teach. Equip your consumers to be smarter patients
or more astute caregivers. We love to hide behind the veil of
educating consumers about their health – and then we proceed
to sell in the traditional manner. Let’s truly educate. What if
we walked them through a procedure, step-by-step, fears and
hopes, using a celebrity not as borrowed interest but as the
real consumer (realitylasik.com)? What if we taught men how
to be conversant in controlling uric acid versus medicating
gout pain (Takeda’s Uloric DTC campaign*)? Designer Jacob
Heberlie found the perfect touch in his multiple sclerosis (MS)
animated video series for Dr. Singer’s MS Clinic (mslivingwell.
org) in taking the complex science and therapies and creating motivating “I get it now” moments for consumers and
caregivers. The year-old GE healthymagination and Howcast
online videos do much of the same (see the case study at howcast.com). And the healthymagination/MedHelp app, “I’m
Expecting,” teaches a mom what is going on with her baby
at any given time along the journey. In all of these examples,
smarter consumers equaled more active consumers. And that
teaching leaps over the hurdles and can lead directly to the
brand.

C = Connect. Connect the conversation. Healthcare
decisions are no longer made unilaterally. They include the
consumer (patient), the caregiver(s), the physician, the nurse,
the payer, and the invite list goes on. Plus, under healthcare
reform, team health management will be standard of care
(SOC) at the doctor’s office. So it will take multiple influencers to get to one decision. Which makes connecting that
conversation even more crucial. This doesn’t mean you have
to have the same campaign across all audiences. But it does

mean that somehow in your campaign, you need to inspire
and incentivize a connected conversation. (Yes, beyond the
ol’ “ask your doctor about…”) Besides, you want people talking about your brand, influencing each other, filling in each
other’s blanks, completing the story – with your brand front
and center.
For example, Eisai realized with Aloxi that the cancer
patient may never speak up about their nausea (for fear of getting reduced, less effective chemo), and the doctor may never
hear the patient complain. So they expanded their campaign
to reach both caregivers and nurses, knowing if they could
connect them, they could create that vital conversation, and
Aloxi would be an important part of the dialogue. The customizable e-postcards of Gardasil’s “Tell Someone” campaign*
helped boost awareness from 5 percent to 50 percent. And just
imagine how a Zeo Personal Sleep Coach (www.myzeo.com)
– with all of its tracking data and “ZQ” score – could create
a connected conversation for a branded sleep aid. (Sorry, you
have to imagine it. Hasn’t happened yet.)
So, as you can see, the necessity of change (and the endless
opportunity of digital) has given all of us the chance to make
DTC mean so much more than “Direct to Consumer” (or
“Dull Television Commercials” or even “Diarrhea to Come”).
By redefining DTC to mean Do, Teach, Connect, we can truly
realize the potential of DTC to responsibly change consumer
healthcare and Deliver the Coveted: improved outcomes. DTC
*Denotes campaigns developed by GSW Worldwide.

As chief creative officer, Bruce Rooke provides strategic leadership for
GSW Worldwide’s creative team. His responsibilities include establishing and implementing standards for creative work and ensuring that
strategic, creative, and branding processes are used consistently across
the agency. Rooke can be reached by e-mail at brooke@gsw-w.com.
DTC Perspectives • September 2011 |

Medication
Non-Adherence:

The Health Care Industry’s
Silent Epidemic
In order to increase adherence, marketers need to understand the
consumer behaviors that lead to the original divergence from intended medication use. Based on the FICO Medication Adherence
Score, this article highlights consumer profile examples and explains
the role such generated scores play in the larger pharmaceutical
marketing ecosystem and forecasted scenarios.
by

he issue of patient adherence to prescription drug regimens hasn’t commanded enough discussion in recent
years, but it has grown into a disturbing trend with significant side effects for the health care industry. Not only are
the effects felt by patients, who suffer worse health outcomes
as a result of not taking their medication, but the health care
industry suffers in several ways as well. Chief among these
are increased costs of doing business, providing treatment and
serving patients.
Despite the negative consequences of medication nonadherence, existing strategies to fight the trend aren’t adequately addressing the problem, and as a result are exposing
patients to greater health risks. The industry as a whole needs
to identify and adopt adherence initiatives that are more preventative in nature to engage earlier with individuals at risk of
failing to take their medication and keep them on track.
Research shows as many as half of all patients in the U.S.
do not take their medication as prescribed, 31 percent do not
fill prescribed medication, 29 percent stop taking medication
before supply runs out and 24 percent take less than the recommended dosage1. As you would expect, this has a significant
effect on patient health outcomes; for example, patients with
high blood pressure who do not take medication as prescribed
are more likely to experience complications like coronary
heart disease or stroke. Worst of all, medication non-adherence is estimated to result in around 125,000 premature deaths
in the U.S. each year2.
In addition to detrimental health consequences, nonadherence adds significant costs to the health care system – the

22 | DTC Perspectives • September 2011

Todd Steffes

issue as a whole costs the U.S. health care system $290 billion
each year3, or 13 percent of the total U.S. health care expenditure. Furthermore, a 2011 study showed that a non-adherent
patient with high blood pressure spends an average of $3,908
more per year for health care than an adherent patient4. For
congestive heart failure, the additional patient cost is estimated to be $7,823, and for diabetes $3,765. Worse yet, these
social and economic costs are rising, and are likely to continue
unchecked unless current approaches to non-adherence are rethought.

Fighting non-adherence today
In recent months, industry leaders have begun to notice
this trend and take action. The National Consumers League
(NCL) and the Surgeon General have announced a three-year
campaign to raise awareness of the importance of medication
adherence. Many prominent health care associations and other
industry leaders are supporting the initiative.
A number of approaches exist today to improve medication
adherence, including (see Figure 1):
• Monitoring: Organizations with access to claims information – health care providers and payer organizations – can
monitor patient treatment history and look for gaps.
Unfortunately, this approach only addresses non-adherence after it has occurred, and once treatment has been
stopped it becomes more difficult to re-engage.
• Point-of-care interaction: Health care providers and retail
pharmacies engage in direct communication with patients,
but this is costly and not always accurate. Patients tend to

IMPROVING ADHERENCE
overstate their own prescription usage,
Figure 1: Solving the Limitations to Current
and it’s hard for practitioners to know
Non-Adherence Tactics
which patients are in most need of
counseling. It’s also difficult for these
organizations to decide where their
time and resources are most needed.
• Behavioral surveys: Pharmaceutical
manufacturers have used psychometric-style surveys to assess current and
future patient adherence behavior.
Though results are useful, responses
often give an incomplete picture of
a patient population because of low
response rates and false or embellished
self-reported information.
• Patient education: Industry organizations
send out mail, e-mails and SMS messages, and use TV and online channels
to communicate with patients. For
example, pharmaceutical manufacturers like to combine educational material with incentives like co-payment
cards to reduce out-of-pocket expenses
early in the course of treatment, when an individual is being
for patients. These education strategies can work, but
prescribed drugs for the first time. We have learned that it is
they are costly because they employ a “one-size-fits-all”
approach and resources are wasted on patients who take
important to develop tools that have the greatest flexibility of
their medication on time and in full.
application and can be made available to multiple stakeholders.
Leveraging publicly available data sources can provide broad
In sum, there are two primary problems with today’s
predictive
tools across the entire patient base for enhanced
approaches to medication non-adherence. First, it’s too late to
adherence
propensity
assessment.
impact non-adherence retroactively; it is difficult and costly
If the score indicates the patient is at higher risk of nonto re-engage with a patient and get them back onto their
adherence, a doctor, pharmacy or other organization would
medication plan after they have already failed to fill a prescription. Second, patient engagement strategies need to be more
have the opportunity to spend extra time when prescribing the
tailored to specific patient and health condition types, channeldrugs to emphasize the importance of taking them on time and
ing resources to those with the greatest risk of non-adherence.
in full. After treatment has begun, other intensive engagement
One-size-fits-all approaches do not effectively accomplish this,
strategies like nurse calls and reminder programs could be used
so new solutions are needed to circumvent these challenges
to reinforce the earlier educational discussions and encourage
and truly curb medication non-adherence.
adherence. Meanwhile, lower-touch and lower-cost strategies
like
e-mails and Web-based educational tools could be used
Using analytics to focus programs
with lower-risk groups, and co-payment offers could be taiThe use of predictive analytics has emerged as an effective
lored by risk group as well.
way to overcome the limitations of current strategies and drive
This differentiated approach has the potential to deliver
improved patient medication adherence. These analytic models
greater health outcomes and lower costs, compared to tradican accurately predict who will become non-adherent before
tional
one-size-fits-all approaches. For example, a payer orgathe prescription is written. This could be a real game-changer
nization might attempt to improve adherence of new diabetes
in the health care industry – if you can identify which patients
patients through a mix of tactics including multiple nurse calls
are most at risk of becoming non-adherent, then you can
and counseling sessions – an expensive strategy. Using predicdevelop tailored preventative engagement strategies and apply
tive analytics, the level of nurse interaction could be adjusted
them to both improve patient health outcomes and save costs.
to reflect a patient’s adherence risk ratings; e.g., the comOne approach to do this, like we’ve established with the
new FICO Medication Adherence Score, is to generate a score
pany could reduce levels of nurse outreach to low-risk patients
DTC Perspectives • September 2011 |

IMPROVING ADHERENCE
Figure 2: Personalized Engagement Tactics

(those most likely to adhere) and re-deploy extra resources to
engage higher-risk patients.

Improving outcomes
By using analytics to predict non-adherence, health care
organizations would have the opportunity to experiment with
the most effective combination of engagement tactics for a
particular patient or group – and then standardize what they
learn to be the best practices. Initiatives such as lifestyle advice
and coaching, e-learning programs, financial incentives and
integrating care management with primary care teams are a
few options at their disposal to encourage patients to play a
more active role in their personal treatment. (See Figure 2.)
These kinds of advanced analytic test-and-learn procedures
are already being deployed successfully in the industry. One
FICO client involved in a multi-year disease management
pilot used this approach to engage and retain diabetes and
chronic heart failure patients. Specifically, the company tested
potential messaging to find which would have the most impact
on patients during the first few seconds of a nurse call. The
messaging was pre-tested in focus groups to gauge audience
understanding and responsiveness, and was tested again in a
nationwide attitudinal survey. Then, analytics were used to
search within this survey information and other available data
sources for groups of patients who respond similarly to specific
engagement tactics. The company used these test-and-learn

24 | DTC Perspectives • September 2011

results to segment patients
into six groups, and to
develop tailored engagement
strategies for each segment.
Results surpassed original
internal patient enrollment
targets by 17 percent, and
exceeded the program sponsor’s target by 36 percent.
Advanced test-and-learn
techniques are particularly
relevant now, as health care
organizations consider the
use of new communication channels such as mobile
and social media. These
approaches provide an effective way for organizations to
test patient response to both
old and new engagement
tactics, helping them find the
most effective engagement
strategies more quickly and
cost effectively.
Medication non-adherence has become a significant problem for the health care
industry, inflicting harm on patients through poorer health
outcomes and the health care industry through increased
costs. The problem appears to be worsening, in part because
existing preventative engagement and educational approaches
aren’t identifying high-risk patients until it’s too late. New
analytic-based strategies, however, can play an important role
in improving patient engagement initiatives and ultimately
patient adherence. As these strategies take hold and become a
standard industry practice, the health care system and patients
will both benefit from improved medication adherence rates, a
healthier population and reduced expenditure across the health
care spectrum. DTC
References
1 National Council on Patient Information and Education. “Enhancing Prescription Medicine Adherence: A National Action Plan” (2007)
2 Norman G. “It takes more than wireless to unbind healthcare.” Presentation at
Healthcare Unbound Conference (2007)
3 Cutler D. & Everett W. “Thinking Outside the Pillbox: A System-wide
Approach to Improving Patient Medication Adherence for Chronic Disease.”
New England Journal of Medicine, 362, 1553-1555 (2010)
4 Medication Adherence Leads To Lower Health Care Use And Costs Despite
Increased Drug Spending, Health Affairs (2011)

Todd Steffes is a vice president at FICO, and the leader of the company’s health care business unit. For more information on the FICO
Medication Adherence Score, please visit www.fico.com/adherence.
Steffes can be reached by e-mail at toddsteffes@ fico.com.

It’s Time to Celebrate
the Stars of the Industry

Mark Bard

Bill Drummy

Joan Mikardos

Nancy Phelan

Executive Director and
Co-Founder
Digital Health Coalition

Founder and Chief
Executive Officer
Heartbeat Ideas

Senior Director Digital
Center of Excellence
Sanofi-Aventis

Executive Director,
Global Communications
Pfizer

Don’t Miss the Chance to Honor these Individuals in Person!
Attend the DTC Hall of Fame Induction Ceremony on October 12, 2011 at the Crowne
Plaza hotel in Fairfield, NJ, all a part of the DTC Perspectives fall conference –
Marketing to the Digital Consumer: Pharma Best Practices Present and Future.
Visit our website at www.dtcperspectives.com,
or call us at 973-239-2051 for more information.

Hall of Fame

Finding Digital Consumers in a
Sea of Mass Media
How Digital
Consumers
Respond
to Variable
Media Mixes

Winning the battle to drive patient-initiated brand discussion with doctors can quickly focus on the excitable
digital consumers who are so eager in seeking solutions. Using findings from seven syndicated studies, the
authors look at various media strategies to determine successful tactics for reaching the digital consumer in a
sea of mass media.
by

J. Douglas Zabor and Qi Jiang

s there an ideal media strategy to reach and influence a digital consumer? Is the answer simply intuitive? And does the
answer vary by the disease category? To attempt to discover
the most definitive answer to these questions requires analysis
of DTC categories that share three characteristics: 1) A large
number of branded options, eight or more, 2) Where most
brands use paid media advertising, and 3) Each category using
all four of the most commonly used media strategies, including
TV, print, online display, and brand website.

Study background
The source of data was selected from Phoenix Healthcare’s
Syndicated DTC monthly tracking studies for the first part of
2011. The trackers deploy a method of accurately measuring
advertising exposure to all forms of media advertising each
month, including all branded websites.
The following selective DTC categories were included, to
which most readers of DTC Perspectives magazine could relate
their brand. Data for the months of January through April

26 | DTC Perspectives • September 2011

2011 was employed in this article, including 13,000 interviews
which involved 31 brands and 146 creatively different ads. In
total, nearly $300 million dollars was spent on the ads tested
for recall of exposure and call to action:
• Lifestyle: Where the patient will choose to ask for and to
use prescription treatment for their purpose, and has the
majority of influence on brand choice; 58 total: 9 TV, 15
Print, 19 Online, 15 Websites;
• Asymptomatic/chronic: Where the need for prescription
treatment is determined through lab work yet the patient
has influence within large choice of brands; 52 total: 11
TV, 17 Print, 16 Online, 8 Websites;
• Symptomatic/chronic: Where patients have differing choices
through various levels of step therapies and where switching is patient-driven by efficacy to reduce symptoms; 54
total: 4 TV, 20 Print, 22 Online, 8 Websites.

MEDIA MIXES
Figure 1: Digital Consumer Segment Size of
DTC Category
55%

60%
45%

50%

• Mass media: Campaigns with branded ads in at least one
mass media (at least TV or national magazine and radio or
newspaper if used), plus the brand’s website, but no online
display ads. A total of 7 brands included.
• Digital media: Campaigns using only online display ads plus
the brand’s website. A total of 4 brands included.

40%

• Brand site: Brands with no other media besides the brand’s
website. A total of 10 brands included.

28%
30%

For purpose of this analysis, the term campaign means the
aggregation of all creatively unique messages in all media that
month validated by Competitrack along with the branded
website (see Figure 2).

20%
10%
0%

or newspaper if used), plus online display and the brand’s
website. A total of 10 brands included.

Asymptomatic &
chronic

Lifestyle

Symptomatic, chronic &
degenerative

All respondents were classified into digital consumers and
non-digital consumers to focus the analysis on the former
respondent segment. Since each study is a representative
sample of the generalized potential market for each DTC, the
sample of segment of digital consumers is also considered to be
a random sample of that population (see Figure 1).
Simply put, the study design permitted analysts to 1) Determine precisely which branded advertisements from any media
source a digital consumer was exposed to, and 2) Correlate
variation in advertising exposure to brand-specific behaviors
recommended by the ads. By measuring how actions vary
among patients based on exposure to different media strategies,
it is possible to determine how one medium (or how one specific creative version of an ad within one medium) provides a
differential contribution to action.
Unlike any other industry where call to action can be as
creative as the core message concepts, the pharmaceutical
industry call to action is regulated by the FDA. Thus, the efficacy of all pharmaceutical ads can be measured comparatively
on proof that exposure to ad resulted in differential behavior
when compared to audience who were not exposed. Those
“Calls to Action” are defined as:

Importance of digital consumers
A digital consumer, for the purpose of this article, is
defined as someone who used the Internet in the last 30 days
to seek information about signs and symptoms, disease information, treatments options, prescription medication options
as well as the use of search for brands, for social feedback on
brands from social media, blogs, and including direct brand
site visits. The size of digital consumer market varies in different disease categories. Specifically, the Asymptomatic and
Chronic category has 28 percent of respondents who are
digital consumers, Lifestyle has 45 percent and Symptomatic
has 55 percent.
The patterns intuitively fit the disease impact on the
individual, with those having aggravating symptoms from
a degenerative disease being the most active consumers
of healthcare information on the Internet. Those with an
asymptomatic chronic condition who are placed on long

Figure 2: Media Campaign Types

Website only, 10

Multi-media, 10

• Talking to your doctor
• Calling an 800 number
• Visiting the brand’s website

Digital only, 4

Mass only, 7

Depending on the media configuration used in the month,
each brand was classified into one of four variations of media
utilization:
• Multi-media: Campaigns with branded ads in at least one
mass media (at least TV or national magazine and radio
DTC Perspectives • September 2011 |

MEDIA MIXES
Figure 3: Digital and Non-Digital Consumers
Recalling Branded Ads
70%

64%

60%

59%
54%

53%

50%
50%
40%

28%

26%

30%
20%
10%
0%

Saw doctor last
3 months

Percent of brands
aware of

Digital Consumer

Discussed campaign
exposed brand with
physician

Initiated discussion
of campaign exposed
brand

Non-digital consumer

term therapy which a physician reviews only periodically, are
the least active. And the lifestyle market is in-between.
A digital consumer is different than a non-digital consumer
in more important ways to pharmaceutical brands than simply
depending more on the Internet for healthcare decision support. When comparing among branded ad recallers, digital
consumers are significantly more likely to 1) See their physician in the last three months, 2) Are aware of more brand
choices by name, 3) Discuss more brands as options for treatment with the physician, and, perhaps most importantly, 4)
Are more likely to initiate a discussion about a brand they saw
an ad for than their non-digital counterparts. In combination,
these behavioral attributes make the digital consumer a highly
desirable target for any brand (see Figure 3).

Finding an ideal motivational strategy
It is clear that digital consumers are very targetable consumers who are more responsive to branded advertising than their
non-digital counterparts. But which media strategy should you
choose from to reach this group of consumers?
Across all of the 31 brands, over $300 million was spent: 73
percent on television, 25 percent on print, and 2 percent on
online display. Clear differences can be seen when comparing
non-digital consumers to digital consumers, in terms of stated
exposure to television ads with non-digital consumers stating a
significantly higher recall of TV ads. The opposite, however, is
not true, while non-digital consumers recall fewer online display ads, the difference is not significant.
Consistently across all three markets, multiple media
achieved the highest level of recall among digital consumers,
followed closely by both mass media and digital. It is no surprise that brand site-only brands achieve the lowest exposure,
but the visibility of these site-only brands justifies their inclusion as a consumer marketing media. Brands relying solely on
their brand website see that these sites stimulate actions second
only to the multi-media campaigns. This finding is true for
both digital and non-digital consumers (see Figure 4).
Surprisingly to some may be that digital media produces
more response per recaller than mass media. Given that digital
media are still most often placed on specific health sites rather
than portals or news media sites’ front pages, this is a media
that needs to be found by the digital consumer in their search
for disease modifying solutions (see Table 1).

Table 1: Effects of Media Strategies
Multi- Mass Digital Brand
Media Media Media Site
Campaign Exposure

72%

43%

38%

16%

Figure 4: Percent Recall by Media Type

Call to Action

51%

30%

36%

49%

60%

Total Market Impact

32%

12%

15%

N/A

53%

Cost per response as a ratio
to the cost of digital media
only

50%
40%

35%
28%

30%

23%

22%

20%

14%

10%
0%

Print
Digital Consumer

Online display

Brand website

Non-digital consumer

28 | DTC Perspectives • September 2011

Combining the reach by media strategy with the degree to
simulate call to action, the impact on the total market can be
clearly seen. Within this study, multi-media campaigns drove
from two to four times the amount of actions compared to the
other media strategies.

The answer depends on your goals
Seeking volume?
If your brand’s goal is to achieve the largest share-of-voice
in order to impact largest share-of-market action then multi-

MEDIA MIXES
media strategy is your solution. A multi-media campaign can
produce the highest recall – the highest conversion-to-action
among those recallers, which adds up to doubling the number
of patients who will discuss our brand with their physician.
This finding is consistent for all three categories even though
ratios of spending in multi-media varied significantly between
the categories.
The volume of patients taking action, however, comes at
a price. Using the cost and the numbers of digital consumers taking action indexed at one, the mixed media campaign
produced 2.4 times more action at 24 times the cost. Response
rates and cost varied within the three markets. For example,
the asymptomatic market mixed media produced 14 times the
number of actions over digital media-only at 14 times the cost,
producing a more justifiable return on investment.
Variations such as that are based on better mix of spending ratios between the media type, better creative and message
consistency and interest across all media, but the incidence of
patients plays a large role, and the third variable is virulence of
the competitive media environment and the number of advertising competitors.

Brands relying solely on their brand website
see that these sites stimulate actions second
only to the multi-media campaigns.
Seeking impact at lower cost?
If your goal is to reduce or keep media spending down, but
still grow your brand’s reach and influence, then online display
strategy is the best solution to reach the digital consumer. At
24 times less cost than a typical multi-media campaign, online
display ads can reach nearly as many digital consumers as TV.
Within a multi-media campaign, online display ads drive nearly a quarter of DTC’s call to action goals. These facts mean
that digital media packs a much bigger punch for the cost than
print or TV.

The silent winner
Campaigns using TV alone, print alone, or even in combination, produce nearly the same outcomes as an online display
campaign to reach and move digital consumers to take action.
Brands that rely solely on their brand website achieved nearly
equal impact on consumer call to action behavior as mixed
media. Within multi-media campaigns, the brand website contributed nearly a third of the influence to act.
The three disease categories included in this study do have
great variation in size of the digital consumer, media spending
within each media as well as between media strategies. How-

ever, the finding of which media strategy has the largest impact
is consistent across the three disease categories: Lifestyle, Symptomatic/chronic, and Symptomatic/chronic & degenerative.

Recommendations
After the FDA approves the consumer marketing materials,
a brand teams’ hands are tied in terms of improving effectiveness or efficiency of their campaign to satisfy management.
Among this small set are three actions a brand market can take
to improve campaign effectiveness (impact on market behavior) and efficiency (lowering the cost to trigger that behavior).
Each plan of action should be directly supported by a brand or
DTC tracker to achieve the highest level of decision support.
• Change media spend: Spend more or to spend to reach your
competitive targets and continuously re-allocate spending
between the media to find the optimal mixture to produce greater response at lower costs.
• Creative asset spend re-allocation: Rapidly determine which
creative assets achieve higher recall along with driving
increased behavior and move your money to those assets
over time to verify the choice was well made.
• Re-balance brand value and promotional value messaging: In
today’s economy and especially to stimulate call to action,
there needs to be a balance in driving home the value of
the brand and providing greater access through lower cost
options, such as saving cards, and building loyalty through
brand site support and on-going support programs.
Above all, make sure you have the breadth and correct
metrics to help you quickly identify a problem or opportunity
that provides quantitative decision support to sustain management support. This includes the ability to:
• Measure all brands and all media within a target population in order to understand your share of market action
and cost to justify to management;
• Link behaviors with exposure within the dynamic competitive market;
• Measure patient initiated discussion of your brand with
physicians. DTC
J. Douglas Zabor is executive vice president of Phoenix Healthcare’s
syndicated studies. Qi Jiang is vice president of marketing science for
Phoenix Healthcare’s syndicated business. Phoenix Healthcare is a
business unit within Phoenix Marketing International, the nation’s
28th largest marketing research firm. The Healthcare unit tracks over
25 percent of all DTC spending in pharmaceuticals. Zabor can be
reached by e-mail at Doug.Zabor@Phoenixmi.com. Jiang can be contacted via e-mail at Qi.Jiang@Phoenixmi.com.
DTC Perspectives • September 2011 |

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October 12-13, 2011, Crowne Plaza,
Fairfield, NJ
Focused on digital and social media
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The Regional
Marketing Roadmap

R E V I E W
Overall DTC Spending Declines 9.2% in Q1-3 2010

Free Publication for DTC Marketers. Read by industry
leaders for over a decade, DTC Perspectives is the
industry’s only magazine devoted exclusively to DTC

Pfizer Producing Seven of Top 20 Promoting Brands
Brand

Manufacturer

Lipitor
Advair Diskus
Cialis
Cymbalta
Abilify
Pristiq
Plavix
Symbicort
Chantix
Lyrica
Toviaz
Lovaza
Crestor
Singulair
Viagra
Simponi
Trilipix
Boniva
Vyvanse

Pfizer
GlaxoSmithKline
Lilly USA
Lilly USA
Otsuka America / Bristol-Myers
Pfizer
Bristol-Myers / Sanofi-Aventis
AstraZeneca
Pfizer
Pfizer
Pfizer
GlaxoSmithKline
AstraZeneca
Merck & Co.
Pfizer
Centocor Ortho Biotech
Abbott Laboratories
Roche / Genentech
Shire

Spiriva

Boehringer Ingelheim / Pfizer

Q1-3 2009

Q1-3 2010

$ Change

$155,572,800
$128,696,300
$122,028,600
$141,415,900
$150,136,800
$70,691,300
$113,096,800
$91,483,100
$38,671,500
$114,818,900
$23,262,500
$5,162,400
$96,436,200
$70,680,700
$88,636,200
$124,400
$39,750,400
$61,381,200
$73,207,700

$204,795,300
$169,488,400
$158,180,200
$146,388,000
$122,396,800
$112,960,000
$103,544,600
$102,071,200
$99,514,300
$93,164,900
$84,171,300
$79,893,800
$79,032,100
$67,844,800
$65,682,100
$61,884,000
$56,349,100
$55,535,300
$52,821,800

$49,222,500
$40,792,100
$36,151,600
$4,972,100
-$27,740,000
$42,268,700
-$9,552,200
$10,588,100
$60,842,800
-$21,654,000
$60,908,800
$74,731,400
-$17,404,100
-$2,835,900
-$22,954,100
$61,759,600
$16,598,700
-$5,845,900
-$20,385,900

% Change
31.64%
31.70%
29.63%
3.52%
-18.48%
59.79%
-8.45%
11.57%
157.33%
-18.86%
261.83%
1,447.61%
-18.05%
-4.01%
-25.90%
49,645.98%
41.76%
-9.52%
-27.85%

$56,565,600

$51,757,100

-$4,808,500

-8.50%

Total Spending for Top 20 Brands

$1,641,819,600

$1,967,475,100

$325,655,500

19.84%

Total Pharma Spending

$3,381,974,400

$3,070,994,000

-$310,980,400

-9.20%

While TV and Internet Lose Slight Market Share

marketing.

Media Type
0%

56% Television
32% Magazine

6% Newspaper

32%

56%

5% Internet
1% Radio

0% Outdoor
Total Pharma
Spending

Q1-3 2009

Q1-3 2010

$ Change

$1,730,615,800

-$374,731,400

$932,512,200
$218,069,900
$19,552,300

$972,458,400
$186,098,000
$154,266,200
$25,226,300

$39,946,200

% Change

Scott Weintraub
able resources. It is important to have a rapid deployment team
ready to take advantage of local market changes as they happen. The overall objective is to drive product performance and
improve ROI through efficient resource deployment and allocation. Other benefits of regional marketing include reduced
program waste and improved productivity for the marketing
and sales teams.

Establishing your plan of action
Regional marketing consists of three disciplines: regional
strategy, regional plan development and regional deployment.
Regional Strategy – In this initial step, assess the many
factors influencing brand performance in each market and
evaluate the company’s capabilities for handling regional
marketing. Next, develop a vision for how regional marketing innovation can help your brand. Then work to gain

-17.80%
DTC Perspectives • March 2011 |

4.28%

$82,555,300

79.73%

-$63,803,700

-29.26%

$5,674,000

29.02%

$2,950,100

$2,329,200

-$620,900

-21.05%

$3,381,974,400

$3,070,994,000

-$310,980,400

-9.20%

In This Issue

Source: Kantar Media for DTC Perspectives, Copyright 2011.
Established in more than 50 countries, Kantar Media helps clients master the world’s multimedia momentum through analysis of print, radio,TV, Internet, cinema, mobile, social media,
and outdoor worldwide. Kantar Media offers a full range of media insights and audience measurement services through its global business sectors – Intelligence, Audiences,TGI and Custom. Kantar Media companies also include Compete, Cymfony and SRDS. Drawing upon the deepest expertise in the industry, Kantar Media tracks more than 3 million brands and
delivers insight to more than 22,000 customers worldwide. www.KantarMediaNA.com. For more information, send an e-mail to David Wood at David.Wood@kantarmedia.com.

Savings Offers: Reach
The Right Audience

12 | DTC Perspectives • March 2011

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DTC in Perspective –
by CEO Bob Ehrlich
A Must-Read Weekly eColumn

egional marketing is a concept whose time has come.
As companies in the pharmaceutical, biotech and medical device (global change) markets begin to embrace
the idea, the question becomes: “How do we make regional
marketing a reality?”
First, let’s take a closer look at regional marketing. Regional
marketing is a targeted allocation of resources to markets / districts for the greatest return on investment (ROI). It is a strategy that relies on understanding regional variability and how
to harness it in order to maximize results. Marketers should
deploy regional marketing when variations exist among payer,
provider, prescriber, population, product, or place.
Regional marketing consists of grouping similar markets
based on common drivers and developing marketing strategies
March
2011drivers. With regional marketing, it is local
utilizing
key market
differences that help determine how to efficiently direct avail-

Vol. 10, No. 1

$2,105,347,200
$103,542,700

The Source For DTC Leaders

P E R S P E C T I V E S

Newspaper Seeing Significant Uptick in DTC Spend in Q1-3 2010
1%

Turning Insights into Innovation
Regional marketing identifies specific opportunities for sales growth and market share that national marketing
plans may not fully recognize. Understanding market variations and the key drivers behind these variations,
brand marketers can enhance a marketing plan with regional strategy, plan development and deployment,
leading to an increase in a brand’s sales performance.

Delivered Every Friday Morning to Your Inbox. A weekly blog column from
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973-239-2051

Memo to Digital Pharma Marketers:
Don’t Overlook the
Long-Tail Internet as a
Viable Content Source
Pharma marketers face a number of unique challenges
in digital advertising: achieving scale, reach, brand
safety, cost-effectiveness and FDA compliance, to
name a few. Marketers can reach their appropriate
audiences, all while maintaining compliance with
FDA regulations, by utilizing “smart targets,” which
map online and offline data to content consumption
patterns.
by

igital marketers face many challenges in identifying
and reaching their target audiences, including such
issues as what channels to use, how much to invest
in each and brand versus direct spend. Pharma digital marketers face additional challenges – stricter privacy restrictions on
customer targeting and the use of online data, heightened concerns over brand safety, expensive premium health content and
low customer interactivity.
Despite these challenges, pharma investment in digital
media is robust – $1 billion in 2010, according to eMarketer.
Yet at this investment level, the stakes are high to deliver
strong results in a cost-effective manner, all while maintaining
federal compliance and ensuring brand-safe ad environments.
While the use of cookie targeting is fairly common in other
industries, it is avoided by pharmas due to concerns over consumer data privacy – think HIPAA regulations – even though
it is not outright forbidden by the FDA. But a replacement for
this type of effective targeting is not easy to find.
Another challenge: the lack of interaction with online ads.
According to a MediaMind study1, standard and rich media
click-through rates (CTR) are half as high for pharmaceutical
ads as they are for those in other industries. Pharma marketers
seem to still be interested in click-through because it can serve
as an indication of interest and is widely used for display cam-

32 | DTC Perspectives • September 2011

Tanayia Washington

paign measurement and optimization, especially in the absence
of online purchase metrics.
Given these challenges, there are four key questions pharma
marketers need to ask in order to ensure their digital strategy is
on track:
• How can I identify my target audience? Because
cookies generally aren’t an option, you need to find other
ways to gain a deeper understanding of who your audience is.
• How can I reach them at scale? Any audience insights
gained must be leveraged to broaden the scope of campaigns in order to make the best use of digital investments.
• Can I reach my target safely? Unless you can guarantee brand-safe environments, nothing else matters in
pharma marketing.
• Am I reaching my target effectively? What is the
optimal mix of targeting tactics that will achieve campaign
goals (reach, brand lift, clicks, page environment) while
maintaining regulatory compliance?
The digital advertising industry as a whole is under the glare
of the data privacy cops. To ward off threats of federal intervention, the industry is developing voluntary, self-governing
privacy standards. In this environment, pharma marketers not
only have to satisfy overall industry standards, but also need to

LONG-TAIL MARKETING
adhere to stringent federal requirements on everything from
privacy to creative copy.

Limited and costly inventory
As most pharma marketers naturally want to have their ads
appear next to health-related content specific to their product, the laws of supply and demand have pushed the price
of impressions up. According to comScore, health display ad
impressions grew by 56 percent between December 2009 and
December 2010, while unique visitor growth was just 29 percent, and page views only grew 11 percent. Thus, the number
of ads per page increased by 41 percent, creating clutter and
ultimately brand dilution and diminished ad performance.
As mentioned above, the limited supply of premium online
health content has pushed costs higher. While pharmas may
have a greater tolerance for higher costs, they’re still looking
for efficiencies. According to the December 2010 comScore
Ad Metrix Display Spend Report2, health sites charged an
average CPM (cost per thousand impressions) of $8.94 –
nearly four times the overall average CPM of $2.36. Auto and
finance were the only vertical categories with higher CPMs.

Brand safety

them. Otherwise, you risk devaluing your brand, limiting
digital spend through lack of effectiveness or inciting the ire
of regulators. The best solution is a multi-pronged approach
that provides targeting, scalability, compliance and brand safety
while not sacrificing effectiveness.

An overlooked resource
Because using cookies for gathering consumer data and targeting audiences is not really an option for pharma marketers,
you have to find creative ways to get around this restriction
and gain the necessary audience insights. One very effective,
cost-efficient way for to reach your target audience at scale is
by using the so-called long-tail Internet. It is composed of millions of websites that are not as heavily trafficked as popular
destinations – for example, Everyday Health or WebMD in
the health category.
While not a replacement for premium health content, a
strategic use of long-tail content can provide much greater
reach and be an efficient use of digital media budget. According to comScore4, using long-tail inventory had the potential
to increase reach by well over 200 percent among consumers either searching for information on a particular ailment or
buying a prescription for it. When adding in non-health content from the long tail, reach potential increased by more than
600 percent5.
Again, health content is the obvious starting point for any
pharma marketer, but it shouldn’t stop there. A mix of shorttail and long-tail content, both health and non-health-related,
can be an effective combination. Additionally, insights on
what content target audiences are consuming can be used to
improve the precision of targeting without running afoul of
privacy restrictions.

Having an online ad appear next to inappropriate content
– profanity, pornography, etc. – is a bad result for any marketer, reflecting poorly on the brand and adversely affecting
campaign results. For pharma marketers, the result could be
more serious if the placement targets a restricted audience and
could be construed as promoting an off-label usage, drawing
unwanted FDA attention.
The critical nature of this issue is borne out in research
from The Winterberry Group3, which found that pharma marketers consider brand safety of greater importance than those
in other vertical markets. For instance, consider the growth
of online user-generated content, especially blogs.
While a major CPG brand might welcome the
Figure 1: Reach with a Targeted Content Mix
association with such content, especially in a target
demographic, pharma marketers would steer clear of
it as the quality of the relatively un-vetted content
could be suspect and adversely affect brand health.
The Interactive Advertising Bureau (IAB) created a set of content quality standards in June 2010,
outlining categories of non-standard and prohibited
content. More recently, the IAB created voluntary
Quality Assurance Guidelines, with IAB certification ensuring advertisers full transparency and
safety. While these are valuable tools for advertisers,
pharma marketers need to go above and beyond
such measures, using their own stricter brand safety
definitions.
To overcome these challenges, you need to
develop a holistic approach that addresses all of

DTC Perspectives • September 2011 |

LONG-TAIL MARKETING
Figure 2: Brand Awareness Lift by Content Category for a
Prescription Gout Brand Campaign (vs. control)

WEB reviewed data on content consumption patterns
for the pharma Smart Target. By analyzing billions of
impressions, it created a statistically significant, refined
custom content channel for this audience, called a
“Hotspot.”

Reaching the target safely
To ensure your ads don’t appear next to inappropriate content, this needs to be checked both before
and after ad serving. When using ad networks and
exchanges, publisher screening must be rigorous and
continuous because online content changes constantly. It must also be done in real time and down to
the individual page level in order to block potentially
harmful Web pages that may come from an otherwise
safe domain. Ideally this process should be customizable for every advertiser.
Just what constitutes brand-appropriate content is highly
subjective and differs widely by industry and even by company. This is why pharma marketers use their own manual
methods of checking content safety. But this makes it hard to
scale beyond short-tail health sites, leaving broader inventory
sources such as networks or exchanges out of the equation.
However, brand safety and scale don’t have to be mutually exclusive if you use automated machine learning that can
mimic your brand’s sensibilities in order to scale safely.

In order to understand and target what content audiences
are consuming, you must know who this audience is beyond
the condition they suffer from. However, this is not often
the case. CONTEXTWEB found in its research than only 29
percent of pharma marketers were providing additional target
information like demographic data to their media partners, and
just 8 percent were providing interest data.
This lack of insight led CONTEXTWEB to conduct an indepth study to determine the profile of consumers interested in
pharma advertising. The study combined leading third-party
audience data with proprietary system data to analyze action
The impact
patterns, in this case clicks on pharma ads.
While understanding your audience and finding new ways
The resulting “Smart Target” profile revealed that the ideal
to reach them safely is important, it means nothing if your
“pharma desirable” is an early retirement boomer, age 56 and
tactics aren’t helping you hit your campaign goals. Based on its
up, living in a city and having older children who are grown
research, CONTEXTWEB found that the most effective strator entering college. They’re college educated with mid- to
egy for pharma marketers is using a mix of targeting tactics,
high-level incomes but are not big spenders. While obviously
with each contributing to an increase in digital media perforinterested in health content given their age, they also consume
mance if used properly.
content on a wide range of subjects. Importantly for advertisReach
ers, they are more likely to respond to a richer display media
Blending health and non-health content doesn’t have to
experience.
be done at the expense of hyper-targeting. Pharma campaigns
Once you know the
profile of your audience,
Figure 3: Lift Generated by Targeting Tactic
you need to leverage
those insights in order
to tap into non-health,
long-tail content and
reach them at scale. As
part of the media budget
planning process, you
need to know which
content channels to invest
in first in order to use a
targeted approach. In its
research, CONTEXT-

34 | DTC Perspectives • September 2011

LONG-TAIL MARKETING
you should take into
consideration as part
of any pharma advertising buy, helping
determine domain
and content priorities.
Trust Metrics,
which took part in
the CONTEXTWEB
research, scored 2,000
Web domains that
ran pharma ads on
the CONTEXWEB
platform in Q4 of
2010. The score was
computed based on
the statistical patterns of more than
12,000 data points on
each site, with results
reported on a 0-100
scale. Sites scoring
above 61 were generally considered to provide a premium value to advertisers.
By combining CTR, CPC and quality score ratings, CONTEXTWEB came up with an overall average index value for
sites within a content category, as seen in Figure 4. While
some categories were found to be stronger in performance
than in quality or vice versa, the average index ranking suggests that non-health content such as education, news and
travel would make excellent all-around choices for pharma
marketers.
Strict regulations and ongoing online privacy concerns over
digital marketing make finding effective ways to reach target
audiences at scale a particularly thorny problem for pharma
marketers. For this reason, you need to seek out alternative,
compliant targeting strategies. This involves getting creative by
implementing tactics that go beyond the traditional heavy reliance on health-related content. With the right approach and
mix of tactics, brand safety, targeting at scale and consumer
privacy can all peacefully coexist within the context of a holistic digital marketing strategy. DTC

Figure 4: Click and Qualitative Performance by Category

employing mixed content are able to reach the intended consumer. Figure 1 illustrates how sufferers of specific conditions
were reached by targeting a mix of content.
Brand lift
For pharma marketers, brand awareness is a key metric
because it’s the first step in getting their product on a condition sufferer’s radar screen. In its research, CONTEXTWEB
found that while health-related content was the most effective
brand awareness driver, non-health content could also have an
impact. Figure 2 shows the results of exposure to prescription
gout ads on three different contextual environments, with
health-related content having the greatest effect.
Clicks
CONTEXTWEB also found that using Hotspot targeting in
pharma with non-health content can have higher CTRs (70
percent above the average) than targeting health content alone
and is 24 percent more cost effective in terms of cost per click
(CPC). Health content was more effective in terms of driving
higher CTRs than run-of-network (RON), but not as efficient due to higher costs. RON placements were not as effective as content targeting in terms of CTR but were highly
efficient – often a strong consideration for pharma advertisers
(see Figure 3). Overall, CONTEXTWEB found using a mix
of the long tail produced a 15 percent higher CTR on pharma
campaigns.
Quality
Content quality and site environment are also important considerations affecting brand perception. Page design,
editorial quality and visitor usage are environmental factors

References
1 MediaMind, “Benchmarks H1 2011,” April 3, 2011, via eMarketer
2 comScore Ad Metrix Trend Report, February 2011
3 eMarketer, Winterberry Group Research, “Advertising Professionals in North
America Who Believe that Brand Safety is a Meaningful Issue,” April 2010
4 comScore Plan Metrix, December 2010
5 ibid

Tanayia Washington is insights and analytics manager for the digital media services firm CONTEXTWEB. CONTEXTWEB is a
real-time contextual advertising solutions provider for online advertising
and publishing. Washington can be reached by e-mail at twashington@contextweb.com.

DTC Perspectives • September 2011 |

What a Wonderful World
it Would Be

In an ideal world, there would be no limits when creating a relationship marketing campaign. However, in
reality, every marketer has to deal with some type of constraint, whether it be budgetary, time or regulatory.
Drawing from an actual case study, this article discusses key steps for developing RM strategies.
by

Louis Winokur

t was a sunny day in June when we met with our newest pharma client. They had a great new product that had
come out of clinical trials with stunning results. Everybody
was excited about the new drug which had been approved by
the FDA in record time.
When it became time to discuss the budget, we learned
that the sky was the limit. We were asked to create 5-10
concepts and not to worry about timelines as it was important to have the right “feel” for the campaign. To our surprise, the normal copy restrictions did not apply for this
product. Because the audience was thought to be affluent and
well educated, we could write communications in “iambic
pentameter,” assuming the target audience had the equivalent
of a Ph.D. in English.

Gaining access to qualitative information
provides insight into what factors influence
patient behavior.

Our client strategy meetings were held in the famous Burj
Al Arab “sail hotel” in Dubai. Relaxing in my luxurious 1,000
square foot suite looking out on the Gulf of Oman, it was hard
to imagine how life could get any better …
Then I woke up.
Back in the here and now, we know the new reality is that times are tough and budgets are tight. Regulatory restrictions are an everyday reality. Timelines should be
reasonable and deadlines must be met. Despite these truths,
there is still room for resourceful and creative companies to
shine. Speaking from a research point of view, there are a
few simple tactics that can be employed to ensure that programs run at maximum efficiency.
To say that programs run in a loop is nothing new. In the
world of RM, the flow to ensure strong results goes along
the following lines, as seen in Figure 1. The chart represents a
holistic view of how we should think about programs – from
their initial creation through optimizations that occur over
time.

Know your audience
Generous marketing and media budgets were approved in
what seemed like the wink of an eye. A battery of longitudinal market research tests was also approved including: Focus
Groups, Concept Tests, Intercept and Re-contact studies.

36 | DTC Perspectives • September 2011

The first step, “know your audience” is not always given
the attention it deserves in the initial stages of program development. The internal analytics team should be brought in at
this early stage to help assess the value of the target audience.

RELATIONSHIP MARKETING
Figure 1: Holistic View of Relationship
Marketing

$50,000. Results from that research helped us understand
ways to motivate patients to increase adherence which in turn
helped crystallize the contact strategy.

Create a measurement plan

There are many great resources available to the pharma
community about disease states and the affected population.
The first place to start is with the Prescribing Information document. This is where information on dosing, effectiveness, and
common side effects of treatment can be found. It also often
points the way towards segmentation strategy. Other resources
such as the CDC, WebMD, or other health related sites can
provide important background information. For Oncology,
the Cancer Facts and Figures report published by the American Cancer Society is an invaluable resource for learning about
patient populations (see Figure 2).
Speaking to client contacts who work on the brand or
counterparts in the research department is also very important
and will help the analytics team avoid the pitfall of proposing a
redundant study when research data may already be available.
Information from the research department on drug costs
and lifetime value will provide valuable inputs for the ROI
model. Gaining access to qualitative information provides
insight into what factors influence patient behavior. This data
will be useful to the creative team as they formulate the program design.
Our recent experience with a new client showed the
advantage of this approach. Existing client data provided
us with information on the patient population (>300,000
strong), demographics (90 percent-plus female), and ethnicity
(63 percent Caucasian). We also learned about segmentation
strategies and initial reaction of HCP’s, including their likeliness to prescribe.
Communicating with the internal research department
allowed us to leverage internal funds to conduct a quick focus
group study, which avoided redundancy and saved them

The best brand managers in the world will have trouble
getting their budgets renewed if they are unable to find a way
to show why their program was successful. Without advanced
planning, they will be forced to frantically ask for data on various program metrics, but will fall short when they realize that
there are gaping holes in the information because measurement
was not thought about in advance.
The key questions to ask is: “What does success look like?”
For the new client program noted in the previous section,
we put together a presentation which outlined what they
should expect from the RM program over the first 12 months
after launch. Based on the media plan, we knew that close to
10,000 people would join the program, of which 80 percent
would be diagnosed with the condition. Using historical data
from past programs and evaluating the program design, we
expected the open rate to be in excess of 15 percent and click
rates to be 4 percent or greater. Other targets were set based
on similar criteria, such as an expected reach of 30 percent and
the percent of enrollees who would report that their knowledge if the disease state and treatment options had increased.
Once targets are established, a measurement plan can be put
into place to capture the important metrics. The plan should

Figure 2: Cancer Patient Populations

DTC Perspectives • September 2011 |

RELATIONSHIP MARKETING
Figure 3: Website - Monthly Unique Visitors

extend over the length of the program and involve both internal and external resources.
Great! Now that initial research data has been acquired and
a measurement plan is in place, we’re home free, right? Not
exactly.

Maximize enrollment
Various factors must be considered when thinking about
how to maximize enrollment. The program design and development process can be thought of as similar to the construction of a high-performance sports car. The account, creative,
and design teams at an agency take great care designing a
seamless user experience with useful content, which provides
the target audience with everything they need to know about
a disease state and its treatment options.
The media plan and enrollment form can be thought of as
the fuel that drives the program. A 2011 Ferrari Enzo’s 660
horsepower can’t beat a rusted-out 1970 Chevy Vega if there
isn’t any gas in the tank. Without fail, whenever we have
come across dramatic drops in enrollment form traffic from
month to month, the culprit has been either a drop in media
spend or a co-reg vendor that has “gone dark” due to the
recent completion of an enrollment goal.

Information from the research department
on drug costs and lifetime value will provide
valuable inputs for the ROI model.
Keeping this in mind, the enrollment form must have an
enticing value proposition and should include the minimum
amount of questions needed to segment consumers. Leave out
questions that are “nice to know” and only include what you
“need to know.” The surest way to cause people to abandon
your form in droves is to offer a weak value proposition and
adopt a long-winded, complex, multiple-page design. Enrollment testing should be incorporated into the plan to understand how people are interacting with the form.

38 | DTC Perspectives • September 2011

We recently invested in a Web tool that closely tracks
interaction with RM enrollment forms. Initial analytics have
provided surprising results. One client’s two step form had an
abandon rate in excess of 90 percent for Step 1 of a two-step
form. Another had issues with getting consistent engagement
with fields that were “below the fold.” Heat map information
shows how strongly people interact with headlines and other
important copy. For a small up-front investment, these new
data points pointed the way towards improving enrollment
rates across multiple programs.
Recommending the proper media plan is outside of the
scope of this article, but experience shows that for the most
part, it is better to plan for a steady stream of enrollments than
to adopt a plan that is front or back-loaded. In the example
seen in Figure 3, a successful patient-education microsite and
enrollment vehicle fell flat on its face as site visits declined by
97 percent when the client decided to cut media due to budgetary constraints.
Once people join an RM program, they are exposed to a
variety of content. The focus of most programs involves education about a disease state. Education can include information
about symptom tracking, topics to discuss with your doctor,
common side effects, and exercise and diet tips to help people
feel their best.

Optimize content
Marketers must be aware of how people interact with the
information that is presented to them. At the very least, e-mail
open and click rates
should be monitored
Figure 4: Average Share
and compared to
of Clicks by Callout Box
either an industry or
internal benchmark.
After a sufficient
amount of data has
been collected, we
often undertake the
extra step of conducting an in-depth analysis of click patterns
within communications. This provides
direct evidence of
which content is of
most interest and if
placement in a callout
box or other primary
location has an effect
on engagement.
In the Figure 4,
we analyzed e-mail

RELATIONSHIP MARKETING
click patterns across three patient segments for a program
geared towards sufferers of a chronic condition. We found
that the “On Drug” segment responded strongly to content,
regardless of placement. The body text received 55 percent
of all clicks, even though the links in this section were not in
callout boxes. In addition, we found that “Outside Links”
to other websites attracted 20 percent of clicks despite the
fact that this callout box was at the bottom of the page.
This was contrary to the popular theory that the majority of
clicks always occur above the fold.
This data pointed to a need for a streamlined design for
future phases of the project. For example, we recommended
that the “Tell-a-Friend” (TAF) feature would work better
if it were taken out of the sidebar and featured in a specific
portion of the body text.
Planning is an important part of the optimization process. New competitors will invariably enter the market.
Information on best practices for treatment of disease states
changes over time. Meanwhile, technology continues to
evolve, providing new ways for people to access and absorb
information. Metrics that were once robust may begin
to decline due to any or all of the above factors. Regular
evaluation of engagement metrics will provide direction as
to when a change is warranted.
For these reasons, a back end re-contact study is a musthave to ensure that conversion and adherence goals are progressing as expected. Dollars spent on evaluating program
measurement are a wise investment. The resulting data will
point to areas for course-corrections that will improve program efficiency and boost ROI. Past studies have provided
us with valuable input which pointed the way to improving value propositions or updating content so that it had a
greater impact on enrollees.
The important message to take away is the only way to
run a “lean and mean” RM program is to know your audience, create a plan to measure results, find a way to reach
them, and remember to optimize the content along the
way. These days, it is especially important to map out a plan
and to be prepared to make adjustments along the way to
ensure success. DTC
Louis Winokur is currently the director of analytics at DKI. With
over 15 years of marketing experience across analytics, client consulting and product development, Winokur has worked extensively on
consumer segmentation and analysis of purchase patterns across various
products and categories. He can be contacted via e-mail at lwinokur@
dkidirect.com.

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DTC Perspectives • September 2011 |

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Anywhere Health

Reinventing Healthcare Marketing in a Connected World
With emerging connections via technological advances, there is a confluence of health data and information
widely available to consumers. Marketers who begin to engage in the anywhere health space will be
positioned well ahead of the curve, reaching customers in new and engaging ways.
by Jim

n a remote village outside of Nairobi, a healthcare worker
walking to a makeshift clinic makes sure to bring her mobile
phone along with a stethoscope so that patient vital signs
can be immediately texted back to the hospital. Along the trails
outside of Seattle, a runner training for a marathon glances at
his watch and knows his exact location, heart rate, and body
temperature. In Houston, a teenager uses her inhaler for an
asthma attack, and her location is sent automatically to an online
database. A physician in Philadelphia clicks on his iPad and has
immediate access to CT scans from the ER. An elderly woman
in Osaka flushes her toilet, and is alerted that her blood sugar is
too high. An elderly man collapses at a church service in Atlanta
and is revived by a portable defibrillator. A mother from New
York posts a brief message about her son’s illness on Facebook,
and a few minutes later a friend alerts her that it’s a serious condition. An overweight man steps on the scale in London and his
weight and BMI are automatically sent to his iPhone where he
can track his progress over time. He touches his phone and the
data is made available to his physician. A mother in Chicago
goes to the drugstore and uses her smartphone in the aisle to
find coupons for children’s pain medicine.

Walker
Each day around the world, scenes like these are occurring
with increasing frequency as the combined impact of portable
devices, wireless Internet access, and social networks revolutionize the ways by which patients are diagnosed, monitored,
and treated. The common threads that link these stories – anywhere diagnosis, anywhere data, and anywhere delivery – are
powerful and far-reaching, and together form the foundation
for anywhere health.
Clearly this phenomenon is going to have a dramatic
impact on both patients and HCPs, but what impact will this
anywhere health revolution have on healthcare communications and marketing? Many marketing teams have already
begun to address various channels such as mobile marketing,
iPad development, and Facebook social marketing. However,
the larger opportunity and challenge lies in creating integrated
marketing programs that take into account the entire anywhere health landscape.
While all of these dynamic medical technologies will continue to evolve, some core principles are emerging that provide practical and ongoing guidance when formulating brand
strategies and tactics in an anywhere health world.
DTC Perspectives • September 2011 |

Transforming Marketing
Start with the patient
Up until very recently, tracking personal data and vital
signs was the sole province of hospital units or elite athletic
programs. However, that model is in the process of being
completely overturned as low-cost devices and powerful datatracking sites flood into the market, allowing for personal
tracking at levels previously undreamed of. Today, devices and
their accompanying websites can help individuals track fitness,
health, sleep, mood, productivity, energy, location, money,
social media patterns, learning and more! When the personal
data and insights from these devices are then shared and discussed on social sites like Facebook or PatientsLikeMe, the
resulting feedback loops can be powerful, if not transformative.
Quite simply, the data-rich anywhere health environment is
sparking an unprecedented rise in patient sophistication regarding his or her own particular condition, a trend that is only
going to accelerate.
Healthcare marketers take note: as patient sophistication regarding anywhere health rises, the relative value and
usefulness of basic disease education information declines in
comparison with more nuanced and “advanced” disease education. Furthermore, patients will now have multiple sources
to turn to when learning about medical products and procedures – making them less tied to branded messaging. In the
face of these changes, marketing campaigns that simply revolve
around producing a body of product-focused content may not
be the most effective approach.

Follow the data
If the flood of medical data is making traditional marketing
content less effective, that same data can also provide insights
for evolving healthcare marketing. The patient journey is not
static, nor is the data which is generated along that journey. To
effectively reach patients along their journey requires a deep
understanding of what particular triggers and data points mean
– not just from a medical standpoint, but from a personal and
emotional stand point. If the pollen count rises, or blood sugar
levels drop, or BMI stays frustratingly high, all of these data
points have medical implications as well as personal impact.
Effective health communications cannot succeed merely
by transferring facts, but must engage in the narrative story
that each individual patient is experiencing. Obviously medical writers play a critical role in the development of content
– but does your marketing team have great storytellers who
can empathize and speak with patients on this emotional level?
Does your brand strategy anticipate the ways in which patients
will be gathering their data, sharing their data, and how they
will be progressing along their disease journey in a highly connected world? If your team can learn the patient story and
imagine how critical patient data points will play out, your
brand messaging will become a trusted voice in the conversation, instead of just another byte of information in the data
flood.

42 | DTC Perspectives • September 2011

This points to the true value of social media monitoring for
healthcare – not in simply counting the number of mentions
or calculating some type of overall tonality – but in providing incredible clarity into what real patients are thinking and
feeling in the context of their overall journey. All of the focus
groups in the world cannot match the ongoing stream of social
media insights that can now be monitored.

Timing is everything
The anywhere health environment does not just connect
patients between devices and data; it also connects patients and
products in real-time and over time. Fundamentally, this combination of real-time conversation with long-term social connection might be the biggest challenge that marketing teams
face in today’s anywhere health communications environment
– how to work effectively in a real-time world with patients
and professional customers who do not simply “move on”
after interacting with a brand message.
This challenge is compounded by the regulated nature of
most healthcare communications which limits not just what
can be said but also when it can be said. Internal planning
processes and staffing also conspire against working either in
real-time or with a long-term perspective! As a result, most
brand marketing ends up as a kind of leisurely but not overly
committed “middle-ground” of quarterly or annual communications flow. The resulting subtext message that gets sent to
patients and HCPs is, “We don’t really want to speak with you
in real-time, and over the long-term everyone on the brand
team is going to be rotated off in a year or two – so we’re not
that interested in speaking with you in the long-term either.”
Ten years ago, in a less connected world, this approach
may have been a workable sort of strategy. Moving forward
though, brand marketers in the healthcare space need to think
very clearly about both their real-time communications voice
and their long-term customer relationship strategy.

Caregiver inclusion is no longer a “Nice to Do”
When a man comes home from a visit to the doctor and
tells his wife that he has a heart condition, or elevated PSA,
or high blood pressure, more often than not the wife will go
online to do further research. In fact, according to a recent
study, up to 91 percent of caregivers conduct their own
research after receiving a healthcare provider recommendation
for their loved one. Furthermore, the same study also found
that more than half of these caregivers use social media sites
like Facebook and Twitter. Pew Internet research has shown
that for chronic and life-threatening conditions, online usage
spikes even higher.
While immediate-level caregivers have always played an
important role in the overall patient journey, the influence of
extended-level caregivers has been amplified in the anywhere
health environment. Now, through social networking sites like
Facebook, “care circles” can easily include friends, distant relatives, and even patients with similar conditions.

Transforming Marketing

So when immediate family members and these extended
caregivers go online to start researching, what do they find?
When your disease category is typed into Google, do you
know what sites appear on the first page? What about YouTube? What is being said about your product on Facebook?
In working with healthcare marketers, it is always surprising
to find brand managers that have not considered these results
from a caregiver perspective. What are the “first impressions”
that your message is making towards caregivers in the online
space? Is your message making any impression at all?! Caregiver testimonials, decision support tools that spur discussion
between patient and caregiver, and doctor discussion guides
can all be valuable ways to engage your caregiver audience.

End with action
In the anywhere health world, marketing should start with
the patient and ultimately aim towards some type of measurable action. The level and type of action will vary depending
on where patients are in their journey; so the type of action
may often be something as simple as clicking on a link or
answering a survey. Other times, the required action might
be simply pointing patients and caregivers to a piece of information at the right time and in the right context (based on
your knowledge of the patient journey). Higher level types of
engagement, such as speaking with your physician (or loved
one) about a course of treatment, are built upon these prior
“smaller steps.” Not only should specific types of action be
planned for, but a reliable way to track and measure customer
activity should be developed before the campaign is launched,
allowing for progress to be tracked on a consistent basis, and
corrective changes to be made as certain tactics succeed or fail.
As the technology driving the anywhere health environment moves forward, patients, caregivers, HCPs and brand

teams will be ever more closely linked in a
sea of real-time data and disease state information. Undoubtedly, these changes will
bring tremendous opportunities and challenges. While it is difficult to predict all of
the ways in which brand marketing will need
to adapt to this new environment, some steps
are already clear:
Move beyond the basics: In light of a
wealth of online health information, brand
teams need to provide more nuanced and
“advanced” disease state information.
Engage on a personal level: As patients
become more intimately aware of their own
condition and progress, brand messaging
needs to understand and speak to the patient
journey on a personal level, not just relay
information.
Listen to what patients are saying: Social
media monitoring provides an unprecedented
view into the patient journey. Use those
insights to understand the patient journey and create
points of meaningful engagement.
Think real-time and long-term: The anywhere health
world is simultaneously real-time and long term, therefore brands need to engage both in the real-time conversation, as well as set in place infrastructure for ongoing customer relationships. Healthcare marketers have
no choice but to engage.
Master the art of caregiver first impressions: The role
of caregivers should be elevated in brand planning and
in the overall communications mix, with special focus
on how “first impressions” are made online. Caregivers
as immediate family members, as well as those in newly
extended circles of care, are here to stay!
Measure and track the small steps: Measurable actions
should be planned for at the start of each campaign,
with a clear way to measure and track success over time.
Simple small actions can often lead to larger outcomes.
Plan for change: The old days of launching a campaign
and then sitting back and remotely monitoring success
are over. In the active and closely connected world of
anywhere health, brand teams need to stay engaged and
flexible, responding quickly and intelligently to market
changes. DTC
Jim Walker is director of emerging trends at Cadient Group (Cadient.com), an interactive marketing company emphasizing digital
solutions. An expert in the “anywhere health” model, Walker also
founded the mobile health solutions firm, Anywhere Health (powered
by Cadient Group). Find the latest news and information at AnywhereHealth.com and on Twitter@AnywhereHealth. Walker can be
reached via e-mail at jim.walker@cadient.com.

DTC Perspectives • September 2011 |

Promises and Perils:
Social Stock Market

A new social media platform, Empire Avenue, has emerged that is becoming widely adopted, including by
corporations. Billed as a “social stock market,” pharma companies can discover how effective and valued
their efforts are through their social capital.
by Jane

he 2011 DTC National Report (DTC Perspectives,
June/July 2011) referred to Jamie Turner, chief content
officer of the 60 Second Marketer and co-author of
“How to Make Money with Social Media,” who noted that
social media is “currently over-hyped and that it is ultimately
one tool of many.” This leads to a problem of pharmaceutical
companies facing pressure to “engage” via social media. How
does an industry move from decades-old habit of information
dissemination to conversations? More than questions of “how”
and “how much” in social media, a bigger worry for pharmaceutical companies is: “how liable?”
Consumers have grown to expect “just in time” responses
to complaints they post on their social networks because companies are constantly monitoring mentions of their brands.
Pharmaceutical companies face an “engagement dilemma”
because current social media trends cannot sustain the “old
way” of communicating a pharmaceutical brand. Yet to stay
within legal and regulatory boundaries and to shift a domi-

44 | DTC Perspectives • September 2011

Chin, Ph.D.
nantly negative public perception of their industry, pharma
companies must disclose safety and risk information.
Empire Avenue is a social network game that opened to
the public in July 2010. According to the company’s website
(http://empireavenue.com/about/), Empire Avenue labels
itself as the “Social Stock Market” where players grow their
social capital. Players enter the market with a free membership and choose a ticker and an Index (there are currently #
indices not including sub-indices). As players link their social
networks (Twitter, Facebook, LinkedIn, YouTube, Flickr, and
blogs), their ticker reflects a “share price.” The share price will
increase in value as each social network links up with Empire
Avenue. (For more information about Empire Avenue, see
related sidebar on page 46.)
The “engagement” stage begins when new players are
noticed by existing players. These “investors” can buy shares
in a new player and through word of mouth, alert other players in their communities about viable new investments. Some

Social Stock Market
investors may check out the new players’ social networks and
engage them on Twitter and Facebook. Players can immediately participate in interest communities on the site.

Eye on business brands
Empire Avenue launched with an eye for business brands,
basing its value proposition for companies to connect with
individuals deeper than a mere “follow” on Twitter or “like”
in Facebook. The company believes that its platform enables
business brands to reach new and engaged audiences. Companies can create networks of virtual shareholders and access
customers across 150+ countries. At the bottom of the Empire
Avenue “about” page, social stocks of business brands are displayed on a rotating basis: AT&T, Oreo (cookies), Swatch,
Toyota, Intel, Dell, Applebees.

Pharma companies interested in using social
media need to identify key opportunities that
are appropriate and feasible to implement
through a social network.
Business brands can generate a lot of buzz upon entry:
when Microsoft (Xbox), BMW, and Rovio (Angry Birds)
signed up, their tickers were announced to a popular private
community group with almost 1,000 members. Within minutes, the volume of new share purchases in these business
brands drove sales commissions from 5 percent to 30 percent.
Investors love business brands for the potential virtual wealth
that these brands may generate for shareholders.
“Luxury items” give Empire Avenue immediate monetization. Players may spend eaves (e) – the virtual currency to pur-

Dividends/. RecomShare
mended

chase most of the game’s luxury items including watercrafts,
housing, automobiles, airplanes, and seasonal items. But certain
luxury items are available only with cold, hard cash. To buy a
castle, players must spend $100 and in return for 25,000 eaves
earned per week and 4,000 eaves net wealth increase per day.
This concept of premium items enables business brands to
offer not only a presence, but specific products that can benefit
players who commit virtual currency to gain. Microsoft struck
a deal with Empire Avenue to offer an Xbox premium item
under a newly created “electronics” category. Players spend
14,600e to purchase a virtual Xbox 360. This is tied to an
Xbox Fanatic achievement worth 500e (look at this as rebate
or “virtual cash back”) if they buy the Xbox luxury item and
post “Xbox FTW” as a status update on Empire Avenue,
Facebook, or Twitter.
Empire Avenue’s business model capitalizes on free membership and a commitment to one’s social stock performance
to create stickiness and loyalty to its platform. However
meager its revenue, luxury items allow the company to not
only monetize immediately but to create a means for business
brands to offer virtual products to reinforce their brands to
potential customers.

Opportunities and risks for pharma
Pharma companies interested in using social media need
to identify key opportunities that are appropriate and feasible
to implement through a social network. Pharma companies
have been criticized as not being transparent or engaging with
consumers, and remain faceless entities stereotyped as “pill
pushers” as opposed to contributors to improving standards of
care for patients in healthcare. Social media opportunities for
pharma that may begin to address such issues may include:

Shareholders

FB
Page
Posts

FB Page
Comments

FB
Page
Likes

YouTube
#Tweets Activity

Blog
Posts

Index

Ticker

Rank

Price

Technology

Nokia

143.33

1.21

178

1105

3363

10906

368

100+

Games:
Console

Xbox .
(Microsoft)

127.82

0.27

241

1465

7112

42407

Technology

Intel

124.26

0.8

139

1024

381

5911

Technology

AT&T

113.28

0.78

459

4411

3088

Cars

Ford

112.27

0.49

647

1885

3890

Cars

Audi

CFO

111.21

0.5

510

1439

36194

Cars

Toyota

99.32

0.4

381

482

1225

The Eaves

Oreo (Nabisco)

91.28

0.39

167

3744

22256

Technology

Dell

87.63

0.33

370

580

1982

Cars

BMW

MGR

59.1

0.02

102

521

Week of: July 26, 2011

DTC Perspectives • September 2011 |

Social Stock Market
1. Announcements of patient adherence initiatives
2. Reminders of product information (such as dosing and
drug interactions)
3. Announcements of disease state educational initiatives
4. Announcements of healthcare reform education for .
consumers
5. Directions for reporting adverse events
6. Directions for addressing patient queries about medication or side effect management
7. Supporting patient advocates/advocacies
8. Identifying consumer and patient influencers
At first glance, Empire Avenue as a platform provides the
means for a social media manager to accomplish tasks in each
of these opportunities. Status updates are also confined to 140
characters, but responses to a player’s “shout-out” (similar to
a response to a status update) are not. Players can create their
own personal communities as long as their share price has
reached 14e, which means pharma companies can potentially
create a moderated community for a particular topic. Community posts allow longer text messages and recently Empire

Avenue has improved its community format to resemble a
rudimentary message board.
Yet the same features that make Empire Avenue an interesting social network model create risks for pharma companies. First is the perception of “buy-backs” or investing in
shareholders who have purchased shares of the social stock
for a business brand. Business brands that do not reinvest back
to shareholders are criticized heavily by players: some players
will hold onto the brands’ social stock until it reaches a price
point and “flip” the stock to reinvest profits elsewhere. Players may then tell others within their communities to sell shares
of the business brand, citing the brand’s lack of engagement.
One automotive business brand was perceived negatively specifically because it did not reinvest its eaves in players who had
purchased the brand’s social stock.
Thus, there may be an expectation of “buy-back” of players
who have invested in the business brand that pharma companies’
social media managers may not want to, or may not be able to
fulfill. If “buy-back” are fulfilled, the next decision is what the
social media manager will do if a shareholder sells the shares of
the brand’s social stock or buys additional shares of the stock.
Will the manager match the additional buy-back? If the share-

How Empire Avenue differentiates

mpire Avenue differentiated itself from other
social networks by adding a “game layer” to
its social media activity and by aggregating
major social network activities onto its platform.
The allure of Empire Avenue is that aggregate
scores are then converted into a “share price” that
players can track, even if the algorithm behind this
metric remains a mystery to its players. For many
loyal players of Empire Avenue, there is a network
amplification effect that had increased the diversity
of Twitter followers and connections via Facebook
and LinkedIn.
Still, Empire Avenue wants to build its own communities rather than serving as another aggregate
measure like Klout or PeerIndex that also assigns a
number to one’s social media activities: it wants to
keep its players on its site while rewarding players’
social media activities off of the platform. Daily “earnings” are weighed favorably toward Empire Avenue
activities including participation in communities, “liking” (via clicking a thumbs up icon) on players’ status
updates, and “shout outs” on players’ walls.
These Empire Avenue-driven activities are
combined with aggregate social media activities

46 | DTC Perspectives • September 2011

and investments (share purchases) by players’
influence, the players’ share price and apparent
social media “value” within the Empire Avenue
walls. Investment even via virtual currency creates a commitment – however artificial – between
shareholders and their investment. This leads to
some players becoming obsessive over their share
prices. The result? Players’ social media activities
across, within and outside of Empire Avenue often
increase or become more disciplined to sustain
their share “value” via price increase or dividend
yield.
Social media achievement badges based on
milestones in social network activities (including number of Twitter mentions and retweets,
number of Facebook “likes” and “comments”)
are unlocked as players attain these within and
outside Empire Avenue’s walls. “Secret achievements” give an element of mystery and frustration
as players try to unlock these. “Special achievements” are tied to current events, notably the
“Will and Kate” during the royal wedding and
“Home of the Brave” to celebrate Independence
Day in the United States.

Social Stock Market
holder sells, will the company hold onto the former shareholder’s social stock or sell? Monitoring of these buy/sell activities
takes up time and does not necessarily increase brand awareness
or accomplish the business brand’s social media objectives.
Next is the participation in communities, interaction
through status-updates or “shout-outs” on shareholders’ walls.
Like any social media channel, the platform is the tool but the
risks fall within what is shared by pharma companies and how
the information is shared. If engagement has been limited by
the companies’ inability to provide proper context (because
of limited text characters per communication), being able to
type longer responses with required safety information may
not eliminate companies’ liability when it comes to regulators’
interpretation of companies’ actions or “intent.”
As it stands, companies that participate in social media
continue to take a limited and primarily responsive approach
to consumer feedback and queries. Participation on Empire
Avenue may not drive a change to the companies’ level of participation or engagement. The platform is another social media
tool: it does not and cannot change the risks in interacting
with consumers that pharma companies still face.
Even the choice of ticker symbol – the very first decision
companies must make if they choose to use Empire Avenue
– can be problematic. If the companies choose predictable
tickers like the names of their brands, this is straightforward.
What if a manufacturer of diabetes medication chooses “DIABETES” as its ticker? Can this be interpreted by regulators as
a form of promotion or a type of claim? Can the regulators
view this choice for a brand as claiming to be “the” diabetes
medication instead of “a” diabetes medication? Based on track
record, regulators show what not to do by means of warnings
and letters instead of clarifying what pharma companies can do
on social networks.
Finally, Empire Avenue has real drawbacks as a social networking platform: the game layer causes new players to burn
out quickly, especially those who fixate on continuing share
price increases. There have been complaints of spamming and
“content farms” that are not truly reflective of quality interactions, but are rewarded by the platforms tabulation of activities. In other words, Empire Avenue’s calculation of transactions has encouraged some players to “game the system” in
order to dominate the top slots of indices: CEO, President,
and CFO positions where their profile image are displayed
while other ranks (Vice Presidents, Senior Managers, Employees) are displayed as lists.
Founders of the platform are taking note of players’ complaints of rewarding the “wrong” behaviors by not differentiating between spam and legitimate actions on the site.
Additionally, players want increased transparency about how
activity-based earnings are calculated. If Empire Avenue bills
its platform as a potential social media training tool (and it

does, by positioning itself as a way of training to integrate
social media interactions across multiple platforms) but guards
its formula for arriving at its social stock price (hence, an indicator of learner’s performance), this renders the tool ineffective
for training.

Based on track record, regulators show what
not to do by means of warnings and letters
instead of clarifying what pharma companies
can do on social networks.
Empire Avenue has the potential for encouraging deeper
social networking relationships within its walls through its
communities and even through player-to-player shout-outs or
messaging system (including shareholder emails that cost eaves
to send). To realize this potential, however, its founders must
improve their reward system to encourage long-term participation. When multiple “successful” players who dominate leaderboards delete their accounts to take a break before “possibly
returning” to the platform (some of them do after a few days,
others after a few weeks), this pattern indicates a game design
that falls short of behaviors congruent with building connections based on dialog and quality interactions.
Should pharma companies write off Empire Avenue? My
recommendation is for companies to refrain from signing up
their business brands without their social media managers
first becoming very familiar with the platform. Social media
managers assessing Empire Avenue as a social media platform
for their pharma clients should identify not only potential
best practices for meeting opportunity goals (such as the list
of eight opportunities mentioned earlier in this article), but
should establish rules of engagement for this specific platform.
All business brands on Empire Avenue should consider writing an “investment policy” as part of their “bio” that explains
why the brand is there, how the brand will engage other players, and how the brand plans to invest as a player on the site,
including policies on buy-backs of shareholders.
Empire Avenue may be questioned as a fad and once upon
a time, Twitter was waved away as a fad; now many pharma
companies are monitoring this fad, if not using it to engage
consumers in a meaningful way. Empire Avenue has created
a niche in the social media space and a unique brand identity
in a relatively short time. This is a social media network to
watch… and one that may be worth waiting for. DTC
Jane Chin, Ph. D. is a healthcare leadership development consultant
and media/content-strategist. She has been blogging and engaging
with Web audiences since 1998 through her private network of blogs.
Additionally, she is an accomplished author and was formerly a columnist for Pharmaceutical Representative magazine. Chin can be reached
via http://about.me/janechin or on Twitter @janechin.
DTC Perspectives • September 2011 |

O N

T H E

M O V E

GCI Health, a leading healthcare public
relations agency, named Catherine Falcetti as senior vice president, and Julie
Fleisher and Robyn Leventhal as vice
presidents. Falcetti was formerly senior
vice president in healthcare with MS&L, a
communications and engagement agency.
Drawing from her experience leading busiAugusta Duffey
Laura Frerer-Schmidt
Kevin White
ness for Roche, Eli Lilly, Johnson & Johnson, Daiichi Sankyo and Genentech, she
magazine. Rodale Inc. also named Laura Frerer-Schmidt
will focus on pharma with specialized, blockbuster and OTC
as publisher of Women’s Health. She was previously associdrugs. Fleisher was most recently vice president of corporate
ate publisher of Self magazine. Kevin White was named
communications at the public relations firm, Ruder Finn,
publisher
of Health magazine. He had been publisher of Real
where she developed and implemented global PR programs
Simple since 2008. Renee Tulenko, Health vice president,
for Novartis Vaccines meningitis and influenza franchises.
associate publisher, expanded her role to include strategic
Leventhal was previously a vice president at MS&L, playing
oversight
and all day-to-day operations of Health.com.
a key role in FDA Advisory Committee meetings and subsequent approvals for Genentech’s Actemra and EMD Serono’s
Egrifta.
Saatchi & Saatchi Wellness hired Augusta Duffey as
group creative director. She was most recently an associate
creative director for Euro RSCG, where she led the creative
development on various campaigns for such clients as Schering-Plough, among others. Pacific Communications added
Catherine Pearson as senior account executive, joining
the Restasis account team. She previously worked at Euro
RSCG Life as an account supervisor.
AbelsonTaylor named Elizabeth Upton Rambach as
vice president, account director; promoted Erin Abbott
from account executive to senior account executive; and
promoted Kiersten Duffey from account coordinator to
account executive. Rambach will continue her focus on the
integration of professional and consumer campaigns for two
infant nutrition products and a major lipid disorder franchise.
Prior to joining the independent healthcare agency, she was
head of the account management department at RTC Relationship Marketing, overseeing the creation and execution
of DTC programs for five pharmaceutical giants, AARP and
Time Warner Cable. Abbott will be in charge of all digital
and e-marketing initiatives for a pain medication. Duffey will
be working on the launch of a new product for the treatment
of lupus, as well as continuing her work on products in the
areas women’s health and epilepsy.
Ronan Gardiner has been promoted from advertising
director and associate publisher to publisher of Men’s Health

48 | DTC Perspectives • September 2011

Good Health Media Rebrands & Grows
Good Health Media is rebranding itself as Precision
Health Media (PHM), sharpening its focus of reaching diagnosed audiences.
Citing July data from
comScore, the health
information portal
revealed via news
release that it became “the number one [platform] in total
audience for the online health category at 44.7 million
unique users … [with an] audience reach of 64.9 percent.”
PHM utilizes an analytical technology platform, “Condition
Match,” to pair the most effective and relevant content with
a DTC advertiser’s messaging.
Drumbeat Digital Expands to West Coast
Drumbeat Digital LLC, parent company of Heartbeat Ideas, has launched
a new integrated marketing company,
Heartbeat West. Based in Los Angeles, Heartbeat West is a privately held,
full service agency providing ideas and
innovation in the emerging marketing environment to clients on the
west coast. The company’s proprietary GRADE™ toolset
rigorously mines competitive and audience insights from
the complexity of the digital landscape, while the agency’s
versatile engagement process flexes to meet the needs of both
traditional and digital environments.

C O N T R I B U T O R S
Jane Chin, Ph. D. is a healthcare leadership development consultant and media/content-strategist. She has
been blogging and engaging with Web audiences since
1998 through her private network of blogs. Additionally, she is an accomplished author and was formerly a columnist for Pharmaceutical Representative magazine.
Chin can be reached via http://about.me/janechin or on Twitter @
janechin. Turn to page 44 to read her article.
Nami Choe is partner, senior director, consulting with
Ogilvy Healthworld. Ogilvy Healthworld is an innovative full service marketing agency and a part of Ogilvy
CommonHealth Worldwide. Choe can be reached by
telephone at 212-237-4789 or by e-mail at Nami.
Choe@ogilvy.com. To read her article, turn to page 17.
Qi Jiang is vice president of marketing science for
Phoenix Healthcare’s syndicated business. Phoenix
Healthcare is a business unit within Phoenix Marketing
International, the nation’s 28th largest marketing research
firm. The Healthcare unit tracks over 25 percent of all
DTC spending in pharmaceuticals. Jiang can be contacted via e-mail at Qi.Jiang@Phoenixmi.com. To read the article she coauthored with colleague Doug Zabor, turn to page 26.
As chief creative officer, Bruce Rooke provides strategic
leadership for GSW Worldwide’s creative team. His
responsibilities include establishing and implementing
standards for creative work and ensuring that strategic,
creative, and branding processes are used consistently
across the agency. Rooke can be reached by e-mail at
brooke@gsw-w.com. Turn to page 20 to read his article.
Todd Steffes is a vice president at FICO, and the leader of the company’s health care business unit. For more
information on the FICO Medication Adherence Score,
please visit www.fico.com/adherence. Steffes can be
reached by e-mail at toddsteffes@fico.com. To read his
article, turn to page 22.

Jim Walker is director of emerging trends at
Cadient Group (Cadient.com), an interactive
marketing company emphasizing digital solutions. An expert in the “anywhere health”
model, Walker also founded the mobile
health solutions firm, Anywhere Health
(powered by Cadient Group). Find the latest news and
information at AnywhereHealth.com and on Twitter @
AnywhereHealth. Walker can be reached via e-mail at jim.
walker@cadient.com. Turn to page 41 to read his article.
Tanayia Washington is insights and analytics manager for digital media services
firm CONTEXTWEB. CONTEXTWEB
is a real-time contextual advertising solutions provider for online advertising and
publishing. Washington can be reached by
e-mail at twashington@contextweb.com. To read her
article, turn to page 32.
Louis Winokur is currently the director of
analytics at DKI. With over 15 years of marketing experience across analytics, client consulting and product development, Winokur
has worked extensively on consumer segmentation and analysis of purchase patterns across
various products and categories. He can be contacted via
e-mail at lwinokur@dkidirect.com. Turn to page 36 to
read his article.
J. Douglas Zabor is executive vice president of Phoenix Healthcare’s syndicated studies. Phoenix Healthcare is a business unit
within Phoenix Marketing International, the
nation’s 28th largest marketing research firm.
The Healthcare unit tracks over 25 percent of
all DTC spending in pharmaceuticals. Zabor can be
reached by e-mail at Doug.Zabor@Phoenixmi.com. Turn
to page 26 to read the article he co-authored with colleague Qi Jiang.

ADVERTISING INDEX & RESOURCE CENTER
Company

Page

Website

Phone

Contact

Beacon Healthcare
Communications

beaconhc.com

908-781-2600

Adrienne Lee

alee@beaconhc.com

ContextMedia

contextmediainc.com

847-912-9612

Shradha Agarwal

shradha.a@contextmediainc.com

Epsilon

Epsilontargeting.com

1-800-603-4555

GSW Worldwide

gsw-w.com

614-543-6951

Parade Magazine

parade.com

212-450-7141

Remedy Health Media

Remedyhealthmedia.com

212-695-5581

SDI

sdihealth.com

SSI

surveysampling.com

Info@epsilontargeting.com
Greg Henderson

greg.henderson@gsw-w.com

Jim Curtis

Jcurtis@remedyhealthmedia.com

1-800-982-5613 Melissa Leonhauser
203-567-7220

Chris DeAngelis

Mleonhauser@sdihealth.com
Chris_DeAngelis@surveysampling.com

DTC Perspectives • September 2011 |

O N

T H E

H I L L

The Debt Ceiling is Just the
Tip of the Iceberg

by Jim

Davidson

While an agreement was reached regarding the debt ceiling, uncertainty still looms. Aside from the
significant risk of defaulting, without reforming spending and entitlements, we are far from being in the
clear. A long-term resolution would be an important first step toward returning us to stronger economic
growth for our industry.

ust hours before the August 2 nd
deadline, Congress and the President reached an agreement to raise
the nation’s debt limit up to $2.4 trillion
in two stages. Passing with a 269 to 161
vote, the federal government can continue to borrow until 2013. However,
neither party is particularly satisfied
with the plan. Our government’s failure comes in spite of numerous commissions, negotiations, and yes, even
gangs that have formed, disintegrated,
and revived themselves over the past
half-year in multiple attempts to resolve
this issue – at least until the next time
Washington has to statutorily raise the
debt ceiling to accommodate its spending habits.
The Congressional Research Service reports the Congress has voted to
increase the debt limit 74 times since
1962. The last 10 votes occurred in the past decade alone.
We are far from being in the clear; Washington desperately
needs to rethink the way it conducts business. It is likely that
the best we can manage may be with the $2.4 trillion dollars in cuts – of which $900 billion is immediate – and some
maneuvering of debts to keep us from default.
The debt issue poses few problems unique to the DTC
industry apart from the obvious fiscal catastrophe that would
hit every market if we fail. The reality is that the only sensible way to get out of this hole is to implement a debt reduction plan that both reforms spending and entitlements and
reevaluates our entire tax code. Republicans have embraced
the adage that “Washington doesn’t have a revenue problem,
it has a spending problem.” To a certain extent, they’re right.
The government had netted $814.9 billion in individual
taxes as of July 2011 and $134.3 billion in corporate taxes
– increases of 24.3 percent and 1 percent over the previous
year, respectively. Yet we still spent more than 1.5 times the
amount we have taken in during this entire fiscal year. Even
Democratic Senator and Budget Chairman Kent Conrad (D
– N.D.) recognized the state we’re in on a recent national
news show interview: “If you look at our spending, it’s the
highest it’s been as a share of our economy in 60 years, revenue is the lowest it’s been as a share of our economy in 60
years, [and] so we’re going to have to work both sides of the
equation.”

50 | DTC Perspectives • September 2011

The trick is that while everyone
agrees that we must reassess our tax
policy, you cannot do that without
opening up the Tax Code and evaluating every credit, deduction, and loophole against sound tax policy standards.
That puts everything on the table and,
by extension, at risk. We have witnessed this threat many times before. It
is important to note that the deduction
of the cost of advertising as an ordinary and necessary business expense
has been established tax policy since
the Tax Code was enacted in 1913. It
never has been treated as a tax expenditure or as a preference item.
The larger issue that doesn’t receive
nearly as much attention is the burden
that this fiscal uncertainty places on
corporations and their business plans.
Ask CEOs of any company about their
number one business concern and their likely response will
focus on the government’s ambiguity about how to fix the
tax code, or when. Businesses large and small are increasingly
challenged about how to budget for raw materials, supplies,
new equipment, employees, and benefit plans – an uncertainty that has to contribute to the stagnation in growth in
this country at a time when our anticipated recovery is on
the rocks.
Advertising, after all, does not exist in a bubble. As DTC
executives increasingly work to reexamine their models and
the returns on investment from DTC spending, decisions
made in Washington or the absence of sound decisions contribute to perpetuating a climate of instability. A resolution to
the debate over crucial deficit and our mounting long-term
debt would be an important first step toward returning us to
stronger economic growth for our industry and potentially
provide a strong impetus to renew marketing programs that
will help stimulate sales and a brand in the current stagnation.
Jim Davidson is an attorney and founder of the public policy firm
Davidson & Company. He currently chairs the Public Policy Group
at the Washington law firm of Polsinelli Shughart PC, and he
has been actively engaged in supporting the advertising industry on
Capitol Hill for almost 20 years. In October 2008, Davidson was
inducted into our DTC Hall of Fame. He can be reached by e-mail
at jhd@davidsondc.com.

2012 AWARDS

Enter the 2012 DTC Awards

Plan now to submit your entry to the DTC National Advertising Awards and nominate
a colleague from a pharmaceutical company for the Top 25 DTC Marketers of the Year.
Entries are free and simple. Visit www.dtcperspectives.com for full details.

a d v e r t i s i n g

a w a r d s

The.DTC.Advertising.Awards.are.designed.
to.recognize.communication.excellence.in.
a.fi.eld.with.multiple.constituencies,.varying.
needs.and.signifi.cant.communication.
challenges..Entries.will.be.judged.by.a.panel.
of.independent.industry.market.research.
experts..Gold,.Silver.and.Bronze.awards.will.
be.presented.in.each.category.at.the.2012.
DTC.National.Conference.

Winners from the 2011 Advertising Awards

Top 25 DTC Marketers
Top
DTC Marketers
from the
2011 Class
The.Top.25.DTC.Marketers.of.the.Year.are.selected.for.their.leadership.and.infl.uence.in.DTC.
marketing..This.award.acknowledges.the.contributions.of.elite.marketers.from.pharmaceutical.
companies.working.toward.the.advancement.of.patient.outcomes.via.direct-to-consumer.(DTC).
pharmaceutical.education.and.marketing.
Don’t Miss Your Chance to enter the 2012 DTC Awards
Associated with the DTC National Conference
April 10-12, 2012 at the JW Marriott in Washington, DC

Visit www.dtcperspectives.com for full details.

BOOKS

Never Say Die

The Myth and Marketing of The New Old Age
By Susan Jacoby
Published by Pantheon Books • 2011 • 332 pages

Reviewed by Robert Ehrlich

ho wants to live to 100? Is today’s 70 the new 50?
Will baby boomers live active lives until their 90’s?
Will the children of baby boomers live routinely
to 90? Do we really want to look forward to living 100 years?
These are the questions Susan Jacoby explores in her new
book Never Say Die. Based on the subtitle “The Myth and
Marketing of The New Old Age” one gets the sense that Ms.
Jacoby is not all that optimistic. Jacoby is a veteran writer and
reporter for numerous newspapers and magazines.
We as a society are barraged with cosmetics, foods, supplements, books, procedures and exercise equipment that promises extended youth. While it is clear that the 50-plus age
looks, dresses and acts younger than our grandparents did, the
questions Jacoby answers are deeper. Is it really possible to
have an active old age that makes living until our 90’s an exciting prospect?
The short answer is no. Despite the claims that we all can
be running on the beach well into our senior years, with
an active sex life, pesky diseases under control, eating out
at trendy restaurants and traveling the world is a myth, says
Jacoby.
Never Say Die is an attempt to look at the facts of aging,
rather than the marketing hype of purveyors of fountain of
youth products. Jacoby concludes that living into your 90’s is
not that much more likely and even if one reaches that age,
it is likely the life you will lead is one of frequent discomfort,
dependence and likely decline in cognition. Though, it is true
that people in their 60’s likely live a more active life because
of modern medicine and a recognition by society that they
can still be fashionable and sexy. We see Jane Fonda, Raquel
Welch, and Christie Brinkley still looking sexy into their later
years. We all remember how women of that age were expected to wear appropriate clothes and hair. Grandma shoes and
floral blouses were the norm.
Jacoby makes the case that once we reach our 80’s we are
likely to get sicker and more dependent on someone else to
take care of our daily needs. Marketers like to show the young
old using their products. Jacoby cites erectile dysfunction ads
where the actors are all in the late 40’s or early 50’s. Marketers know that showing real old people is not attractive. The
marketing myth is that we can all live active lives like never
before. There is no reason to age cites the longevity industry.

52 | DTC Perspectives • September 2011

Age is a state of mind
and is controllable with
proper diet, exercise,
and a little help from a
pill or two.
Yet, Jacoby says that 50 percent
of people who live to 85 will develop senility. Most will not
have the financial resources to survive without government or
family aid. Most will develop vision problems, bone weakening, arthritis, high blood pressure and other serious conditions.
Jacoby traces the history of aging in an interesting chapter
of how we treated old people historically. Of course that was
easier a hundred years ago when their fewer of them. Most did
not reach their 60’s so accommodating the elderly, both socially
and financially was easier. Yet, says Jacoby, we did not treat old
people too well then either. They frequently had to beg to survive, and their last years were spent alone and in pain. She says
the idea that their children always took them in was a myth.
Jacoby is at her best when she describes the financial health
of the elderly. Most outlive their savings, especially post-recession where investments hurt dramatically. Since most peoples’
wealth is in their house value, that decline is severe for middle
income people. Jacoby also describes how we artificially
extend life where quality is gone. This is bankrupting our
health system as well as denying the elderly a dignified death.
Never Say Die is not an optimistic book. No one will be
uplifted by it. On the other hand it is a sobering reminder that
we cannot, at least yet, make old age a seamless transition from
youth. It is inevitably going to be a period of decline and not
loads of fun. Jacoby is not arguing that life extension is not
good, just that we are being conned by longevity gurus that
we can spit in the eye of old age and act whatever mental age
we want. Yes, 70 may be the new 50, but 90 is probably the
old 87.
Robert Ehrlich, chairman and chief executive of DTC Perspectives Inc., regularly reviews books about the pharmaceutical industry,
marketing and advertising for DTC Perspectives magazine. He
also writes a weekly e-newsletter providing insights on pharmaceutical marketing trends. To subscribe to this FREE weekly analysis,
sign up at the website, www.DTCPerspectives.com. Ehrlich can be
reached by e-mail at Bob@DTCPerspectives.com.

Marketing Diabetes
Prevention and Awareness
June 6-7, 2012
Intercontinental Hotel
Buckhead
Atlanta, GA

www.mdpaconference.com
For more information, please contact Scott Ehrlich
at 770-559-0702 or scott@mdpaconference.com
Follow us on Twitter for updates,
discount offers, and more:
@MDPAConference

E ditorial

The Uncertainty of
Healthcare Continues
While we await a ruling on the constitutionality of Obamacare, millions of people are being
left in limbo. The reformed healthcare system should utilize more free market measures before
conceding to a government run structure.

bamacare or Nobama care? When
will we know? Appeals courts
have ruled on the legislation both
ways. The Supreme Court will tell us sometime next year, we hope, whether this is the
law of the land or part or all of it is unconstitutional. It does not matter what the partisan spin doctors tell us on cable television
about who is right. It only matters what the
Supreme Court says in a likely 5-4 ruling.
If the individual mandate is ruled unconstitutional, then how we will fund Obamacare? Underpinning the new law is all
of these healthy people buying insurance
to subsidize the
uninsured. WithWe would much
out them the
rather see some
program falls apart financially.
Our hope is that we get a
genuine free market
chance to start over using more
principles applied
free market measures. We supbefore we surrender port several free market ideas that
should lower cost overall while
to government run
broadening access. First, consumhealth.
ers need to be allowed to buy
insurance across state lines to get
the best deal. Second, we must encourage and grow the use
of less costly medical personnel to diagnose and treat common illnesses. These can be more use of nurses, physician
assistants, or a new class of medical diagnosticians with less
training and cost. Third, we would like to see tort reform to

54 | DTC Perspectives • September 2011

reduce excessive cover-your-butt-testing.
Fourth, it is important to better educate
and train consumers to know what things
cost and put some personal skin in the game
with their own money. Fifth, we can utilize
our vast retail network to expand speedy
clinics and reduce use of emergency rooms.
Finally, we need to stop paying extraordinary amounts of money to keep people
alive that final week or two when there is
no hope of recovery or any quality of life.
Obamacare is not realistic in requiring high quality plans for all and telling us
somehow it will cost less. That is really just
disguised price controls. All we will end
up with is mediocre care with shortages of
providers and consequently long waits for
service. We would much rather see some genuine free market principles applied before we surrender to government
run health. We are not advocating the status quo. We need
change we really can believe in and Obamacare is not credible.
Of course the longer we wait for that one deciding
judge, we have significant uncertainty for a $2.3 trillion part
of our economy. This is delaying investment in the sector and reducing, not increasing, employment. Would any
healthcare entrepreneur put serious new capital at risk not
knowing the potential ground rules? We doubt it; so what
is the Supreme Court waiting for? We need some supreme
pragmatism here, not delay while 300 million lives are put
on healthcare hold.

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Copyright © 2011 Epsilon Data Management, LLC. All rights reserved.

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History When                    : 2010:01:25 11:20:55-05:00, 2010:01:25 11:21:48-05:00, 2010:01:25 11:21:48-05:00, 2010:01:25 11:42:05-05:00, 2010:01:25 11:42:51-05:00, 2010:01:25 11:47:09-05:00, 2010:01:25 11:55:13-05:00, 2010:01:25 13:18:45-05:00, 2010:01:25 13:18:46-05:00, 2010:01:25 14:49:10-05:00, 2010:01:25 15:07:18-05:00, 2010:01:25 15:12:42-05:00, 2010:01:25 15:28:01-05:00, 2010:01:25 15:46:59-05:00, 2010:01:26 09:07:36-05:00, 2010:01:26 09:14:41-05:00, 2010:01:26 09:23:43-05:00, 2010:01:26 09:33:13-05:00, 2010:01:26 10:13:14-05:00, 2010:01:26 10:16:15-05:00, 2010:01:26 10:20:14-05:00, 2010:01:26 11:57:52-05:00, 2010:02:01 10:28:20-05:00, 2010:02:01 10:39:54-05:00, 2010:02:01 10:46:29-05:00, 2010:02:01 10:54:54-05:00, 2010:02:01 10:56:11-05:00, 2010:02:01 11:13:50-05:00, 2010:02:02 13:48:52-05:00, 2010:02:02 14:08:24-05:00, 2010:02:02 14:24:10-05:00, 2010:02:02 14:36:31-05:00, 2010:02:03 14:10:48-05:00, 2010:02:04 08:30:55-05:00, 2010:02:04 10:31:24-05:00, 2010:02:04 11:05:04-05:00, 2010:02:04 11:28:48-05:00, 2010:02:04 13:46:52-05:00, 2010:02:04 13:51:21-05:00, 2010:02:04 14:06:11-05:00, 2010:02:05 14:33:37-05:00, 2010:02:05 14:48:48-05:00, 2010:02:05 16:02:22-05:00, 2010:02:05 16:18:33-05:00, 2010:02:08 08:39:25-05:00, 2010:02:09 07:24:16-05:00, 2010:02:09 15:21:40-05:00, 2010:02:09 15:27:41-05:00, 2010:02:09 15:37:55-05:00, 2010:02:09 15:47:18-05:00, 2010:02:09 15:56:51-05:00, 2010:02:09 16:07:53-05:00, 2010:02:10 09:32:53-05:00, 2010:02:10 09:34:08-05:00, 2010:02:10 09:36:33-05:00, 2010:02:10 10:02:35-05:00, 2010:02:10 10:07:13-05:00, 2010:02:10 10:11:04-05:00, 2010:02:10 10:18:09-05:00, 2010:02:10 12:37:08-05:00, 2010:02:10 12:45:42-05:00, 2010:02:10 13:09:18-05:00, 2010:02:10 13:09:46-05:00, 2010:02:10 13:38:27-05:00, 2010:02:10 13:49:10-05:00, 2010:02:12 07:53:25-05:00, 2010:02:12 08:00:04-05:00, 2010:02:12 08:56:17-05:00, 2010:02:12 09:01:25-05:00, 2010:02:12 09:07:49-05:00, 2010:02:12 09:16:37-05:00, 2010:02:15 13:30:11-05:00, 2010:02:15 13:36:21-05:00, 2010:02:15 13:45:48-05:00, 2010:02:15 13:54:52-05:00, 2010:02:15 14:07:28-05:00, 2010:02:15 14:38:04-05:00, 2010:02:15 14:55:46-05:00, 2010:02:16 08:33:36-05:00, 2010:02:16 08:36:08-05:00, 2010:02:16 08:42:06-05:00, 2010:02:16 08:50:20-05:00, 2010:02:16 08:58:38-05:00, 2010:02:16 09:04:48-05:00, 2010:02:16 09:09:04-05:00, 2010:02:16 09:15:03-05:00, 2010:02:16 09:31:53-05:00, 2010:02:16 11:13:44-05:00, 2010:02:16 12:56:05-05:00, 2010:02:16 12:59:53-05:00, 2010:02:16 13:08:08-05:00, 2010:02:16 13:19:07-05:00, 2010:02:16 13:33:29-05:00, 2010:02:16 13:43:06-05:00, 2010:02:16 13:47:12-05:00, 2010:02:16 13:52:39-05:00, 2010:02:16 13:55:52-05:00, 2010:02:16 14:07:22-05:00, 2010:02:16 14:09:59-05:00, 2010:02:16 14:43:49-05:00, 2010:02:16 14:52:37-05:00, 2010:02:16 15:10:06-05:00, 2010:02:16 15:34:31-05:00, 2010:02:16 15:42:47-05:00, 2010:02:16 15:59:19-05:00, 2010:02:16 16:10:23-05:00, 2010:02:16 16:30:53-05:00, 2010:02:16 16:35:16-05:00, 2010:02:16 16:39:43-05:00, 2010:02:16 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Derived From Instance ID        : xmp.iid:E519B46899226811A0B3A844AA19ADAF
Derived From Document ID        : xmp.did:0BB763EE50216811A0B3A844AA19ADAF
Derived From Original Document ID: xmp.did:0BB763EE50216811A0B3A844AA19ADAF
Derived From Rendition Class    : default
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Manifest Placed Resolution Unit : Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches
Manifest Reference Instance ID  : uuid:4A8641B8CFEFDD11BA23D1491A8EB639, uuid:1F81470691D4E011B598B3EFBD3E500C, uuid:F40222D490D4E011B598B3EFBD3E500C, uuid:90011502-9958-154e-95d5-af7cd41cfeb9, uuid:18a65753-a7b3-1545-b2d8-ada2c7865d05, uuid:3D10CB1A92D0E011B598B3EFBD3E500C, uuid:F095D872A2D4E011B598B3EFBD3E500C, uuid:E43581FCA045E011B878BC14BFE0C527, uuid:18a65753-a7b3-1545-b2d8-ada2c7865d05, uuid:3BCF03B6F195E011823DB04B96C196E3, uuid:22ce8602-8314-624e-9511-2d8169789b7d, uuid:6A9203B966D5E011B598B3EFBD3E500C, uuid:729203B966D5E011B598B3EFBD3E500C, uuid:50599c15-e3f7-1444-97a2-8f6fc969caef, uuid:302e4f79-9460-d641-b18d-c8404452725f, uuid:3032a55c-bffb-6d47-8f7e-4a8c70a84320, uuid:6fc53d04-39df-ce46-9604-fac85889210a, uuid:4de71e0f-faf0-c647-be69-497b3b4692c3, uuid:0B8249CFC3E9DF118C0291898F1C0C79, uuid:0B8249CFC3E9DF118C0291898F1C0C79, uuid:9d9a3b77-5a3a-4249-ba2b-0a1f25816f33, uuid:0B8249CFC3E9DF118C0291898F1C0C79, uuid:ccc73cb6-a0c1-9d44-a8ce-97ba02bb3fb2, uuid:0B8249CFC3E9DF118C0291898F1C0C79, uuid:71e52ea3-aa3c-4348-b9cd-9f4ec366f42a, uuid:0B8249CFC3E9DF118C0291898F1C0C79, uuid:cddc110b-d576-114e-9723-00c0f4c40454, uuid:acb41a86-db6c-11dd-86b9-9e957d4c820d, uuid:3195C07CEACFE011B598B3EFBD3E500C, uuid:98BA1724C7CFE011B598B3EFBD3E500C, uuid:39CB8C2BC8CFE011B598B3EFBD3E500C, uuid:251ABE4CB3D0E011B598B3EFBD3E500C, uuid:2D1ABE4CB3D0E011B598B3EFBD3E500C, xmp.iid:5025B090AFE411E09DE9E5F45BFA09FD, uuid:E5D962CD54D1E011B598B3EFBD3E500C, uuid:28f9bb11-5a11-dc4d-a1b5-b75bd46d1dea, uuid:c1d89f29-d53b-9645-89b2-56a8b6631197, uuid:eba284ec-523f-2e41-8aa9-1665e28dc602, uuid:619eda0a-d6cd-1d40-919c-1e79dd32e905, uuid:3D10CB1A92D0E011B598B3EFBD3E500C, xmp.iid:910E1A08E52468118679D32B5A4D043D, xmp.iid:B8FFB255E32468118679D32B5A4D043D, xmp.iid:7DECB5E2E12468118679D32B5A4D043D, xmp.iid:7DECB5E2E12468118679D32B5A4D043D, uuid:634ADAE4A6D0E011B598B3EFBD3E500C, uuid:843FDC3AB7D0E011B598B3EFBD3E500C, uuid:C42F9721B7D0E011B598B3EFBD3E500C, uuid:0A0AB65EB7D0E011B598B3EFBD3E500C, uuid:E0BEC6ECB8D0E011B598B3EFBD3E500C, uuid:A51F52805684E011B6C5B9EC0EAD40C2, uuid:4A7C6395CCCFE011B598B3EFBD3E500C, uuid:F095D872A2D4E011B598B3EFBD3E500C, uuid:276A0EE334D6E011B598B3EFBD3E500C, uuid:B415720F35D6E011B598B3EFBD3E500C, uuid:E6380E3734D6E011B598B3EFBD3E500C, uuid:E593C6FE36D6E011B598B3EFBD3E500C, uuid:A745A88237D6E011B598B3EFBD3E500C, uuid:12A057F37BB0E011AEC49E0A8446CBBB, uuid:1F81470691D4E011B598B3EFBD3E500C, uuid:EE0222D490D4E011B598B3EFBD3E500C, uuid:F40222D490D4E011B598B3EFBD3E500C, uuid:79AB227B91D4E011B598B3EFBD3E500C, uuid:BE9487CD8CB3E011AEC49E0A8446CBBB, uuid:1981470691D4E011B598B3EFBD3E500C, uuid:1CE79C934EFEDF11BB5EC8D5793814BC, uuid:7C43993A91D4E011B598B3EFBD3E500C, uuid:DC6F0C71ADD4E0118020EB54FF4199A7, uuid:F3F53860DA3BDE11BD96805EEA4D0C3A, uuid:dfc5479f-4950-fe4e-97cd-f17dd398efa9, uuid:91DAEB563ED6E011B598B3EFBD3E500C, uuid:4196FD4A6CD5E011B598B3EFBD3E500C, uuid:c5be7aef-dadb-514f-be77-ef68423bc30b, uuid:49e8ec07-7e92-ab42-bd96-f026d37d645e
Manifest Reference Document ID  : uuid:260F2C32CFEFDD11BA23D1491A8EB639, uuid:1E81470691D4E011B598B3EFBD3E500C, uuid:F30222D490D4E011B598B3EFBD3E500C, xmp.did:ADCCDC4A4420681195FEEF69AC41FBF1, uuid:845B5719D617DF11BFBB9D60D1E03F69, uuid:3C10CB1A92D0E011B598B3EFBD3E500C, uuid:EF95D872A2D4E011B598B3EFBD3E500C, uuid:E33581FCA045E011B878BC14BFE0C527, uuid:845B5719D617DF11BFBB9D60D1E03F69, xmp.did:0080117407206811A7BAD5D2C00451BB, uuid:76FD4B14BBD4E011B598B3EFBD3E500C, uuid:719203B966D5E011B598B3EFBD3E500C, xmp.did:B2D968E4882068118C14A5FFCEDFBBC7, xmp.did:108110CF22206811B133DF06C1C8031D, uuid:A11F52805684E011B6C5B9EC0EAD40C2, uuid:94906FA40D3CE011AAF7BA7C72E1D93A, uuid:307511a6-4031-e54b-a547-fe79c317877e, uuid:098249CFC3E9DF118C0291898F1C0C79, uuid:098249CFC3E9DF118C0291898F1C0C79, uuid:05a10f1e-7e48-b74c-8643-cc97a9520fe8, uuid:098249CFC3E9DF118C0291898F1C0C79, uuid:44eb25c3-7ef8-7249-b32f-63824cd1ac09, uuid:098249CFC3E9DF118C0291898F1C0C79, uuid:9e5b7d3f-d258-bb44-b760-152fd097fc9e, uuid:098249CFC3E9DF118C0291898F1C0C79, xmp.did:0280117407206811ACAFC29C450D25C4, adobe:docid:photoshop:a756d6d0-db6c-11dd-86b9-9e957d4c820d, uuid:97BA1724C7CFE011B598B3EFBD3E500C, uuid:38CB8C2BC8CFE011B598B3EFBD3E500C, uuid:241ABE4CB3D0E011B598B3EFBD3E500C, xmp.did:520AEDDEAFE311E09DE9E5F45BFA09FD, xmp.did:5025B091AFE411E09DE9E5F45BFA09FD, uuid:EABEC6ECB8D0E011B598B3EFBD3E500C, uuid:FF98FBD723D3E0118020EB54FF4199A7, uuid:94B0F8378DD4E0118020EB54FF4199A7, uuid:96B0F8378DD4E0118020EB54FF4199A7, uuid:99B0F8378DD4E0118020EB54FF4199A7, uuid:3C10CB1A92D0E011B598B3EFBD3E500C, xmp.did:910E1A08E52468118679D32B5A4D043D, xmp.did:B8FFB255E32468118679D32B5A4D043D, xmp.did:7DECB5E2E12468118679D32B5A4D043D, xmp.did:7DECB5E2E12468118679D32B5A4D043D, xmp.did:B6FFB255E32468118679D32B5A4D043D, uuid:C32F9721B7D0E011B598B3EFBD3E500C, uuid:497C6395CCCFE011B598B3EFBD3E500C, uuid:EF95D872A2D4E011B598B3EFBD3E500C, uuid:266A0EE334D6E011B598B3EFBD3E500C, uuid:B315720F35D6E011B598B3EFBD3E500C, uuid:E5380E3734D6E011B598B3EFBD3E500C, uuid:E493C6FE36D6E011B598B3EFBD3E500C, uuid:A645A88237D6E011B598B3EFBD3E500C, uuid:41842A495DA5E01181C7F459E894558D, uuid:1E81470691D4E011B598B3EFBD3E500C, uuid:ED0222D490D4E011B598B3EFBD3E500C, uuid:F30222D490D4E011B598B3EFBD3E500C, uuid:78AB227B91D4E011B598B3EFBD3E500C, uuid:BD9487CD8CB3E011AEC49E0A8446CBBB, uuid:1881470691D4E011B598B3EFBD3E500C, uuid:1BE79C934EFEDF11BB5EC8D5793814BC, uuid:7B43993A91D4E011B598B3EFBD3E500C, uuid:DB6F0C71ADD4E0118020EB54FF4199A7, uuid:CBEF5DBAD43BDE11BD96805EEA4D0C3A, xmp.did:E6C74E739D2068118F77A582A1928251, uuid:90DAEB563ED6E011B598B3EFBD3E500C, uuid:4096FD4A6CD5E011B598B3EFBD3E500C, adobe:docid:indd:b4a1104c-c9a3-11e0-a13c-94cda76a45fd, xmp.did:658D3997E72068118083B88907100707
Manifest Reference Version ID   : 1, 1, 1, 1
Doc Change Count                : 24253
Format                          : application/pdf
Producer                        : Adobe PDF Library 9.0
Trapped                         : False
Page Count                      : 56
Creator                         : Adobe InDesign CS4 (6.0.6)

EXIF Metadata provided by EXIF.tools

Evolution E 908 D DTCPM Sept 2011

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