DTC Perspectives Magazine - Winter 2013 by DTC Perspectives

T h e S o u r c e F o r D I REC T T O CO N S U M ER T HOU G H T L e a d e r s

MAGAZINE Winter 2013

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

DTC HALL OF FAME The year’s DTC Hall of Fame honors four of the industry’s leading pioneers and visionaries DTC CHAMPIONS IN 2013:

RE-HUMANIZE DIGITAL:

MULTICHANNEL DATA:

Looking at the 3 Qualifiers To MakeYou Stand Out

Using Emotion to Help Fill Untapped Opportunities

Distilling it Down to Develop A 1-to-1 Patient Relationship

The DTC National 2013 April 2- 4, 2013 JW Marriott, Washington DC

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

Winter 2013

4 Editor’s Desk 6,8 DTC in Brief 10 Sticking to the Script: Acquisition Tactics & Patient Adherence

A series from Crossix RxMarketMetrics

14 Harnessing the Wild West

Acquisition & Adherence RxMarketMetricsTM 18.5%

DEB FUREY OF MERKLE LIFE SCIENCES

18 Three Qualifiers for DTC Champions in 2013

ELLEN HOENIG-CARLSON OF ADVANCEMARKETWORX

20 Hold Me, Thrill Me, Kiss Me: Why We Need to Re-Humanize Digital DTC

7.5%

1.0%

Acquisition/Conversion Tactics Existing Patient Registrants (% On Product)

REID CONNOLLY OF EVOKE INTERACTION

Top 20%

Bottom 20%

24 Make Sense of Your Multichannel Data: Developing a One-to-One

Patient Relationship

Median

Data Integration

ELINOR SORIANO & ERIK PRINCE OF APPATURE

30 How Pharmacist and Patient Engagement Drives Behavior Change STACEY IRVING OF MCKESSON PATIENT RELATIONSHIP SOLUTIONS

32 DTC HALL OF FAME

Profiles of the 2012 Inductees: Deborah Dick-Rath, Stu Klein, Don Lowy & Sheri Stump

38 People on the Move

An update on DTC personnel and company changes within the industry

39 Contributors’ Page

A closer look at the contributors to this issue of DTC Perspectives Magazine

39 Advertiser Index and Resource Center 40 Marketing on the Edge: Come As You Are

Jonathan Isaacs shares his astute views on the marketing industry

42 Eye on the Hill: A Look at the Year Ahead in Washington

14 Driving Behavior Change

Jim Davidson reports on the latest regulatory events & implications

44 Perspectives on Books: How We Do Harm

Reviewed by Robert Ehrlich of DTC Perspectives, Inc.

46 DTC Perspectives Editorial: The Medicare Debacle Miss an issue, or want to order one from our archives? Please visit our website www.dtcperspectives.com to view recent issues of DTC Perspectives magazine, or call Debra Sander at 973-521-7475 to purchase previous issues.

30 DTC Perspectives • Winter 2013 |

What a Year It Was? What a Year It Will Be!

he DTC industry underwent a lot of new changes last year, from the smaller things such as a Facebook policy changes to the larger news of the Supreme Court’s decision to uphold the Affordable Care Act, and everything in between. But what an exciting time it is to be in this industry moving forward! Consumers expect a certain level of customer service in today’s world. As detailed by Ellen Hoenig-Carlson of AdvanceMarketWoRx (read her article starting on page 18), DTC Champions will be judged on these three qualifiers in 2013: exceptional brand stewardship, superior integration, and outstanding curating. “Today, though, in a progressively complex and digital marketplace, customer experiences and business value are being determined by how seamlessly a company can integrate and collaborate with its customers and a diverse set of business partners. This requires a more adaptive, open and diverse network that must work to achieve seamless, efficient learning and application real-time,” she explained. It is important to remember though, as all of these technological innovations emerge, that we must not lose the “human element” in communications. As Reid Connolly of evoke interaction explains, consumers crave that emotional connection, especially when it comes to something as affecting as healthcare. Yet, it can be easy to overlook this with so many standard web forms or the flat calls-to-action requiring a visitor to “click here” for more information. As Connolly poignantly stated, “The reason re-humanizing digital DTC is a provocative idea is not only because we marketers are falling short of paying off on the emotional, but because what is emotionally-resonant has dramatically changed.” The solution is complicated yet simple: think different. “We need to re-think human and re-think digital” to do it differently and “thrill” consumers through innovative, yet emotional, advancements. What a DTC National It Will Be, Too! A progressive faculty of speakers will share their learnings on these very topics, and more, all during our 2013 DTC National Conference (held April 2-4 at the JW Marriott in Washington, DC). Some of the future-planning presentations will be led by Karla Anderson, partner of the Pharmaceutical and Life Sciences Advisory Practice at PwC and David Houle, futurist and author of “The Shift Age” and “The New Health Age: the Future of Healthcare and Medicine in America.” A number of standout case studies at this year’s event include: Sanofi Pasteur’s Jennifer Jennifer Havens, Deputy Director of Consumer Marketing and Michael Szumera, Director of Public Relations, Communications US – two of the leaders behind Fluzone’s hedgehog and Coop de Quill VacciNation campaigns; Amy Lemen, Associate Brand Manager at Eli Lilly & Co. and Terry Voltz, SVP, Group Management Director from DraftFCB will discuss Cialis’ evolution and market entry with a new indication; Paul Ewing, Senior Director/Group Leader, Consumer Marketing, US Primary Care and Karen Lazan, Director, Consumer Marketing & Adherence Innovation, US Primary Care, will share some of Pfizer’s new engagement and adherence tactics. Visit www.dtcperspectives.com to view our full agenda. We look forward to seeing you in April!

Sincerely,

Jennifer Haug P.S. – We’d love to hear from you! Send an email or Tweet to DTC Perspectives or myself: info@dtcperspectives.com @dtcperspectives Jennifer@dtcperspectives.com @jen_haug

4 | DTC Perspectives • Winter 2013

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

DTC Perspectives is Published Quarterly By: DTC Perspectives, Inc. 1120 Bloomfield Avenue, Suite 108 West Caldwell, NJ 07006 Phone: 973-521-7475 ELECTRONIC SERVICE REQUESTED FREE to Qualified Industry Subscribers in the U.S. Apply online at www.dtcperspectives.com. Rates for International and Non-Industry Subscribers: $72 Per (1 Year) in the U.S. $96 (1 Year) Outside of U.S. Back Issues $10 in U.S. $30 in All Other Countries ©2013 DTC Perspectives, Inc. All rights reserved. No part of this publication may be reproduced in any form unless given permission by the publisher.

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Contact: Jim Curtis • jcurtis@remedyhealthmedia.com • 212-695-5581

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E&Y Report: Using ‘Firepower’ to Face the Growth Gap Challenge

January 2013

Perspectives from the Ernst & Young Global Life Sciences Center

Prescriptions

Despite having kept pace with growth of the overall drug market in the past, pharma’s growth fell behind in 2011 by about $20 billion and the gap is expected to increase to approxiClosing the gap? mately $50 billion in 2012 and $100 billion by 2015, according to a recent Ernst & Young report. The reason is largely attributed to the patent cliff, and with future pipelines unable to recoup the losses of such blockbuster drugs as Lipitor. E&Y “expects big pharma to fall even further behind in the years ahead.” According to their “Closing the Gap?” report, one of the solutions for big pharma to fill the gap is via mergers and acquisitions. Yet, in general, pharma’s financial capacity, or “firepower” as they refer to it, to conduct such transactions have also decreased by 23% from 2006 to 2012. Conversely, specialty pharma and big biotech firms increased their firepower. Specialty pharma experienced a 61% increase in that same time period due to “premium pricing power and no generic exposure.” Big biotech firms rose 20%, “reflecting the rising strength of generics offset to some extent by patent expirations of a few major brands.” Big pharma’s growth challenge and implications for deals The challenge: pharma’s growth gap

As big pharma companies drew inexorably closer to the patent cliff — and grew increasingly aware that their existing pipelines were insufficient to fill the ensuing revenue gaps — it became imperative to find additional ways to boost shareholder value to meet investors’ expectations. In particular, these firms needed to find new sources of growth beyond their current drug portfolios.

In recent years, big pharma companies have undertaken numerous measures to drive shareholder value. In addition to fervent cost-cutting, they have downsized operations, spun off assets, restructured R&D, repurchased stock and increased dividends. These efforts will continue, but they are not, by themselves, a sustainable long-run solution. At some point, companies run out of fat to trim — and risk cutting into muscle and bone instead. Stock repurchases and raising dividends work in the short run — the 16 largest big pharma companies delivered total shareholder returns of more than 17% in 2012 — but ultimately require increasing operating cash flow. In the long run, therefore, big pharma inevitably needs revenue growth to create shareholder value in a sustainable way.

Growth, of course, hasn’t been easy to come by. With anemic sales growth in developed markets, companies have looked to emerging markets as a key part of the solution. However, this strategy presents its own challenges. Emerging markets have slowed in recent quarters, exacerbating the growth gap. Stagnation in the Eurozone has hurt even more.

Appature Launches Partnership Program To Enable Data-Driven Marketing Model Appature has created a new model for pharmaceutical companies to achieve data-driven “informed” marketing by combining its cloud-based marketing software platform with top professional service providers. This Partnership Program will enable brands to deliver a consistent, customer-centric brand experience to consumers and physicians and use multichannel marketing data to drive insights and campaign optimization. Being able to respond in such a timely and nimble manner is paramount in today’s rapidly changing environment. Kabir Shahani, cofounder and CEO of Appature, noted that “This will truly transform the industry by enabling marketers to fully own the customer experience, empowering them to more easily achieve strategic and financial goals, and raising the standard for informed life sciences marketing.” The partners who have joined Appature on this program provide a range of services, including: strategic consulting, platform implementation, change management, RM strategy, campaign operations, reporting and analytics. Partner companies include: ZS Associates, Digitas Health, closerlook, Crossix, The Encima Group, DKI Direct, Extraprise, GCMS, Harrison and Star, BioLumina, Highpoint Solutions, and The CementBloc.

PHCG Creates First Business Network Integrating Media, Health & Wellness Publicis Healthcare Communications Group (PHCG) established Publicis Health Media (PHM), a first-of-its-kind network that will combine media with a specialized health and wellness practice. Matt McNally, who was named President of the new business unit, explained that PHM will combine media with the creative process to increase efficiencies, something that is not only new for PHCG, but is unique for the healthcare category as well. The decision to embark upon such a venture came about as a result of market demands for an industry requiring such a specific skillset. PHM “blurs the line between content and context,” he added, which allows a team who knows and understands the brand to handle both media and content strategy and execution. In his elevated position, McNally will be responsible for media strategy, planning, buying, content distribution, and search across all PHCG agency brands worldwide, including Digitas Health, Saatchi & Saatchi Health, and Publicis Life Brands.

6 | DTC Perspectives • Winter 2013

Observe a better brilliance. What happens when the agency renowned for leading technology, strategy and analytics mines rich, new veins in creative, digital and media? Showcase results. On a material scale. Expect more. www.merkleinc.com/lifesciences

UPDATED QR Codes:

Innovations fromTomorrow that Pharma Can Use Today In our Fall issue, we published QR codes corresponding with Geoff McCleary’s article, entitled Innovations from Tomorrow that Pharma Can Use Today (pages 14-16). It has been brought to our attention that if your device was an older generation, it may have experienced some difficulties reading the code. We apologize for any inconvenience, and to ensure all of our readers have a chance to scan and view the full Digitas Health QR codes, please see the updated versions below. Excerpt: Seems like “innovation” is everywhere you look these days. Innovative technology allows us to talk to our phones – and for them to answer us back. It allows us to view a hidden world of content not visible to the naked eye. It even allows us to better understand our bodies and how we can be healthier. No matter how innovative the technology is though, it still has to connect with the end user and provide them value. Here are seven innovative technologies of tomorrow that you can use to make sure your marketing efforts provide users value today: 1. Link Print to Digital with QR Codes.

One of the easiest ways to enable digital for your brand is to include a QR code on all of your print materials or ads that connects users to a mobile optimized experience for the brand. You can deliver supporting information, programs, multimedia, coupons and much more. Learn how Scandinavian Air used targeted advertising with two QR codes to engage couples planning travel. 2. Become a Part of Adherence with Location-Based SMS. One of the newest ways to interact with users is loca-

tion-based SMS as it provides that ability to deliver an SMS or MMS message to an OPTED-IN user within a specific geo-fenced area anywhere in the world. 3. Connect Check-Ins to Rewards. A connected check-in allows a patient or caregiver’s physical check-in at a location using a service like foursquare to connect with a reward in a secondary program. Foursquare’s current partnership with American Express is an excellent example of a connected check-in reward program. 4. Use Augmented Reality to Expand Your Packaging and Enhance Their World.

Brand marketers are more frequently adopting the use of augmented reality because it allows them the ability to integrate the brand into their lives in a far more interactive and engaging way than ever before. You can view examples of two different innovative AR programs:

8 | DTC Perspectives • Winter 2013

one from the makers of Band-Aid (left QR code), in partnership with the Muppets, and the other from Swedish furniture maker IKEA, who made their entire catalog an augmented reality experience this year (right QR code). 5. Turn What They Hear into Engagement with Shazam Audio Tagging.

Shazam’s new “second screen” engagement model has turned it into a powerful tool for advertisers to use in driving engagement beyond the standard :15 to :60 spot. Brand marketers are more frequently adopting the use of augmented reality because it allows them the ability to integrate the brand into their lives in a far more interactive and engaging way than ever before. 6. Connect Health Efforts and Outcomes by Embracing Quantified Self.

Personalized connected health services like Hea!thrageous are taking it a step further by using their connected monitors to collect information on your smartphone and then they will analyze the data to help you optimize your health outcomes. 7. Have Them Pick Up a Prescription at the Neighborhood App Pharmacy. With

everyone so interested in the app and better patient outcomes, the pharma brand of the future, may not be just a pill… it may very conceivably include an app as well. Scan the related code to learn about a company that is working to provide the service physicians and providers can use to “prescribe” apps to their patients. As the examples above clearly demonstrate, though these technologies have yet to be routinely integrated into pharma marketing efforts, they do indeed exist and drive value for their brands. We are rapidly approaching a time in the not too distant future, when these tools are commonly used and will change the way healthcare is dispensed and consumers monitor and care for themselves. Geoffrey McCleary is Vice President/Group Director of Mobile Innovation at sister agencies, Digitas Health and Razorfish Health. He can be contacted via email at Geoff.McCleary@digitashealth. com or follow Digitas Health on Twitter @Digitas_Health.

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Sticking to the Script Acquisition Tactics & Patient Adherence

With many younger brands emphasizing conversion to product as the goal of DTC advertising spend, they often overlook the adherence benefit of these acquisition-focused campaigns. Meaningful improvements in patient adherence have been measured for acquisition campaigns across the industry, validating the positive effect on patient outcomes.

n 2009, a study of adherence among patients treating with oral diabetes medications found annual healthcare cost savings for adherent patients of close to $850 per person.1 Across treatment categories, the cost of a non-adherent patient is substantial to every stakeholder, including patients, physicians and insurers. As healthcare costs move to the forefront of budgetary debates, the search for effective tools with which to drive patient adherence gains momentum, and has the potential for meaningful improvements in overall economic welfare. The causes of patient non-adherence are wide-ranging; however, the exposure of patients to direct-to-consumer advertising presents a uniquely adaptable and measurable forum for potential influence. Patients, in general, have positive opinions of DTC utility and these positive opinions have significant impact on the use of DTC information for healthcare decision making.2 DTC drives an increased demand for treatment, and helps put under-diagnosed patients in physicians’ offices.3 Beyond simply driving a doctor’s visit, evidence suggests that DTC spending correlates with an increase in appropriate prescriptions, with no significant effect on inappropriate prescriptions.4

acquisition tactics. Even with the goal of new patient acquisition, however, these tactics inevitably reach existing patients. Through the use of Rx-based analytics, the share of existing patients driven by these acquisition tactics can be measured. Chart 1 displays the Crossix RxMarketMetrics™ benchmark for the percentage of existing patients driven by acquisition tactics. Sometimes, the share of registrants already on product is small, but often the size of this pool is substantial, and can be meaningful when calculating ROI. Existing patients driven by acquisition tactics cannot contribute to the net impact of the program on new patient starts, often thought of as the only

Chart 1: Benchmark for Percentage of Existing Patients Driven by Acquisition Tactics RxMarketMetricsTM 18.5%

7.5%

1.0%

Existing patients reached by all forms of DTC The goal of driving that initial prescription, and acquiring that new patient, is a major force behind DTC spending. While many marketing teams have a dedicated CRM strategy for enrollees driven by adherence-focused tactics, the majority of the brand spend can often be allocated toward broad-reach

10 | DTC Perspectives • Winter 2013

Acquisition/Conversion Tactics Existing Patient Registrants (% On Product) Top 20%

Median

Bottom 20%

CROSSIX RxMARKETMETRICS : ADHERENCE substantial source of incremental revenue for such programs. With the success of acquisition tactics defined strictly as impact on new patient starts, the RxMarketMetrics™ benchmark indicates that, at the median, 7.5% of registrants (and in some cases close to 20% of registrants) will not contribute to measured value, diluting measured success of ROI maximization efforts and potentially inhibiting positive ROI. Existing patients register into acquisition-focused CRM programs for many reasons, including the desire for support, information and savings from a branded outlet. Just as messaging toward potential new patients seeks to provide support, similar messaging can influence behaviors of existing patients as well. Exposure to branded or unbranded messaging, for example, can help patient adherence (especially of “newer” existing patients), whether by increasing comfort level, or simply serving as a reminder. Therefore, only through the measurement of adherence impact, in addition to new patient starts, can a brand gain a holistic understanding of the impact of an acquisition campaign.

Acquisition campaigns can drive adherence As shown by the RxMarketMetrics™ benchmark in Chart 2, acquisition tactics drive an incremental 0.4 Rx, at the median, from existing patients in the six months following registration. Brands should more often recognize this impact of acquisition programs on patient adherence for a more accurate look at performance; moreover, acquisition programs can drive increased adherence among new patient starts, post-conversion to product. These effects have the potential to provide a substantial positive boost to program ROI when measured. Using the benchmarks for existing patient registration rate (7.5%) and adherence benefit (0.4 Rx/person), an average acquisition campaign producing 100,000 registrants realizes 3,000 net Rx from existing patients in the six months following registration. With the broad range of script values for various brands, the incremental benefit in this example runs the gamut from marginal to game-changing.

Chart 2: Benchmark for Acquisition Tactics from Existing Patients in the 6 Months after Registering

RxMarketMetricsTM 0.6 0.4

C 0.1

Acquisition/Conversion Tactics Existing Patient Registrants: Net Rx/Person through 6 Months Post-Registration Top 20%

Median

Bottom 20%

The audiences exposed to acquisition tactics across various channels can differ greatly in their share of existing patients. Identifying the composition of a tactic’s audience and responder base upon launch supports the potential for differing creative, CRM or level of spend, according to campaign goals. Instead of Rx-based measurement after a campaign has concluded, timely “in-flight” Rx-based measurement can identify meaningful differences in existing patient shares driven across campaign tactics, informing spending and communication decisions and supporting “real-time” optimization. Marketing teams can seize the opportunity to potentially augment the adherence benefit of acquisition programs through the tailoring of campaign messaging not only to potential new patients, but also to those currently on product. In terms of a patient’s exposure to healthcare messaging, DTC can play an important role between doctor visits. Even more proactive patients, who seek information from independent

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

DTC Perspectives • Winter 2013 |

CROSSIX RxMARKETMETRICS : ADHERENCE sources, will often receive a range of DTC messaging. Creative and CRM strategies for acquisition campaigns can seek to convert patients to product, while being a force for increased patient understanding, comfort, and adherence.

Timely “in-flight” Rx-based measurement can identify meaningful differences … informing spending and communication decisions and supporting “real-time” optimization.

acceptance by patients, DTC tactics, including those focused on new patient starts, can play an important role in improving patient adherence. DTC This is a part 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). References

Lead to better outcomes via adherence Net Rx represent far more than simply the “adherence benefit” of acquisition programs, they also represent an influential factor in improving overall economic welfare. In November 2012, the Congressional Budget Office published its finding that an increase in overall Rx utilization results in decreased spending on medical services among Medicare beneficiaries.5 For the US healthcare system in general, the New England Health Institute estimated that non-adherent patients cost up to $290 billion annually, or 13% of total healthcare expenditures.6 A doctor has limited influence in driving a patient to fill the next Rx, but, collectively, the decisions have broad economic implications. Given their reach and general

1 Hansen, Richard A., et al. “A retrospective cohort study of economic outcomes and adherence to monotherapy with metformin, pioglitazone, or a sulfonylurea among patients with type 2 diabetes mellitus in the United States from 2003 to 2005.” Clinical therapeutics 32.7 (2010): 1308-1319. 2 Deshpande, Aparna, et al. “Direct-to-consumer advertising and its utility in health care decision making: a consumer perspective.” Journal of Health Communication 9.6 (2004): 499-513. 3 Jayawardhana, Jayani. “Direct-to-consumer advertising and consumer welfare.”International Journal of Industrial Organization (2012). 4 Abel, Gregory A., et al. “Impact of oncology‐related direct‐to‐consumer advertising.” Cancer (2012). 5 Congressional Budget Office. Offsetting Effects of Prescription Drug Use on Medicare’s Spending for Medical Services. Congressional Budget Office, 2012. 6 New England Healthcare Institute. Thinking outside the pillbox: A system-wide approach to improving patient medication adherence for chronic disease. New England Health Care Institute, 2009.

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THE FORUM FOR DTC THOUGHT LEADERS

DTC NATIONAL CONFERENCE

April 2-4 2013 JW Marriott Washington, DC KEYNOTE SPEAKERS Karla Anderson

David Houle

Partner, Pharmaceutical and Life Sciences Advisory practice, PwC

Acclaimed Futurist and Author of “The Shift Age” and “The New Health Age: the Future of Healthcare and Medicine in America”

Michelle Blechman

Karen Lazan

Associate Director, Market Intelligence Astellas Pharma US

Director, Consumer Marketing & Adherence Innovation, US Primary Care, Pfizer

Peter Dorff

Barbara Lippert

Senior Portfolio Insight Manager, AstraZeneca

Creative Guru, Editor-at-Large for MediaPost and former author of the Adweek Critique

Dr. Kevin Pho Founder of KevinMD.com

Michael Szumera

Director, Public Relations, Communications US, Sanofi Pasteur

…and many more. For conference news and to register, please visit the conference website at: www.dtcperspectives.com regularly. To register by phone, call: 973-521-7475 x221

Harnessing the Wild West It’s old news: what makes for impactful direct-to-consumer marketing is no longer “direct.” It is the Wild West in today’s market, where consumers, caregivers and patients are exploring vast new territory as they navigate their options for interacting with pharma brands. by

eople are assertively choosing where and when to interact across the multitude of media and channels for information on therapies, providers and care. Pharmaceutical marketers who believe that the traditional approaches (e.g., attitudinal segmentation, “targeted” media advertising) will work to engage consumers in this new terrain are missing the point; the way consumers and patients behave in reality is far more dynamic and complex than ever before. This change in dynamics is evident in key trends in the pharma marketplace. Consumers interact in multiple channels throughout the day and are online in droves where marketers have limited control and ability to directly impact behavior and choices. For instance, while a significant share of pharma investment online is in therapy and branded product websites, these websites represent a very small portion of consumer health search activity. In fact, of the 6.5 million unique visitors to all websites about cancer, only 4.2% were to branded sites1. Patients are also increasingly using mobile devices to search the web, seek peer experience and are logging into mobile applications to track and manage chronic conditions. Approximately 75 million individuals are using mobile phones for health information and tools – 14 million more than last year, according to a recent Manhattan Research study2. And, as most consumer marketers know, consumers are interacting with health information at different points in their treatment journey – to understand the diagnosis, determine options, or perhaps learn more about a treatment that they have been prescribed.

Early endeavors The industry is beginning to get the message in response to these trends. Companies such as Boehringer Ingelheim, Sanofi

14 | DTC Perspectives • Winter 2013

Deb Furey

and AstraZeneca3 are experimenting with a variety of social media tools including Facebook and YouTube – providing disease, product education and tools with the goal of reaching consumers and patients wherever they appear to be. These companies are also working to manage the concerns about adverse event reporting and privacy by focusing on education and cautiously providing guidelines for interactivity. But it may be too much of a good thing. A quick internet search demonstrates a proliferation of YouTube channels and videos on disease, treatment and resources focused on patients. And on iTunes, there are over 100 apps for diabetes alone. This implies that perhaps, rather than focusing on understanding where and how consumers are interacting, marketers are creating even more locations to engage. Clearly, traditional segmentation now doesn’t really work in this “Wild West,” where consumers self-segment according to their most immediate interests and needs. Attitudinal segmentation that is created from bi-annual research has a minimal role when one puts the customer at the center; consumers pursue diverse activities to get the information they need and they have very different healthcare needs along their treatment journey. Their needs and goals are, in fact, more evident through their individual actions and interactions than through a template that marketers may have created to describe their needs. Marketers thus face daunting challenges as they look out into this frontier now, specifically: • How to determine the optimal consumers to invest in, based on their activities and interactions • How to find and engage consumers and patients at the right point in their journey – particularly when most interactions are anonymous and diversity is more complex

D ATA I N T E G R AT I O N • How to understand where and what are the most valuable investments to drive market impact

Embracing self-segmentation

Once data is integrated, step three is to process data sets – both identified and anonymous – to narrow down the “big data” into actionable information that can be used to drive deeper insights into consumer behavior and value, better personalization, and robust program measurement. This data narrowing process begins with developing a clear roadmap of the marketing questions that a brand is seeking to address. Finally, at step four, the data is analyzed to develop activitybased segments to serve goals such as improved targeting and personalization, performing longitudinal analysis to understand the end-to-end interaction and the behavior of the most valuable consumers, and ultimately creating predictive models to find more of these consumer populations (e.g., look-alike segmentation).

At the center of understanding how consumers self-segment is the emerging ability to track, capture and analyze multiple sources of data, particularly digital, both identified and anonymous. While this capability is fairly new to pharma, other industries – media and consumer products in particular – have made significant advances over the past few years in harnessing large data sets (aka “big data”) to develop optimized, insightful portraits of consumer behavior. They achieve this through four key steps that begin with understanding all possible digital data sources available and the level at which the data can be extracted (cookie/IP, email, aggregate segment). This So, does opt-in really matter? evaluation includes web analytics data (Webtrends, Omniture, Consider the scenario of a brand that is in its second year Google, etc), ad serving data (DoubleClick, Atlas, etc), social in the market. Product marketers have core elements of their data (Facebook, Twitter) and mobile engagement data [apps, consumer/patient campaign, including investments in thirdweb browsing, short messaging service (SMS)]. party sites (e.g., WebMD) to capture audience, an unbranded Step two is optimizing the data capture within and across website (where the product is a novel therapy), and a branded website with optional patient opt-in to download a coupon internal and third-party systems to ensure maximum linkage for a 14-day free trial. In the doctor’s office, patients can also across online and offline interactions. Often this means negosee and snap QR codes on patient materials that capture their tiating with partners to capture data that was previously of less email address in return for a mobile coupon. In addition, the interest. Some of these linkages are created through adjusting brand has a full digital media plan, including search/search how data is captured, while other connections must be made optimization display ads to drive click-through to the Step tthe wo data is optimizing data capture within and across internal and third-‐party and systems to ensure once has beenthe extracted from these systems and comsite and offer. maximum across online Importantly, and offline icare nteractions. ften this mbranded eans negotiating with Questions partners to that would come to mind in bined withlinkage other data sources. must beOtaken this scenario include: capture d ata t hat w as p reviously o f l ess i nterest. S ome o f t hese l inkages a re c reated t hrough adjusting to ensure alignment with privacy and security standards to patients/caregivers how data is captured, while other connections must be made once the • Are data hactual as been extracted from engaging in our media, ensure HIPAA compliance. (See Figure 1) these systems and combined with other data sources. Importantly, care must be taken to ensure website, mobile app? alignment with privacy and security standards to ensure HIPAA compliance. • What other media/ Figure 1 – Activity Segmentation through Digital Data Integration channels/properties did they explore or Display Social* Site Mobile respond to? • Cookie I D ( Primary) • Social H andle ( Primary) • Device I D ( Primary) • Cookie I D ( Primary) • What path did they Party • IP Address • Email (Facebook) • Cookie ID (Primary) • IP Address Identifiers take to finally “con• Phon e # • Profile ID • Profile ID vert”? Did they take Primary First • Ad servers (DFA, Atlas) • Social Networks (Facebook*, • Web An alytics tools • SMS platforms, Web the most valued path? (Omniture, w ebtrends, an d D SP ( Media M ath, Twitter) a nd s ocial p latforms analytics, a pps Party Data etc) Turn, [X+1]) Systems • D i d t h e y e v e n t u ally opt-in? Redeem a • FB user profile data including • Browser User agent • SMS send and click, • Browser User coupon? likes, interests, geo, e tc Mobile Browsing • Referral site, Campaign First Party • Ad Impressions, activity, Click-‐throughs • Other e ngagement based on data • Campaign data (SEO, • A re there insights Data Capture specific social n etwork SEM, Ban n er clicks, • Engagement on site (clicks, (Example) about these consumers (Twitter, Linkedin, e tc) email clicks) views, downloads, e tc) that can help me bet• Con version on site ter identify and target *Full Facebook data integration requires opt-‐in from Customer others? Insights  Survey Data –  Ad interest and 3rd  Likes, Interests,  Mobile Device By integrating the treatment history, Party media Profile  Geography data sets as noted above interests response  Search  Incentive Use /Response Data and creating activity Contact based segmentation that Information d e f i n e s a n o n y m o u s Figure 3 – Activity segmentation through digital data integration

DTC Perspectives • Winter 2013 | Once data is integrated, step three is to process data sets – both identified and anonymous – to narrow

D ATA I N T E G R AT I O N

to-identifiable linkages, the brand can inform media targeting The goal of pro forma is to anticipate the impact of a program, and third-party sponsor strategies, refine display strategies and based on a series of assumptions which are determined based structure website navigation to achieve the optimal pathways. on prior experience and are applied to future programming. As And while opt-ins for a subset of patients will be important in an example, if one knows that: order to assign value to activities, they will ultimately no lon1. 25% of all mobile visits to a site that result in the downger be the sole source of actionable data. load of a mobile educational app will request a trial couBuilding activity-based segmentation can, thus, serve as the pon via SMS, and foundation for marketers to drive dynamic targeting, program 2. Of those, 45% will redeem the coupon, resulting in $50 personalization and development of best next action rules incremental revenue based on behavioral “paths” observed in consumer popula…then one can determine the target KPIs for mobile and tions. When a consumer moves from the unbranded to brandsite visits/downloads/requests against which to measure. Coned site and hits a specific page, for example, business rules can versely, one can also use predicted potential revenue to deterbe defined – based on past learnings – to serve up a specific mine how to allocate dollars to media and mobile to achieve message about the brand to drive the desired action. Or, while the greatest ROI. In this case, the activity and chosen pathbrands will often track web page views for pre-defined activities ways of consumers are more important than their attitudinal that they deem valuable, assigning a score to site visitors and or even treatment profile – and these measures can be deterpassing this along to the anonymous longitudinal data vendor mined, at least partially, without identification. The pro forma (for the subset of opt-in patients) allows the brand to deterdiscipline will become increasingly important as the industry mine if the activity is associated with conversion and retention. on specialty markets and the need to make significant ts can also see and snap QR codes on patient materials that capture their email address focuses in return This puts more tools at marketers’ fingertips to fully optimize choices about where to spend and why. mobile coupon. In addition, the brand has a full digital media plan, including search/search website program investments. (See zation and display ads and to dthird-party rive click-‐through to the branded site and Figure offer. Q2) uestions that wUnderstanding ould consumers’ activity-based segments with Redefining how to engage with patients/consumers is only to mind in this scenario include: these emerging capabilities will help marketers truly harness Are actual ppart atients/caregivers engaging in our media, website, mobile app? is of the equation. Direct-to-consumer (DTC) marketing a challenging Wild West, enabling them to reach and value What other notorious media/channels/properties did to they explore o r respond to? for being difficult measure, unless a) consumers/ What path patients did they topt-in ake to finally “convert”? Did tincentive hey take the most path? consumers/patients based on observable activity. Marketers and b) a traceable such asvalued a co-pay will have the data and tools to determine how to invest and Did they eventually opt-‐in? Redeem a coupon? or coupon is offered that can be tracked via anonymous lonAre there insights about these consumers that can help me better identify and target o thers? how to gauge the potential impact of their campaigns with an gitudinal patient data. This approach to performance measureend-to-end view of valued activity (avoiding the 40-version canas be expensive, providing chance for program egrating the dment ata sets noted above and creating aminimal ctivity-‐based segmentation that defines creative when five would be sufficient!). Ultimately, marketers mous-‐to-‐identifiable linkages, the brand an inform available media targeting and months). third-‐party sponsor optimization (results are ctypically after six can apply these insights to deliver – and continually refine – a gies, refine display strategies structure ebsite navigation to apotential chieve the conoptimal pathways. Further, it onlyand addresses aw small portion of the hile opt-‐ins for a subset of patients will be important in order to assign value to activities, they will experience for consumers and patients that engages connected sumer population. tely no longer be the sole source of actionable data. them wherever they are to deliver important service, commuA trail toward anticipating impact nications and resources. DTC ng activity-‐based segmentation can, thus, serve as the foundation for marketers to drive dynamic With a view into consumer activity-based segments and ing, program personalization and development of best next action rules based on behavioral response, marketers fullymembrace discipline ” observed in consumer pharma populations. When a ccan onsumer oves from athe unbranded to bReferences randed 1 AdAge more typical of direct marketing industries: pro oforma. d hits a specific page, for example, business rules can be defined the – based n past learnings – to Insights Whitepaper “Pharmaceutical Marketing: Targeting Consumers &

Connecting up a specific message about the brand to drive the desired action. Or, while brands will often track Online,” October 2011 2 Manhattan Research Cybercitizen Health, September 27, 2012 age views for pre-‐defined activities that they deem valuable, assigning a score to site visitors and 3 Weinstein, Deborah; Boehringer Ingelheim wants to make cancer care social, 2 – Capabilities through g this along to tFigure he anonymous longitudinal data Delivered vendor (for the subset of opt-‐in patients) allows Medical Marketing & Media, May 31, 2012. Weinstein, Deborah: Text4baby Data Integration and wActivity-Based and to determine if the activity is associated ith conversion and retention. This puts more tools firm launches mobile diabetes program, Medical Marketing & Media, October 4, keters’ fingertips to fully optimize website and third-‐party program investments. Segmentation 2012 and Kolodjeski, Laura; Introducing Diabetapedia – Diabetes Doesn’t Define You…So Help Define Diabetes!

Enhanced Targeting Personalize Messaging

With contributions from: Peter Vandre, Vice President of Merkle Digital Solutions, and Elizabeth Barrows, Senior Director of Merkle Integrated Marketing Strategy.

Channel/ Path Prediction Dynamic Look Alike Models

Best Next Actions

Attribution and Impact

Figure 4 – Capabilities delivered through data integration and activity-‐based segmentation

Deb Furey is currently Vice President and GM with Merkle Life Sciences. Drawing from her more than 15 years of experience working with FT500 companies to drive growth through innovative customer relationship strategies, Deb is responsible for healthcare client management, strategy and solution integration. She can be contacted via email at dfurey@merkleinc.com.

| DTC Perspectives • Winter 2013 ning how to e16 ngage with patients/consumers is only part of the equation. Direct-‐to-‐consumer marketing is notorious for being difficult to measure, unless a) consumers/patients opt-‐in and b) a

tion 1, 2013 a n i Nom anuary 3 e: J n i l d ea

TOP 25 DTC MARKETERS OF THE YEAR AWARD Nominate Someone Now and Help Us Recognize the Most InďŹ&#x201A;uential DTC Marketers in the Pharmaceutical Industry! To nominate a pharmaceutical company colleague, please visit www.dtcperspectives.com under the Conferences tab or contact Jennifer Haug at 973-457-5718 or Jennifer@dtcperspectives.com. Top 25 Marketers will be honored at a private congratulatory luncheon following the DTC National Conference on April 4, 2013.

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Three Qualifiers for DTC Champs in 2013: Exceptional Brand Stewardship, Superior Integration, Outstanding Curating Champions have a “constant restlessness that disallows the arrogance that we’re fast or agile enough.” In today’s consumer-driven marketplace, what will make for a successful DTC brand champion this year and beyond? by

Ellen Hoenig-Carlson

n 2013, pharma and biotech DTC Marketers face a tough balancing act among three compulsories that weren’t on the original scorecard to the same degree when most of us learned our craft: • Exceptional brand stewardship to keep a brand’s promise fresh, pristine: true to the brand’s image and values at every brand intersection point despite the increasing number of specialists working on a brand. • Superior integration of brand assets, data and learning that is consistently applied across channels and customers. • Outstanding content curating that truly invigorates learning and conversation through relevant and valuable information. Healthcare consumers face many of the same issues that challenge marketers. They’re stressed from a higher cost of living, being inundated with information, overwhelmed with communications and spam from every which way, tired from working long hours (or looking for work), with insufficient time to enjoy the simple, healthful things in life. And when they finally do get to a doctor, s/he isn’t likely to be able to spend much quality time with them. Pharma and biotech marketers may have a more strategic view of relentless change, but our long hours, scarce resources yet bigger deliverables, and ongoing generic and cost containment pressures are similarly stressful and mind-numbing.

18 | DTC Perspectives • Winter 2013

Champions find ways to ensure that stress does not sully their performance. Good marketing still rests on slowing down enough to articulate clear objectives, deep customer insight, and positioning that differentiates. Certainly smart marketers view DTC far beyond traditional TV ads: as the crux of all consumer engagement. But the mantra for brand champions is new: the connections that will power your brand’s vitality can’t be bought – they must be earned. As we move into 2013 and beyond, how can DTC Marketers win this new competition, accelerating brand engagement, growth, and loyalty? Challenge yourself with these three questions: 1. Are you effectively leading your brand? In a world of increasing specialists, every brand faces the imperative to bring numerous internal and external specialists together for true collaboration without letting go of laser brand stewardship and without acquiescing to each specialist who may want to exercise their own mark on the project. Where do you stand on the brand marketer’s “control spectrum”? Top notch brand stewardship starts with an inspiring and clear vision for the brand and its community. It is a special kind of leadership challenge, requiring facilitation, providing scope, tools and resources, and opening the doors to opportunity. It means guiding where necessary, but avoiding imposing a “heavy hand” or “command and control” attitude. It means creating an environment that is open, supportive and agile in its own learning and interactions. It means that every action

BRAND CHAMPIONS you and your teams take at every level of the organization reflect and support the essence of your brand. Anything less makes it easier for competition to steal share and growth by creating stronger relationships with your customers. Don’t let a long “to do” list curtail the time and effort you place here. In a time when everyone has too much to do and not always enough focus, this is an opportunity to excel: for a brand lead to be an exceptional brand steward. 2. How well have you mastered the art of integration?

How seamless is your brand experience across programs and channels and between customers? How well are you synthesizing and employing “big data” into new learning that is leveraged throughout or across touchpoints? How well are you bringing integration to diverse high-potential consumer segments that might not otherwise get value from your brand? For brand managers today, Integration is the new “hub of the wheel,” and essential for brand innovation and transformation. “Brand Integration,” initially meant to use someone else’s TV program content to drive your brand. The term dates back to when the Lifesavers brand was integrated into the 1932 Groucho Marx movie “Horsefeathers,” National Geographic had a starring role in the 1946 movie “It’s a Wonderful Life,” and Spielberg’s “E.T.” featured the first paid candy integration with Reese’s Pieces, or when Proctor & Gamble and Unilever sponsored soap operas. Today, though, in a progressively complex and digital marketplace, customer experiences and business value are being determined by how seamlessly a company can integrate and collaborate with its customers and a diverse set of business partners. This requires a more adaptive, open and diverse network that must work to achieve seamless, efficient learning and application real-time. When brands aren’t well-integrated across customers, channels, partners, or even country management, brand power is limited, opportunities for transformative growth are negated. Don’t do your competition any favors by overlooking: • Consistent messaging and “look and feel” across channels and/or customers. This includes telling a consistent story at every touchpoint ever time. It cannot be achieved with siloed functions and partners. • Building a centralized inventory of approved brand assets and content elements, such as claims, messages, patient quotes, relationship marketing content, video, images, style guides, etc., enables different teams to execute new campaigns across channels, segments and customers more nimbly and productively while ensuring consistency and uniformity of brand promise and branding elements. • Digesting learning from year to year, study to study, tactic to tactic, country to country, in a deliberate manner. Institutionalizing the use of data analytics is essential if you are to better employ “big data” and turn it into action-

able insights and outputs. Additionally, the transfer of best practice knowledge and experience to each team working on a brand can help elevate marketing performance and bring consistency and uniformity to marketing practices and results. • Leveraging growing customer diversity and bringing along different customer segments so the end result is a stronger but unified brand. This can help to encourage diverse advocates for the brand. 3. How good are your content strategy and curator skills?

Do you have your eye on creating content that is relevant, that helps customers learn and make decisions? Are you still thinking you can fool consumers with your messages vs. what they want to know? This is the age of earned media, Seth Godin’s definition of “remarkable content” is how winning brands create relevance and spur action. It’s the door to the personalization that customers now expect. Content is no longer a tactic, it has become a brand’s lifeblood. Champion marketers are inventing and adjusting content strategy every day, knowing that content creation and delivery – when done well – are competitive levers that harness and nurture loyal fans. “People see more than 34 billion bits of information per day – an equivalent of two books a day.” [From the book “The 24-Hour Customer.”] Exhausted consumers don’t have tools to filter information down to the most useful bits with minimal effort. How much are you genuinely helping them navigate exploding information? Are you succeeding in deepening your relationships with customers? Where do you fall on the “selling” vs. “valuable educating” continuum through customers’ eyes? In today’s increasingly open, digital, and social environment, the more companies can focus on conversations, and providing some give and take between writer and reader, the greater the opportunity to get closer to your customers and build deeper relationships. DTC Marketers are forewarned not to turn “content marketing” into what Shel Israel calls “message mongering”: just another way to get the message out. Rather, use it to listen to what your audience wants and needs – let them make you smarter. That is the win for the 2013 DTC champ. DTC Ellen Hoenig-Carlson is founder of AdvanceMarketWoRx, a consulting firm known for powering consumer and healthcare brand growth, through traditional and non-traditional marketing, leveraging critical customer interpretations and insights at key points. Voted among the 25 most powerful marketing executives by Advertising Age magazine in 1999 and 2000, Hoenig-Carlson is experienced domestically and globally in developed and emerging markets. She has led consistently in the field of DTC/P marketing since the August 1997 change in FDA regulations permitting mass DTC. She can be reached by telephone at (609) 333-0549, via her blog at blog.advancemarketworx.com, or Twitter @ellenhoenig. DTC Perspectives • Winter 2013 |

Hold Me, Thrill Me, Kiss Me Why We Need to Re-Humanize Digital DTC As pharma marketers contend with historically low brand growth, declining sales rep and media effectiveness and many post-ACA unknowns, there is growing pressure on DTC to drive high sustainable impact at lower cost and with lower risk. Where then, is the untapped opportunity in digital DTC? It is in more human ideas that move consumers to seek real, meaningful, emotional connections with our brands. by

Reid Connolly

emember discussing whether digital will replace human interactions or supplement them? While the digital vs. human debate is so five years ago, it is unarguable that digital has changed everything we do, how we think and how fast we react, to the point where we are – as users, consumers, patients and business people – much more efficient, a little more mechanical, and somewhat less soft. Even digital DTC has been peppered with this residue. Despite the layering of feelings patients experience with regard to their health, our digital campaigns are not exempt from being unemotional, sterile and flat. Do you have chronic pain? Click here for questions to ask your doctor. Do you have questions about vaccines? Click here. Action-inducing copy these are, but they don’t make you feel, cry, commit.

Start at the objective What do we want DTC consumers to do? To respond to our campaigns or to remember us forever? Well, the Direct Response vs. Branding question is really a worthless one, because as marketers, everything we do today is direct response. Every piece of marketing we release is designed to get a response. An ad drives a site visit. A site visit drives a registration. A registration drives an email view. An email view drives a video forward. A forward drives several likes.

20 | DTC Perspectives • Winter 2013

But even though communication should be, by definition per Seth Godin, the transfer of emotion, not everything is designed to drive an emotion, especially in digital DTC today.

Why the premium on emotion? a) Simple findability: In a medium that is even more billboarded than Las Vegas on a good night, truly remarkable purple cow-like executions help your brand break through the clutter. Think about your own web searches, inboxes, phone apps, social activity: there is so much you want to do that it takes something truly personal, anticipated, and relevant to sway you away. b) Staying power: Communications that evoke emotion go beyond eliciting a single response. They have the power to engage, to stimulate discussion and interaction, to deeply persuade and to be remembered, ad infinitum. The American Express Shop Small campaign is a powerful example of a campaign that struck a primal chord and drove a real public sentiment, rallying consumers, retailers, and public officials to not just change the way they act but also the way they feel. Amortize that over a person’s lifetime and you get a fat, hefty ROI. c) Because the alternative could destroy us: There is a more subtle and deeper aspect to the importance of the human in health. Celebrity author and Stanford physician

R E - H U M A N I Z I N G D I G I TA L Dr. Abraham Verghese has grappled publicly with our growing dependence on technology in the healthcare setting, and has widely advocated what he calls the “powerful, old-fashioned tool of human touch.” Describing the deficit of a human dimension during his own stay at a hospital, he writes, “the computer records what I call an ‘iPatient’ – and this iPatient threatens to become the real focus of our attention, while the real patient in the bed often feels neglected, a mere placeholder for the virtual record.”1 Has digital marketing, with its relentless focus on consumer direct response, driven our consumers to become mere placeholders for clicks, registrations, and downloads?

Four digital handicaps In the era of social connections and Facebook, how can we accuse digital of being anti-human? Thanks to digital communications, many more consumers than ever before will encounter our ads, interact with our content, review user feedback, and talk to their doctor about our brands. Consumer access to health information is at an all time high of 80% of all adult Internet users, while access to other people’s commentary or experience about health or medical issues is up to 34% of all adult Internet users.2 So yes, with social media, the digital channel has enabled more human interaction and fostered more touch points than could be possible with a TV or direct mail campaign. But the digital communications we do control (display, search, email, mobile, pharma-sponsored social), are handicapped by four issues that are keeping our efforts from reaching their full potential: 1) Content-heavy medium: Digital has always been considered a content-heavy medium. For pharma products with complicated messaging, this has been a safe haven, where we can hold patients’ hands and lead them through to a decision. The tradeoff though is that we lead with functional benefits at the cost of the emotional. 2) Micro-targeting: As we get more sophisticated with targeting and “thin slicing,” our collective focus is turning to “big data,” segmentation, operations, and analytics, with consumer insights and the “big idea” commanding less and less of a role in marketing decision-making. 3) Technology blindness: We’re enamored with the technology. Our management is enamored with the technology. At least 70% of product directors we have talked to have received a call from management asking for their Pinterest/Twitter/Foursquare/Tumblr/Instagram strategy. Digital marketing is becoming about the utility, not the user. 4) Regulatory limitations: We can’t avoid the elephant in the room – regulatory. Every DTC marketer has had

at least one instance of being told they needed to pull back on an execution due to limited space, dynamic experience, or two-way interactions. Marketers now assume that much of the dimensionality of the digital experience has been taken off the table, leaving very little room for magic. It is common practice now, too often, to use regulatory as a reason to rationalize mediocre work.

Has digital marketing, with its relentless focus on consumer direct response, driven our consumers to become mere placeholders for clicks, registrations, and downloads? The changing face of “human” The reason re-humanizing digital DTC is a provocative idea is not only because we marketers are falling short of paying off on the emotional, but because what is emotionally-resonant has dramatically changed. I was watching the Rockefeller Center Christmas tree lighting celebration last November (on TV). Mariah Carey was up on stage singing in all her resplendent resplendence. The camera panned across the audience: one out of every two people was watching Mimi through the screen of his camera phone. Not interacting with the queen of R&B, not experiencing the bulk of her vocal presence in the here and now, but recording it for later, for posting, for likes. There is a new human face of digital, and really, a new digital face of human. The role brands play in peoples’ lives will change. Digital marketers need to notice.

Playing to digital’s strengths Following are three approaches to make digital communications more present, and more real. 1) Content: Tie educational content closer to the inperson experience According to multiple studies done by Millward Brown and Manhattan Research, the in-person and very human doctor-patient conversation is still the most influential source of information relating to drug brands. And per HealthTalker’s Andrew Levitt, in his article on Word of Mouth Marketing in the last issue of this very publication3, in person, offline conversations between consumers constitute 90% of conversations about brands. The closer we can integrate consumer content on our educational websites and our digital/social/mobile efforts to the in-person experience, the more alive and therefore more influential our content. Borrow credibility from physicians. Help simulate the doctor conversation. Facilitate in-person advocacy or educational meetings. Help with documenting patient histories. Help with transport DTC Perspectives • Winter 2013 |

R E - H U M A N I Z I N G D I G I TA L to or m-connectivity with a doctor. The space is vast and the needs are many.

lenge your creatives to really think through what this consumer viscerally wants, needs and will spark to.

2) Customization: Targeted messages that actually make a difference

• Don’t assume you know. If you assume you know what your consumers want, chances are you’re wrong. Take the time to work with real people. A few relationships now will yield millions post program launch.

With growing investments in talent, systems and infrastructure, today’s marketers have, according to a study by IBM, more consumer data at their disposal than they can cope with, yet the vast majority of it goes unanalyzed and unused. In other words, we’re expending our resources on data gathering, at the expense of other aspects of marketing, but we’re not using it. Double whammy. Most, if not all, DTC marketers have segmented their DTC population and are delivering tailored communications to target segments. But, for ease of MLR approval, we create boilerplate templates, and selectively swap out chunks of copy, imagery, or calls to action under the banner of tailoring. We understand, for the most part, what makes our consumers tick, but because of the cost of design, burden of approval and complexity of operations, we don’t necessarily carry this comprehension through to communications development. Here’s the truth though: being more attuned to consumers’ emotional interplay is not more expensive, not harder to approve, and just as complex an operation. All it takes is thinking about it differently. 3) User Experience As I said earlier, digital communications need to be about the user, not the utility. Our industry has fine-tuned interface design, usability, and even persona development; but in this multi-channel world of three-eight screens, we need to raise the bar on user experience. Here’s my doctrine on user experience: • User experience is not user interface. It is more than aesthetics and call-to-action placement. It is a holistic discipline, with a heavy strategic component, and multi-disciplinary responsibility. • Technology is the means not the end. To quote a brand marketer from Coke, “Digital is the experience, not the venue.” Location-based services are great only if consumers really need retail-specific promotions or doctor office specific information. “What’s our Pinterest strategy?” is not a legitimate question. “How are we relevant to our advocates’ advocates?” is. • Less ‘user,’ more ‘experience.’ I may have said that communications need to be about the user. But a big mistake many of us user-centric marketers make is that we over-emphasize the user and forget about the experience – resulting in a static understanding of the consumer and point-in-time program design. Chal-

22 | DTC Perspectives • Winter 2013

The reason re-humanizing digital DTC is a provocative idea is not only because we marketers are falling short of paying off on the emotional, but because what is emotionallyresonant has dramatically changed. What you can’t say, sing! I’m enamored with these lyrics: Hold me, hold me Never let me go Until you’ve told me, told me What I want to know And then just hold me, hold me Make me tell you I’m in love with you I’ve spent a lot of time with health consumers. This is exactly what I hear them saying they want from us marketers (sans the poetry and 50’s sentiment). Other industries do this. Soap. Hotels. Phone Services. Phones. But health is as human as it gets. The stakes are simply higher for us. DTC marketers need to, to borrow from Apple, “think different.” We need to re-think human and re-think digital. If we think about digital DTC in a different way, we will do it differently. Let’s use technology to hold and thrill our consumers. It is well within our reach. DTC References 1 Abraham Verghese, Treat the Patient, Not the CT Scan, The New York Times, Published: February 26, 2011 2 The Social Life of Health Information, 2011, Pew Internet & American Life Project 3 The Surprising Science Behind Word of Mouth Marketing, Andrew Levitt, DTC Perspectives, Fall 2012

Reid Connolly brings more than 15 years of experience in the integrated healthcare marketing field. As CEO, he is responsible for driving evoke’s strategic vision and partnering with clients to develop rich, insight-driven strategies that shift brand business. Prior to founding evoke, Reid has held numerous senior and executive leadership roles with agencies such as Digitas Health, imc2, and Saatchi & Saatchi Healthcare. He can be contacted via reid.connolly@evokeinteraction. com.

2 0 1 3 a w a r d s a d v e r t i s i n g

2013

ADVERTISING AWARDS

Enter the 2013 DTC National Advertising Awards – Now With Expanded Categories

Act Now!

Entry Deadline – January 31st New categories include “Most Innovative Campaign” and “Best PR Event or Program”, plus additional category divisions such as Branded TV – Large Brand, Branded TV – Small. For full entry details, please visit the Awards tab on www.dtcperspectives.com. Please call the DTC Perspectives office at 973-521-7475 with questions.

Make Sense of Your Multichannel Data: Developing a One-to-One Patient Relationship The need for a data-driven, integrated marketing strategy is more relevant than ever. Marketers face pressure to optimize within ever-shrinking budgets, while moving from a siloed, tactic-driven strategy to a fully integrated patient experience that creates high-value one-to-one relationships. To get there, one must understand the latest technology available, identify data sets to gather insight, and garner internal support. by

Elinor Soriano & Erik Prince

here has been a dramatic shift within the past few years in how consumer marketers are using multichannel data to communicate with patients. Marketers are faced with the challenge of building a one-to-one relationship with patients in a landscape of patent expirations, shift towards generic medications and shrinking advertising and promotional budgets. Creating a brand strategy that optimizes the channel mix, derived from multichannel data brand insights, will allow marketers to create a personalized dialogue with patients and increase engagement in market conditions that make getting through to patients more important than ever.

These many sources, while adding complexity, also increase the ability for marketers to connect with the types of tools, resources and messaging that matter to patients. Being able to interpret the types of data that can be derived both online and offline within the organization’s data privacy parameters is essential to developing one-to-one relationships with patients. Patient channel preferences, opted-in email address, online tracking of tools and resource downloads can help marketers drive a patient experience with brands that are unique and personalized – beyond traditional push messaging based on aggregate market research.

Proliferation of channels & data

Prioritize & leverage multichannel data

Marketers have an astounding breadth of online and offline channels to choose from when creating an ideal marketing mix. Digital channels continue to grow in number and complexity, even as many offline channels remain on the table. A recent Manhattan Research survey of 8,745 U.S. adults found that 73% of U.S. adults (ages 18 and older) use online health information and tools, and new research finds that these resources are shaping consumers’ choices of health products and services. From those adults who use online health information and tools, 54% say the online information or tools have influenced their choice of healthcare providers, treatments, and services.

Sorting through consumer data that is available can be daunting. A first step is taking an inventory of tactics that capture explicit opt-in data (which may require working with your organization’s legal team and their interpretation of the privacy policy as it relates to the tactic) and determining which of these data sets can be applied to create a two-way dialogue. In order to organize the multichannel data to gain brand insight, a marketer should have the target patient’s behavioral pathway mapped out. The questions to ask when developing a patient behavioral pathway are: • How does a patient find out about their disease state predoctor’s office visit?

24 | DTC Perspectives • Winter 2013

D I S T I L L I N G M U LT I C H A N N E L D A T A • How does the patient have the dialogue with the physician regarding medication to be prescribed? What drives the patient to get to the pharmacy to fill the initial prescription? • What factors weigh in regarding the patient staying on that prescription or switching to a competitor product? • What keeps a patient compliant on that prescription for the length of time it is prescribed? Once a marketer has a patient behavioral pathway mapped out, they can identify which opted-in information could be used during each stage. Identifying the types of opted-in patient data can also help the marketer identify other influencers within the patient’s behavioral pathway, for example, caregivers that are responsible for administering the patient’s prescription. (See related sidebar below.) Once these types of opted-in information are identified, marketers can consolidate that data into an integrated data management platform to derive segments and plan personalized online and offline campaigns based on the patient’s preferences. Data integration allows for a patient marketing strategy that is not only more personalized, but also focuses advertising and promotional dollars on messaging and channels that matter to the patient. By integrating this information, marketers can focus A&P dollars on the tactics that gain the most return on investment, moving from a “push,” tactic-focused strategy to an integrated two-way patient dialogue focused on the right messaging at the right time. (See Figure 1.)

The role of enabling technology for marketing For the past 20 years pharmaceutical companies have spared no expense building technology capabilities that support the

sales force – be they sales force automation systems, reporting tools or iPads. Meanwhile the marketing function has been significantly underserved in most organizations, operating without sufficient tools to manage their data, deliver integrated campaigns, or gather insights necessary for optimization. This is changing as marketing becomes increasingly datadriven as well as more influential within organizations. As a result, there is currently a major shift taking place toward investment in marketing capabilities. According to Gartner, by 2017 CMOs will spend more on technology than CIOs. This means marketers need to understand the current technology landscape, particularly tools that enable them to develop a 360 degree of the patient, personalize content or trigger messaging to keep the patient engaged, and garner insights to drive segments and campaign optimization. Marketers can then work with the players inside and outside their organization that can help them leverage enabling technology to implement an integrated marketing strategy. These may include commercial operations, digital/multichannel centers of excellence, IT, and agency partners.

Understanding the technology landscape The integrated/multichannel marketing space offers a number of different solutions each of which has a fit in different organizations and/or situations. • Cloud-Based/Software-as-a-Service (SaaS) Platforms: Cloud-based, software as a service solutions are generally designed for fast implementation, flexible to scale and provides broad access. There is no hardware to procure or lengthy development timelines. Frequent software upgrades mean marketers have the latest tools and func-

Examples of Explicit Opted-In Information that May be Used* (refer to your organization’s data privacy policy) Branded Websites: Opt-In for a patient to register online. If the site includes registration, a marketer can track unique patient information such as web engagement on certain areas of the website, downloads of patient education tools/PDFs, interaction with cost-comparison tools, etc. Third-Party Sites (such as WebMD, Quality Health): Banner ads, other online ads that drive to online branded patient registration page. Patient Social Media Communities: Banner ads, etc. that drive to an online branded patient registration page. Healthcare Associations [such as the Juvenile Diabetes Research Foundation (JDRF), American Health Association]: Opt-ins during a patient conference to receive more information about your product. Patient Loyalty Programs, Savings Cards and Voucher Programs: Opt-ins when a patient registers via online registration or business reply card into a patient savings card/voucher program or an ongoing program.

DTC Perspectives • Winter 2013 |

D I S T I L L I N G M U LT I C H A N N E L D A T A

Figure 1: The Roadmap to Relationship Marketing

Figure from Appature Relationship Marketing Roadmap (Consumer Relationship Marketing)

tionality to gain a competitive advantage. This is ideal for those marketers who would like to be in control of multichannel campaign planning, execution and insights without having to rely on internal systems or traditional technology providers. Pros: Agile, flexible, allows data management, campaign execution and business intelligence to be placed in hands of marketers and partners through real-time application, can be easily integrated with other data sources, systems (e.g., sales force automation), and vendor programs. Cons: Less flexible for extensive customization, need to ensure appropriate resources are in place to drive campaigns using the technology, either through internal resources or by professional services partner. • Commercial IT: Onsite Data Warehouse and Enterprise Marketing Software On-site physical data warehouses and marketing technologies require that organizations have the infrastructure and resources to build and maintain a system. The initial implementation can be quite lengthy and costly. Organizations that go this route are usually interested in leveraging internal assets and want to hold on to all intellectual property, with strong belief that the data and systems are safer if it resides internally. These solutions often leverage older technologies, require extensive customization, and

26 | DTC Perspectives • Winter 2013

are slower to evolve. Pros: All of the multichannel data can be controlled internally, no reliance on third-parties; allows for extensive customization of systems. Cons: Extensive internal IT resources required to maintain, often leverages older technologies which are not as agile to respond to market events, multiple software packages must be integrated to create fully-functional platform, upgrades and new features may require long cycle times. • Marketing Service Providers that Bundle Technology and Services Marketing service providers (MSPs) both build and maintain the technology (typically systems that are similar to the enterprise IT platforms described above) and also provide staff to run the systems and campaign programs on a full-service basis. MSPs are often used by large organizations that don’t want to rely on internal IT teams and can afford the higher costs for implementation and ongoing support. These organizations may not prioritize having direct access to their data nor have a strong preference in the technologies used (technology-agnostic). The solution often involves integrating different toolsets (campaign planning and management, business intelligence and reporting) which can be a weak link if not built with a long-term vision in mind. The organization’s primary

D I S T I L L I N G M U LT I C H A N N E L D A T A focus is having a dedicated team of people that will take their direction and execute accordingly. Pros: Dedicated account teams to execute campaigns, provide reporting. Customized/complex multichannel marketing systems can be built. Cons: Leverage enterprise IT technologies (see aforementioned pros/cons), data typically stored within the MSP’s data warehouse which can limit direct and fast access to data for marketers, inability to change service providers if dissatisfied due to “lock in” with MSP technology platform and data warehousing.

Change management: ‘Selling’ internally Change management is often the most neglected aspect of changing to a data-driven environment and often the one that prevents it from being successful. Marketers need to understand that there are processes that need to change and that people will be impacted. The changes often run the gamut from getting data faster to reviewing marketing materials in an accelerated manner. Marketers need to reach out early on in the project to gain the support and input from those that will play a role in supporting the change, no matter how minor. Marketers should take the needs and constraints of other departments into consideration because what might seem like a clear win for them might not be seen in the same light by others.

Putting it all together Making sense of your multichannel data and integrating into relationship marketing tools and strategies that work for your brand and your organization requires commitment and effort. However, focusing on the right enablers – understanding which data are available to use to make informed decisions, utilizing technology solutions that help manage data, execute campaigns and provide patient insight, and garnering internal support within your organization – will help move you towards developing a unique patient experience with your brand and driving one-to-one relationships. DTC Elinor Soriano is an Engagement Manager at Appature with over 11 years of pharmaceutical marketing industry experience. Prior to joining Appature, Elinor was been responsible for consumer CRM strategy and execution for clients such AstraZeneca, Bayer and Sanofi-Aventis. Erik Prince is a Marketing Solution Architect with Appature where he brings 15 years experience in designing and developing digital solutions for brand marketers to engage both patients and healthcare professionals. Prior to Appature, Erik was an IT Director of Innovation and New Customer Channels at Sanofi. Please contact Elinor and Erik at info@appature.com.

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depress the speed of new patient acquisition? 7/28/11 11:13 PM • How efficient was the programming selected to reach the actual patient audience?

become a research vehicle. Second-‐by-‐second click stream data digitally captured, aggregated (non-‐identifiable) and then matched to aggregated and anonymized patient-‐level data

In order to secure a place within the brand budget, marketers must validate television’s impact on prescription drug sales. Even with

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Action and Compliance: Patient-Centric Marketing Patient-Centric via Marketing Patient-Centric via Marketing via F Z 94% ofNetworks patients are Specialty Acquisition: Specialty Point-of-Care Specialty Point-of-Care Networks Point-of-Care Networks

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How Pharmacist and Patient Engagement Drives Behavior Change As a trusted resource, pharmacists are uniquely positioned to support and encourage patients to properly adhere to their medication regimens. Through behavioral coaching and engagement, pharmacists can utilize branded or unbranded programs to provide a more thorough understanding of an illness and prescribed treatment. by Stacey Irving

dherence. Compliance. Persistence. All terms associated with how well – or not – patients take their medications as prescribed. While these terms are often used interchangeably, there are key differences that are relevant to encouraging patient engagement to drive lasting behavior change. Compliance typically implies treatment decisions that are physician-directed with a passive or unequal role for patients. However, adherence suggests a collaborative relationship between clinicians and patients and is more respectful of the role patients play in treatment decisions. This collaboration, where the patient is involved in making and adhering to their own treatment decisions, is a critical distinction. In order to maintain lifestyle changes and be adherent, patients must first be engaged and believe that they can do so.

Pharmacist-patient engagement This article will explore how community pharmacists have a unique opportunity to help patients adhere to their medication regimens and improve outcomes through behavioral coaching and engagement, giving brands an effective channel to reach patients. Serving as trusted and accessible resources, pharmacists have the ability to engage with patients through targeted behavioralbased patient conversations delivered in the pharmacy. These conversations are designed to help patients better understand their disease or illness, the role and function of their medication, and the importance of adherence.

30 | DTC Perspectives • Winter 2013

Building on the benefits of this patient-centric approach, there are a growing number of opportunities for pharmacies to participate in branded and unbranded programs targeted at improving medication adherence, including pharmacist behavioral coaching sessions, pharmacy reminder programs, and relationship marketing programs provided on behalf of the brand.

Engaging patients in a two-way conversation driven by the patients’ needs involves a shift in approach for many pharmacists. For example, McKesson’s Pharmacy Intervention Program found patients who received face-to-face behavioral coaching from their pharmacists showed significant adherence benefits. For example, COPD patients who received coaching showed an average of 1.6 incremental fills over 12 months and patients coached by top-performing pharmacies in multiple diabetes programs showed an average of 4 incremental refills over 18 months when compared to patients who did not receive behavioral coaching. It is also worth noting that a statistically significant difference still existed between intervention and control at the 18-month mark, which means a program can drive true and lasting behavior change for many patients.

Driving behavioral change How is behavioral coaching different than legally required counseling (e.g., OBRA 90), and how can brands leverage this emerging channel to reach patients?

PHARMACIST COACHING Legally required counseling is essentially a one-way narrative in which a pharmacist describes side effects, dosing guidelines and other medication-specific information patients need. In contrast, behavioral coaching takes it a step further in encouraging a two-way, patient-led conversation to uncover barriers to adherence, express empathy, and offer personal support that results in a collaborative action plan to maximize adherence. Research shows that the use of behavioral techniques improves the likelihood of behavior change by 14 to 20%. (See Table 1.)

Table 1: Behavioral Coaching Benefits Benefit

Description

Positive Clinical Outcomes

Encourage patients to self-monitor (e.g., blood pressure, blood glucose monitoring)

Enhanced Patient Engagement

Increase knowledge, confidence and skills for self-management

Increased Positive Coping Strategies

Increase the likelihood that patients will incorporate healthier behaviors, such as diet and exercise, into their daily routine

Perceived Social Support

Provide patients with psychosocial support that they need to change behavior

Source: Wolever R. et al. (2010). “Integrative Health Coaching for Patients with Type II Diabetes: A Randomized Clinical Trial.” The Diabetes Educator. 36:629.

Evolution of the pharmacist Having strong relationships with their customers, more and more pharmacists are actively engaged in helping support patient adherence. They perceive adherence programs as a way to not only improve patient care, but also to provide additional revenue from sales and reimbursements and differentiate the pharmacist and pharmacy’s services. As pharmacists and pharmacy owners are embracing their expanded clinical role, many are adding patient-support services and making physical changes to the pharmacy to accommodate more personalized, one-on-one interactions and counseling. For example, many Health Mart® independent pharmacy franchises are creating more discrete consultation rooms and mini clinics. This new pharmacy design allows for product demonstrations and confidential adherence coaching, and supports a variety of clinical-services solutions such as executing MTM (medication therapy management) or other alternative revenue opportunities. In addition to being an active participant in the Pharmacy Intervention Program, Christine Jacobson, owner, Wasatch

Pharmacy Care in Ogden, Utah, also offers a counseling program for patients seeking individualized informational sessions with her on topics ranging from the advantages of natural hormone replacement, to concerns over sexual dysfunction, to questions regarding medications for depression and pain management, and to options for combatting aging. Jacobson meets with six to seven patients per day in hour-long sessions to discuss their healthcare concerns in detail and is booked several months out.

Building a network of trained pharmacists Christine Jacobson and others like her are leaders in this new era of pharmacist-based behavioral outreach. But just as no two patients are the same, pharmacists have different levels of interest and training in applying behavioral techniques. Building an effective pharmacist network that presents brands the opportunity to build relationships with pharmacies and reach patients to drive behavior change requires ongoing training and the ability to operate within the normal pharmacy workflow. Integrating with pharmacy software to alert pharmacists to sponsored clinical opportunities, established networks provide comprehensive training, and many include compensation for offering behavioral coaching sessions to help patients overcome adherence barriers, enrolling patients in savings programs, and providing information about clinical trials to eligible patients. Patients are often told what to do by healthcare professionals without being asked their opinion and these practitioners rarely look for barriers that may impact patients’ success. Engaging patients in a two-way conversation driven by the patients’ needs involves a shift in approach for many pharmacists. However, pharmacists able to engage in collaborative, patient-centered conversations are proven to be more effective at bringing about and strengthening the motivation for change. In a busy pharmacy, it can be difficult to sit down with patients for lengthy consultations. Proven motivational interviewing techniques, such as using open-ended questions, help focus the conversation. Reframing questions helps pharmacists gain knowledge about the patient’s attitudes and approach to his or her medication therapy. (See Table 2.) When the patient reveals insights and information, pharmacists are then able to uncover adherence barriers and help the patient create a plan for his or her medication therapy. This contributes to an effective coaching session, which inspires positive health behaviors that may be measured in additional refill rates from more-adherent patients. As pharmacists elicit information, they can more effectively probe to uncover potential barriers to medication adherence, monitor the patient’s progress, and look for ways to reinforce adherence in subsequent conversations. They may also gain insight in how to engage the patient and help (Continued on page 38) DTC Perspectives • Winter 2013 |

Hall of Fame Four More DTC Pioneers Join the DTC Hall of Fame

Deborah Dick-Rath

Stu Klein

Don Lowy

Sheri Stump

DTC Perspectives proudly welcomed four outstanding executives into the DTC Hall of Fame for their significant achievements in advancing DTC communications. The 2012 members are: Deborah Dick-Rath, CEO & Founder ofEpic Proportions LLC; Stu Klein, Healthcare Practice Lead at Interpublic; Don Lowy, President & Founder of Donald Lowy Consulting; Sheri Stump, Senior Marketing Director, Pediatric ADHD, Behavioral Health Business Unit with Shire. The honorees were joined by their peers for the DTC Hall of Fame Induction Ceremony, a part of the eDTC Revolution Conference. Evening festivities included a celebratory cocktail party followed by the formal ceremony. Each Hall of Famer received a personal introduction from close peer from the industry, as well as a video presentation of colleagues honoring them with personal anecdotes and words of praise. (Full-length videos can be found on our website, www.dtcperspectives.com, under the Hall of Fame portion of our Awards section.) Profiles of the 2012 members appear on the subsequent pages. The DTC Hall of Fame is designed to honor individuals who have demonstrated extraordinary achievement in the advancement of DTC marketing. Industry-wide nominations are collected and then reviewed by the DTC Perspectives’ Advisory Board, a select group of industry experts who serve as counsel. Together with the DTC Perspectives’ staff, the final four inductees are selected. Candidates may be current or retired, must have at least five years of experience, and can be from all sectors of the industry: pharmaceutical manufacturer, agency, media channel, DTC service provider, DDMAC, and academia. Previous recipients of this distinguished honor are: (from the inaugural 2008 class) Jim Davidson of Polsinelli Shughart PC, Matt Giegerich of Ogilvy CommonHealth Worldwide, Ed Slaughter of Merck & Co., and Len Tacconi of Merck & Co.; (2009 class) Herb Ehrenthal of Herb Ehrenthal, LLC and formerly Schering-Plough, Paula Garrett of Lilly USA, Joe Hoholick of Amgen, and Lucy Rose of Lucy Rose & Associates and formerly DDMAC/FDA; (2010 class) Minnie Baylor-Henry of Johnson & Johnson and formerly DDMAC, Scott Grenz of GlaxoSmithKline, Andrew Schirmer of McCann HumanCare, and Dorothy Wetzel of Extrovertic; (2011 class) Mark Bard, Executive Director and Co-Founder of the Digital Health Coalition; Bill Drummy, Founder and Chief Executive Officer of Heartbeat Ideas; Joan Mikardos, Senior Director, Digital Center of Excellence with Sanofi-Aventis; and Nancy Phelan, VP, Customer Strategy and Operations at Bristol-Myers Squibb.

Congratulations to our DTC Hall of Fame inductees! 32 | DTC Perspectives • Winter 2013

D T C H A L L O F FA M E

DTC Perspectives • Winter 2013 |

D T C H A L L O F FA M E

Deborah Dick-Rath Optimizing the Media Mix

With a knack for creating dynamic messaging, Deborah Dick-Rath has an unparalleled understanding of strategy, insight and measurement that uniquely positions her. By DTC Perspectives staff

rawing from more than 25 years of healthcare she instituted best practices and provided expermarketing experience, Deborah Dick-Rath is tise on various topics, from brand development to an established pioneer in the DTC industry. media strategy to agency management. Her knowlHaving started on the ground floor when DTC was edge allowed Novartis’ brand teams and agency first allowed in the 1990s, she has crafted quite the partners to optimize performance from pitch accomplished career path, as seen through her through execution. With numerous industry awards inspiring, insight-based communications. under her belt for creating integrated campaigns as Prior to DTC marketing’s inception, Deborah well as an innovative advertising platform, Deborah worked in the OTC industry, beginning her career helped position Novartis as a DTC advertising powat the William Esty Company working with such clierhouse. In addition, she led the firm’s first global ents as Unilever, Colgate and Wyeth (now Pfizer). media agency selection as well as collaborating She moved over to the Wyeth brand team, holding with her team to craft internal media and producthe title of Group Product Manager. Here, she was tion guidelines to help drive campaign efficiencies. responsible for several OTC brand launches as well The success of her initiatives helped earn her a as repositioning brands within their Family Planning position representing Novartis on PhRMA’s initial and Cough-Cold franchises. In 1994, she signed DTC Guideline committee. on with Bates Worldwide as Senior Vice President, After eight years with Novartis, Deborah moved Management Representative, leading strategy for to Symphony Advanced Media as Senior Vice Carter products and supervising special projects for President of Healthcare Solutions. Utilizing her Warner-Lambert. background in optimization and Deborah made the leap over to strategy, she helped her clients DTC in 1996, starting at one of the obtain real marketing accountfirst DTC-focused specialty agenability through measurement of cies in the industry, The Quantum cross-channel campaign ROI. In Group (presently Ogilvy CommonMay of 2012, she branched out on Health). She gleaned a wealth of her own, founding the healthcare experience working with such pharcommunications consultancy, Epic maceutical clients as Bristol-Myers Proportions “to help healthcare Squibb, Schering-Plough, Sanofi, brands and their agencies get the GlaxoSmithKline, Wyeth-Lederle biggest piece of the pie by creating and Johnson & Johnson. After four dynamic messaging and optimal, years of establishing and growing the DTC unit, she transitioned to the Deborah Dick-Rath of Epic Proportions receives integrated media mix.” Unquesclient side of the business by joining tionably we all look forward to the her award from Andrew Schirmer of McCann Novartis Pharmaceuticals. As Exec- HumanCare, a former agency partner from her innovative tactics she’ll continue to utive Director of Global Advertising, Novartis days. unveil.

34 | DTC Perspectives • Winter 2013

D T C H A L L O F FA M E

Stu Klein

Cultivating Memorable DTC Stu Klein has created some of the more memorable DTC campaigns of this era, setting a standard for innovations in patient communications.

By DTC Perspectives staff

Healthcare before signing on with Interpublic Group. hile marketers still need to convey the Stu continues his tireless efforts as a champion for benefits (and yes, risk information, too) the patient and brand in his current role, where he is properly to consumers, “the form and venue of those communications will continue to responsible for managing IPG’s pharmaceutical clievolve at the rapid pace we’ve seen transform our ent relationships. industry over the past five years,” noted Stu Klein, In addition to his notable creative achievements, currently the Healthcare Practice Lead at InterpubStu is also highly regarded for his pragmatic, yet lic. As one of the pioneers at the forefront of DTC enlightened, expertise. In fact, he has been asked to advertising, Stu has a strong understanding of evopresent to OPDP twice – once regarding proposed lutionary marketing. He has generated a successful changes to DTC guidelines and again to share study track record comprised of award-winning campaigns results that analyzed DTC discussions between docdeemed significantly memorable by both the industors and their patients. Anyone who has ever met try and consumers. Stu will tell you that he is one of the most upbeat, Stu spent nearly two decades honing his skills optimistic people out there. and knowledge working in consumer goods marFacing his challenges head-on, he has an innate keting on some of the industry’s premier brands, capacity to get to the consumer-driven insight and including Procter & Gamble, Nestle, and Campturn it into an engaging and relatable experience. As bell’s. But feeling drawn to a higher calling in a result, he has created some of the most successpharmaceutical marketing, he joined The Quantum ful campaigns for such blockbuster clients as ScherGroup as President in 2000. He and ing-Plough’s Claritin, Clarinex and his team grew the specialty agency, NuvaRing, GlaxoSmithKline’s Leviturning into the DTC Mid-Sized tra, and AstraZeneca’s Crestor, to Agency of the Year from 2002-2004. just name a few. In his decadeIn 2005, Stu expanded upon his plus time working in pharmaceutiknowledge of the healthcare marketcals, he has had the opportunity to ing industry by switching to the prodevelop DTC and/or professional fessional side. He spent two years communications for more than 50 serving as Chief Executive Officer brands across approximately 20 of KPR, one of the first agencies to different therapeutic areas. And specialize in healthcare marketing, that number will undoubtedly conbefore moving back to DTC. He later Stu Klein of Interpublic is presented with his held the title of Executive Vice Presi- award by Sue Manber of Digitas Health, a former tinue to grow... with exceptional partner from Lowe Alchemy. outcomes, one might add. dent Managing Director at Draftfcb DTC Perspectives • Winter 2013 |

D T C H A L L O F FA M E

Don Lowy A Strategic Vision

Both analytical and creative, Don Lowy has always been able to strike the balance between being realistic yet a crusader throughout his career. By DTC Perspectives staff

Director of Consumer Marketing & Communication, on Lowy has one of the most storied careers Don managed the development and implementation in this industry’s history. Over the course of campaigns – with a focus on patient education/ of more than three decades, he has proven CRM – for Ambien, Pletal, Mirapex and Xalatan. to be a premier brand builder in pharmaceuticals, Don then transferred to Schering-Plough (now packaged goods, OTCs and digital technology. His Merck & Co.) as Vice President, Global Advertising passion for knowledge and ability to understand & Marketing in 2003, where he earned many accohow to unlock the potential of emerging opportunilades for his work on brands including Nasonex, ties has helped forge his path when developing his Zetia, Levitra, Vytorin and NuvaRing, to name a few. successful consumer-centric approaches. With a keen understanding and strong passion for Starting his career in advertising, he rose through digital opportunities, he was able to spearhead the the ranks to eventually become Vice President, integration of traditional and digital consumer comGroup Management Supervisor at Grey. In this munications for these brands, setting them apart in role, he was responsible for managing big-name the marketplace. Additionally, this early e-pioneer clients, including P&G, IBM, General Foods, Duracell, Bristol Myers and Ciba-Geigy. It was with the formed the “Schering Plough Digital University” as Ciba-Geigy account that he worked on the launch of a global eMarketing learning resource for employHabitrol Nicotine Patch’s “Portrait of a Quitter” camees. In recognition for his innovative efforts during paign, one of the earliest DTC efforts. In early 1995, his marketing tenure thus far, Don has also been he left to sign on with The Senior Network, taking selected to serve as a Digital Health Scholar by the on the role of Senior Vice President, Digital Health Coalition. Director of Health Care Marketing. In 2010, Don decided to start He established and grew the healthhis own consulting firm, Donald care practice by developing strateLowy Consulting, which would gies, positioning, grass roots initiaallow him to focus his talents on tives and healthcare expertise for small to mid-sized companies such clients as Merck & Co. (Zocor), with resource-constrained brands. Novartis (Miacalcin), ScheringCombining his out-of-the-box Plough (Coricidin HBP) and Ross thinking with his analytical and Products (Ensure). strategic mind, this seasoned marAfter more than five years at the keter will continue creating unique healthcare firm, he transitioned to Don Lowy of Donald Lowy Consulting receives and creative communication soluhis award from longtime colleague Marjorie the client side to join Pharmacia tions on numerous brands for Reedy of Merck & Co. (now Pfizer). Serving as a Senior years to come.

36 | DTC Perspectives • Winter 2013

D T C H A L L O F FA M E

Sheri Stump Keeping Patients At the Core

Understanding the needs and expectations of patients, Sheri Stump utilizes an “in-service” approach when crafting consumer communications. By DTC Perspectives staff

Also in this role, she developed the corporate strates a veteran marketer, Sheri Stump continugy and organizational structure for multicultural marally sets her sights on the horizon to improve keting – further demonstrating the commitment she the communications her brands have with has to patients. Multicultural marketing is a unique consumers. Having worked in several therapeutic entity in an already challenging industry, and is areas, including women’s health, pain, cardiovascuoftentimes overlooked; establishing such a program lar, oncology, respiratory and CNS, she has always shows the understanding and foresight she has ensured that the patient or caregiver remain at the when it comes to ensuring patient comprehension epicenter. Through an honest, transparent dialogue, and compliance, as well as recognizing the potential the patient communications she crafts are able to business opportunities. After some time in this role, properly support individuals as they manage their she then moved over to the Crestor team as the healthcare issues. brand’s Consumer Director. Here she spearheaded Sheri began her healthcare career over 25 years a number of successful, innovative campaigns for ago as a sale representative for Johnson & Johnson the cholesterol treatment, collecting several awards before moving into marketing, working on prescripalong the way – including quite a few DTC National tion and OTC brands, including Children’s Tylenol, Advertising Awards. Motrin and Imodium A-D. After 10 years with the Nearly three years ago, Sheri took on a new pharmaceutical giant, she decided to switch to the endeavor: ADHD marketing at Shire. Starting as the agency side, holding various roles at Dorland SweeConsumer Brand Director, she and her team cultiney Jones, 30 West Advertising (Wyeth) and Medivated award-winning campaigns, cal Broadcasting Company (Digitas both educational and branded. Health). The additional experience Most recently, she assumed the she gained managing a number of role of Senior Marketing Direchealthcare accounts for major phartor, Pediatric ADHD, creating and maceutical clients led her back to executing the integrated marketing being a client herself as she was strategies for Vyvanse and Intuniv, hired by AstraZeneca in 2001. in both the professional and conDuring her nine-year tenure with sumer spaces. She continues to AstraZeneca, she held several marbe a fearless champion for her keting positions, including Director patients, driven by a passion for Consumer and Alternative Commuand keen understanding of going nications, where she led the profes- Sheri Stump of Shire is presented with her DTC beyond the standard DTC mesHall of Fame award by her manager, sional training and career developsaging to being “in-service” for Mike Yasick. ment for consumer brand managers. patients and caregivers. DTC Perspectives • Winter 2013 |

O N

T H E

M O V E

MicroMass Communications hired Julie Jelenewski as account supervisor and Linnea Warren as behaviorist. Jelenewski will work on an oncology product as well as on a company-wide patient-focused initiative for a pharmaceutical giant. She joins from BeaconLBS, a laboratory benefit solutions company, where she served as network operations administrator. Warren will work across all brands at MMC to develop patient education programs for the company’s growing list of accounts. Most recently, she was a research assistant for the University of North Carolina, Chapel Hill. Cadient Group has hired Amy Everingham and Colleen Burns as account managers and Kelly Jo Schenck as project manager. Everingham will support the agency’s efforts on behalf of a rapidly growing specialty biologics client. She joins from M3 Health, an interactive healthcare marketing agency, where she was interactive project lead and account executive on products in the areas of oncology, haematology and enterology. Burns will support activities on behalf of a unique, personalized oncology therapy as part of her role within Cadient’s diversified and specialized life sciences portfolio. She joins from inVentiv Health where she helped prepare for the launch of a vaccine for infants and toddlers as account executive. Schenck will be responsible for the company’s growing involvement in the obesity management and metabolic disease categories. She was previously a project manager at Digitas Health, handling the development of three launch brand websites, mobile sites, patient brochures, videos and podcasts, and media initiatives. AbelsonTaylor has promoted account directors Eric Densmore and Mark Finn to the position of vice presidents. Densmore has worked on both professional and consumer accounts in a variety

of categories, including urology, autoimmune disease, and dermatology, to Julie Jelenewski Eric Densmore Mark Finn name a few. Finn will be working on products for the treatment of psoriasis and for use in surgery and aesthetic dermatology. His experience has also encompassed a number of disease states as well, including oncology, dermatology, HIV/AIDs, among others. AbelsonTaylor has also promoted Stacy Gordon and Laura Jansen from account executives to senior account executives. Gordon will continue work on consumer marketing initiatives for a GERD treatment. Jansen will work in the rheumatology area, having previously worked on both professional and consumer projects for lupus and osteoporosis treatments. Ogilvy CommonHealth Worldwide announced that Ogilvy CommonHealth Consumer Care and Ogilvy CommonHealth Insights & Analytics will be rebranded as Ogilvy CommonHealth Wellness Marketing and Ogilvy CommonHealth Behavioral Insights, respectively. According to Matt Giegerich, Chairman & CEO of Ogilvy CommonHealth Worldwide, the reason for the name change is the “result of our ongoing determination to provide clarity and focus in all our business efforts.” The WPP brand has an increased focus on helping brands become an integral part of consumers’ lives for healthier living, particularly as they become more and more responsible for managing their own health.

P H A R M A C I S T C O A C H I N G (Continued from page 31)

Table 2: How to Use Open-Ended Questions Instead of … Do you have any questions?

Try saying ... What questions do you have about your medicine?

Do you understand how to What instructions were take this medicine? given to you for taking the medication? Are you going to take the medicine like you are supposed to?

How do you plan to remember to take it as your doctor prescribed?

them visualize what being adherent could mean by tying the reason to take their medicine with their life goals and what’s most important to them. For example, a patient may want to keep their glucose levels under control so that they can prevent future complications from diabetes and see their grandchildren grow up.

Creating a plan for success While patient engagement is critical to improve adherence, it does not automatically result in behavioral change.

38 | DTC Perspectives • Winter 2013

To ensure lasting impact, the pharmacist-patient team needs to create a plan with long-term goals. This plan needs to be based on what the patient thinks the next steps should be, how important being adherent is to them, and how the pharmacist can help to support them. Perhaps, most importantly, the pharmacist must encourage the patient to commit to the plan that they helped to create. Behavioral coaching enables pharmacists to uncover and address potential barriers to adherence. When done well, these coaching sessions allow pharmacists to go beyond the requirements of legally required counseling – to engage patients in ways that can lead to realistic and effective plans that can give their therapy the best chance of working and lead to positive clinical outcomes. DTC Stacey Irving has over 12 years’ experience in business development and management consulting and has spent 10 of those years specifically focused on the healthcare industry. She is currently the Vice President of Sponsored Clinical Services for McKesson Patient Relationship Solutions, where she is responsible for the development of the company’s pharmacy-based adherence platform and Sponsored Clinical Services Pharmacy Network. Stacey can be contacted via email at Stacey.Irving@McKesson.com.

C O N T R I B U T O R S Elinor Soriano is an Engagement Manager at Appature with over 11 years of pharmaceutical marketing industry experience. Prior to joining Appature, Elinor was been responsible for consumer CRM strategy and execution for clients such AstraZeneca, Bayer and SanofiAventis. Elinor can be contacted via email at info@appature.com. To read the article Elinor coauthored with her colleague Erik, turn to page 24. Deb Furey is currently Vice President and GM with Merkle Life Sciences. Drawing from her more than 15 years of experience working with FT500 companies to drive growth through innovative customer relationship strategies, Deb is responsible for healthcare client management, strategy and solution integration. She can be contacted via email at dfurey@merkleinc.com. To read Deb’s article, turn to page 14. Ellen Hoenig-Carlson is founder of AdvanceMarketWoRx, a consulting firm known for powering consumer and healthcare brand growth, through traditional and non-traditional marketing, leveraging critical customer interpretations and insights at key points. Voted among the 25 most powerful marketing executives by Advertising Age magazine in 1999 and 2000, Hoenig-Carlson is experienced domestically and globally in developed and emerging markets. She has led consistently in the field of DTC/P marketing since the August 1997 change in FDA regulations permitting mass DTC. She can be reached by telephone at (609) 333-0549, via her blog at blog. advancemarketworx.com, or Twitter @ellenhoenig. To read Ellen’s article, turn to page 18.

Stacey Irving has over 12 years’ experience in business development and management consulting and has spent 10 of those years specifically focused on the healthcare industry. She is currently the Vice President of Sponsored Clinical Services for McKesson Patient Relationship Solutions, where she is responsible for the development of the company’s pharmacy-based adherence platform and Sponsored Clinical Services Pharmacy Network. Stacey can be contacted via email at Stacey.Irving@McKesson.com. Turn to page 30 to read her article. Erik Prince is a Marketing Solution Architect with Appature where he brings 15 years’ experience in designing and developing digital solutions for brand marketers to engage both patients and healthcare professionals. Prior to Appature, Erik was an IT Director of Innovation and New Customer Channels at Sanofi. Erik can be reached via email at info@appature.com. Turn to page 24 to read the article Erik co-authored with his colleague Elinor. Reid Connolly brings more than 15 years of experience in the integrated healthcare marketing field. As CEO, he is responsible for driving evoke’s strategic vision and partnering with clients to develop rich, insight-driven strategies that shift brand business. Prior to founding evoke, Reid has held numerous senior and executive leadership roles with agencies such as Digitas Health, imc2, and Saatchi & Saatchi Healthcare. He can be emailed via reid.connolly@evokeinteraction.com. Turn to page 20 to read Reid’s article.

ADVERTISING INDEX & RESOURCE CENTER Company

Page

Website

Phone

Contact

Beacon Healthcare Communications

beaconhc.com

908-781-2600

Catalina

catalinamarketing.com

1-877-210-1917 Kristen Kaighn

Kristen.Kaighn@catalinamarketing.com

Health Monitor Network

Healthmonitornetwork.com

201-391-1911

info@healthmonitor.com

Merkle Inc.

Merkleinc.com/lifesciences

443-542-4000

Parade Magazine

parade.com

212-450-7141

Remedy Health

RemedyHealthMedia.com

212-695-5581

Adrienne Lee

alee@beaconhc.com

Deborah Furey

dfurey@merkleinc.com

Jim Curtis

jcurtis@remedyhealthmedia.com DTC Perspectives • Winter 2013 |

Marketing ON THE EDGE

by Jonathan Isaacs

Come As You Are In cyberspace, you can be anyone you want. But have we lost touch with our commitment to remain true to ourselves in everyday reality? Authenticity can set you apart with your colleagues, clients or consumers.

ecently, over bad dim sum and The Good Wife, my mother casually mentioned, “I’ve met someone online.” Now she’s been widowed for 6 years, so being the encouraging, supportive son I am, I answered back, “What???!!!” “Oh yes,” she said. “He’s a retired 4-star general who commanded our forces in Afghanistan. He’s very handsome. He wants to meet me.” “Yes well, before you and General Zod hold hands at the Chat N’ Chew, why don’t I take a look at his profile page.” My mom is a vibrant, highly intelligent woman, but when it comes to online behavior, she is a neophyte and, thus, far too trusting. Sure enough, it didn’t take long to smell a scam. There was a patriotic shot of a real General (taken from a Wikipedia page) and a Nicholas Sparks-level note about how he had dedicated his life to military service and now he was looking for the right woman to share his hobbies: reading, long walks, and killing terrorists with high-altitude Predator drone strikes. Of course, that’s one of the deep attractions of cyberspace. You can be anyone you want when you’re alone at 3 am in your Hulk PJs discussing Honey Boo Boo in a chat room. People love you for who you pretend to be. But in real life, in agency life, you have to be true to who you are, don’t you? Well… only if you want to be spectacular at what you do. We preach the power and glory of authenticity to our clients every day. But perhaps we’re the ones who need to do a better job of living up to that ideal ourselves. Many of us work at legendary consumer agencies where the overall body of work reflects, embodies and ultimately enhances what the organization stands for. But when it comes to the healthcare offering, can we say the same? I think that far too often, somewhere between the electrifying creds deck and the final execution, something goes awry. And I’m not talking about all of the fun outside forces that impact the work. I’m talking about something closer to home and, in many ways, more influential: our unwavering commitment to being who we say we are. Tell me, who is the Goodby of healthcare? The Weiden? The R/GA? Who lays claim to the throne? It feels more like the NFL. Lots of talent but also lots of parity. On any given Monday, you win some, I win some. And to me, one big rea-

40 | DTC Perspectives • Winter 2013

son is we don’t hang on tightly enough to the things that make us special. The things that set us apart. How can you do your best work when you don’t fully embrace your best self? Of course, being authentic is difficult. First off, it’s hard to have an honest conversation with yourself. It’s tough to say, “We’re great at this and not that” or “We stand for this and not that.” Because if you say it out loud, you have to do something about it or risk looking like the biggest hypocrite since Nixon. You have to align your values, structure, business portfolio and people and take a bubble bath in the truth of your wisdom. You won’t always succeed, but to be authentic you always have to try, and that takes time and money. Which leads me to number two: the money. Now, I don’t think anybody in advertising is under the impression that they work for Amnesty International. Everyone likes to get paid. The question is, what are you getting paid for? Donuts or transformational ideas? I would argue that we are in an idea and talent based economy, not a commerce-driven one. But if you think the ideas follow the money, that’s fine. Just be honest about it. Otherwise, how can you excel at it? It’s difficult to hire great people and keep them inspired and motivated if every day there are glaring signs that what your agency “believes” and what it does is a contradiction in terms. Like Deniro says in The Deer Hunter while holding a bullet up in John Cazale’s face, “This is this. This ain’t something else. This is THIS!!!” Do you hear that giant sucking sound? It’s a power vacuum. A huge opportunity for someone to step up, truly embrace their inner-awesome and dominate. I think my organization has the vision, the talent and the will to get there first. But if you beat me to it, remember this: no matter how good you are, even if your fake Facebook page says you are an Admiral in Starfleet, you will never be good enough to date my mom. Jonathan Isaacs is Chief Creative Officer of Ogilvy Healthworld, NY, part of Ogilvy CommonHealth Worldwide. Drawing from his position as a marketing authority, he identifies the latest advertising and creative trends, and shares his astute views. He can be reached by email at jonathan.isaacs@ogilvy.com or telephone at (212) 237-4713.

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O N T H E H I L L by Jim

Davidson

Released Fall 2012

A Look at the Year Ahead in Washington There are a number of important issues ahead of us in this New Year after the political results in 2012. It will be a fast and busy year as we tackle tax reform and the implementation of health reform.

he 2012 campaign season is long gone and it’s time to get back to business. Business advertisers can freely place their ads now that the last super PAC has closed up shop – for the moment – and relinquished the airwaves. Enough time also has passed that we can justifiably tweak those who haven’t thrown out their political yard signs or bumper stickers along with their Christmas trees in the New Year. Indeed, the newly sworn-in 113th Congress must now resume its official duties and tackle the long list of legislative items it failed to address in the 112th. By now, the irony is not lost on anyone that the costliest campaign season in American history yielded zero shift in the balance of power. The presidential race alone cost the Romney and Obama campaigns more than $2 billion. Approximately another $3.8 billion was spent on Senate and House races. With a near status quo outcome, only a few people in the Administration or in Congress will have to schedule a moving day. The Senate Democrats expanded their still filibuster-vulnerable effective majority from 53-47 to 55-45. Republicans in the House of Representatives held onto their majority, albeit with six fewer seats, completing the divided government trifecta. While the end product of this record political spending spree may strikingly resemble its starting points, both parties did emerge changed, with Democrats feeling emboldened and Republicans reflecting the need for more reflection. But there is little time for pondering the results when we count the number of issues awaiting resolution in 2013. Tax Reform. This big-ticket item likely will take center stage for much of this year. Tax reform, as a stand-alone issue, is long overdue but the urgency of addressing expiring Bushera tax rates, expiring unemployment benefits, and the mandatory spending/entitlement cuts called for in sequestration legislation, have dragged reform to the forefront early. No deal had been reached as of printing, but it would be nearly impossible to avert a fiscal crisis in the long-term without a major reexamination of the Tax Code. Luckily for DTC, discussions to avoid the fiscal cliff have centered specifically over individual

42 | DTC Perspectives • Winter 2013

rates and deductions rather than corporate taxes, but anything could be put on the table once the Tax Code is opened this year. Health Care. The best domestic policy change that Republicans could have hoped for if they had won the White House was to defund parts of the Affordable Care Act. HHS can resume its scheduled implementation now that this funding threat largely has evaporated. The challenge in 2013 will shift to the responsibility of the states and the federal government to establish health exchanges in 2014 and to hammer out who ultimately will be responsible for covering the uninsured. At printing, onethird of the states had declared their intent to run their own exchanges, one-third had kicked the responsibility of running them over to Washington, and the other third is split between undecideds and those opting for a partnership exchange with the federal government. Entitlement Reform. This issue is intertwined with the previous two items and might be where prescription drug manufacturers should pay the most attention. The post-election proposals offered by the President and House Republicans clearly reflected different ideologies but both were united in proposing savings to Medicare: $350 billion in the President’s first offer and $600 billion in the House GOP counter-offer. This is an arena where even the mention of benefit changes to the under-55 crowd is a non-starter to many in Congress and in advocacy groups. So it wouldn’t be surprising if a less anti-populist idea, like negotiating prescription drug prices, is circulated among Members on both sides who either want to appease core demographics or make good on their promise to seriously cut spending and manage the debt. It’s going to be a busy year. Fasten your seat belts. 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 more than 20 years. He can be reached by e-mail at jhd@ davidsondc.com.

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ON BOOKS

How We Do Harm By Otis Webb Brawley, M.D. with Paul Goldberg Published by St. Martin’s Griffin / 2012 / 304 pages

Reviewed by Robert Ehrlich

r. Otis Webb Brawley is a noted oncologist from the American Cancer Society who was a fellow at the National Cancer Institute. He is also an AfricanAmerican and has that unique perspective in understanding the underserved minority population. He likes to be called Otis so I will honor his wishes in the rest of this review. Otis has a basic message throughout the book. That is, we generally over treat and in doing so doctors can do serious harm. This is book of stories and recollections from his long career of clinical practice. Otis teaches us by telling powerful and graphic case studies. His introduction involves Edna, a single working mother, who walks into the ER with her detached breast in a bag. Edna had breast cancer that was untreated and the tumor ulcerated and caused the breast to fall off. This horrifying tale illustrates how the poor are treated so differently in America. Edna could not afford to take off from work to get treatment and did not have insurance. What could have been diagnosed and treated a decade earlier was neglected and she had metastatic cancer and was doomed. Otis takes on his fellow doctors who like to treat excessively. He says they over treat because some are plain greedy, doing tests and procedures because they like the income. Others over treat because they follow some outdated protocol which always prefers aggressive action over watchful waiting. His case study of Ralph, a 70 year old man with low level prostate cancer, is a great study in how the desire to test and treat caused great harm. Ralph was urged by his wife to get a free PSA test offered at some mall. He had elevated PSA and was advised to get a biopsy. The biopsy showed some cancer still isolated on part of the prostate. Ralph decided to have the prostate removed and did a DaVinci robotic procedure. He ended up with urinary incontinence and sexual dysfunction. Unfortunately, the surgeon left in a small part of the prostate and that still showed an elevated PSA. Ralph was advised to have some radiation treatment, did that and then had an ulcerated rectal area from the radiation. He had infections and eventually died. The point Otis was making is that screening is not always good. Ralph probably had cancer that never would have spread. He would have lived a good life had he never known about the cancer. He cautions that this trend toward screening

44 | DTC Perspectives • Winter 2013

causes needless tests, harm from those tests both psychological and physical. Who is behind this desire to screen everyone for possible disease? Otis blames fee for service medicine which incents doctors to treat. He also blames drug and device companies who need a pool of diagnosed candidates for their drugs, cat scans, and stents. He is not against aggressive treatment when it is needed. He just feels we have developed this health system that is perverse in putting profit before patients. He calls for evidence based medicine and demands proof that extra care is good care. In one of the best chapters, Otis describes the end of life care issue. In this section he describes the case of Fred Huzjak, a smoker whose lung cancer had progressed to the brain and he was unresponsive. He advised the family to end efforts to treat him because he had no chance to live with any quality. The family demanded all care needed to keep Fred alive even though this care would cause Fred much pain and discomfort. A series of costly tests, procedures and surgeries were done on various parts of Fred’s system. Spinal taps, scopes, breathing tubes, feeding tubes, chest tubes, and other futile measures were demanded by his family. Otis estimates that at least $250,000 was spent making Fred miserable with no chance to save him. He died mercifully but only after being put through agony. Otis has written a wonderful book and should be must reading for Congress, physicians and advocacy groups. It is rare to have these complex issues so artfully distilled into anecdotes that illustrate the problems and solutions we face. Otis might be a bit harsh on drug companies as he dislikes DTC for creating demand for drugs, but he deserves to be heard. Robert Ehrlich, chairman and chief executive of DTC Perspectives Inc., regularly reviews books about the pharmaceutical industry, marketing and advertising for DTC Perspectives Magazine. He also writes a weekly e-newsletter providing insights on pharmaceutical marketing trends. To subscribe to this FREE weekly analysis, sign up at the website, www.DTCPerspectives.com. Ehrlich can be reached by email at Bob@DTCPerspectives.com.

Experience Count$. Ehrlich

Consulting Services

If your drug or device brand is currently doing or considering DTC advertising ask Bob Ehrlich to help improve it. Bob Ehrlich has been involved in DTC for 17 years as a consultant, writer, and speaker. As CEO of DTC Perspectives, Bob has been a leader in the drug and device Industry. Prior to starting DTC Perspectives in 2000, Bob was responsible for the consumer launch of Lipitor in 1997. Bob will help make your new or existing DTC program more effective. He can help with pre-launch, at launch, or at any point in the DTC cycle. Services include agency selection, strategy development, copy development, market research planning, ROI targets, media selection, and digital and social media. Bob will personally work on all projects. No delegation to junior partners. You have only one chance to launch a DTC effort. Make sure you have the best advice.

Give Bob a call at 561-455-2394 or email him at bob@dtcperspectives.com

E ditorial

The Medicare Debacle Everyone loves Medicare – politicians, patients and providers. But in today’s society, it is no longer feasible nor fair to sustain the current program. With minimal sacrifices, common sense changes can be made to prevent the bubble from bursting.

ebacle might be too kind a word to describe the exploding Medicare bill. In 1965 when we had plenty of young folks to support the old folks, and medical treatment was priced modestly, there was no problem paying for the Medicare program. The average age of death was 70, so the Medicare program expected to pay for five years. There were no MRI’s, Angiograms, $100,000-a-treatment cancer drugs, and few expensive specialists. Turning to 2013, the average person lives to 78. That means Medicare will be expected to treat you for 13 years. There are all of those extraordinary and costly treatments available to keep you going longer. There are wonderful and expensive diagnostic tests to find whatever ails you. There are specialists for every part of your body willing to send you for any test imaginable. If you have a pain in the chest, expect a full battery of heart related tests all covered by Medicare. Politicians on both sides extol the virtues of Medicare. Everybody loves it. Patients have a wide choice of doctors and broad coverage. Providers like the certainty of payment and their ability to have most things covered. In fact, Medicare is a cash machine for them since their pockets are deep and they are not very astute as to what the doctors are asking them to cover. Medicare admin costs are touted as being so low compared to private insurers. This is because Medicare pays first and asks questions later. There is about 10% fraud in the system as shady providers game the system. So what can we do about a program that is so insidious, it will behave as a budget cancer eating up all discretionary funds the government takes in from the taxpayers? We hear both sides of the aisle say no one should get between the doctor and their patient. The senior lobby wants nothing touched in their Medicare. The people who are near Medicare age expect

46 | DTC Perspectives • Winter 2013

promises fulfilled and to have access to reasonable care like current seniors. The reality is we cannot expect those under 55 to give up all of their tax money to fund Medicare excess for current and near seniors. It is not feasible and not fair. We are robbing our kids and grandkids to give current seniors a program that is unsustainable. There are common sense changes that can be made which involve relatively minor sacrifices. First, the life expectancy must be taken into account. If we have gained eight years of added life, what is unfair about starting Medicare at age 67 or 68? Second, we need to end unlimited fee for service. Good care does not mean in all cases every diagnostic test available. Providers need to be incentivized not to use an elderly patient as a diagnostic cash machine. Third, we need to decide when end of life care is just too much to give. When someone else pays it is always nice to give grandma the full ride. The problem is that someone is us. Most of us will see the government spending $200,000 on a relative who is dying and has lost any quality of life. Finally, the fraud aspect needs to be swiftly addressed. Patients do not report fraud much because they are not expert at reading bills, or loathe questioning their provider, and frankly do not care much if someone else is paying. Here is where government needs to add fraud specialists and increase penalties for criminal behavior. Medicare is a great safety net that must be preserved in an affordable way. If we avoid the real issues, the bubble will burst and everyone on the program will face rapid and drastic restrictions. It is better to have a frank discussion now while minor pain is still an option with shared sacrifice pushed by both parties. President Obama must do this and perhaps he is the only one who can really reform Medicare. If he does, maybe he deserves another Nobel Prize for economics or medicine.

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