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The Source For DTC Leaders

PERSPECTIVES

Vol. 10, No. 3 September 2011

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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

In This Issue

Nami Choe

Partner, Senior Director,

Consulting with Ogilvy

Healthworld

Bruce Rooke

Chief Creative Ofﬁcer at

GSW Worldwide

Marketers have the opportunity to modernize DTC,

improving both campaign ROI and consumer reach

67 million readers • 43.4 million uniques 36 million readers • 6.2 million uniques 3.9 million uniques

yesterday

an apple a day is so

PARADE offers Americans practical steps for better living with

a dose of wellness, nutrition, beauty and medical news.

mediakit.parade.com Source: GfK MRI Fall 2010/Spring 2011; Dash is a publisher-deﬁ ned 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

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

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

Reviewed by Robert Ehrlich of DTC Perspectives, Inc.

DTC Perspectives Editorial: The Uncertainty of Healthcare Continues ..........54

Viable Content

Sources

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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.

PERSPECTIVES

September 2011 Vol. 10, No. 3

DTC Perspectives • September 2011 | 3

Social

Stock

Market

Relationship

Marketing

DTC Perspectives is Published Quarterly By:

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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 Com-

pany 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 chan-

nels 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 communicat-

ing 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 evalu-

ate 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 induct-

ing 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.

PERSPECTIVES

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

Jennifer Haug

Sincerely,

4 | DTC Perspectives • September 2011

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IN BRIEF

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 con-

cerns 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 pres-

ident 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 ana-

lytics to pharma/healthcare professionals. While the ﬁrm is cur-

rently seeking a buyer, they plan to continue as a leader in the

health information space.

Rep. Ben Quayle (center) met with WKPS’ Bob Jansen, president

and chief commercial ofﬁcer, and Michelle Woker, president and

chief operating ofﬁcer, to discuss improvements of today’s delivery

of health information.

6 | DTC Perspectives • September 2011

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 ﬁ rms, trust their most important projects to SSI. Now, SSI is bringing the scientiﬁ c 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 beneﬁ t from:

• Wide reach across key therapeutic categories, including metabolic

syndrome, respiratory ailments, mental health, lifestyle treatments and more

• Real-time dynamic proﬁ ling to identify and engage precise segments

• Advanced quality processes—from digital ﬁ ngerprinting to third-party

database matches—to ensure data integrity

• A full range of online and ofﬂ ine 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.

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Pure Science

Now…the Science of Sampling

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SSI’s New Webinar—

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IN BRIEF

Botox Receives FDA Approval

For Seventh Medical Treatment

The FDA has granted Allergan’s Botox approval for the treatment of “urinary inconti-

nence 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 pipe-

line 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 ana-

lyst 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 phar-

maceutical 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 pro-

vide 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

PROVEN SALES LIFT

MEASURABLE ROI

TARGETED MEDIA

Patient-Centric Marketing via

Specialty Point-of-Care Networks

Awareness:

1 million patients are

watching each month

Compliance:

94% of patients are

purchasing products

immediately

Action and Acquisition:

51% of patients are

asking their HCP

PROVEN SALES LIFT

MEASURABLE ROI

TARGETED MEDIA

Patient-Centric Marketing via

Specialty Point-of-Care Networks

Awareness:

1 million patients are

watching each month

Compliance:

94% of patients are

purchasing products

immediately

Action and Acquisition:

51% of patients are

asking their HCP

PROVEN SALES LIFT

MEASURABLE ROI

TARGETED MEDIA

Patient-Centric Marketing via

Specialty Point-of-Care Networks

Awareness:

1 million patients are

watching each month

Compliance:

94% of patients are

purchasing products

immediately

Action and Acquisition:

51% of patients are

asking their HCP

Patient-Centric Marketing Via

Specialty Point-of-Care Networks

Awareness:

Millions of patients are

watching each month1

Action and

Acquisition:

51% of patients are

asking their HCP2

Compliance:

94% of patients are

purchasing products

immediately3

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

✔ ROI Guarantee

✔ Proven Results

✔ State-of-the-art Technology

✔ Advanced Reporting

1115a-CM_DTC_Ad_7'11.indd 1 7/28/11 11:13 PM

REVIEW

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 1H 2010 1H 2011 $ Change % Change

Lipitor Pﬁzer $141,059,869 $144,924,859 $3,864,990 2.7%

Cymbalta (Pain) Lilly USA $0 $72,541,275 $72,541,275 N/A

Uloric Takeda Pharmaceuticals $244,590 $72,269,377 $72,024,787 29447.2%

Cialis Lilly USA $93,285,343 $71,352,468 -$21,932,875 -23.5%

Celebrex Pﬁzer $0 $66,677,970 $66,677,970 N/A

Abilify Bristol-Myers/Otsuka America $71,729,538 $63,926,868 -$7,802,670 -10.9%

Seroquel XR AstraZeneca $0 $62,028,290 $62,028,290 N/A

Pristiq Pﬁzer $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 $0 $40,800,076 $40,800,076 N/A

Beyaz Bayer HealthCare $0 $39,360,372 $39,360,372 N/A

Total Spending for Top 20 Brands $887,257,556 $1,198,144,321 $310,886,765 35.0%

Total Pharma Spending $2,010,966,227 $2,163,414,680 $152,448,453 7.6%

Media Type 1H 2010 1H 2011 $ Change % Change

65%

Television $1,345,251,695 $1,401,769,069 $56,517,374 4.2%

29%

Magazine $547,455,629 $624,932,017 $77,476,388 14.2%

Newspaper $92,678,960 $117,297,547 $24,618,587 26.6%

Radio $23,663,848 $18,468,477 -$5,195,371 -22.0%

Outdoor $1,916,095 $947,570 -$968,525 -50.5%

Total Pharma

Spending

$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.

29%

65%

Television Sees Slight Increase in DTC Promotions

Magazine Segment Gains Market Share

NOTE: Excludes

Internet Advertising

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

12 | DTC Perspectives • September 2011

Branded Versus

Unbranded Digital Tactics

What to expect in reaching relevant

consumers and converting to brand

ampaign planning involves analyzing the tradeoffs

between marketing approaches. In pharmaceuticals,

these decisions grow more complex when choos-

ing not just between channels, but also between branded or

unbranded communications. Marketing decisions become

even murkier considering regulatory compliance requirements

and legal approvals – especially, though not exclusively, with

branded messages. Unbranded messages can often be under-

taken at a lower cost because of the less stringent fair balance

requirements. This results in messages that can be

conveyed in fewer pages, shorter television time,

or smaller display space.

Of course, an unbranded message is typically

not as powerful in driving direct conversion ben-

eﬁt (new patient starts) to a brand. Branded mes-

sages drive the product ethos to patients while

unbranded messages serve to increase disease

awareness and education. While unbranded mes-

saging can grow the size of the market, branded

messaging is necessary to increase a brand’s share

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

digital marketing. Cost considerations aside, one

would hypothesize that branded tactics executed

digitally would more effectively generate conver-

sion to a prescription while unbranded tactics

would hit a wider audience to raise disease or

category awareness and drive a qualiﬁed audi-

ence. A meta analysis of branded versus unbrand-

ed digital tactics supports this hypothesis and uncovers

actionable insights into when each should be used along the

continuum of prospect identiﬁcation, consumer engagement

and conversion to brand use.

Benchmarking quality

Crossix RxMarketMetrics sheds light on performance dif-

ferences between branded and unbranded tactics using mean-

ingful norms that can help guide brand teams in their planning

efforts. RxMarketMetrics generates these market norms by

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.

Crossix RxMarketMetrics Series

Figure 1: Percentage of Audience Treating in Category

57% 58%

20%

40%

60%

80%

Audience Treating in Category

Branded

Unbranded

% of Audience

Source: Crossix RxMarketMetricsTM March 2011.

DTC Perspectives • September 2011 | 13

BRANDED VS. UNBRANDED

aggregating hundreds of actual Rx matchback

analyses over a broad range of media tactics,

brands and therapeutic categories. RxMarketMet-

rics 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. Per-

centage 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.

Audience vs. prospects

A comparison of quality of engaged audiences

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

unbranded tactic. (See Figure 1.) However, by

drilling down and looking at only those not exist-

ing patients (candidates for conversion), further

insights emerge.

Analysis of the Percentage of Prospects Treating in

Category demonstrates that unbranded tactics drive more quali-

ﬁed prospects than branded tactics. The median unbranded

tactic generates seven percentage points more qualiﬁed pros-

pects than the median branded tactic. The lower level gener-

ated 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 effec-

tively 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 Pros-

pects Treating in Category, typical unbranded audiences may not

start at the same point in their treatment decision-making pro-

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 web-

site, 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 spe-

ciﬁc 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.

Figure 2: Percentage of Prospects Treating in Category

vs. Existing Patients

46%

11%

53%

20%

40%

60%

80%

Prospects Treating in Category Existing Patients

Branded Unbranded

% of Audience

Source: Crossix RxMarketMetricsTM March 2011.

14 | DTC Perspectives • September 2011

rates of conversion than unbranded tactics. Sometimes branded

communication elements follow unbranded campaigns, poten-

tially 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

unbranded. Unbranded search share of bene-

ﬁt continues to track comparably with brand-

ed 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 three-

ﬁfths 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 ben-

eﬁt. (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 visit-

ing 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 treat-

ing in category. However, these individuals

convert more slowly and need further sup-

port by branded messages to continue to

move the potential customer from a prospect

to a patient. In considering unbranded cam-

paigns, the lower cost of media, the reduced

regulatory constraints in messaging, and the

broader appeal to higher volume of quali-

ﬁed 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).

BRANDED VS. UNBRANDED

Figure 3: Percentage of Total Conversion Beneﬁt – Search

25%

50%

75%

100%

1 2 3 4 5 6 7 8 9

Unbranded

Branded

% of Total Conversion Benefit

Month

Source: Crossix RxMarketMetricsTM March 2011.

Figure 4: Percentage of Total Conversion Beneﬁt – Website

25%

50%

75%

100%

1 2 3 4 5 6 7 8 9

Unbranded Branded

Month

% of Total Conversion Benefit

Source: Crossix RxMarketMetricsTM March 2011.

Providing targeted data driven

solutions for consumer focused

health & lifestyle brands

Call:

Jim Curtis, Chief Revenue Oﬃ cer

jcurtis@remedyhealthmedia.com

212-695-5581

your

remedy

we have

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DTC Perspectives • September 2011 | 17

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 contem-

porary marketers can nimbly adapt. By the time mar-

keters collectively acknowledge and begin to understand a new

advent in the industry, another innovation emerges to trans-

form the landscape yet again. (Marketers were still attempt-

ing 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 combina-

tions 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 gener-

ated 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 inte-

grated marketing efforts, though, has been the lack of cross-

channel benchmarks to inform assumptions for lift and return.

Traditionally, third-party vendors specialized in the measure-

ment of a single medium, so most historical data points pertain

to a channel’s independent efﬁcacy, regardless of its relation-

ship with other campaign elements in the consumer’s overall

experience with a brand. Research vendors are making sig-

niﬁcant 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.

Optimizing ROI

Through

Integrated

Marketing

18 | DTC Perspectives • September 2011

At the eventual step of minimizing costs to maximize the

ROI output, channels and touches thereby risk omission with-

out the model reﬂecting the opportunity from its relationship

with other media. In other words, the channels are evaluated,

mixed and matched as independent entities – contrary to the

underlying principles of integrated marketing. Rather than

wait for third-party vendors to release blinded benchmarks

to improve media mix assumptions, marketers should focus

on building their internal repository of cross-channel results

through robust measurement planning that truly reﬂects the

integration for which their plans strive.

Establish measurement plans

Commence measurement planning before creative

development to ensure that all tactics are tracked prop-

erly. Deﬁning tracking requirements upfront ensures sufﬁcient

time for creative partners and vendors to assist with maximiz-

ing visibility into campaign dynamics. Measurement is too

often an afterthought upon the program’s completion, when

it is too late to implement the appropriate tracking instruments

to address key questions.

The most challenging part of this process is agreeing upon

campaign and tactical objectives. Once key stakeholders are

in agreement, the measurement plan becomes less of a burden

and less time consuming on the analyst without going back

and forth with vendors and marketers. When approached with

discipline and structure, translating objectives into measure-

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 require-

ments should focus

on enabling tracking

consumer engagement

across multiple chan-

nels. While legal parameters

might limit the granularity

at which consumer activi-

ties may be tracked, generic

source coding can be lever-

aged to identify user paths

and link disparate data

sources. Ideally, marketers

should also consider formal

Media Mix Modeling (an

econometric model which

determines revenue contri-

bution per tactic/program

that accounts for overall

marketing efforts, seasonality and conversion lag times), which

requires substantial campaign setup prior to launch, but can

correlate media exposures/engagement to conversions without

instruments for direct attribution (e.g., source codes and tag-

ging). However, as with any model, it requires marketers to

let ample time for the campaign to make an impact and gather

enough data. Given the need for some level of patience, Media

Mix Modeling is still a particularly attractive solution for mea-

suring DTC campaigns where bridging between consumer

media exposure to actual Rx or product adoption remains a

large gap.

Document key hypotheses/tests in the measure-

ment plan, and allow sufﬁcient time for data to accrue

for statistically significant findings. Data is becoming

increasingly more accessible in real-time, allowing for prompt

in-market optimizations. However, eagerness to optimize has

also led to premature reactions. Adequate sample size is critical

to statistical integrity but is often overlooked when marketers

observe trends only directionally. Rash and frequent optimi-

zations risk dismantling the test plan and might inadvertently

inhibit learnings at the end of the campaign.

Identify connections

Identify key performance indicators (KPIs) that

are aligned with how consumers actually engage with

each channel and across channels. When marketers hold

all tactics against the same objective, the measurement plan

OPTIMIZING ROI

Ogilvy CommonHealth Worldwide’s overall framework for planning, implementing, executing and sustaining

campaign measurement.

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REACH THE RIGHT DTC MARKETERS

DTC Perspectives • September 2011 | 19

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 compari-

son 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 catego-

ry. 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 pri-

mary 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 sophis-

ticated, 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 relation-

ship of three key factors: audience type, channel mix, and tim-

ing. 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 market-

ing 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.

20 | DTC Perspectives • September 2011

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, Cre-

stor, 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 Con-

gressional 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 put-

ting out the same Beauty and the Beast formula of a disease-

stricken 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 respon-

sibility – to respond to the changing landscape with a whole

new vocabulary of action.

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 dissemi-

nating 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) The AllergyManager app (from

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.)

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

It’s Time “DTC”

Stood for

Something Else

DTC Perspectives • September 2011 | 21

3) GoMeals (from Sano-

fi-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 cam-

paign* for Roche

where, beyond the

“Happy Feet” danc-

ing 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 creat-

ing 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 how-

cast.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 inﬂu-

encers 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 talk-

ing 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 get-

ting 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 cus-

tomizable 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 estab-

lishing 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.

REDEFINE DTC

22 | 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 in-

tended 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 Todd STeffeS

he issue of patient adherence to prescription drug regi-

mens hasn’t commanded enough discussion in recent

years, but it has grown into a disturbing trend with sig-

niﬁcant 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 non-

adherence, existing strategies to ﬁght the trend aren’t ade-

quately 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 pre-

ventative 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 rec-

ommended 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-adher-

ence is estimated to result in around 125,000 premature deaths

in the U.S. each year2.

In addition to detrimental health consequences, non-

adherence adds signiﬁcant costs to the health care system – the

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 expen-

diture. 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 esti-

mated 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 re-

thought.

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 informa-

tion – health care providers and payer organizations – can

monitor patient treatment history and look for gaps.

Unfortunately, this approach only addresses non-adher-

ence 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

DTC Perspectives • September 2011 | 23

IMPROVING ADHERENCE

overstate their own prescription usage,

and it’s hard for practitioners to know

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 psychomet-

ric-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 mes-

sages, and use TV and online channels

to communicate with patients. For

example, pharmaceutical manufactur-

ers like to combine educational mate-

rial with incentives like co-payment

cards to reduce out-of-pocket expenses

for patients. These education strategies can work, but

they are costly because they employ a “one-size-ﬁts-all”

approach and resources are wasted on patients who take

their medication on time and in full.

In sum, there are two primary problems with today’s

approaches to medication non-adherence. First, it’s too late to

impact non-adherence retroactively; it is difﬁcult and costly

to re-engage with a patient and get them back onto their

medication plan after they have already failed to ﬁll a prescrip-

tion. Second, patient engagement strategies need to be more

tailored to speciﬁc patient and health condition types, channel-

ing resources to those with the greatest risk of non-adherence.

One-size-ﬁts-all approaches do not effectively accomplish this,

so new solutions are needed to circumvent these challenges

and truly curb medication non-adherence.

Using analytics to focus programs

The use of predictive analytics has emerged as an effective

way to overcome the limitations of current strategies and drive

improved patient medication adherence. These analytic models

can accurately predict who will become non-adherent before

the prescription is written. This could be a real game-changer

in the health care industry – if you can identify which patients

are most at risk of becoming non-adherent, then you can

develop tailored preventative engagement strategies and apply

them to both improve patient health outcomes and save costs.

One approach to do this, like we’ve established with the

new FICO Medication Adherence Score, is to generate a score

early in the course of treatment, when an individual is being

prescribed drugs for the ﬁrst time. We have learned that it is

important to develop tools that have the greatest ﬂexibility of

application and can be made available to multiple stakeholders.

Leveraging publicly available data sources can provide broad

predictive tools across the entire patient base for enhanced

adherence propensity assessment.

If the score indicates the patient is at higher risk of non-

adherence, a doctor, pharmacy or other organization would

have the opportunity to spend extra time when prescribing the

drugs to emphasize the importance of taking them on time and

in full. After treatment has begun, other intensive engagement

strategies like nurse calls and reminder programs could be used

to reinforce the earlier educational discussions and encourage

adherence. Meanwhile, lower-touch and lower-cost strategies

like e-mails and Web-based educational tools could be used

with lower-risk groups, and co-payment offers could be tai-

lored by risk group as well.

This differentiated approach has the potential to deliver

greater health outcomes and lower costs, compared to tradi-

tional one-size-ﬁts-all approaches. For example, a payer orga-

nization might attempt to improve adherence of new diabetes

patients through a mix of tactics including multiple nurse calls

and counseling sessions – an expensive strategy. Using predic-

tive analytics, the level of nurse interaction could be adjusted

to reﬂect a patient’s adherence risk ratings; e.g., the com-

pany could reduce levels of nurse outreach to low-risk patients

Figure 1: Solving the Limitations to Current

Non-Adherence Tactics

24 | DTC Perspectives • September 2011

IMPROVING ADHERENCE

(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

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 spon-

sor’s target by 36 percent.

Advanced test-and-learn

techniques are particularly

relevant now, as health care

organizations consider the

use of new communica-

tion channels such as mobile

and social media. These

approaches provide an effec-

tive 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-adher-

ence 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 Prescrip-

tion 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 com-

pany’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.

Figure 2: Personalized Engagement Tactics

Hall of Fame

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the Stars of the Industry

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Attend the DTC Hall of Fame Induction Ceremony on October 12, 2011 at the Crowne

Plaza hotel in Fairﬁ eld, 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.

Mark Bard

Executive Director and

Co-Founder

Digital Health Coalition

Bill Drummy

Founder and Chief

Executive Ofﬁ cer

Heartbeat Ideas

Joan Mikardos

Senior Director Digital

Center of Excellence

Sanoﬁ -Aventis

Nancy Phelan

Executive Director,

Global Communications

Pﬁ zer

26 | DTC Perspectives • September 2011

s there an ideal media strategy to reach and inﬂuence a dig-

ital 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

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 switch-

ing is patient-driven by efﬁcacy to reduce symptoms; 54

total: 4 TV, 20 Print, 22 Online, 8 Websites.

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

DTC Perspectives • September 2011 | 27

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) Deter-

mine 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 spe-

ciﬁc 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 efﬁ-

cacy 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:

• Talking to your doctor

• Calling an 800 number

• Visiting the brand’s website

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

or newspaper if used), plus online display and the brand’s

website. A total of 10 brands included.

• 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.

• Brand site: Brands with no other media besides the brand’s

website. A total of 10 brands included.

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).

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 infor-

mation, 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 dif-

ferent 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

MEDIA MIXES

Figure 1: Digital Consumer Segment Size of

DTC Category

10%

20%

30%

40%

50%

60%

Asymptomatic &

chronic

Lifestyle Symptomatic, chronic &

degenerative

28%

45%

55%

Figure 2: Media Campaign Types

Multi-media, 10

Mass only, 7

Digital only, 4

Website only, 10

28 | DTC Perspectives • September 2011

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 sup-

port. When comparing among branded ad recallers, digital

consumers are signiﬁcantly more likely to 1) See their physi-

cian in the last three months, 2) Are aware of more brand

choices by name, 3) Discuss more brands as options for treat-

ment 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 consum-

ers 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 dis-

play 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 sur-

prise that brand site-only brands achieve the lowest exposure,

but the visibility of these site-only brands justiﬁes their inclu-

sion 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).

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

Figure 3: Digital and Non-Digital Consumers

Recalling Branded Ads

10%

20%

30%

40%

50%

60%

70%

Saw doctor last

3 months

Percent of brands

aware of

Discussed campaign

exposed brand with

physician

Initiated discussion

of campaign exposed

brand

64%

60% 59%

54%

50% 53%

26% 28%

Digital Consumer Non-digital consumer

Multi-

Media

Mass

Media

Digital

Media

Brand

Site

Campaign Exposure 72% 43% 38% 16%

Call to Action 51% 30% 36% 49%

Total Market Impact 32% 12% 15% 7%

Cost per response as a ratio

to the cost of digital media

only

24 18 1 N/A

Table 1: Effects of Media Strategies

Figure 4: Percent Recall by Media Type

10%

20%

30%

40%

50%

60%

TV Print Online display Brand website

35%

23%

28%

14%

53%

20% 22%

Digital Consumer Non-digital consumer

DTC Perspectives • September 2011 | 29

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 consum-

ers 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 spend-

ing 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 adver-

tising 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 near-

ly 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 combi-

nation, 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 con-

tributed 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, Symp-

tomatic/chronic, and Symptomatic/chronic & degenerative.

Recommendations

After the FDA approves the consumer marketing materials,

a brand teams’ hands are tied in terms of improving effective-

ness 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 behav-

ior) 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 pro-

duce 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 manage-

ment support. This includes the ability to:

• Measure all brands and all media within a target popula-

tion in order to understand your share of market action

and cost to justify to management;

• Link behaviors with exposure within the dynamic com-

petitive 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 con-

tacted via e-mail at Qi.Jiang@Phoenixmi.com.

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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.

by Scott Weintraub

egional marketing is a concept whose time has come.

As companies in the pharmaceutical, biotech and medi-

cal 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 / dis-

tricts for the greatest return on investment (ROI). It is a strat-

egy 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

utilizing key market drivers. With regional marketing, it is local

differences that help determine how to efﬁciently direct avail-

able resources. It is important to have a rapid deployment team

ready to take advantage of local market changes as they hap-

pen. The overall objective is to drive product performance and

improve ROI through efﬁcient resource deployment and allo-

cation. 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 mar-

keting innovation can help your brand. Then work to gain

The Regional

Marketing Roadmap

REVIEW

Overall DTC Spending Declines 9.2% in Q1-3 2010

Pﬁzer Producing Seven of Top 20 Promoting Brands

Brand Manufacturer Q1-3 2009 Q1-3 2010 $ Change % Change

Lipitor Pﬁzer $155,572,800 $204,795,300 $49,222,500 31.64%

Advair Diskus GlaxoSmithKline $128,696,300 $169,488,400 $40,792,100 31.70%

Cialis Lilly USA $122,028,600 $158,180,200 $36,151,600 29.63%

Cymbalta Lilly USA $141,415,900 $146,388,000 $4,972,100 3.52%

Abilify Otsuka America / Bristol-Myers $150,136,800 $122,396,800 -$27,740,000 -18.48%

Pristiq Pﬁzer $70,691,300 $112,960,000 $42,268,700 59.79%

Plavix Bristol-Myers / Sanoﬁ-Aventis $113,096,800 $103,544,600 -$9,552,200 -8.45%

Symbicort AstraZeneca $91,483,100 $102,071,200 $10,588,100 11.57%

Chantix Pﬁzer $38,671,500 $99,514,300 $60,842,800 157.33%

Lyrica Pﬁzer $114,818,900 $93,164,900 -$21,654,000 -18.86%

Toviaz Pﬁzer $23,262,500 $84,171,300 $60,908,800 261.83%

Lovaza GlaxoSmithKline $5,162,400 $79,893,800 $74,731,400 1,447.61%

Crestor AstraZeneca $96,436,200 $79,032,100 -$17,404,100 -18.05%

Singulair Merck & Co. $70,680,700 $67,844,800 -$2,835,900 -4.01%

Viagra Pﬁzer $88,636,200 $65,682,100 -$22,954,100 -25.90%

Simponi Centocor Ortho Biotech $124,400 $61,884,000 $61,759,600

49,645.98%

Trilipix Abbott Laboratories $39,750,400 $56,349,100 $16,598,700 41.76%

Boniva Roche / Genentech $61,381,200 $55,535,300 -$5,845,900 -9.52%

Vyvanse Shire $73,207,700 $52,821,800 -$20,385,900 -27.85%

Spiriva Boehringer Ingelheim / Pﬁzer $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%

Media Type Q1-3 2009 Q1-3 2010 $ Change % Change

56%

Television $2,105,347,200 $1,730,615,800 -$374,731,400 -17.80%

32%

Magazine $932,512,200 $972,458,400 $39,946,200 4.28%

Newspaper $103,542,700 $186,098,000 $82,555,300 79.73%

Internet $218,069,900 $154,266,200 -$63,803,700 -29.26%

Radio $19,552,300 $25,226,300 $5,674,000 29.02%

Outdoor $2,950,100 $2,329,200 -$620,900 -21.05%

Total Pharma

Spending

$3,381,974,400 $3,070,994,000 -$310,980,400 -9.20%

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 Cus-

tom. 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.

6% 5%

32% 56%

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

While TV and Internet Lose Slight Market Share

12 | DTC Perspectives • March 2011

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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 TaNayia WaShiNgToN

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 market-

ers face additional challenges – stricter privacy restrictions on

customer targeting and the use of online data, heightened con-

cerns 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 con-

sumer 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-

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 audi-

ence is.

• How can I reach them at scale? Any audience insights

gained must be leveraged to broaden the scope of cam-

paigns in order to make the best use of digital investments.

• Can I reach my target safely? Unless you can guar-

antee 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 inter-

vention, 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

Memo to Digital Pharma Marketers:

DTC Perspectives • September 2011 | 33

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 prod-

uct, 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 per-

cent, 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

Having an online ad appear next to inappropriate content

– profanity, pornography, etc. – is a bad result for any mar-

keter, 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 mar-

keters 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

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) cre-

ated 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 certifi-

cation 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

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 tar-

geting 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 mil-

lions 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. Accord-

ing to comScore4, using long-tail inventory had the potential

to increase reach by well over 200 percent among consum-

ers either searching for information on a particular ailment or

buying a prescription for it. When adding in non-health con-

tent 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 short-

tail 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.

LONG-TAIL MARKETING

Figure 1: Reach with a Targeted Content Mix

34 | DTC Perspectives • September 2011

LONG-TAIL MARKETING

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 in-

depth 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

patterns, in this case clicks on pharma ads.

The resulting “Smart Target” proﬁle revealed that the ideal

“pharma desirable” is an early retirement boomer, age 56 and

up, living in a city and having older children who are grown

or entering college. They’re college educated with mid- to

high-level incomes but are not big spenders. While obviously

interested in health content given their age, they also consume

content on a wide range of subjects. Importantly for advertis-

ers, they are more likely to respond to a richer display media

experience.

Once you know the

proﬁle of your audience,

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-

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 inappro-

priate 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 con-

stantly. 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 customiz-

able for every advertiser.

Just what constitutes brand-appropriate content is highly

subjective and differs widely by industry and even by com-

pany. 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 mutu-

ally exclusive if you use automated machine learning that can

mimic your brand’s sensibilities in order to scale safely.

The impact

While understanding your audience and ﬁnding new ways

to reach them safely is important, it means nothing if your

tactics aren’t helping you hit your campaign goals. Based on its

research, CONTEXTWEB found that the most effective strat-

egy for pharma marketers is using a mix of targeting tactics,

with each contributing to an increase in digital media perfor-

mance if used properly.

Reach

Blending health and non-health content doesn’t have to

be done at the expense of hyper-targeting. Pharma campaigns

Figure 2: Brand Awareness Lift by Content Category for a

Prescription Gout Brand Campaign (vs. control)

Figure 3: Lift Generated by Targeting Tactic

DTC Perspectives • September 2011 | 35

LONG-TAIL MARKETING

you should take into

consideration as part

of any pharma adver-

tising 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 pat-

terns of more than

12,000 data points on

each site, with results

reported on a 0-100

scale. Sites scoring

above 61 were gener-

ally considered to provide a premium value to advertisers.

By combining CTR, CPC and quality score ratings, CON-

TEXTWEB 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 sug-

gests 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 reli-

ance 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 holis-

tic digital marketing strategy. DTC

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 digi-

tal 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 twashing-

ton@contextweb.com.

employing mixed content are able to reach the intended con-

sumer. 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 condi-

tion 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 efﬁ-

cient due to higher costs. RON placements were not as effec-

tive 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 impor-

tant considerations affecting brand perception. Page design,

editorial quality and visitor usage are environmental factors

Figure 4: Click and Qualitative Performance by Category

36 | DTC Perspectives • September 2011

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 new-

est 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 impor-

tant to have the right “feel” for the campaign. To our sur-

prise, 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.

Generous marketing and media budgets were approved in

what seemed like the wink of an eye. A battery of longitudi-

nal market research tests was also approved including: Focus

Groups, Concept Tests, Intercept and Re-contact studies.

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 real-

ity is that times are tough and budgets are tight. Regula-

tory 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 pro-

grams 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

The ﬁrst step, “know your audience” is not always given

the attention it deserves in the initial stages of program devel-

opment. The internal analytics team should be brought in at

this early stage to help assess the value of the target audience.

What a Wonderful World

it Would Be

DTC Perspectives • September 2011 | 37

RELATIONSHIP MARKETING

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 doc-

ument. 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 Ameri-

can 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 pro-

gram 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 likeli-

ness 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

$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

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 vari-

ous 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 knowl-

edge 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

Figure 1: Holistic View of Relationship

Marketing

38 | DTC Perspectives • September 2011

RELATIONSHIP MARKETING

extend over the length of the program and involve both inter-

nal 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 devel-

opment process can be thought of as similar to the construc-

tion 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. Enroll-

ment testing should be incorporated into the plan to under-

stand how people are interacting with the form.

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 bud-

getary constraints.

Once people join an RM program, they are exposed to a

variety of content. The focus of most programs involves edu-

cation 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

and compared to

either an industry or

internal benchmark.

After a sufficient

amount of data has

been collected, we

often undertake the

extra step of conduct-

ing an in-depth anal-

ysis of click patterns

within communica-

tions. 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

Figure 3: Website - Monthly Unique Visitors

Figure 4: Average Share

of Clicks by Callout Box

DTC Perspectives • September 2011 | 39

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 pro-

cess. 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 must-

have to ensure that conversion and adherence goals are pro-

gressing 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 pro-

gram efﬁciency and boost ROI. Past studies have provided

us with valuable input which pointed the way to improv-

ing 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 audi-

ence, 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 consult-

ing 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.

RELATIONSHIP MARKETING

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DTC Perspectives • September 2011 | 41

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 Walker

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 con-

dition. 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.

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 revolu-

tionize the ways by which patients are diagnosed, monitored,

and treated. The common threads that link these stories – any-

where 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 communica-

tions 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 any-

where health landscape.

While all of these dynamic medical technologies will con-

tinue to evolve, some core principles are emerging that pro-

vide practical and ongoing guidance when formulating brand

strategies and tactics in an anywhere health world.

Anywhere Health

42 | DTC Perspectives • September 2011

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 data-

tracking 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 dis-

cussed 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 regard-

ing his or her own particular condition, a trend that is only

going to accelerate.

Healthcare marketers take note: as patient sophistica-

tion regarding anywhere health rises, the relative value and

usefulness of basic disease education information declines in

comparison with more nuanced and “advanced” disease edu-

cation. Furthermore, patients will now have multiple sources

to turn to when learning about medical products and proce-

dures – 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 medi-

cal 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 con-

nected 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 conversa-

tion, instead of just another byte of information in the data

ﬂood.

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 provid-

ing 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 com-

bination of real-time conversation with long-term social con-

nection 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 commu-

nications 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 rela-

tives, and even patients with similar conditions.

TRANSFORMING MARKETING

DTC Perspectives • September 2011 | 43

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 You-

Tube? 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?! Care-

giver 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 measur-

able 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 infor-

mation 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 environ-

ment moves forward, patients, caregivers, HCPs and brand

teams will be ever more closely linked in a

sea of real-time data and disease state infor-

mation. Undoubtedly, these changes will

bring tremendous opportunities and chal-

lenges. 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, there-

fore brands need to engage both in the real-time con-

versation, as well as set in place infrastructure for ongo-

ing 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 (Cadi-

ent.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 Any-

whereHealth.com and on Twitter@AnywhereHealth. Walker can be

reached via e-mail at jim.walker@cadient.com.

44 | DTC Perspectives • September 2011

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 ChiN, Ph.d.

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 pharma-

ceutical companies is: “how liable?”

Consumers have grown to expect “just in time” responses

to complaints they post on their social networks because com-

panies 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-

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 member-

ship 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 play-

ers in their communities about viable new investments. Some

Promises and Perils:

Social Stock Market

DTC Perspectives • September 2011 | 45

investors may check out the new players’ social networks and

engage them on Twitter and Facebook. Players can immedi-

ately 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. Com-

panies 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 dis-

played 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 min-

utes, 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 monetiza-

tion. Players may spend eaves (e) – the virtual currency to pur-

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 mem-

bership 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:

SOCIAL STOCK MARKET

Index Ticker Rank Price

Dividends/

Recom-

mended

Share-

holders

Page

Posts

FB Page

Com-

ments

Page

Likes #Tweets

You-

Tube

Activity

Blog

Posts

Technology Nokia VP 143.33 1.21 178 1105 0 3363 10906 368 2 100+

Games:

Console

Xbox

(Microsoft)

VP 127.82 0.27 241 1465 22 7112 42407 25 0 0

Technology Intel VP 124.26 0.8 139 1024 3 381 5911 5 22 22

Technology AT&T VP 113.28 0.78 74 459 16 4411 3088 88 8 8

Cars Ford VP 112.27 0.49 77 647 0 1885 3890 23 1 4

Cars Audi CFO 111.21 0.5 59 510 4 1439 36194 24 0 0

Cars Toyota VP 99.32 0.4 52 381 4 482 1225 17 10 0

The Eaves Oreo (Nabisco) VP 91.28 0.39 28 167 2 3744 22256 25 0 0

Technology Dell VP 87.63 0.33 54 370 8 580 1982 30 0 1

Cars BMW MGR 59.1 0.02 102 521 0 0 0 4 0 0

Week of: July 26, 2011

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 com-

munities 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 “earn-

ings” are weighed favorably toward Empire Avenue

activities including participation in communities, “lik-

ing” (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

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 cre-

ates 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 (includ-

ing 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 achieve-

ments” give an element of mystery and frustration

as players try to unlock these. “Special achieve-

ments” 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.

46 | DTC Perspectives • September 2011

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 medica-

tion 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. Com-

munity 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 inter-

esting social network model create risks for pharma compa-

nies. 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. Play-

ers 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 spe-

ciﬁcally 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-

SOCIAL STOCK MARKET

DTC Perspectives • September 2011 | 47

holder sells, will the company hold onto the former sharehold-

er’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 par-

ticipation 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 “DIA-

BETES” 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 net-

working 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 interac-

tions, but are rewarded by the platforms tabulation of activi-

ties. In other words, Empire Avenue’s calculation of transac-

tions 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, Employ-

ees) are displayed as lists.

Founders of the platform are taking note of players’ com-

plaints of rewarding the “wrong” behaviors by not differ-

entiating 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 indi-

cator 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 partici-

pation. When multiple “successful” players who dominate lea-

derboards 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 connec-

tions 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 writ-

ing an “investment policy” as part of their “bio” that explains

why the brand is there, how the brand will engage other play-

ers, 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 colum-

nist for Pharmaceutical Representative magazine. Chin can be reached

via http://about.me/janechin or on Twitter @janechin.

SOCIAL STOCK MARKET

48 | DTC Perspectives • September 2011

GCI Health, a leading healthcare public

relations agency, named Catherine Fal-

cetti 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 busi-

ness for Roche, Eli Lilly, Johnson & John-

son, Daiichi Sankyo and Genentech, she

will focus on pharma with specialized, blockbuster and OTC

drugs. Fleisher was most recently vice president of corporate

communications at the public relations ﬁrm, Ruder Finn,

where she developed and implemented global PR programs

for Novartis Vaccines meningitis and inﬂuenza franchises.

Leventhal was previously a vice president at MS&L, playing

a key role in FDA Advisory Committee meetings and subse-

quent 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 Scher-

ing-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 Rela-

tionship 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

magazine. Rodale Inc. also named Laura Frerer-Schmidt

as publisher of Women’s Health. She was previously associ-

ate publisher of Self magazine. Kevin White was named

publisher of Health magazine. He had been publisher of Real

Simple since 2008. Renee Tulenko, Health vice president,

associate publisher, expanded her role to include strategic

oversight and all day-to-day operations of Health.com.

Good Health Media Rebrands & Grows

Good Health Media is rebranding itself as Precision

Health Media (PHM), sharpening its focus of reaching diag-

nosed 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 com-

pany of Heartbeat Ideas, has launched

a new integrated marketing company,

Heartbeat West. Based in Los Ange-

les, Heartbeat West is a privately held,

full service agency providing ideas and

innovation in the emerging market-

ing 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.

Laura Frerer-Schmidt Kevin WhiteAugusta Duffey

ON THE MOVE

ADVERTISING INDEX & RESOURCE CENTER

Company

Page

Website Phone Contact Email

Beacon Healthcare

Communications

5 beaconhc.com 908-781-2600 Adrienne Lee alee@beaconhc.com

ContextMedia 9 contextmediainc.com 847-912-9612 Shradha Agarwal shradha.a@contextmediainc.com

Epsilon 55 Epsilontargeting.com 1-800-603-4555 Info@epsilontargeting.com

GSW Worldwide 56 gsw-w.com 614-543-6951 Greg Henderson greg.henderson@gsw-w.com

Parade Magazine 2 parade.com 212-450-7141

Remedy Health Media 15 Remedyhealthmedia.com 212-695-5581 Jim Curtis Jcurtis@remedyhealthmedia.com

SDI 11 sdihealth.com 1-800-982-5613 Melissa Leonhauser Mleonhauser@sdihealth.com

SSI 7 surveysampling.com 203-567-7220 Chris DeAngelis

Chris_DeAngelis@surveysampling.com

Jane Chin, Ph. D. is a healthcare leadership develop-

ment consultant and media/content-strategist. She has

been blogging and engaging with Web audiences since

1998 through her private network of blogs. Additional-

ly, she is an accomplished author and was formerly a col-

umnist 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 innova-

tive 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 contact-

ed via e-mail at Qi.Jiang@Phoenixmi.com. To read the article she co-

authored 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 lead-

er 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 solu-

tions. 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 ana-

lytics manager for digital media services

firm CONTEXTWEB. CONTEXTWEB

is a real-time contextual advertising solu-

tions 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 mar-

keting experience across analytics, client con-

sulting and product development, Winokur

has worked extensively on consumer segmen-

tation 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 presi-

dent of Phoenix Healthcare’s syndicated stud-

ies. 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 col-

league Qi Jiang.

CONTRIBUTORS

DTC Perspectives • September 2011 | 49

ON THE HILL

by Jim davidSoN

ust hours before the August 2nd

deadline, Congress and the Presi-

dent 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 con-

tinue to borrow until 2013. However,

neither party is particularly satisfied

with the plan. Our government’s fail-

ure comes in spite of numerous com-

missions, 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 spend-

ing habits.

The Congressional Research Ser-

vice 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 dol-

lars 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 sensi-

ble way to get out of this hole is to implement a debt reduc-

tion 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, rev-

enue 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.”

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 evaluat-

ing every credit, deduction, and loop-

hole against sound tax policy standards.

That puts everything on the table and,

by extension, at risk. We have wit-

nessed this threat many times before. It

is important to note that the deduction

of the cost of advertising as an ordi-

nary 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 expen-

diture 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 uncer-

tainty 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 con-

tribute 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.

The Debt Ceiling is Just the

Tip of the Iceberg

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.

50 | DTC Perspectives • September 2011

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.

2012 AWARDS

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.

advertising awards

Top 25 DTC MarketersTop 25 DTC MarketersTop 25 DTC Marketers

Winners from the 2011 Advertising Awards

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.

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.

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, supple-

ments, books, procedures and exercise equipment that prom-

ises 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 excit-

ing 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 expect-

ed 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. Market-

ers 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.

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 weaken-

ing, 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 sur-

vive, 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-reces-

sion 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 Perspec-

tives 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 pharmaceuti-

cal marketing trends. To subscribe to this FREE weekly analysis,

reached by e-mail at Bob@DTCPerspectives.com.

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

ON BOOKS

52 | DTC Perspectives • September 2011

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

discount offers, and more:

@MDPAConference

bamacare or Nobama care? When

will we know? Appeals courts

have ruled on the legislation both

ways. The Supreme Court will tell us some-

time next year, we hope, whether this is the

law of the land or part or all of it is uncon-

stitutional. It does not matter what the par-

tisan 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 uncon-

stitutional, then how we will fund Obam-

acare? Underpinning the new law is all

of these healthy people buying insurance

to subsidize the

uninsured. With-

out them the

program falls apart ﬁnancially.

Our hope is that we get a

chance to start over using more

free market measures. We sup-

port several free market ideas that

should lower cost overall while

broadening access. First, consum-

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 com-

mon 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

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 extraor-

dinary 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 requir-

ing 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 mar-

ket 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 cred-

ible.

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 sec-

tor 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.

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.

EDITORIAL

The Uncertainty of

Healthcare Continues

We would much

rather see some

genuine free market

principles applied

before we surrender

to government run

health.

54 | DTC Perspectives • September 2011

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49611_nchmar_action_ad_fa.indd 1 8/11/11 4:25 PM

Evolution E 908 D DTCPM Sept 2011

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