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THE SOURCE FOR DIRECT TO CONSUMER THOUGHT LEADERS

MAGAZINE Fall 2013

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

PATIENTS VS. CONSUMERS: MAKING THE MOST OF MARKETING DOLLARS

CHANGING CHANNELS: HOW ‘NEW TELEVISION’ ADAPTS TO CONSUMERS

DRUG BRANDING: BRAND NAMES VIA THE CONSUMER LENS

MEDICAL INFORMATICS

Investing in the physician-patient relationship will enhance dialogue, improving patient outcomes

November 6-7, 2013 Sofitel Philadelphia www.dtcperspectives.com

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

Fall 2013

4 Editor’s Desk 6,7 DTC in Brief

Industry Forum

8 Spending Review 10 Getting to the Point: Engaging Qualified Consumers at the

Point of Care A series from Crossix RxMarketMetrics

30

14 Making the Most of Marketing Dollars: Patients vs. Consumers CHRISTINE CUNNINGHAM AND DONNA KERNEY CORREIA OF PHREESIA

18 Investing in the Physician-Patient Relationship DAVID ORMESHER OF CLOSERLOOK

23 Changing Channels

The ‘Internet of Things’

CRAIG A. DOUGLASS OF DIGITAS HEALTH

26 Drug Branding Through the Eyes of the Consumer BRANNON CASHION OF ADDISON WHITNEY

30 Industry Forum: Biggest POC Influencers

Thought leaders from the POC space predict key forces of growth

32 People on the Move

34

An update on DTC personnel and company changes within the industry

33 Contributors’ Page A closer look at the contributors to this issue of DTC Perspectives Magazine

The Next Steps

33 Advertiser Index and Resource Center 34 Marketing on the Edge: The Thing of It Is…

Dan Chichester shares his astute views on the marketing industry

36 Eye on the Hill: Scripting the Next Scene in DTC Regulations Jim Davidson reports on the latest regulatory events & implications

38 Perspectives on Books: Do You Believe in Magic? Reviewed by Robert Ehrlich of DTC Perspectives, Inc.

40 DTC Perspectives Editorial: Being Fair About Obamacare

36 DTC Perspectives • Fall 2013 |

3


Change. It’s a Good Thing. I may have borrowed the latter half of that title from Martha Stewart’s famed expression, but change is a good thing. No really, it is. All too often we are afraid of change, afraid of the uncertain.

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

It is easier to stick with the “tried and true” or err on the side of caution, but where’s the fun in doing that 100% of the time? We shouldn’t let fear hold us back or dictate our decisions. Change revitalizes. Change inspires. Change innovates. Look at television. It may dominate DTC spending, largely due to its relevance and reach, but competing channels were gaining in importance as they innovated and spawned new levels

Robert Ehrlich Chairman and CEO DTC Perspectives, Inc.

of accountability and efficiencies. What was TV to do? Well adapt, of course. As Craig Douglass, Executive Creative Director at Digitas Health, noted in his article, aptly titled Changing Channels, TV

Jennifer Haug

“embraced the changes in technology and consumer habits driving the rise of ‘new media.’ … Given

Director of Publishing & Content

the choice (to paraphrase an ad from my youth) to fight or switch, television chose both. … Like consumers, the ‘new TV’ is more active, connected, ubiquitous and social. And the truly wonderful thing is that all of those attributes make it possible for us to help people better manage their health and wellness.” (See Craig’s article beginning on page 23.) Our industry is notorious for taking a “wait and see” approach. But let that be the old way of doing things. Work with your Med/Legal/Regulatory teams from the get-go, establish some ground rules that all groups are comfortable with, and figure out how to make it work for your brand and its patients. Dan Chichester also encourages marketers to embrace inventive changes in the latest installment of his column, Marketing on the Edge (see, The Thing of It Is… on page 34). In discussing the “Internet of Things,” the Chief Digital Officer of Ogilvy Healthworld stated, “As an emerging

Matt Yavorski Sales Director Scott Ehrlich President MDPA Division Amanda Lawhorne

movement, and one with such clear hooks into healthcare, it’s a critical and exciting time to become

Director of Marketing

aware – and take positions out ahead of what will certainly be considered ‘issues.’”

MCH Division

We all know not participating can hurt a brand more than being active, so why continue shying away? More guidances – both internal and federal – are arising. Use them to get your brand out there, where and how consumers want it. Whether it be information or support, branded or disease awareness, discover what voids exist and determine how you can be an active participant in filling them. Changes are going to happen with or without you. You might as well be a part of it so you can help steer things in the right direction.

Are You Dictating Change or Following It? Just as much as you want to know what your consumers want, we want to know what you want. Head on over to our website, www.dtcperspectives.com, and take our surveys to let us know what

John Woodbridge Director of Special Projects Carmen-Alyce Murray Conference & Sales Development Consultant Debra Sander Office Coordinator

you like or what changes you would find beneficial. We’ll be having a few of them in the fall as we continue our planning for 2014. We welcome the input!

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 • Fall 2013

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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I N

B R I E F

Millions Flock to Federal ACA website, Crashing Healthcare.gov on Launch Day Despite the government shutdown, the Obamacare website still launched as planned on Oct 1st. It is been long known that there would be a flood of newly-insured patients under the Affordable Care Act. However, what was not anticipated was the volume of interest to the federal website, Healthcare. gov, as it crashed on its launch day. Even though many are not in favor of the ACA (as of Oct 1st 55.8% of respondents oppose it according to Reuters/Ipsos polling), millions of individuals are still in need of insurance and sought information via Healthcare.gov, the health insurance marketplace. According to CBS News correspondent, Wyatt Andrews, the president stated that more than 1 million people had visited the main website by 7am. Approximately 2.8 million visitors overwhelmed the website, “[exceeding] even what we’ve seen in Medicare in any given day” explained David Simas, White House senior adviser. Thirtyfour states use the federal site, but even the state-run sites experienced delays and crashes. California alone saw 1.7 million visitors to its site within the first hour. While this clearly shows an intense interest among individuals, according to Andrews, there are no reports being issued as of yet as to how many people have enrolled. This is partially due to the fact “that officials won’t know until people sign a contract with an insurance company and make a down payment.” One thing that is certain? Pharma has a big opportunity to connect with this growing pool of potential patients.

FDA Issues Final Guidance On Mobile Medical Apps The FDA released its final guidance for Mobile Medical Applications in late September, which shared that the agency will be considering functionality instead of the platform utilized when exercising its authority. The FDA plans to focus its regulatory oversight on mobile apps that are “medical devices and whose functionality could pose a risk to a patient’s safety if the mobile app were to not function as intended.” Such apps are designated as “mobile medical apps.” The FDA will also exercise “enforcement discretion” over apps that may meet the definition of a medical device, but pose a lower risk to the public. The remaining category of apps – those that do not meet the definition of medical devices – will not be regulated by the FDA. The Digital Health Coalition (DHC) noted that this is “good news for developers concerned about limiting innovation” in reaction to the guidance. While acknowledging that the guidance still leaves some gray area, Marc Monseau, Managing Partner at the Mint Collective and member of the DHC Board of Directors, referred to it as “a positive development,” that will allow “projects that may have been on hold … [to] now begin.” Erik Hawkinson, VP, Global Health of Strategic Marketing at Roche and DHC Advisory Board Member, added that “Knowing where we can take [mobile medical apps] today and possibly tomorrow helps us move the process along more effectively when it comes to mobile app exploration; while never losing sight of the safety priority aspects for our patients and customers.” Robert Palmer, EVP, Managing Director of Juice Pharma Worldwide and DHC Advisory Board Member, applauded the government agency for taking an “enlightened approach” to the matter in his portion of the DHC statement. He added that while “the interpretations of the guidelines frequently err on the side of caution,” pharma has an opportunity to make a “concerted effort” to align marketing, regulatory and agency teams, establishing internal protocols and enhancing the overall process.

6 | DTC Perspectives • Fall 2013


I N

B R I E F

Improving Supply Chains Could Increase Access, Reduce Costs

Impact on Profit throughout the Value Chain 9-­‐11%  

Pharmaceu)cals  

Manufacturers  

The current healthcare supply chain “remains fragmented and incomplete, with weaknesses that put patients at risk, cost billions in value, and lessen the healthcare sector’s ability to take on the challenges it faces,” noted a recent McKinsey article. The authors, Thomas Ebel, Erik Larsen and Ketan Shah, recommended the healthcare industry draw from the experiences of other industries, such as fast-moving consumer goods (FMCG). In addition to cutting down lead times and creating efficiencies, an improved manufacturing system “also could give millions of people around the world access to safer and more affordable healthcare, reduce costs, and provide new revenue sources for manufacturers.” Acknowledging the difficulties that come with making such changes, Strengthening health care’s supply chain: A five-step plan shared a few capabilities that would positively impact both performance and the bottom line: better segmentation; greater agility; improved measurement; stronger alignment with global standards; and more collaboration across the healthcare value chain. With annual supply chain costs so high (approx. $230 billion for pharmaceuticals and $122 billion for devices, cited the article), “even minor efficiency gains could free up billions of dollars for investments elsewhere. In fact, if the sector adopted straightforward advances well established in other industries, we estimate that total costs (from the supply chain and external areas, such as patient care) could fall by $130 billion.” 10-­‐20%  

Medical  supplies  

9-­‐21%  

Medical  devices  

6-­‐11%  

Providers  

Retail/pharmacies  

Hospitals  

Innovative Marketing Could Work with Customer Groups More Best Practices, LLC set out to discover “how companies structure, staff and organize specialized marketing units to find, use and quickly incorporate innovative practices to improve marketing across key customer groups.” These customer groups – healthcare providers, patients, payers and key opinion leaders – face a litany of communications from various sources, leading marketers to turn to innovative tactics to effectively reach and engage with the end target. Results from their study found that more than three-quarters of the Innovation Units are housed under either the Marketing (48%) or Commercial Operations (28%) departments.

12-­‐21%  

Percentage of Companies Focusing On... 80%  

Healthcare  Professionals  

72%  

Consumers  

52%  

Hospitals  

48%  

Payers  

44%  

Advocacy  Groups  

Other  

8%  

These Innovation Units largely focus their efforts on healthcare professionals, with consumers ranking in second. This reveals “great opportunities to work with other customer segments, such as advocacy and payers organizations. (See related chart for more details.) Participants in the research for “Best Practices in Advancing Customer Marketing: Innovations in Engaging and Communicating with Health Care Providers, Patients, Payers and KOLs” consisted of 35 executives from 25 biopharmaceutical and medical device companies participated, including representatives from Boehringer Ingelheim, Bayer, Pfizer, EMD Serono, and Novartis, to name a few.

DTC Perspectives • Fall 2013 |

7


R E V I E W DTC Spending Stablizes in First Half One-Third of Top 20 Spenders Up Their Dollars by Over 50% Brand

Manufacturer

1H 2013

1H 2013

$ Change

% Change

Humira

AbbVie

$127,662,600

$107,044,300

$20,618,300

19.26%

Cialis

Lilly USA

$103,509,000

$106,212,900

-$2,703,900

-2.55%

Enbrel

Amgen / Pfizer

$98,106,600

$93,491,100

$4,615,500

4.94%

Lyrica

Pfizer

$94,363,800

$65,718,200

$28,645,600

43.59%

Cymbalta

Lilly USA

$92,626,100

$131,911,700

-$39,285,600

-29.78%

Viagra

Pfizer

$84,663,100

$42,198,900

$42,464,200

100.63%

Celebrex

Pfizer

$74,104,800

$63,686,500

$10,418,300

16.36%

Abilify

Otsuka America Pharmaceutical

$65,668,300

$80,467,100

-$14,798,800

-18.39%

Chantix

Pfizer

$47,402,800

$38,329,300

$9,073,500

23.67%

Restasis

Allergan

$45,054,400

$29,958,000

$15,096,400

50.39%

Advair

GlaxoSmithKline

$41,661,200

$49,962,100

-$8,300,900

-16.61%

Xarelto

Janssen Pharmaceuticals

$40,762,700

$1,687,800

$39,074,900

2315.14%

Androgel

AbbVie

$39,054,200

$24,991,000

$14,063,200

56.27%

Symbicort

AstraZeneca

$38,981,300

$37,974,800

$1,006,500

2.65%

Axiron

Lilly USA

$38,771,000

$15,939,800

$22,831,200

143.23%

Toviaz

Pfizer

$38,448,700

$607,600

$37,841,100

6227.96%

Orencia

Bristol-Myers Squibb

$38,042,400

$28,866,900

$9,175,500

31.79%

Prolia

Amgen

$36,672,400

$38,981,800

-$2,309,400

-5.92%

NovoLog

Novo Nordisk

$31,258,700

$35,264,300

-$4,005,600

-11.36%

Pristiq

Pfizer

$30,084,400

$26,128,400

$3,956,000

15.14%

Total Spending for Top 20 Brands

$1,206,898,500

$1,019,422,500

$187,476,000

18.39%

Total DTC Spending

$1,887,966,600

$1,872,780,000

$15,186,600

0.81%

TV Sees Modest Increase in Promotional Spending TV's Share Grows VYA, Comprising 59% of Market 2%

Media Type

10%

59% Television 29% Magazine Television  

10% Internet Magazine   Internet  

29%

59%

Newspaper  

2% Newspaper Radio  

1H 2013

1H 2012

$1,105,744,800

$1,065,809,400

$ Change $39,935,400

% Change 3.75%

$552,567,800

$553,170,100

-$602,300

-0.11%

$178,251,800

$180,747,300

-$2,495,500

-1.38%

$45,697,400

$62,396,600

-$16,699,200

-26.76%

$4,651,500

$8,935,000

-$4,283,500

-47.94%

$1,053,300

$1,721,400

-$668,100

-38.81%

$1,887,966,600

$1,872,780,000

$15,186,600

0.81%

Outdoor  

0% Radio

0% Outdoor Total Spending

Source: Kantar Media for DTC Perspectives, Copyright 2013. Established in more than 50 countries, Kantar Media helps clients master the world’s multimedia momentum through analysis of print, radio,TV, Internet, cinema, mobile, social media, and outdoor worldwide. Kantar Media offers a full range of media insights and audience measurement services through its global business sectors – Intelligence, Audiences, TGI and Custom. Kantar Media companies also include Compete, Cymfony and SRDS. Drawing upon the deepest expertise in the industry, Kantar Media tracks more than 3 million brands and delivers insight to more than 22,000 customers worldwide. www.KantarMediaNA.com.

8 | DTC Perspectives • Fall 2013


CROSSIX RXMARKETMETRICS™ SERIES

CROSSIX RxMARKETMETRICS: LEVERAGING POC

Getting to the Point

or tens of millions per campaign – the volume of incremental new patient starts generated by these campaigns can prove meaningful from a campaign ROI perspective.

Engaging Qualified Consumers

Chart 2: Net conversion to Rx rates through 3 months – compared to control – generated by branded Point of Care1 and Online Advertising2 campaigns

at the Point of Care

0.13%  

0.09%  

Point of care (POC) programs reach consumers at one of the key decision points in healthcare management. Research reveals the effectiveness of POC marketing efforts in reaching and engaging target audiences, as individuals are more receptive to information at this stage in their health continuum.

M

ass media DTC initiatives such as TV, print and online advertising continue to command the lion’s share of pharmaceutical brand marketing plans and budgets, primarily due to the larger reach and scale that these channels represent. These high-scale channels have traditionally been designed to drive brand awareness and reach the largest audiences possible – or that budgets will allow – in the hopes that by casting a wide net, the brand messages will resonate with the smaller, relevant portion of the overall audience exposed to these messages. And while new, innovative and privacy-safe ways for healthcare marketers to target specific audiences in these “reach” channels have emerged and will continue to evolve toward greater sophistication, brand marketers still apply quite a bit of guesswork with respect to understanding to what extent the exposed audience is qualified and the message is relevant. Point of care programs, however, remove much of this guesswork by enabling brand marketers to engage consumers directly at the point of care, as opposed to in front of their TV or laptop screens. Relative to those reached via mass media tactics, audiences exposed to brand messaging at the point of care are more captive, less distracted and have advanced further along the patient lifecycle – all of which should translate into greater receptiveness for brand messaging and a higher likelihood that this exposure will influence their conversation with their HCP and lead to an Rx fill for the brand in question. But is this indeed the case? Leveraging its Point of Care (POC) Impact ™ analytics solution, Crossix has measured the impact of multiple in-office marketing programs, across various condition categories and Rx brands. And the benchmarks gathered via these analyses – as illustrated in the following three charts – reveal that POC tactics are indeed effective in reaching qualified audiences with respect to the relevant Rx treatment profile and driving incremental new patient starts for the Rx brand in question.

10 | DTC Perspectives • Fall 2013

Moreover, compar ing POC prog ram perfor mance benchmarks to those culled from another reach media channel – in this case, online advertising campaigns measured by Crossix Digital Impact™ – yield provocative insights. As Chart 1 illustrates, POC and online campaigns are nearly equally effective in reaching qualified audiences, with respect to the exposed audiences’ Rx treatment behaviors for the condition categories and/or Rx brands promoted via the respective campaigns. Chart 1: With respect to Rx treatment behavior in relevant condition categories, how targeted are audiences exposed to branded POC campaigns1and online advertising campaigns2? Point  of  Care  (POC)  Campaigns  

2.2x  

General  Popula9on  of   Pharmacy-­‐Goers  

Online  Adver;sing  Campaigns  

across  various  condi4on  categories.  Analyses  performed  for  various  types  of  branded  POC  tac4cs  including  in-­‐office  TV,   publica4ons,  and  wallboards,  among  others.     2  Source:  Benchmark  conversion  data  aggregated  via  mul4ple  Crossix  Digital  Impact™  analyses  performed  for  various  Rx  brands   across  various  condi4on  categories.  Analyses  performed  for  branded  online  adver4sing  campaigns  across  both  endemic  and   lifestyle  publisher  sites.     Metric  Defini1on:  Metrics  displayed  reflect  the  benchmark  net  conversion-­‐to-­‐Rx  rate  through  3  months  post-­‐exposure  to  the   campaign  aggregated  across  the  respec4ve  Rx  brands  analyzed,  calculated  by  taking  the  conversion  rate  observed  among  the   audience  exposed  to  the  campaign  and  subtrac4ng  the  conversion  rate  observed  among  a  matched  control  group  not  exposed   to  the  campaign.      

Chart 3: Lift in Rx conversion rates through 3 months vs. control generated by branded Point of Care1 and Online Advertising2 campaigns 99%  

Online  Adver9sing  Campaigns  

2.4x  

more   targeted  

Exposed  to     POC  Campaign  

Point  of  Care  Campaigns  

1  Source:  Benchmark  conversion  data  aggregated  via  mul4ple  Crossix  POC  Impact™  analyses  performed  for  various  Rx  brands  

39%  

more   targeted  

Exposed  to     Online  Campaign  

General  Popula9on  of   Pharmacy-­‐Goers  

1  Source:  Benchmark  Rx  profile  data  aggregated  via  mul7ple  Crossix  POC  Impact™  analyses  performed  for  various  Rx  brands  across  various  condi7on  

categories.  Analyses  performed  for  various  types  of  branded  POC  tac7cs  including  in-­‐office  TV,  publica7ons,  and  wallboards,  among  others.     2  Source:  Benchmark  Rx  profile  data  aggregated  via  mul7ple  Crossix  Digital  Impact™  analyses  performed  for  various  Rx  brands  across  various  condi7on   categories.  Analyses  performed  for  branded  online  adver7sing  campaigns  across  both  endemic  and  lifestyle  publisher  sites.     Metric  Defini1on:  Metrics  displayed  are  index-­‐like  “targe7ng  mul7ples”  that  compare  (A)  the  Rx  treatment  rate  within  the  relevant  condi7ons  analyzed  in  the   18-­‐month  period  prior  to  campaign  exposure  among  the  audiences  exposed  to  the  respec7ve  campaigns  to  (B)  the  corresponding  treatment  rates  observed   within  the  general  U.S.  popula7on  of  pharmacy-­‐goers.  For  example,  a  targe7ng  mul7ple  of  2.5x  reflects  that  the  audience  exposed  to  the  campaign  is  2.5  7mes   more  targeted  for  the  relevant  condi7on  category  than  the  general  U.S.  popula7on  of  pharmacy-­‐goers.      

Charts 2 and 3 reveal that both POC and online efforts generate incremental conversion (e.g., new patient starts) for the brands in question, but in notably different ways. While POC initiatives drive a higher net conversion rate (compared to a matched control group) than online efforts, they drive a substantially lower lift in conversion rates vs. control than online campaigns. It is also worth noting that upon cursory glance, the net conversion rates for both POC and online advertising campaigns – 0.13% and 0.09% respectively – may seem lower than might be expected. However, when these rates are applied to large volumes of unique individuals exposed to these campaigns – which may often number in the millions

Point  of  Care  Campaigns  

Online  Adver5sing  Campaigns  

1  Source:  Benchmark  conversion  data  aggregated  via  mul4ple  Crossix  POC  Impact™  analyses  performed  for  various  Rx  brands   across  various  condi4on  categories.  Analyses  performed  for  various  types  of  branded  POC  tac4cs  including  in-­‐office  TV,   publica4ons,  and  wallboards,  among  others.     2  Source:  Benchmark  conversion  data  aggregated  via  mul4ple  Crossix  Digital  Impact™  analyses  performed  for  various  Rx  brands   across  various  condi4on  categories.  Analyses  performed  for  branded  online  adver4sing  campaigns  across  both  endemic  and   lifestyle  publisher  sites.     Metric  Defini1on:  Metrics  displayed  reflect  the  benchmark  li#  in  conversion-­‐to-­‐Rx  rate  through  3  months  post-­‐exposure  to  the   campaign  aggregated  across  the  respec4ve  Rx  brands  analyzed,  calculated  by  dividing  the  conversion  rate  observed  among  a   matched  control  group  (not  exposed  to  the  campaign)  by  the  net  conversion  rate  observed  when  comparing  the  conversion   rate  among  the  audience  exposed  to  the  campaign  to  the  conversion  rate  observed  among  the  control  group.    

The comparison of these key performance indicators – and in particular, the nuances between the POC and online conversion benchmarks – reinforce that while both channels are effective conversion drivers, the POC channel impacts a greater proportion of consumers who are further along the Rx decision-tree and the online channel impacts consumers that represent a broader spectrum of stages along the patient lifecycle. Ultimately, pharmaceutical brand marketers should feel confident in adopting patient-centric approaches to designing, measuring and optimizing POC initiatives, and benefiting from the combined impact of POC and other reach channels within their integrated marketing strategies. DTC About Crossix POC Impact ™: Crossix POC Impact is an actionable, accurate and patient-centric analytics solution for HCP and patient directed in-office programs using the Crossix proprietary consumer Rx data network. Leveraging a unique, HIPAA-compliant double-control methodology that connects the dots between both HCP and patient data, POC Impact enables consistent 360-degree measurement covering HCP, Point of Care (POC), pharmacy and consumer marketing, across various types of tactics. With POC Impact, brand marketers and POC solution providers alike can fully understand how effective their POC programs are with respect to the Rx treatment profile of the audience exposed, as well as the incremental impact of these programs on Rx conversion and adherence. About Crossix Digital Impact™: Crossix Digital Impact measures the impact of media spend across the Internet, including all health and non-health publishers, social networking sites and ad networks. Leveraging an innovative, HIPAA-compliant opt-in panel-based methodology that tracks the full impact of online media exposure – including the 99.9% of individuals who do not click on or engage with ads – Digital Impact offers the most accurate, comprehensive way to evaluate the quality of the audience exposed to online media and the lift in conversion-to-Rx driven by these campaigns. With Digital Impact, marketers can proactively optimize their campaigns through early indicators and predictive metrics – not just rearview measurement after the campaigns have ended. 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).

About Crossix As the only company founded and focused on a consumer-centric healthcare analytics approach, Crossix is the industry standard by which Top 10 Pharma companies and leading agencies & publishers plan, measure and optimize consumer marketing initiatives. Crossix offers the most complete cross-channel solutions, helping marketers by correlating campaign exposure to increased sales. Crossix quickly analyzes data, offers forward-looking strategic guidance, and follows through with recommendations to optimize. Leveraging trends in “Big Data,” and by partnering with some of most respected names in the industry, Crossix helps marketers get marketing messages to the desired audience. The Crossix patented methodology incorporates best-in-class privacy safeguards far exceeding HIPAA regulations. Founded in 2004 and headquartered in New York City, Crossix is a PoC3 affiliate member (www.poc3.org). To learn more, visit www.crossix.com DTC Perspectives • Fall 2013 |

11


CROSSIX RxMARKETMETRICS: LEVERAGING POC or tens of millions per campaign – the volume of incremental new patient starts generated by these campaigns can prove meaningful from a campaign ROI perspective. Chart 2: Net conversion to Rx rates through 3 months – compared to control – generated by branded Point of Care1 and Online Advertising2 campaigns 0.13%  

0.09%  

Point  of  Care  Campaigns  

Online  Adver;sing  Campaigns  

1  Source:  Benchmark  conversion  data  aggregated  via  mul4ple  Crossix  POC  Impact™  analyses  performed  for  various  Rx  brands  

across  various  condi4on  categories.  Analyses  performed  for  various  types  of  branded  POC  tac4cs  including  in-­‐office  TV,   publica4ons,  and  wallboards,  among  others.     2  Source:  Benchmark  conversion  data  aggregated  via  mul4ple  Crossix  Digital  Impact™  analyses  performed  for  various  Rx  brands   across  various  condi4on  categories.  Analyses  performed  for  branded  online  adver4sing  campaigns  across  both  endemic  and   lifestyle  publisher  sites.     Metric  Defini1on:  Metrics  displayed  reflect  the  benchmark  net  conversion-­‐to-­‐Rx  rate  through  3  months  post-­‐exposure  to  the   campaign  aggregated  across  the  respec4ve  Rx  brands  analyzed,  calculated  by  taking  the  conversion  rate  observed  among  the   audience  exposed  to  the  campaign  and  subtrac4ng  the  conversion  rate  observed  among  a  matched  control  group  not  exposed   to  the  campaign.      

Chart 3: Lift in Rx conversion rates through 3 months vs. control generated by branded Point of Care1 and Online Advertising2 campaigns 99%  

39%  

Point  of  Care  Campaigns  

Online  Adver5sing  Campaigns  

1  Source:  Benchmark  conversion  data  aggregated  via  mul4ple  Crossix  POC  Impact™  analyses  performed  for  various  Rx  brands   across  various  condi4on  categories.  Analyses  performed  for  various  types  of  branded  POC  tac4cs  including  in-­‐office  TV,   publica4ons,  and  wallboards,  among  others.     2  Source:  Benchmark  conversion  data  aggregated  via  mul4ple  Crossix  Digital  Impact™  analyses  performed  for  various  Rx  brands   across  various  condi4on  categories.  Analyses  performed  for  branded  online  adver4sing  campaigns  across  both  endemic  and   lifestyle  publisher  sites.     Metric  Defini1on:  Metrics  displayed  reflect  the  benchmark  li#  in  conversion-­‐to-­‐Rx  rate  through  3  months  post-­‐exposure  to  the   campaign  aggregated  across  the  respec4ve  Rx  brands  analyzed,  calculated  by  dividing  the  conversion  rate  observed  among  a   matched  control  group  (not  exposed  to  the  campaign)  by  the  net  conversion  rate  observed  when  comparing  the  conversion   rate  among  the  audience  exposed  to  the  campaign  to  the  conversion  rate  observed  among  the  control  group.    

The comparison of these key performance indicators – and in particular, the nuances between the POC and online conversion benchmarks – reinforce that while both channels are effective conversion drivers, the POC channel impacts a greater proportion of consumers who are further along the Rx decision-tree and the online channel impacts consumers that represent a broader spectrum of stages along the patient lifecycle. Ultimately, pharmaceutical brand marketers should feel confident in adopting patient-centric approaches to designing, measuring and optimizing POC initiatives, and benefiting from the combined impact of POC and other reach channels within their integrated marketing strategies. DTC About Crossix POC Impact ™: Crossix POC Impact is an actionable, accurate and patient-centric analytics solution for HCP and patient directed in-office programs using the Crossix proprietary consumer Rx data network. Leveraging a unique, HIPAA-compliant double-control methodology that connects the dots between both HCP and patient data, POC Impact enables consistent 360-degree measurement covering HCP, Point of Care (POC), pharmacy and consumer marketing, across various types of tactics. With POC Impact, brand marketers and POC solution providers alike can fully understand how effective their POC programs are with respect to the Rx treatment profile of the audience exposed, as well as the incremental impact of these programs on Rx conversion and adherence. About Crossix Digital Impact™: Crossix Digital Impact measures the impact of media spend across the Internet, including all health and non-health publishers, social networking sites and ad networks. Leveraging an innovative, HIPAA-compliant opt-in panel-based methodology that tracks the full impact of online media exposure – including the 99.9% of individuals who do not click on or engage with ads – Digital Impact offers the most accurate, comprehensive way to evaluate the quality of the audience exposed to online media and the lift in conversion-to-Rx driven by these campaigns. With Digital Impact, marketers can proactively optimize their campaigns through early indicators and predictive metrics – not just rearview measurement after the campaigns have ended. 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).

About Crossix As the only company founded and focused on a consumer-centric healthcare analytics approach, Crossix is the industry standard by which Top 10 Pharma companies and leading agencies & publishers plan, measure and optimize consumer marketing initiatives. Crossix offers the most complete cross-channel solutions, helping marketers by correlating campaign exposure to increased sales. Crossix quickly analyzes data, offers forward-looking strategic guidance, and follows through with recommendations to optimize. Leveraging trends in “Big Data,” and by partnering with some of most respected names in the industry, Crossix helps marketers get marketing messages to the desired audience. The Crossix patented methodology incorporates best-in-class privacy safeguards far exceeding HIPAA regulations. Founded in 2004 and headquartered in New York City, Crossix is a PoC3 affiliate member (www.poc3.org). To learn more, visit www.crossix.com DTC Perspectives • Fall 2013 |

11


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The Impact of New Regulations: How ACA and ACO Changes Patient Marketing Why Personalized Medicine is Poised to Fuel Growth in Point of Care The New World of Provider Integration via Digitization Point of Care Media Optimization – An Evolving Channel Next Generation Point of Care Measurement Effectively Communicating at the ‘Moment of Truth’ Bridging the Conversational Gaps at the Point of Care

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Eileen Regan Associate Brand Manager, Tradjenta, Lilly

Whit Rawlinson

Jennifer Greufe

Frank Chipman

Jill Strickman

Ketki Gupte

Vice President, LRW (Lieberman Research Worldwide)

Associate Director Marketing, Tradjenta, Boehringer Ingelheim

President of Strickman-Ripps Real People Casting + Research

Dr. Keith Batchelder Founder & CEO, Genomic Healthcare Strategies

Director, Target:Health

Manager, Linguistics and Analytics, Verilogue


Making the Most of Marketing Dollars: Patients versus Consumers

There is greater value – and better return for your marketing spend – if the messages reach potential users of the product. Add the right setting and you theoretically have an ideal mix of the right patient at the right place at the right time seeing a relevant message. By Christine Cunningham & Donna Kerney Correia

T

he ultimate goal of pharmaceutical marketing is to increase condition awareness and treatment within the brand’s target audience. While specific tactics around marketing campaigns can vary, there are three necessary components: target audience reach, message delivery and impact measurement. There are two key target audiences in the healthcare market: patients and prescribers. Both audiences need to be educated on the product and key condition triggers. For example, the asthma patient who has increased nighttime awakenings, a decreased ability to exercise and general fatigue needs to be aware that these are key symptoms of poor asthma control that need to be discussed with the physician so that products for improved treatment can be discussed. Prescribers have become increasingly more difficult to access, and the need to bridge the asymmetry of knowledge between these two constituencies has become more important as patients take on a greater burden of the cost of care.1 How can pharmaceutical marketers take advantage of the new healthcare consumerism and seize this unprecedented opportunity to encourage patients to take active roles in their care? The answer is by identifying patients, rather than general

14 | DTC Perspectives • Fall 2013

consumers, that have a medical condition that is most aligned with the benefits of the pharmaceutical products.

Just the facts Did you know that 85% of adults in the US, or more than 200 million people, say that they have seen or heard a “healthcare” advertisement for an OTC product or a directto-consumer prescription drug ad over the past 12 months?2 The question pharmaceutical marketers must ask themselves is, does this form of mass consumer message delivery really work? Is the message getting seen and heard by the right people? What is the impact of that ad on consumer behavior? And am I wasting valuable dollars by potentially messaging the wrong consumers? Health decisions are made at the point of care, but that is not to say that both prior to and following that interaction, health decisions are not being contemplated. With the explosion of health-related websites and the widespread use of the Internet for information gathering about diseases, symptoms, and treatment options, it is not a stretch to see how patients can become overwhelmed and confused. While pharmaceutical marketers are wise to take advantage of these channel tactics, they should consider leveraging other technology platforms to add greater specificity to their patient


POINT OF CARE MESSAGING

marketing strategy. Messaging to patients within the context of their visit to their doctor has proven to be a highly effective method of communicating a valued message.

Consider a 360° approach A 360° approach should engage patients with consistent information as their medical needs change. The key areas are before the visit, at check-in, in the exam room and post visit follow-up. When delivering health messages using scientifically-based information, the relevance of the message becomes essential to its success. Giving patients information that provides condition-specific value is essential if the expectation is that patients will incorporate the information into an actionable plan. At the University of Rhode Island, James Prochaska and colleagues developed a transtheoretical model for change that can inform your desire to engage patients.3 There are five states of change: 1. Pre-Contemplation: Resisting Change 2. Contemplation: Change is on the Horizon 3. Preparation/Determination: Getting Ready 4. Action/Willpower: Taking Steps Required for Change 5. Maintenance: Sticking with it • Termination/Relapse: Self-Efficacy or Relapse A patient can be at any stage when they present at the office, but overall they are most open to receiving actionable information because they are in the healthcare moment seeking care. Point of care messaging mitigates recall bias as there is little time between the receipt of the information and the interaction with the doctor. If the information is relevant and available while the patient is in the doctor’s office, a more meaningful and productive conversation can be had. Add to that, the potential for patients to receive digital communications from their physician between office visits and this keeps patients engaged in their care, keeps their health top-of-mind, and reminds patients that the doctor is there as a resource. Patients who opt-in to receive messaging during the check-in process are motivated to learn more and take action. Arming patients with the knowledge they need to engage in a meaningful dialogue with their physicians can optimize the increasingly shorter office visits. Empowerment of patients today is everyone’s business. Patients are taking a much more active role in the management of their health conditions and we as marketers can help! Marketing ads can be used to educate patients and the spillover effect from this education lasts well beyond the actual receipt of the message. Following are some specific tactics that demonstrate this approach.

The finer points Individualized Patient Messages at the Physician’s Office: In a recent nationwide marketing campaign, 90,000 men with

a very sensitive health condition received a targeted, point of care message during check-in at their physicians’ offices. Seven out of 10 of those men reported that they were likely to talk to their doctor about their condition and a staggering 81% of those same men said that they had learned new information from the messaging. 71% said that they found the information helpful.

Giving patients information that provides condition-specific value is essential if the expectation is that patients will incorporate the information into an actionable plan. The positive feedback from patients lends support to the value of delivering a relevant message during check-in, prior to the visit with the physician. The impact is further documented through results of a patient conversion analysis, looking at actual Rx data for the product being marketed. The results showed that those men who saw the message at check-in converted to the product at a rate of over five times higher than that of a matched group of men who did not see the message. Imagine if all of your messaging had this kind of impact. Patient Messages from the Physician Outside the Medical Practice: Another approach that can complement and reiterate the messaging in the office is the use of digital communications sent directly to patients from their physician. A physician-approved program delivered by Phreesia disseminates one-to-one communications to patients directly from their own physicians. The communication includes information, including disease state data and treatment options, targeted to the patient’s condition. These communications have been very effective. In a recent dissemination, patients received a communication about hypertension and a branded treatment option. Analysis of its impact revealed that patients open the communication and click though to both articles and advertisements. Since the content is relevant to the patient, the open rate is quite high at 36%. Patients are also reviewing the content as demonstrated by a 20% click through rate. When asked about the value of the communication, 71% of patients said the information was helpful and 84% indicated they would like to receive these communications monthly. In addition to delivering patients relevant and important information, the digital communications are also impacting the bottom line for the advertised brand. Analysis from an independent third-party showed that patients exposed to the branded advertisement converted to brand three times more than the control group. Patients who were already on therapy filled nearly 5% more scripts for the brand than a matched DTC Perspectives • Fall 2013 |

15


POINT OF CARE MESSAGING

group of patients who did not see the communication. All of this impact comes from a targeted communication outside the medical office.

In summary Patients can be a brand’s best resource. They are the end users of these products and arguably the closest marketers can get to physicians when they can’t reach the prescribers directly. Marketers should continue to develop targeted point of care messages that include a call to action for the patient at check-in, as well as consistent communications when they are outside the physician’s office. The messages need to be relevant, consistent, informative and clearly communicated. In the new age of accountable care and higher patient responsibility, physicians are struggling to find ways to manage chronic conditions, improve patient outcomes and reduce the overall cost of healthcare, while at the same time, give patients the tools and knowledge they need to take responsibility. Knowledge is power. If patients are educated about their symptoms, conditions, treatment options and the importance of compliance with their regimens, they are more likely to have better, more productive conversations with their doctors – and ultimately better care. DTC References Centers for Medicare and Medicaid, National Health Expenditure Projections, 2006-2021 2 http://beyondthepill.medivo.com/2013/06/point-of-care-a-marketingchannel-set-for-takeoff-as-more-people-become-insured/ 3 Prochaska, J. O., DiClemente, C. C., & Norcross, J. C. (1992). In search of how people change: Applications to addictive behavior. American Psychologist, 47, 1

1102-1114.

Christine Cunningham RNC, NNP, was trained as a Nurse Practitioner in Neonatal Medicine at Georgetown University. Since leaving patient care, she has seven years’ experience in healthcare and pharmaceutical marketing. Her expertise has been on patient survey and interview creation, patient education and the overall facilitation of the patient/physician relationship. In her current role at Phreesia as the Medical Science Liaison, she is responsible for all of the clinical applications on the platform including identifying health surveys, screenings and scales appropriate to administer during patient check-in, aligning physicians with meaningful use and other quality healthcare initiatives. She can be reached at ccunningham@phreesia.com or followed on Twitter @phreesia. Donna Kerney Correia, PhD, earned a PhD in Health Services Research from The Pennsylvania State University and has over 15 years of experience with analytics in the healthcare and pharmaceutical industries. Her expertise focuses on survey design, market research, business intelligence and ROI modeling. She also earned a BS from the University of Notre Dame and an MS from the University of Maryland. In her current role as Director of Analytics at Phreesia, she is responsible for leading all of the measurement solutions associated with Phreesia campaigns. She can be reached at dcorreia@phreesia. com or followed on Twitter @phreesia.

16 | DTC Perspectives • Fall 2013

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Investing in the Physician-Patient Relationship Pharmaceutical marketers can improve patient outcomes as well as their own reputation by helping to enhance the dialogue patients have with their HCPs via several important intervention points. By utilizing personalized technology, marketers can provide a more productive and efficient conversation at the point of care. By David Ormesher

F

or years pharma has wrestled with the question of how to engage with physicians more effectively. Answering that question requires that a more fundamental question be answered first: what do physicians really need and is this something that pharma can provide? Broadly, healthcare professionals (HCPs) want their patients to be as healthy and satisfied with their care as possible. More specifically, at the point of care HCPs want more productive, informed, efficient and pleasant interactions with their patients. The factors conspiring against this ideal have been well documented. Patients aren’t always very articulate about their symptoms, don’t always take their medications as prescribed and struggle to follow the diet and lifestyle recommendations their HCPs make. On the other hand, physicians have less time and attention to give to patients, feel less confident that their prescribed solutions will be appropriately followed and have less autonomy when it comes to making treatment decisions due to changes in the payer environment.

18 | DTC Perspectives • Fall 2013

If there is an overarching physician need, it’s related to enhancing the physician-patient relationship by helping doctors be more efficient and patients be more aware. If pharma wants to engage with physicians more effectively, this is a good place to start. It would be naïve to think there’s a single silver bullet solution to address these challenges. However, advancements in the development and application of technology provide opportunities to significantly improve the relationship between physicians and their patients. And because HCPs and patients generally don’t have the expertise or resources to implement these new technologies, an opportunity exists for outside experts. Successful enablers of better physician-patient relationships stand to gain the goodwill, business and loyalty of both patients and physicians. For decades, pharma has done much to contribute to the health and wellbeing of patients. But today much of what ails individuals – and therefore vexes HCPs – can’t be addressed solely with a pill, injection, device or procedure. The needs


M E D I C A L I N F O R M AT I C S are broader, and the individuals and companies leading the way towards improved point-of-care experience are coming from all corners of the healthcare industry – and from outside as well, not just from the traditional biopharma and medical device companies. Can pharma play a role in this new world? If so, pharma leadership needs to start with a better understanding of the role of these innovators in enhancing the physician-patient relationship and then determine how and where it can contribute.

Saving everyone’s precious time Dr. Lyle Berkowitz: Dr. Lyle Berkowitz is a wired physician at Northwestern Memorial Hospital who has been recognized for his leadership in medical informatics by the Mayo Clinic, Healthspottr and HealthLeaders Magazine. “We don’t have a shortage of physicians,” Dr. Berkowitz said. “We have a shortage of physicians’ time.” Dr. Berkowitz has been writing for years about the relationship between the practice of medicine and the advancement of technology. Innovation with Information Technologies in Healthcare, published in 2012 and co-edited by Dr. Berkowitz, highlights real life cases in which technology has been applied to improve quality, efficiency, financial health and patients’ experiences in today’s healthcare system. In addition to studying and writing about healthcare and technology, Dr. Berkowitz has led the creation of technological solutions that positively affect the point-of-care experience. For example, recognizing that the refill process can be an excruciatingly annoying one for physicians, office staff and patients alike, Dr. Berkowitz and his colleagues at healthfinch1 created RefillWizard, a software tool to simplify the prescription refill process. Physicians appreciate that the reduction in their refill workload allows them to get back to focusing on patient care.

Uncovering clues in chronic symptoms Tummy Trends: One mobile app designed to help patients and their HCPs better identify patterns in their symptoms, daily activities and treatments is called Tummy Trends2 (created by Takeda Pharmaceuticals U.S.A., Inc.). It’s focused on the symptoms and activities typically related to irritable bowel syndrome and constipation. Tummy Trends is free to download at the iTunes App Store, easy to use, confidential and meant to help people with gastrointestinal conditions rather than to promote a particular product. Lina Nudera, Associate Director at Takeda Pharmaceuticals U.S.A., Inc., explains how they saw the opportunity. “It can be difficult and often embarrassing to talk to your physician about these [gastrointestinal] conditions. The previous tools were paper-based – inconvenient to carry around, easy to forget

when you have an appointment and not as private as patients would prefer. It became clear that a mobile app could solve these problems and help benefit patients.” T h e a d va n t a g e s f o r t h e patient include the ease of use in tracking and observing trends with such things as bowel movements, symptoms, treatments, diet and other relevant f actor s. Fo r the physician, there’s self-reported data about severity, symptoms and timing, with the added ability for patients to send their data to their physicians in an The Tummy Trends app on the iPhone email report, making face-toface appointment time more efficient and meaningful. Most important, it’s successful. There have been thousands of downloads, enabling Takeda to develop closer ties to HCPs by helping them to enrich their physician-patient relationship. And researchers at Medical Economics included Tummy Trends in their latest list of top 10 apps physicians recommend to their patients.

Alerting patients & HCPs to life-threatening events VGBio: Solutions that allow patients to contact emergency staff and request help in the case of a critical health event have existed for years. VGBio 3 is taking the critical alert paradigm from a reactive mode to a proactive one. Its remote patient monitoring system is based on applying predictive analytics to data being collected about the patient, so it can detect a worsening condition before it results in an avoidable hospitalization. According to VGBio CEO Gary Conkright, “Clinicians car ing f o r t h e c h ro n i c a l l y ill believe they could prevent most 30-day readmission if they had a few days warning of an exacerbation that will ultimately lead to an acute hospitalization. A screen shot from the VGBio Using predictive analytics on a personalized basis, versus a population ‘big data’ view, provides the sensitivity and specificity needed to provide real clinical value.” A wearable sensor tracks vital signs in congestive heart failure (CHF) patients and transmits the data via smart phone DTC Perspectives • Fall 2013 |

19


M E D I C A L I N F O R M AT I C S to VGBio’s data center, where predictive analytical tools identify abnormalities. Those patients who veer from their own “normal” baseline are flagged and healthcare staff is alerted. Early detection of an exacerbation is not only useful information to the clinician but the patient as well. Providing a feedback loop to the patient that links a non-compliance incident, like not taking a medication, to a worsening condition is a powerful tool for reinforcing clinically helpful behavior. CHF sends more than one million patients to the hospital annually, one quarter of whom will return within 30 days. In addition to the stress on clinicians and the distress patients and their loved ones experience as a result of these hospitalizations, the costs associated with these admissions total in excess of $12 billion. VGBio believes its system will reduce the number of acute hospitalizations – and the financial impact they have – significantly.

About the Interviewees Dr. Lyle Berkowitz is the Associate Chief Medical Officer of Innovation for Northwestern Memorial Hospital, Founder and Director of the Szollosi Healthcare Innovation Program (SHIP), President of Back 9 Healthcare Consulting and the Founder and Chairman of healthfinch, a healthcare software company making “Doctor Happiness Tools.” In 2008, HealthLeaders Magazine named Dr. Berkowitz one of the nation’s top "individuals who are making a difference in today’s complex healthcare world.” In 2009, Healthspottr chose him as one of the “Future Health Top 100.” In 2010, his “Change Doctor” blog was voted one of the “Top 50 Healthcare IT Blogs,” and he was a winner of the Mayo Clinic’s Center for Innovation’s iSpot Competition for “Ideas that Will Transform Healthcare.” In 2011 and 2012, he was named one of the Top 25 Clinical Informaticians in the country by Modern Healthcare magazine.

L i n a N u d e r a i s A s s o c i a t e D i re c t o r a t Ta k e d a

Making behavior change more fashionable Misfit Wearables: Sonny Vu has a background in the healthcare industry (he developed the first glucose meter for the iPhone®), but his new company, Misfit Wearables4, is as much about fashion as it is about health. Misfit offers a wireless biometric fitness device called Shine. It’s wearable in the sense that it looks like a cool accessory, but it’s also a tool that tracks sleep, exercise and other metrics. Shine links to the iPhone and has a battery life up to six months. Vu s e e s t h e technology as the easy part. “There are lots of sensors out there. But how do you get people to u s e t h e m ? We focused on three factors that would improve The Shine wearable biometric device t h e d e s i r a b i l i t y. We made the design timeless, not trendy. The price point, at $99, is affordable. And the longer battery life of up to six months adds to the appeal.” Although the first iteration is just for personal use, Vu and the staff at Misfit Wearables see many kinds of applications in the future, including tracking chronic care patients, measuring employee productivity and earning discounts on health insurance. The product is evidence of what he calls the “consumer era of healthcare.”

Pulling it all together From a traditional pharma perspective, these technology solutions are clearly innovative and intellectually interesting, but largely ir relevant. They are not connected to the complexity or business model of getting a molecule to market.

20 | DTC Perspectives • Fall 2013

Pharmaceuticals U.S.A., Inc. She recently earned the Trailblazer Brand Champion award in the gastrointestinal category from PM360 magazine. At Takeda, Nudera has driven all aspects of brand management, including strategic planning, direct and indirect physician promotion, KOL/thought leader development and patient support and promotion. She has developed and implemented strategies utilizing both online and offline tactics and has significant experience with in-pharmacy and in-office programs and developing disease education and branded/promotional programs. Nudera has extensive knowledge of diabetes, metabolic disorders, cardiovascular and gastroenterologyrelated disease states.

Sonny X. Vu is Founder of Misfit Wearables, makers of highly wearable computing products, including Shine, an elegant activity monitor (Red Dot and A’ Design Awards). Vu also founded AgaMatrix, makers of the world’s first iPhone-connected hardware medical device (Red Dot and Good Design Awards), and built it from a two-person start-up to shipping 15+ FDA-cleared medical device products, 1B+ biosensors, and 3M+ glucose meters for diabetics. He worked at Microsoft Research on machine learning/linguistic technologies. He studied math at UIUC and linguistics (PhD) under Noam Chomsky at MIT. Vu knows a number of languages and is a patron of good product design. He believes an era of wearable computing is coming soon where user experience design will be geared towards glanceable displays and non-visual modalities.

Gary Conkright is CEO of VGBio, which brings advanced predictive analytics technology to the healthcare industry to enable personalized and proactive heath management. VGBio believes that society’s capacity to accumulate and aggregate data has greatly surpassed its ability to make sense of it all. Its solution is to use “machine learning” or “smart” software technology to reduce the data into the clinically significant and actionable intelligence the healthcare industry needs to produce better outcomes at a reduced cost. Leveraging their success in the industrial equipment health monitoring industry, they intend to have the same impact in healthcare.


M E D I C A L I N F O R M AT I C S And that’s the important distinction. In the traditional pharma business model, the center of the universe is developing and selling a product.

This offers an opportunity for pharma to demonstrate a material commitment to holistically addressing its customers’ needs. A customer-centric perspective, however, focuses on, well, the customer. The brand that becomes an expert in discovering what pharma’s most important customer – the physician – needs and wants, and then turns around and helps meet that need, will have built itself a valuable foundation for a long-term relationship. And this is why technology that enhances the physician-patient relationship is relevant. This offers an opportunity for pharma to demonstrate a material commitment to holistically addressing its customers’ needs. It’s important to reiterate that most of the newest technology-based healthcare solutions have not been developed by pharma. Most came from entrepreneurs trying to solve a healthcare problem, usually centered on physician efficiency or patient quality of life. And yet, no one is in a better position to know and understand the needs and challenges of physicians and their relationships with their

patients than phar ma. With this knowledge comes the opportunity to introduce relevant, valuable technologies to strengthen the relationship. Physicians understand that pharma is principally in the business of inventing and selling pharmaceutical products, but they are beginning to expect more from their relationship with pharma. The way for pharma to earn the respect and loyalty of physicians is by helping them address their own fundamental concern: the physician-patient relationship. By focusing on the needs of physicians and patients, and exploring ways to use technology to support that relationship, pharma will find the answer to its own need for better physician engagement. DTC CEO David Ormesher provides leadership and direction for closerlook, inc., a digital marketing agency serving the pharmaceutical industry. As founder and CEO, Ormesher has taken closerlook from a small, creative media boutique and grown it into a recognized leader in creating innovative relationship-marketing solutions that help pharmaceutical brands build and maintain meaningful relationships with their most valuable HCPs. He can be contacted by email at dormesher@closerlook.com or on Twitter @ormshr. References www.healthfinch.com bit.ly/tummy-trends-constipation 3 www.vgbio.com 4 http://misfitwearables.com 1

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Changing Channels

As emerging media channels gained in popularity, television has found ways to revitalize itself and thrive in a marketplace with greater consumer expectations. By embracing technological advancements, television can provide deeper levels of consumer engagement and interaction than ever before, which can be utilized by healthcare marketers to connect with and educate patients. By Craig A. Douglass “It is not the strongest of the species that survives, nor the most intelligent, but the one most responsive to change.” – Charles Darwin

T

his is a story about survival (and paella, but mostly, survival). It’s a story of how the television industry, seeing its days of media dominance were numbered, embraced the changes in technology and consumer habits driving the rise of “new media.” It’s a story of how openness, innovation and adaptability (not Breaking Amish) are ensuring television’s continuing relevance. It’s also a story of how this “new television” can help people better manage their health.

Adapt or die Given the choice (to paraphrase an ad from my youth) to fight or switch, television chose both. What was once a closed, proprietary environment is becoming an open-source culture, welcoming ideas from manufacturers of hardware, application and platform developers, as well as advertisers and their agencies.

Television has become adaptable and innovative: if viewers insist on time shifting, TV says, “No problem. We’ll give you a built-in VCR and on-demand channels you can watch whenever you want,” with ads that can’t be disabled and interactive features that deepen viewers’ relationship with advertisers and programming. If viewers want to watch programs on their laptops, tablets, or phones, TV says, “Have it your way. We’ll give you Hulu and Crackle so you can watch wherever you want.” Like consumers, the “new TV” is more active, connected, ubiquitous and social. And the truly wonderful thing is that all of those attributes make it possible for us to help people better manage their health and wellness.

The new TV is active Here’s the paella part of the story – and it’s a true story. My favorite team is knocked out of the playoffs. It’s crushing, and I DTC Perspectives • Fall 2013 |

23


INTERACTIVE TELEVISION seek solace in mindless channel surfing. I land on Rick Bayless (Mexico – One Plate at a Time) cooking up paella in his backyard. Within seconds, I’ve got my laptop and I’m buying a 22” paella pan and burner. (Don’t you love a happy ending?) This story is several years old, so now, the link between what I see on TV and a resulting action is even faster and more frequent (although my team is still capable of breaking my heart). Shazam Entertainment is just one company providing viewers of TV commercials with additional content, instantly, through their smartphones and tablets. Nearly half the commercials that aired during Super Bowl XLVI in 2012 were Shazam-enabled, providing viewers who downloaded the Shazam-for-TV app the opportunity to receive offers, enter sweepstakes, vote in polls, or share comments on Facebook and Twitter. How can healthcare marketers take advantage of the instant gratification provided by the second screen? During the heart of the 2012 flu season, viewers saw a Shazam icon pop up during a TV spot for Fluzone influenza vaccine. Those who engaged their smartphone app could use a locator tool to find the nearest pharmacy offering the vaccine.

The new TV is connected It was only a matter of time until our televisions joined the “Internet of things.” Where once, our analog TVs might be plugged into a VCR, then a DVD player, our HD smart TVs can now be networked to a vast array of cable boxes, gaming consoles, and streaming devices. These devices give consumers even more choice – and even more power – to move from passive viewer to active learner, seeker, buyer, reviewer, and more.

And the truly wonderful thing is that all of those attributes make it possible for us to help people better manage their health and wellness. To cite just one example, you can watch the HBO series Game of Thrones on your Xbox, while you access interactive maps and character guides on your tablet or smartphone. But how do we enlist the Xbox to improve people’s health? Imagine a teenager, who’s had type 1 diabetes as long as he can remember, is browsing through Xbox LIVE’s marketplace looking for something cool. A short video clip featuring Jay Cutler catches his attention, so he drives to the branded destination for the full video. There, he watches several inspiring stories of professional athletes living with type 1 diabetes. While he’s there, he takes a quiz and plays a game, which reinforces the importance of blood glucose control, before heading out for soccer practice.

24 | DTC Perspectives • Fall 2013

The new TV is social Like virtually everything else involving the human species, TV has always been social. We gathered in front of the set to share transformative experiences, both good (the first moon landing) and bad (the devastation of Katrina). Around the water cooler, we speculated about who shot JR and pondered the final episode of The Sopranos. And now, we vote with our cellphones for our favorite American idols and dancing stars.

By opening itself up to partner with other stakeholders, TV has innovated new revenue streams and ways to deliver deeper engagement with content. Today, platforms like YuMe and Viggle enable connected consumers to engage more deeply with brands – and each other – across multiple screens. On Viggle, a kind of Foursquare for TV viewers, a 30-something checks in to New Girl, earning points she can redeem for real rewards from Starbucks, Barnes & Noble and other retailers. After watching Winston and Nick sabotage Elaine’s wedding, she learns she has enough points for her favorite facial cleanser and lotion. Before leaving, she shares her thoughts on the episode on TV Chat, and shares her skin-care score with her Facebook friends. Now imagine that same viewer is watching the new Michael J. Fox sitcom on NBC. Her Viggle app automatically starts adding up reward points she can redeem at a special Parkinson’s Store on Amazon.com – which is great, because her dad was just diagnosed with PD. While watching the show, she chats with friends in her local Parkinson’s community, who have formed a team for the upcoming Moving Day Walk. Before logging out, she clicks on a link for information about a clinical trial on statins and PD, and shares it with her dad via email. All of the pieces of this scenario are in place, now, if we choose to use them.

The new TV is ubiquitous I’m old enough to remember when the typical American family had a single screen in the house. It was usually a console TV located in the living room or den. Fast forward to today. Where isn’t there a screen? We can and do watch TV any and everywhere. Every device with a screen is there for our viewing pleasure, ever ready to offer up a TV-like experience. One of the sexiest examples of multiscreen marketing is for American Express. Viewers with smart TVs can access several AmEx apps, including a travel app with the latest rewards program offers, and one for the brand’s Unstaged concert series, a 4-year partnership with VEVO (a web-based premium music video service) and YouTube. Each concert, held at famous venues around the world, pairs an artist (Alicia Keys, Kenny Chesney, Coldplay) with directors like Jonathan


INTERACTIVE TELEVISION Demme and Steve Buscemi. The event is live-streamed on the artist’s dedicated VEVO page on YouTube, while video clips of the performance and backstage goings-on are available on YouTube, Twitter, and Xbox Live. Performers are featured in TV and online ads, and viewers can chat during the concert on Facebook and Twitter. During the livestream, viewers can switch camera angles and collaborate online with the artists in creative ways. Multiscreen viewing has implications for healthcare brands, as well. Imagine a mom decides to re-watch a past episode of Law and Order: SVU. Why watch on the laptop, when she has a big flat screen TV with a streaming device? Before entering Hulu Plus, she pauses the Renee & Jeremy station she’s playing on Pandora for her toddler. She clues in to an audio commercial for a prescription lotion that treats head lice, Googles the brand, and downloads a co-pay card from the product website.

for healthcare brands to engage more deeply, and more

Staying relevant in the future

marketing playbook built for our people-centric world, Craig has

TV has learned to survive and thrive by adapting to changing technology and the new consumer habits it drives. By opening itself up to partner with other stakeholders, TV has innovated new revenue streams and ways to deliver deeper engagement with content. This active, connected, social, multiscreen world has created tremendous opportunities

helped clients find new ways to forge more relevant and meaningful

meaningfully, with healthcare consumers. Will we, the healthcare brands and agencies, be open to new ways of working and new partnerships? Will we push for imaginative, innovative solutions that take full advantage of our new connected world? Will we adapt quickly enough to a consumer base that demands more and better choices that fit the way they live? Stay tuned, using any and all screens, platforms, and networks at your disposal. DTC With over 20 years of pharmaceutical marketing experience, few individuals in the industry have dedicated as much time to connecting people to brands and brands to people as Craig Douglass, Executive Creative Director, Digitas Health. Craig joined Digitas Health in 2006. A passionate advocate for (and oft time architect of) a new

relationships with both physicians and healthcare consumers. When not helping brands align with the new marketing realities, Craig can be found conducting various forms of research at The Institute for Suburban Living. Follow him on Twitter @craigadoug.

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.

Call Bob at 561-455-2394 or email him at bob@dtcperspectives.com DTC Perspectives • Fall 2013 |

25


Drug Branding Through the Eyes of the Consumer Not long ago doctors were the only ones driving prescription decisions. But now, patients are better informed and more empowered, causing a shift in the way pharma thinks about branding their medications. No longer do companies just need to speak to a drug’s efficacy, they also need to resonate with consumers, build trust, and most importantly be easily recognized. By Brannon Cashion

P

harmaceutical drug naming and branding can seem like a complicated mystery to most consumers. Because of extensive research and regulations, medication names are getting less and less intuitive, but marketed more than ever. It wasn’t too long ago that doctors were the only ones driving decisions about what to prescribe to their patients. But, times have changed. Access to information and technological advancements have exploded over the past decade – completely changing the game for pharmaceutical companies. Here, we’ll look at how the role of the consumer has evolved over time, the current industry landscape, ways that strong branding strategy can help the end-user, and a few hypotheses regarding how the industry will continue to change in the future. Histor ically, phar maceutical dr ug companies have focused on a medication’s efficacy to resonate with medical professionals, who would then prescribe the drug to patients. The relationship was somewhat simple, almost transactional, between the pharma company and practitioners: “Tell us what conditions your medication focuses on and we’ll prescribe it to the appropriate patients.” This, however, is no longer the case. Now more than ever, pharmaceutical branding has become crucial to creating distinctions in the mind of the patient as

26 | DTC Perspectives • Fall 2013

well as the physician.1 And, several factors have contributed to this shift.

Pharma companies are focused on creating brand names that will resonate with practitioners and patients, but will also stay relevant for the life of the brand. First, technology has made patients’ access to information incredibly easy and, in return, patients are asking more questions than ever. Online resources offer the latest p h a r m a c e u t i c a l n ew s , i n d u s t r y t re n d s a n d m e d i c a l breakthroughs, and in a very interactive manner, empowering consumers to learn and examine everything from the common cold to more serious ailments. Because patients are more informed, pharmaceutical companies have had to start thinking of their brands differently. It’s no longer enough to just speak to a medication’s effectiveness – pharma companies have to create names and brands that will resonate and build trust with consumers and gain recognition in a crowded industry. It’s an evolution of mindset from focusing on the medication to considering the patient’s perceptions and needs.


DRUG BRANDING A large amount of available information is also coming from health advocacy groups and national associations ranging from the American Cancer Society to more niche organizations like the International Pompe Association. These organizations raise millions of dollars every year to conduct research and build awareness about various diseases and conditions. Taking this into consideration, pharma companies need to make sure they’re talking to these groups in the most effective ways possible and clearly communicating how their drugs are advancing treatments. Another huge contributor to the shift in pharmaceutical branding is direct-to-consumer (DTC) advertising. Today, consumers are seeing more drug advertisements than ever before and across all mediums. Many of them say, “ask your doctor if ______ is right for you,” pushing consumers to take a more proactive role in their health. As a result, medication brands need to be memorable enough for patients to ask their physicians about it. How has all of this shaped the current landscape? Well, medication names are becoming more fanciful and there has been a definite shift in focusing on end-benefits to stand out in the cluttered DTC marketplace. Additionally, pharma companies are hiring major marketers from large CPG companies because of their consumer marketing experience. These companies are doing everything they can to build an arsenal of resources for targeting the consumer. With all of this in mind, it’s easy to see the importance of a strong brand strategy. In the simplest terms, branding is ultimately about creating a relationship with the consumer through a credible, differentiated and sustainable brand. But, achieving this balance can be challenging. Pharma companies are focused on creating brand names that will resonate with practitioners and patients, but will also stay relevant for the life of the brand. Interestingly enough, the strategic process for building a strong brand name is relatively linear, but the results of this process vary greatly from product to product. Best practice kicks off a branding project with preliminary evaluation – a comprehensive brand landscape audit followed by discovery research to identify functional and emotional attributes, unmet needs and any white space that exists in the therapeutic area. From there, creativity takes over. Brainstorming activities help guide a project through viable candidates before comprehensive screening and evaluations take place. For pharmaceutical branding, being able to smartly and accurately examine, interpret and analyze research can mean success or failure for a brand. These analyses and recommendations are the basis for submitting brands for regulatory approval, and if due diligence hasn’t been fully executed, all of the hard work could be for naught. We’ve walked through this process to better illustrate how complicated pharma branding really is. There’s an incredible

amount of layers to work through to build a strong brand, and with the changes over the past decade or so, these layers have become even more intricate. Because, once a brand is approved, it’s up to the pharmaceutical company to take those extra steps to market it to the patients and practitioners.

For pharmaceutical branding, being able to smartly and accurately examine, interpret and analyze research can mean success or failure for a brand. What does all of this mean for the future? Consumers will continue to be front and center in pharmaceutical branding. They should be included in focus groups, online testing and phone interviews to get their perspectives on potential name candidates. Additionally, print advertising and social media will continue to drive consumer drug brand communications. With the endless proliferation of social apps and media available on any smart device in the world, a more direct line of communication can be made by manufacturers to consumers, and leveraging that opportunity will be key to brand success. With so much growth and change over the past decade, pharmaceutical branding through the eyes of the consumer is an expansive and ever-changing landscape. Technology and ease of access to information have turned this industry on its ear – and the response from pharma companies has been extensive. Because of the immense segmentation of information, the future seems less focused on the many and more on the few. And, it’s all incredibly strategic. Pharma companies are going to have to figure out more ways to more tactically reach consumers and really resonate with them. With such an evolving environment, it’s exciting to see what they come up with next. DTC With more than two decades of marketing experience, Brannon Cashion has led Addison Whitney’s offerings in brand strategy and development, brand name and logo creation, corporate identity consulting and market research. As President, Brannon also leads the company’s specialized pharmaceutical and healthcare branding division: Addison Whitney Health. As one of the leading global branding firms, Addison Whitney has created many of the world’s strongest and most iconic brands, including work with Bank of America, Callaway Golf, Coca-Cola, GE, GlaxoSmithKline, Grainger, Microsoft, Novartis, Olive Garden, Pfizer and Stryker. Brannon can be contacted by telephone at (704) 697-4022 or email at bcashion@addisonwhitney.com References Coyler, Edwin. “Time Release Branding.” brandchannel. 2002. Web. http://www. brandchannel.com/features_effect.asp?pf_id=97.

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DTC Perspectives • Fall 2013 |

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R E V I E W Cymbalta, Lipitor Trade Spots as Spending in 2012 Gets Underway Brand

Manufacturer

Cymbalta (Pain)

Lilly USA

Lipitor

Pfizer

Cialis

Lilly USA

Abilify

Q1 2011

Q1 2012

$444,360

$ Change

$46,638,742

$46,194,382 -$27,394,832

$71,892,406

$44,497,574

$33,284,477

$42,170,152

Bristol-Myers / Otsuka America

$29,659,156

$35,890,555

Celebrex

Pfizer

$35,538,879

$32,176,539

-$3,362,340

Humira

Abbott Laboratories

$0

$29,045,688

$29,045,688

$8,885,675

It’s Time to Celebrate the Stars of the Industry… R E V I E W R E V I E W

Brand

Cymbalta,Manufacturer Lipitor Trade Spots as Spending in 2012 Gets Underway Q1-3 2009 Q1-3 2010 $ Change

Chantix

Lipitor Brand Advair Diskus Cymbalta (Pain) Cialis Lipitor Cymbalta CialisAbilify Abilify Pristiq Plavix Celebrex Symbicort Humira Chantix Chantix Lyrica NovoLog Toviaz Nasonex Lovaza Lyrica Crestor Pradaxa Singulair Viagra Enbrel Simponi Januvia Trilipix Dulera Boniva Advair Diskus (COPD) Vyvanse

Pfizer Manufacturer

GlaxoSmithKline Lilly USA Lilly USA Pfizer Lilly USA Lilly USA America / Bristol-Myers Otsuka Bristol-Myers / Otsuka America Pfizer / Sanofi-Aventis PfiBristol-Myers zer AstraZeneca Abbott Laboratories Pfizer Pfizer Pfizer Novo Nordisk Pfizer Merck & Co. GlaxoSmithKline PfiAstraZeneca zer

Boehringer Merck & Ingelheim Co. Pfizer/ Pfizer Amgen Centocor Merck & Co.Ortho Biotech Abbott Laboratories Merck & Co. Roche / Genentech GlaxoSmithKline Shire Intuniv Shire Spiriva Boehringer Ingelheim / Pfizer Cymbalta Lilly20USA Total(Depression) Spending for Top Brands Spiriva Pfizer / Boehringer Ingelheim Total Pharma Spending Orencia

Bristol-Myers Squibb

Q1$155,572,800 2011 $128,696,300 $444,360 $122,028,600 $71,892,406 $141,415,900 $33,284,477 $150,136,800 $29,659,156 $70,691,300 $113,096,800 $35,538,879 $91,483,100 $0 $38,671,500 $35,433,793 $114,818,900 $1,436,850 $23,262,500 $16,830,988 $5,162,400 $30,647,033 $96,436,200 $75,525 $70,680,700 $88,636,200 $19,601,299 $124,400 $12,418,915 $39,750,400 $0 $61,381,200 $25,900,465 $73,207,700 $5,701,740 $56,565,600 $34,731,648 $1,641,819,600

$204,795,300 Q1 2012 $169,488,400 $46,638,742 $158,180,200 $44,497,574 $146,388,000 $42,170,152 $122,396,800 $35,890,555 $112,960,000 $103,544,600 $32,176,539 $102,071,200 $29,045,688 $99,514,300 $26,676,564 $93,164,900 $25,796,066 $84,171,300 $25,557,191 $79,893,800 $25,098,717 $79,032,100 $23,402,795 $67,844,800 $65,682,100 $23,075,113 $61,884,000 $21,900,924 $56,349,100 $21,307,986 $55,535,300 $19,853,088 $52,821,800 $19,661,254 $51,757,100 $18,998,318 $1,967,475,100

$12,887,046 $3,381,974,400 $14,327,643

$17,602,473 $3,070,994,000 $15,933,294

31.64% % Change

$36,151,600 -$27,394,832 $4,972,100 $8,885,675 -$27,740,000 $6,231,399 $42,268,700

29.63% -38.1% 3.52% 26.7% -18.48%

21.0% 59.79% -8.45% -9.5% 11.57% N/A 157.33% -24.7% -18.86% T H$60,908,800 E S O U 1695.3% R261.83% CE $24,359,216 $8,726,203 51.8% $74,731,400 1,447.61% -$5,548,316 -18.1% -$17,404,100 -18.05% $23,327,270 30886.8% -$2,835,900 -4.01% -$22,954,100 -25.90% $3,473,814 17.7% 49,645.98% $61,759,600 $9,482,009 76.4% $16,598,700 41.76% $21,307,986 N/A -$5,845,900 -9.52% -$6,047,377 -23.3% -$20,385,900 -27.85% $13,959,514 244.8% -$4,808,500 -8.50% -$15,733,330 -45.3% $325,655,500 19.84%

AstraZeneca

6% 1% 32% 6%

5%

0%

$21,007,449

56%

22%

6% Newspaper Media Type 5% Internet

71% TV 1% Radio 22% Magazine 0% Outdoor 6% Newspaper Total Pharma 1% Radio Spending 0% Outdoor

Source: Kantar Media for DTC Perspectives, Copyright 2011.

Grand Total

$103,542,700 Q1$218,069,900 2011

$687,621,149 $19,552,300 $284,168,590 $2,950,100 $55,888,867 $3,381,974,400 $12,620,972

$25,557,191

$8,726,203

Pfizer

$30,647,033

$25,098,717

-$5,548,316

-18.1%

$75,525

$23,402,795

$23,327,270

30886.8%

Boehringer Ingelheim

Merck & Co.

$0

GlaxoSmithKline

$23,075,113

17.7% 76.4%

N/A

-23.3%

$19,661,254

$13,959,514

244.8%

$34,731,648

$18,998,318

-$15,733,330

-45.3%

Spiriva

Pfizer / Boehringer Ingelheim

$12,887,046

$17,602,473

$4,715,427

36.6%

Scott Weintraub

Total Spending FallsWashington Below $1M Mark DCin Q1 2012 by

Cocktails 5:30

Induction Ceremony and

Dinner 7:00pm

LEVERAGE4.28% LOCAL MEDIA TO $39,946,200

PERSONALIZATION: CONNECT79.73% WITH CONSUMERS $82,555,300

HEALTHCARE IS PERSONAL, SO SOCIAL MEDIA SHOULD BE

MEANINGFUL DIALOGUE:

DTCP_0612.indd 12

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DTC Perspectives • March 2011 |

FAMILY CAREGIVERS:

$1,393,279

-$6,047,377

$5,701,740

Lilly USA

egional marketing is aAll concept whose timeExcept has come.Outdoor, able resources. It is important to have a rapid deployment team Categories, Experience Drops As companies in the pharmaceutical, biotech and mediready to take advantage of local market changes as they hap1% 2011The overallQ1 2012 $ Change Change 0% change) markets Media cal device (global begin Type to embrace Q1pen. objective is to drive product%performance and Vol. 11, No. 2 “How • Summer 71% $636,949,845 -7.4% and allo6% the idea, the question becomes: do TV we2012 make regional $687,621,149 improve ROI through efficient-$50,671,304 resource deployment 22% Magazine $284,168,590 $196,760,870 -$87,407,720 -30.8% reduced marketing a reality?” cation. Other benefits of regional marketing include 22% Newspaper Regional $55,888,867 $50,173,435 -$5,715,432 for-10.2% First, let’s take a closer look at regional6%marketing. program waste and improved productivity the marketing 71% 1% Radio -$3,825,869 -30.3% marketing is a targeted allocation of resources to markets / dis- $12,620,972 and sales teams. $8,795,103 0% (ROI). OutdoorIt is a strat$140,622 $1,393,279 $1,252,657 890.8% tricts for the greatest return on investment Establishing your plan of action Grand Total $894,072,532 -$146,367,668 -14.1% egy that relies on understanding regional variability and how $1,040,440,200 Regional marketing consists of three disciplines: regional to harness it in order to maximize results. Marketers should strategy, regional plan development and regional deployment. deploy regional marketing when variations exist among payer, Source: Nielsen for DTC Perspectives NOTE: Excludes Regional Strategy In this initial step,Forassess provider, prescriber, population, product, Nielsen isor theplace. leader in innovative advertising information services and tracks advertising–activity across 18 media types. more the many Internet Advertising send an email to mediaprospects@nielsen.com. factors influencing brand performance in each market and Regional marketing consists of information, grouping similar markets evaluate the company’s capabilities for handling regional based on common drivers and developing marketing strategies 12 | DTC Perspectives • Summer 2012 marketing. Next, develop a vision for how regional marutilizing key market drivers. With regional marketing, it is local keting innovation can help your brand. Then work to gain differences that help determine how to efficiently direct avail-

Q1$154,266,200 2012 $ Change -$63,803,700% Change -29.26% $636,949,845 $25,226,300 -$50,671,304 $5,674,000 -7.4% 29.02% $196,760,870 $2,329,200 -$87,407,720 -$620,900 -30.8% -21.05% $50,173,435 -10.2% $3,070,994,000 -$5,715,432 -$310,980,400 MIND THE-9.20% DOCTOR-PATIENT $8,795,103 -$3,825,869 -30.3% $894,072,532

$9,482,009

$21,307,986

$19,853,088

Shire

Cymbalta (Depression)

MAGAZINE R

-9.20% MOVING11.2% UP THE CURVE:

$140,622

$3,473,814

$21,900,924 $21,307,986

$25,900,465

Intuniv

MAGAZINE

P E R S36.6% P E C T I V E S

$1,040,440,200

51.8%

Orencia Bristol-Myers Squibb $14,327,643 Regional marketing identifies specific opportunities for sales growth $15,933,294 and market share$1,605,651 that national11.2% marketing F O R D I R E C T T O C O N Splans U M may E R not T Hfully O Urecognize. G HAstraZeneca T LUnderstanding E A D E R S market Crestor $21,007,449 $15,069,404 Renaissance variations and the key drivers-$5,938,045 behind these-28.3% variations, Spending for Top 20 Brands $401,819,672 $530,352,437 $128,532,765 32.0% brand Total marketers can enhance a marketing plan with regional strategy, plan development and deployment, Spring 2013 Spending $1,040,440,200 $894,072,532 -$146,367,668 -14.1% Downtown Hotel leadingToptoPharma an increase in a brand’s sales performance.

35

COMMUNICATION GAP $1,252,657 890.8%

IF I MARKET TO THEM,WILL THEY Hall of Fame is a part of the eDTC Revolution held September 13-14, 2012 at -14.1% The STILL RESPECT ME IN THE MORNING? the Renaissance Washington DC Downtown Hotel. Tickets can be purchased

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Nielsen is the leader in innovative advertising information services and tracks advertising activity across 18 media types. For more information, send an email to mediaprospects@nielsen.com.

12 | DTC Perspectives • March 2011 12 | DTC Perspectives • Summer 2012

Hall of Fame Class

$16,830,988

Turning Insights into September 13,Innovation 2012

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

Internet Advertising

N/A

Merck & Co.

Dulera

HOW TO-28.3% NAVIGATE MARKETING -$5,938,045

$186,098,000

-9.5%

1695.3%

Advair Diskus (COPD)

$4,715,427 -$310,980,400 $1,605,651

32% Magazine $932,512,200 $972,458,400 All Categories, Except Outdoor, Experience Drops

21.0%

-24.7%

$24,359,216

Pradaxa

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

$15,069,404

26.7%

-$8,757,229

$25,796,066

Enbrel Amgen / Pfizer $19,601,299 T$40,792,100 H E S O10395.7% U31.70% R C E F O R D I R E C T T O C O NJanuvia S U M E R T Merck H O&UCo.G H T L E A D ERS $46,194,382 $12,418,915

-$9,552,200 -$3,362,340 $10,588,100 $29,045,688 $60,842,800 -$8,757,229 -$21,654,000

-38.1%

$26,676,564

$1,436,850

Marketing Roadmap

% Change

$49,222,500 $ Change

10395.7%

$35,433,793

Nasonex

OF CARE: Newspaper Seeing Significant Uptick in$530,352,437 DTC Spend $128,532,765 inPOINT Q1-3 IN AN2010 ‘INSIGHTS-DRIVEN’ ERA Total Spending for Top 20 Brands $401,819,672 32.0% THE CORNERSTONE While TV and Internet Lose Slight Market Share Top Pharma Spending $1,040,440,200 $894,072,532 -$146,367,668 -14.1% OF$ Change DTC STRATEGY Media Type Q1-3 2009 Q1-3 2010 % Change 1% A NEW RX FOR MEDIA: 0% 56% Television -$374,731,400 -17.80% Total Spending Falls Below$2,105,347,200 $1M Mark$1,730,615,800 in Q1 2012 Crestor

Pfizer

% Change

Novo Nordisk

NovoLog Lyrica

$6,231,399

The Regional

Join Us in Inducting the 2012

Overall DTC Spending Declines 9.2% in Q1-3 2010 Pfizer Producing of Top 20 DTC Promoting Top 20 Brands Continue toSeven Increase their SpendBrands in Q1 2012

71%

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I N D U S T R Y

F O R U M

Biggest Growth Influencers In the Point of Care Space Point of care is that all-important time where patients are most interested in and aware of their healthcare. But with the proliferation of information at the empowered patient’s fingertips up against shorter times with healthcare professionals, it is at a tipping point.

P

atients are increasingly armed with information to engage in better discussions with their healthcare providers. However, the strain on the healthcare system – which will only be exacerbated as more individuals secure health insurance under the Affordable Care Act – means doctors will have less time to have the wanted, in-depth conversations. Point of care, the part of the patient journey appropriately dubbed “the moment of truth,” is facing an evolutionary upsurge. But do you know what forces will be pushing these changes forward? To help you know what transformations are afoot, we proposed the following to a few select players in the point of care space:

There will be several key drivers fueling the growth of the point of care space. What do you believe will be one of the biggest influencers? Terence Finn Chief Technology Officer Remedy Health Media There are two major catalysts that will have a large impact on the point of care space in the near future. First is simply the increase in audience – the number of people insured is projected to increase by 30 million* in 2014 due to the Affordable Care Act. Second is how point of care will come to be defined given the increase in healthcare provider to patient electronic interactions, and the expanded access and use of pharmacy retail space. Besides audience growth, the demographics of the point of care consumer will change considerably. The additional newly insured will more likely be single and older, and less likely to speak English or have a college degree*, providing a great opportunity for advertisers to reach a new market segment. Equally important is the evolution of the point of care space. As the future unfolds we may see the point of care, the point of learning, and the point of dispensing all

30 | DTC Perspectives • Fall 2013

consolidating. With our busy and active lifestyle, it will be more efficient to go to our local pharmacy for screenings and prescriptions, as well as to ask questions and obtain health information materials. The same thing is true online, with the expansion of patient portals**, tele-health, and disease management** and behavioral change solutions. Pharma marketers will need to be prepared for these changes in order to reach this growing audience at all aspects of the new point of care landscape. * Of the 30 million newly insured Americans under the Affordable Care Act, 32% will gain coverage from Medicaid, 45% from the individual exchanges, and 23% from their employers. Source: PwC's Health Research Institute, (HRI). ** In the next 5 years, patient portals will grow over 200% (Frost & Sullivan); tele-health over 230% (Kalorama); disease management will grow at a CAGR of 19.9% (TechNavio).

Dan Stone CEO of AccentHealth, Co-Chair of PoC3 The doctor’s office has always been a very valuable place to communicate with and educate patients – right before they talk to their doctor about


I N D U S T R Y their condition and treatment options. In fact, AccentHealth research has shown that patients believe that after healthcare professionals themselves, waiting room media is the most credible source of health information. As access to the doctor’s office has become increasingly challenging for detail reps, the demand for non-personal promotion has increased and the need for patient education has expanded. As the key parts of the Affordable Care Act are implemented in 2014 and beyond, and millions of new patients enter the healthcare system, the importance of the point of care channel as a communication tool becomes even more essential and relevant. From a brand marketer’s standpoint, the ability of point of care media to directly measure campaign performance means that the benefit of those increased expenditures can be quantified. Another important trend increasing demand for point of care media is the continued shift in promotional spend to smaller, specialty drugs. The ability of point of care media to offer a vast array of targeting criteria – including specialty, prescribing behavior, demographics, geography – makes targeted communications to smaller patient populations that much more effective and efficient.

Tom McGuinness CEO of PatientPoint, Co-Chair of PoC3 The point of care (POC) channel is already starting to accelerate – and for good reason. Marketing investments at the POC are driving significant incremental growth for brands and provide a return on investment that is roughly twice that of more traditional DTC channels such as TV, radio, and print. These superior returns are driven by five important reasons. First, new brands continue to be more specialized and require marketing strategies than can efficiently reach more targeted patient populations. The POC channel is well positioned to meet this challenge, without all of the marketing “overspray” that is inevitable in traditional channels. And depending on the POC specialty channel, targeting gets even better. For example, reaching atrial fibrillation patients at their cardiologist office is an ideal time to educate about them about new anti-arrhythmic therapies for the patient and their doctor to consider. Second, the POC is a unique setting when consumers are highly engaged and thinking about their health. No other channel can reach the consumer at such an important moment of truth. Reaching the patient right before they talk

F O R U M with their healthcare provider is an important opportunity to help the patient prepare for that very important physicianpatient dialogue. Clearly, no other channel can deliver a brand's message right before the script is actually being written. Third, programs delivered at the POC channel are highly measureable, and can be directly tied to the impact of those investments. The POC industry continues to use rigorous, fact-based approaches that track incremental scripts driven by the programs delivered. Given the ability to track the success of programs, brand leaders are well equipped to ensure they reach indicated patients in the most efficient and effective manner. Traditional DTC investments face a much more difficult challenge linking investment to impact. Fourth, providers are increasingly receptive to programs anchored at the POC. Given the economic pressures facing physicians including consolidation of practices, and risk sharing payment models, providers are increasingly interested in POC programs that drive the right therapies for the right patients, which leads to better outcomes and reduced costs. Finally, investments in POC amplify marketing investments in other channels. Given the importance of reaching consumers at multiple points along their care lifecycle, most marketers employ a multi-channel strategy that leverages various channels to reach the consumer. And increasingly, investing in the “last mile” at the point of care serves to ensure that maximum impact is achieved from the broader set of investments. DTC television ads may serve to create early awareness for a brand, but often need to be enhanced by a message at the point of care. Overall, given these superior returns, most brands are already increasing the allocation of their marketing budgets to better leverage this important point of care channel. What may represent about 5% of DTC spend today is likely to be closer to 10% to 20% in 2014 and beyond. DTC Editor’s Note: By popular demand, DTC Perspectives will begin posting the Industry Forum as a monthly online feature in 2014. Visit www.dtcperspectives.com for the exclusive online content. Let us know if there is a question you would like us to ask the industry. And keep an eye on your inbox – you might just receive an invitation to participate one month!. DTC Perspectives • Fall 2013 |

31


O N

T H E

M O V E

Craig DeLarge moved to Global Leader, MultiChannel Marketing Strategy & Innovation within Merck. DeLarge was previously US Leader, MultiChannel Marketing & Customer Craig DeLarge Maureen Malloy Business Line Support. He is now responsible for leading strategy and innovation within the Global Multichannel Marketing Center of Excellence. Maureen Malloy has rejoined Manhattan Research as Director, Product Commercialization. She was most recently Digital Communications Specialist at the Campbell Soup Company. Prior to that, she held the titles of Senior Analyst and Manager, Strategic Marketing & Corporate Communications with Manhattan Research. Gina Metsker has left her post as Senior Marketing Manager with AccentHealth. She joined WE TV Network (Rainbow Media) as Ad Sales Marketing Manager. Arnold Worldwide named Corey Mitchell as President of its New York office. This appointment coincides with the agency’s launch of 23andMe (Arnold Worldwide NYC was announced as the agency of record, premiering the first brand campaign for the health and ancestry DNA service in the beginning of August). Jordan Barnes joined SKOUT as a Public Relations Manager. The start-up company is a location-based social network for meeting new people. Barnes was previously Senior Public Relations Specialist with MEplusYOU Agency (formerly imc2), an integrated marketing agency. AbelsonTaylor has promoted: Hillary Armstrong from Account Supervisor to Senior Account Supervisor; Craig Taylor from Account Executive to Senior Account Executive; Chelsie Patterson, Mackenzie MacDonald and Laura Kunberger from Account Coordinators to Account Executives. Armstrong will be responsible for a portfolio of oncology products. Taylor will manage an HIV treatment. Patterson will work across four cardiology brands. MacDonald will be responsible for brands within the oncology space. Kunberger will focus on an osteoporosis treatment. Univision Communications hired Rick Ehrman as Executive Vice President of Cor porate Business Development. The Spanish-language media company also promoted Jennifer Ball from Senior Vice President of Distribution Marketing to Executive Vice President of Content Distr ibution Marketing and Partnerships.

32 | DTC Perspectives • Fall 2013

Corey Mitchell

Hillary Armstrong

Craig Taylor

Telemundo Media hired Latha Sarathy as Vice President, Telemundo Media Digital Research, and promoted Yatisha Bothwell to Vice President, Insights & Strategy. Sarathy was previously Vice President, Audience Insights & Analytics at Interactive One/Radio One Digital. Bothwell was most recently Director, Consumer Insights with Telemundo Media. NBCUniversal named Marlene Sanchez Dooner as Executive Vice President, Hispanic Enterprises & Content, a newly-created position effective by the end of 2013. Dooner is currently Senior Vice President of Investor Relations at Comcast Corporation. CBS Entertainment promoted Margot Wain from Director, Daytime Programs to Vice President, Daytime Programs. Health.com named Christine Mattheis as Senior Editor. She was previously an Editor at Fitbie.com, a diet and fitness editorial collaboration between MSN and Rodale. Rodale promoted Molly O’Keefe from Associate Publisher to Publishers of Runner’s World and Running Times magazines, and Zack Grice from Associate Publisher of Marketing to Associate Publisher for Sales and Marketing for Bicycling Magazine. TIME has named Nancy Gibbs as Managing Editor, making her first female to hold this role at the newsmagazine. She previously served as Executive Editor for the news publication.

GSW Launches New Branding G S W Wo r l d w i d e u nve i l e d a n e w l o o k in late August. They explained via Facebook that it is representative of their “new mission to create experiences that transform people into success stories … through the power of human connections.” The full-service healthcare agency also changed its website and Twitter handle to reinforce their new call, “Speak People.” Their new username on Twitter is @ gswspeakpeople; their revamped graphical website is divided into three main sections: GSW/Speak/People.


C O N T R I B U T O R S With more than two decades of marketing experience, Brannon Cashion has led Addison Whitney’s offerings in brand strategy and development, brand name and logo creation, corporate identity consulting and market research. As President, Brannon also leads the company’s specialized pharmaceutical and healthcare branding division: Addison Whitney Health. As one of the leading global branding firms, Addison Whitney has created many of the world’s strongest and most iconic brands, including work with Bank of America, Callaway Golf, Coca-Cola, GE, GlaxoSmithKline, Grainger, Microsoft, Novartis, Olive Garden, Pfizer and Stryker. Brannon can be contacted by telephone at (704) 697-4022 or email at bcashion@addisonwhitney.com. Turn to page 26 to read his article. Donna Kerney Correia, PhD, earned a PhD in Health Services Research from The Pennsylvania State University and has over 15 years of experience with analytics in the healthcare and pharmaceutical industries. Her expertise focuses on survey design, market research, business intelligence and ROI modeling. She also earned a BS from the University of Notre Dame and an MS from the University of Maryland. In her current role as Director of Analytics at Phreesia, she is responsible for leading all of the measurement solutions associated with Phreesia campaigns. She can be reached at dcorreia@phreesia.com or followed on Twitter @phreesia. To read the article she co-authored with her colleague Christine Cunningham, turn to page 14. Christine Cunningham RNC, NNP, was trained as a Nurse Practitioner in Neonatal Medicine at Georgetown University. Since leaving patient care, she has seven years’ experience in healthcare and pharmaceutical marketing. Her expertise has been on patient survey and interview creation, patient education and the overall facilitation of the patient/physician

relationship. In her current role at Phreesia as the Medical Science Liaison, she is responsible for all of the clinical applications on the platform including identifying health surveys, screenings and scales appropriate to administer during patient check-in, aligning physicians with meaningful use and other quality healthcare initiatives. She can be reached at ccunningham@phreesia.com or followed on Twitter @phreesia. Turn to page 14 to read the article she co-authored with colleague Donna Kerney Correia. With over 20 years of pharmaceutical marketing experience, few individuals in the industry have dedicated as much time to connecting people to brands and brands to people as Craig Douglass, Executive Creative Director, Digitas Health. Craig joined Digitas Health in 2006. A passionate advocate for (and oft time architect of) a new marketing playbook built for our people-centric world, Craig has helped clients find new ways to forge more relevant and meaningful relationships with both physicians and healthcare consumers. When not helping brands align with the new marketing realities, Craig can be found conducting various forms of research at The Institute for Suburban Living. Follow him on Twitter @craigadoug. To read his article, turn to page 23. CEO David Ormesher provides leadership and direction for closerlook, inc., a digital marketing agency serving the pharmaceutical industry. As founder and CEO, Ormesher has taken closerlook from a small, creative media boutique and grown it into a recognized leader in creating innovative relationship-marketing solutions that help pharmaceutical brands build and maintain meaningful relationships with their most valuable HCPs. He can be contacted by email at dormesher@ closerlook.com or followed on Twitter @ormshr. To read his article, turn to page 18.

ADVERTISING INDEX & RESOURCE CENTER Company

Page

Website

Phone

Contact

Email

Beacon Healthcare Communications

22

beaconhc.com

908-781-2600 Adrienne Lee

Catalina Health

5

catalinahealth.com

201-291-2263 Julie Manganella Julie.Manganella@catalinamarketing.com

Context Media

17

contextmediainc.com

312-257-3121 Ashik Desai

ashik.d@contextmediahealth.com

Cult Health

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culthealth.com

646-736-0771

jrothstein@culthealth.com

DTC Awards

37

dtcperspectives.com

973-457-5718 Jennifer Haug

jennifer@dtcperspectives.com

DTC National

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dtcperspectives.com

973-457-5718 Jennifer Haug

jennifer@dtcperspectives.com

DTC Perspectives

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dtcperspectives.com

973-457-5718 Jennifer Haug

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Health Monitor Network

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healthmonitornetwork.com

201-391-1911 Ken Freirich

freirichk@healthmonitor.com

POC National

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dtcperspectives.com

973-457-5718 Jennifer Haug

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Remedy Health

2

remedyhealthmedia.com

212-695-5581 Jim Curtis

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Spirit Health Group

35

spirithealthpartnerships.com 561-554-2010 Joshua Davis

Jeff Rothstein

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Joshua@spirithealthgroup.com DTC Perspectives • Fall 2013 |

33


Marketing ON THE EDGE

The Thing of It Is…

By Dan Chichester

Keeping up with consumers’ whereabouts used to be simple. The mailbox. The TV. The radio. Then the computer screen came along. Then it was two – a desktop and an “on-the-go” laptop. Wait – where did that cell phone come from? And how did it get “smart”? And what’s that electronic pad thing? You better work on your juggling skills – because it’s about to get a lot more.

O

pen your arms to the “Internet of Things.” AKA the “Internet of Everything,” the “Industrial Internet,” or the “Sensor Revolution.” (We’ll stick with IOT for our time together here.) No matter what you call it, it’s not a discrete number of gadgets. It’s the potential of a multiplicity of “intelligent” devices connecting to provide a kind of “X-ray vision” into an individual’s situation and needs. This is more than just an “always-on Internet.” In fact, it’s kind of the opposite of the Internet model, where every device can be seen as equal. In the IOT, the relevant devices act like a swarm, coming together as a single machine… or brain. There’s power in this coherent system: a world that can be choreographed. When devices are programmed to talk to one another, they can solve our problems. “So… my refrigerator knows when it’s out of milk and calls Peapod for a delivery. That kind of thing?” Sure… if we’re selling dairy products. But in talking to our clients’ consumers, let’s apply this to health. Algorithms between devices can look for trends that can equal more continuous and sophisticated monitoring; which in turn can help keep an individual from ever having to go to the hospital in the first place. It’s more than an alarm clock that perks up a coffee maker. It’s a heart monitor picking up on a heart attack and pointing the way to the nearest defibrillator. Consumers are becoming comfortable with measuring their activities, as evidenced by the spread of devices like Fitbit, Nike+ Fuel Band or Jawbone UP. They may be 21st century pedometers now, but they point the way to more involved and accurate tracking of data before too long. [Right now they are good models to study for pluses and minuses in terms of user experience (UX), both in wearability and what their app screens reveal and motivate. If UX fails to fascinate, the device and its promise will never gain momentum or live up to its promise.] Soon we’ll benefit from more ubiquity, and its potential for preventative medicine: blood pressure sensors in the seatbelt of our cars or ingestible wireless capsules – cameras in a pill – that can be swallowed and help intercommunicate to accurately predict the chances of becoming ill.

34 | DTC Perspectives • Fall 2013

Heady stuff – but not that far out. Hospitals are already seeing benefits from this in as simple a thing as monitoring hand washing. Staff members wear badges that register each washroom entry and exit. These badges “talk” to the soap dispensers, which transmit whether or not they’ve handed out cleanliness in time with those washroom visits. When it matches up, hospital-acquired infection rates go down. It’s a social life of products, environments and people. The IOT isn’t activating full-on tomorrow… or even next year. So why care now? Healthcare advertising is too often – but accurately – accused of being “behind the times” when it comes to opportunities, especially in the digital space. As an emerging movement, and one with such clear hooks into healthcare, it’s a critical and exciting time to become aware – and take positions out ahead of what will certainly be considered “issues.” Consumers will be concerned about “Big Brother” (especially in the shadow of NSA in the news). The FDA has asserted that it will be more vigilant regarding apps that purport to provide actual health services (vs. information). Start figuring out the answers to these issues today… and when the time is soon right, we’ll be as smart as the devices that will increasingly surround us. Dan Chichester is Chief Digital Officer of Ogilvy Healthworld in NY, part of Ogilvy CommonHealth Worldwide. Drawing from his diverse and creative background, he identifies the latest marketing and innovative DTC trends, and shares his astute views. He can be reached by e-mail at dan.chichester@ogilvy.com or telephone at (212) 2377008.


IF YOU DON’T LIKE WHAT’S BEING SAID, CHANGE THE CONVERSATION. SPIRIT HEALTH GROUP IS THE ONLY DISEASE AWARENESS AND EDUCATIONAL CHANNEL IN THE UNITED STATES REACHING WOMEN, THE HEALTHCARE DECISION MAKERS FOR THE AMERICAN FAMILY, BY PARTNERING WITH HOSPITALS, PHYSICIANS AND NURSES. SPIRIT WORKS WITH LEADING PHARMACEUTICAL BRANDS TO PRODUCE HEALTH AND WELLNESS EVENTS, PHYSICIAN OFFICE PROGRAMS, CLINICAL TRAINING, AND MULTI-MEDIA COMMUNICATIONS TO EFFECT CHANGE IN CONSUMER BEHAVIOR AND DRIVE PHYSICIAN INTERACTION. Contact Joshua Max Davis, President of Spirit Health Group, for a complimentary evaluation on how hospital-to-consumer relationships can activate your message. joshua@spirithealthgroup.com ² 561.544.2010

35 | DTC Perspectives • Fall 2013

© 2013 Spirit Health Group. All rights reserved.

Proud promoters of

DTC Perspectives • Fall 2013 |

35


O N   T H E   H I L L

Scripting the Next Scene in DTC Regulations

by Jim

Davidson

The most recent legislative battles over the taxes, spending, and the government shutdown are just a few examples that reinforce how politics is truly a world unto itself. Politics even comes with its own stubborn cast of characters who provide a compelling sideshow against the backdrop of serious issues facing the nation.

T

o even a casual observer, it should be no wonder why government has been the basis of countless books and films – after all, sometimes this stuff practically writes itself. Watching the latest “will they, won’t they?” scene unfold over the fate of tax reform may inspire some to look beyond this legislation and take stock of the environment in which DTC advertising will find itself after the curtain comes down on corporate rates. As with any good script, there are always secondary and tertiary conflicts that keep a story alive and moving. This theme readily applies to DTC marketing, and there are a number of rumblings already out there that may be setting the stage for what life could look like once the dust settles on tax reform. There are few issues capable of transcending the partisan divide which would allow both sides of the political aisle to safely unite. Consumer protection fits this bill and historically has been one of the least likely legislative issues to break down along party lines. Even if elected officials do not end up taxing all advertising, they may be tempted to attack DTC advertising in the name of protecting consumers preyed upon by so-called misleading ads. This is a familiar argument, but it highlights the importance of two themes common to both the movies and real-life political theater – guilt by association can be deadly and image is everything. Just one or two high-profile negative instances may be all that are necessary to motivate Congress or the Administration to closely examine all pharmaceutical marketing, both in the DTC and OTC arenas. Since many pieces of legislation are crafted as catch-all bills or omnibus, such drafts may have far-reaching consequences for those who consistently keep their heads down and stay out of the fray. Stimuli for government intervention may include last year’s landmark $3 billion fine leveraged for marketing antidepressants for unapproved uses or revelations that other manufacturers had pushed certain drugs to be prescribed despite little or no positive results and the potential for severe health risks. These events were exacerbated by a timely article last year in the Journal of the American Medical Association that argued drugs are less likely to state negative effects once they go

36 | DTC Perspectives • Fall 2013

OTC. Couple this with recent findings in the Journal of General Internal Medicine that conclude six out of 10 drug claims are false in ads aired during the nightly news, and the plot is already starting to thicken a bit for drug marketers of all stripes. One would need to look no further than to a perennial bill introduced by Rep. Jerrold Nadler (Dem.-N.Y.) to become reacquainted with the argument slated to makes its guest return. This bill would deny the deductibility of DTC drug advertising, and according to its sponsor, it is necessary because “Direct-toconsumer drug ads are not Public Service Announcements… Drug companies regularly tout benefits of their products while downplaying – or inadequately explaining – health risks in order to lure in potential customers. Instead of encouraging health and wellness, these ads promote medicating, regardless of whether the medication is necessary.” 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.


DTC NATIONAL AWARDS

2014

Enter the 2014 DTC National Awards Plan now to submit your entry to the DTC National Advertising Awards and nominate a pharmaceutical company colleague for the Top 25 DTC Marketers of the Year.

ADVERTISING AWARDS The DTC Advertising Awards are designed to recognize communication excellence in a field with multiple constituencies, varying needs and significant communication challenges. Entries will be judged by a panel of independent industry market research experts. Gold, Silver and Bronze awards will be presented in each category at the 2014 DTC National Conference.

Winners from the 2013 Advertising Awards

Top 25 DTC Marketers TOP 25 DTC MARKETERS The Top 25 DTC Marketers of the Year are selected for their leadership and influence in patient communications. This award acknowledges the contributions of elite marketers from pharmaceutical companies working toward the advancement of patient outcomes via DTC marketing and pharmaceutical education. Top Marketer from the 2013 Class

Don’t Miss Your Chance to Enter the 2014 DTC National Awards! Don’t Miss Your Chance to Enter the 2014 DTC National Awards! Visit: www.dtcperspectives.com for entry forms and full details. Entries are free and simple. Awards Deadline: December 31st.


ON BOOKS

Do You Believe in Magic? The Sense and Nonsense of Alternative Medicine By Paul A. Offit, M.D. Published by Harper / 2013 / 336 pages

Reviewed by Robert Ehrlich

I

n a piercing analysis Dr. Offit takes on the alternative medicine industry and its supporters. By the title of the book, it is clear Dr. Offit has some serious criticisms of the supplement, vitamin, and herbal treatments. His premise is this: Treatments for illness or for prevention of illness are either proven through clinical studies or they are not. In other words, there is no such thing as an alternative medicine. Something is medicine or it is not. Dr. Offit is a great story teller and, in a highly readable fashion, debunks some of the myths of alternative medicine. He says most are totally ineffective and have no clinical evidence that they do what they claim. Much of the problem is that supplements are regulated differently than drugs. The FDA cannot regulate natural products the way they regulate drugs. Supplements can make all kinds of claims not allowed by drug makers. Dr. Offit says this difference was forced on regulators by a compliant Congress willing to give naturals a regulatory pass. Dr. Offit takes on the celebrity endorsers who always push these alternatives. He criticizes one of the most beloved television physicians, Dr. Oz, for touting alternatives not clinically proven. His wrath is strong for the diet and life extension celebrities, like Suzanne Somers, for pushing their diet regimens which have no scientific basis for success. These celebrities are great salespeople, says Dr. Offit, but are engaging in phony claims based on no clinical evidence. In fact, Dr. Offit claims many of these supplements are downright dangerous in large quantities. Mega dosing vitamins can actually cause disease. Just because they are on the shelves of a GNC store does not make them safe to take. Many of these supplements contain the same ingredients as approved prescription drugs, but without the assurance of the appropriate dose or purity of ingredients. Dr. Offit is most angry at the celebrities who push avoidance of vaccines. Jenny McCarthy, not noted for her medical background, decided that vaccines cause autism. She started a movement to tell parents the dangers of vaccines. Thus, many

38 | DTC Perspectives • Fall 2013

parents decided to avoid certain common vaccines and now we have a resurgence of cases of childhood diseases. There is no evidence vaccines cause autism, but that does not stop the celebrity parade of alternative treatments. Dr. Offit says most alternatives are a waste of money. Those include saw palmetto for prostates, chondroitin for knee cartilage, and mega doses of vitamim C for colds. Some do work, such as calcium and vitamin D for healthy bones, and folic acid for preventing birth defects. Why do some people swear by many of these alternatives? Dr. Offit credits the placebo effect. It works and people do report felling better when they take what they are told works. The placebo effect will not replace real cures, however. Dr. Offit tells us the case of Steve Jobs, who had a controllable pancreatic cancer. He spent a year taking alternative treatments and by then his cancer spread and was inoperable. Dr. Offit says when a Steve Jobs is fooled into trying unproven alternatives, most of us are, too. Dr. Offit I am sure will be vilified by the alternatives industry but his analysis is well-written, supported by clinical evidence and quite reasonable. What is clear is somehow we look for natural alternatives in preference to synthetic compounds. There seems to be something in our makeup that longs for “natural” solutions used for hundreds of years. Dr. Offit says we have ways to prove or disprove their effectiveness using double blind clinical studies. Few are proven using the scientific method and remain anecdotal successes. 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.


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E D I T O R I A L

Being Fair About Obamacare Let’s all try to engage in a fact-based discussion on Obamacare. Can we strip out the extreme positions and actually say what it does and does not do? If we listen to the extremes, we are all being misled. Here are the good and bad of the law.

O

bamacare is basically a coverage extension program. It tries to add the uninsured to the insured roles by offering affordable plans made affordable by government subsidies. It also insures the previously uninsurable who have preexisting conditions. It makes prevention exams mandatory with no deductibles. That is basically the guts of the program. The good is that no family who wants coverage should be denied it for financial reasons. No family will go bankrupt because an insurer denied coverage or because someone was dropped because of an illness. Americans can now get preventive exams for no additional fee. The negatives of Obamacare are that many people will pay more for less coverage than before the law. Those people are mostly the young and healthy. To allow affordable care for those who have pre-existing conditions, someone else needs to pay. That someone else is the young person who will, under most estimates, pay more than they did prior to 2014. To force those young to enroll and pay more, the government made coverage mandatory and imposes fines for non-enrollment. For many young people, they may choose the fines if they are lower than the premium cost. What is being offered on the exchanges in many cases are plans that rein in cost by reducing the choices of consumers. Insurers are making deals with doctors willing to take less by promising more patients will be sent their way. We are also seeing plans with high deductibles of $10,000. What will happen is consumers will make sacrifices in their choices of doctors and paying more out of pocket. There is no magic solution if we are to cover those aging boomers and those with serious pre-existing conditions. Obamacare is, in reality, a transfer of premium payments from the older and unhealthy to the healthy. We are asking the young and well-off to spend more to cover our less fortunate citizens. It is a social engineering program. It is not

40 | DTC Perspectives • Fall 2013

the end of America or a destruction of care, as many on the right say. It is expensive and will raise healthcare costs for many and the nation as a whole. Government is subsidizing premiums for people making up to 400% of poverty income. That means it pays subsidies for most Americans. Where is this money coming from? Most of it is government debt and higher taxes from the wealthier Americans. We think the costs will rise faster than predicted unless something is done to deal with fee for service. More care for more people is unlikely to be cheaper. Doctors will be expected by insurers to take less for services but they will make up for it by doing more procedures. They will add more patients and it will be harder to get in to see a doctor. Many older doctors will just retire earlier and we can expect a severe doctor shortage. Obamacare will mean more rationing of service. If rational people could really discuss the issues instead of talking hyperbole maybe Obamacare could be made to work. Unfortunately, rational people are being drowned out on both sides by the fringe elements. Obamacare is neither inherently evil nor wonderful. It is just a complex insurance program that was hastily put together with numerous unintended consequences.


SAVE THE DATE THE FORUM FOR DTC THOUGHT LEADERS

DTC NATIONAL CONFERENCE

DON’T MISS THE MOST IMPORTANT GATHERING OF DTC THOUGHT LEADERS IN 2014

For more information on how to get involved at the DTC National 2014 please contact Matt Yavorski at matt@dtcperspectives.com or 973-521-7475 x226

JW Marriott Hotel

WASHINGTON DC

April 22-24 2014

N A T I O N A L


Issue 2 | Fall 2013

Multicultural

Health Marketing

Magazine

Languages in the

Healthcare Setting as D i v e r s e as the Patients

Children with Chronic Illness from Multicultural Families

Asian Americans and Healthcare: Understanding the Opportunities

Healthcare Dialogue Analysis: Linguistically Tune Your Target Message

Multiculturalism in the Healthcare Paradigm

November 6-7, 2013 Sofitel Philadelphia www.dtcperspectives.com


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85%

of population growth was multicultural in the the last 10 years

40%

increase in African-American population (in states such as Florida, Georgia, Texas, Nevada and Arizona)

50%

of the population growth in the U.S was due to the increase in the Hispanic population from 2000-2010

43%

increase in Asian population in the past 10 years (more than any other major race group)

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contents 4 5 6

BY THE NUMBERS Book REVIEW LANGUAGES IN THE HEALTHCARE SETTING AS DIVERSE AS THE PATIENTS

06

By Katherine A. Margolis, PhD, Director of Health Behavior Strategy and Research at HealthEd

10

ASIAN AMERICANS AND HEALTH CARE: UNDERSTANDING THE OPPORTUNITIES

Asian Americans and Health Care: Multicultural Understanding Activation in thethe Opportunities Face of Common

14

CHILDREN WITH CHRONIC ILLNESS FROM MULTICULTURAL FAMILIES

18

By Sandra B. Jones, President at Healthettes, & Stephanie E. Jones, Freelance Editor

MULTICULTURALISM IN THE HEALTHCARE PARADIGM

14

10

Obstacles and Road Blocks

By Dr. Corey Hebert, Chief Executive Officer of Black Health TV

20

HEALTHCARE DIALOGUE ANALYSIS: LINGUISTICALLY TUNE YOUR TARGET MESSAGE By Kaity Arctander, Linguistics Analyst, Client Services, & Carolyn Reed, Senior Analyst, Linguistics Insights, at Verilogue

20

Multicultural Health Marketing • FALL 2013

By Robert Kumaki, Managing Principal of the Ronin Group

3


WORLD ECONOMY PAGE BY THE TITLE NUMBERS

African American adults are 2X as likely as non-Hispanic white adults to be diagnosed with diabetes by a physician and

1.4X as likely to have high blood pressure. American Indian/Alaska Native adults were more than 2X as likely as non-Hispanic white adults to be diagnosed with diabetes and 1.3X as likely as to have high blood pressure. Source: 2011 data. US Department of HHS, The Office of Minority Health, August 2012.

B

Mississippi ranks last in the US for obesity and sedentary lifestyle: Obesity is more prevalent among non-Hispanic blacks at 43.2% than Hispanics at 33.4% and non-Hispanic whites at 30.9%. Sedentary lifestyle is more prevalent among non-Hispanic blacks at 37.2% than Hispanics at 27.3%. Source: America's Health Rankings by the United Health Foundation, 2012.

1H 2013: $21.69MM

1H 2012: 1H  2$28.89MM 012   4% 5%

13%

Multicultural Health Marketing • FALL 2013

TV Magazine Newspaper Internet

4

87%

TV Magazine Newspaper Internet

91%

DTC spending in Hispanic media dropped by a quarter in the first half of 2013 when compared to the same period the prior year. The only media channel to see an increase was magazine, with promotional spending more than doubling. As a result, Magazine was able to gain some market share, rising from 5% to 13% - 4 percentage points coming from each TV and Newspaper. Source: Kantar Media for DTC Perspectives, Copyright 2013.


BOOK REVIEW

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

Reviewed by Robert Ehrlich

5

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 causes needless tests and 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. 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 is the chairman and chief executive of DTC Perspectives, Inc.. He writes a weekly e-newsletter providing insights on pharmaceutical marketing trends.

Multicultural Health Marketing • FALL 2013

D

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 African-American 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, which he did and then had an ulcerated rectal area from the radiation. He had infections and eventually died.

5


WORLD ECONOMY PAGE TITLE HEALTH CARE

Languages In The Healthcare Setting As Diverse As The Patients By Katherine A. Margolis, PhD

“ 6

cross-cultural outreach is no longer an attractive growth strategy; it’s the only way to remain viable in today’s diverse health care marketplace

Multicultural Health Marketing • FALL 2013

Activating your

E

very day, millions of Americans manage chronic conditions and others are diagnosed with acute conditions. It can be daunting for them to gather information, find specialists, navigate insurance coverage, and begin treatment—all while dealing with the medical condition diagnosed. These patients also must navigate a changing healthcare environment impacted by the Affordable Care Act (ACA) and, increasingly, by new technologies that seem to

arrive daily. Now imagine those patients whose first language is not English. Or those whose cultural background differs from their healthcare provider’s. These differences in language or culture can pose barriers to effective communication, which can greatly impact the quality of healthcare that patients receive or their ability to self-manage their condition. A new report by HealthEd Academy, the ‘think tank’ of HealthEd, found that 48% of


healthcare extenders surveyed often or sometimes experience a situation in which language differences between them and a patient or family member prevents effective communication. These healthcare extenders—non-MD healthcare professionals who work directly with and on behalf of patients—reported that they make efforts to meet the needs of culturally diverse patient populations; however, they still worry that their patients and family members may not truly understand the information. They also worry that their patients may not understand the medical need for a lifestyle change or treatment plan. Further, they say patients may lack the ability to make the needed change if it conflicts with their cultural beliefs. The report, “Engaging Patients From Multicultural Backgrounds,” details the findings from a survey of 192 healthcare extenders and in-depth interviews with 4 experts. The survey was conducted to gain a better understanding of how healthcare extenders care for diverse populations. Specifically, HealthEd Academy wanted to understand what challenges healthcare extenders face in providing quality healthcare to a changing patient population. Respondents were recruited through SurroundHealth (www. surroundhealth.net), an online community for

Spanish is just the beginning for language needs*

Hello Hola! ENGLISH (95%)

SPANISH (94%)

Bonjour FRENCH

CHINESE

Guten Tag GERMAN

Ciao! Czesc Olá! ITALIAN

POLISH

PORTUGUESE

こんにちは JAPANESE

HINDI

PUNJABI

KOREAN

BENGALI

CAMBODIAN

VIETNAMESE CREOLE

URDU

INDONESIAN FRENCH CREOLE

TAGALOG ARABIC

HMONG TAIWANESE GREEK

AFRICAN LANGUAGES *Among your patient population, what are the 4 most common languages spoken?

While 94% of healthcare extenders surveyed said Spanish was one of the 4 most common languages spoken by their patients, many other non-English languages also made the cut. Source: HealthEd Academy

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Multicultural Health Marketing • FALL 2013

Let us drive your strategy.

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7


WORLD ECONOMY PAGE TITLE

Who Are The Healthcare Extenders? While navigating the health system, most patients are likely to interact with healthcare extenders. Healthcare extenders are non-MD healthcare professionals who work directly with and on behalf of patients—including registered nurses, certified diabetes educators, social workers, and dietitians. Moreso than physicians, healthcare extenders often are the professionals who educate patients and family members and support chronic health management. Because healthcare extenders play such a key role in healthcare, HealthEd Academy seeks to get their insights on key health topics. health professionals created by HealthEd. HealthEd Academy was specifically interested in the role that culture and language play in healthcare as the US population continues to diversify. The US Census Bureau estimates that by 2050, racial and minority groups may account for almost half of the US population. Despite the diversification of the US population, persistent healthcare disparities continue to exist. Race, ethnicity, and ability to speak English may impact the quality of care patients receive. It is particularly important to understand the barriers to providing quality care for all patients as the ACA emphasizes prevention and engaging patients as partners in care.

Multicultural Health Marketing • FALL 2013

Spanish Is Just The Start

8

One of the key findings to emerge from the survey is that the populations that healthcare extenders serve are truly diverse. Although English and Spanish were the mostly widely reported languages, healthcare extenders report that they also see patients who speak languages including Chinese, French, Italian, Japanese, Polish, and Portuguese. And when asked which top 4 languages their patients speak, 4 in 10 healthcare extenders selected “Other.” This was a surprising finding, since respondents were able to choose from the top 10 most-spoken languages in the US, per recent Census data. For healthcare marketers, it suggests that offering patient communications only in “popular” languages may not be meeting the needs of healthcare professionals seeking a much broader spectrum of language-appropriate resources. Due to the number of languages spoken by patients, the survey found that many healthcare extenders report using interpreters. Healthcare extenders who work in hospital settings report having greater access to interpreters (87%) than do healthcare extenders in non-hospital settings (69%). Many of those using interpreters report using phone-based interpreter services, such as MARTI. Although many extenders report having interpreters available, this finding does reveal that there is still work to be done to ensure that

all patients are understood.

And when asked which top 4 languages their patients speak, 4 in 10 healthcare extenders selected “Other.” The report also found that the diversity of languages can present a real challenge for creating adequate patient education programs. This is particularly true for take-home patient education materials. Many healthcare extenders surveyed develop their own materials for use and 42% of respondents translate patient education materials into other languages. However, almost half of all respondents reported that they do not have access to patient education materials in the languages they need. Just as many respondents report needing materials in Chinese as Spanish/Spanish Creole (18%). And it is not just language differences that present barriers to effective patient education: 44% of respondents are often or sometimes uncertain how to best educate a patient or family member because of cultural differences. The data on languages, combined with the report’s other topics—including patients’ comfort-level with the healthcare system, the impact of community workers, and the use of educational technology— all tell the story of an increasingly diverse patient base. This growing base has created gaps that are impeding healthcare extenders’ ability to effectively communicate with and educate patients. Without effective communication, patient care is likely to suffer. The survey findings underscore the need to make working with patients from diverse cultural backgrounds a top priority in healthcare—for the sake of patients, as well as marketers. ■ Katherine A. Margolis, PhD, is currently Director of Health Communication Strategy at inVentiv Health. Previously, she was Director of Health Behavior Strategy and Research with HealthEd Group. To download a free excerpt and purchase the report referenced in this article, visit: www.healthedacademy. com


WORLD ECONOMY PAGE TITLE ASIAN AMERICAN

Asian Americans and Health Care: Understanding the Opportunities

Multicultural Health Marketing • FALL 2013

I

10

’ve never heard of the Asian American marketplace described without the word complex. In the AA community, there are indeed issues of language, generational imprints, and immigration status among a host of other variables a marketer must review. Then again, is this any different from any other target market? Does this mean African Americans, Gays & Lesbians, High Net Worth Investors, Teenage Heavy-user Candy Consumers, or any other target markets don’t also have their own complexity? Of course they do.

Recognition as a Market When Immigrants from any country have come to the United States, they identified themselves

as part of their country of origin e.g. Irish, Japanese, Brazilian, Russian etc., and not part of a larger group, at least until they became citizens. As the Civil Rights movement of the 20th Century grew, members of different ethnic, gender, and religious groups saw the advantages of working together, or at least claiming to work together, as a mass group in order to effect social change through political and economic power. That said, just as marketers have created a Hispanic Marketplace that combines those of Mexican, Puerto Rican, Cuban, Chilean, and other backgrounds, so can marketers think in terms of a combined Asian American market.

For health care companies, the 18 million person Asian American market opportunity is big enough and the data clear enough to allow those companies to develop a firm and accurate understanding of the opportunity.

By Robert Kumaki


• • • •

“The absolute size of the market is too small” “There are too many languages” “They’re hard to reach with mass media” “The African American and Hispanic markets are more important” • “We don’t have any products geared towards Asians” • “We can’t reach them with a single message” • “If they wanted our attention, we’d be hearing about it” For much of America, “minority” and African American are interchangeable. For those who live in areas like Southern California, Texas or most major metropolitan areas, “minority” may also include Latinos. Despite numerous obvious examples (like a population of 18 million), AAs remain relatively invisible in the nightly news reports when discussing U.S. ethnic groups. The literature on race continues to have a primarily black/white focus, with a Latino addendum. This bi-racial thinking fails to recognize the complex, post-civil rights era reality of an increasingly complex American identity.

Getting Started As marketers, we try to coalesce the largest audience of like background people as possible to make the most of our dollars spent trying to reach them. At the same time, in order to do this with the most accuracy, we must do a “deep dive” to learn as much as possible about our target, beyond topline demographics. This is where the problem lies with AAs. The deeper we seem to dive, the less of a mass market their appears to be, at least on the surface. Part of the mission of any good marketer is to wade through the clutter that gets in the way of understanding the target market. For health care companies, the 18 million person Asian American market opportunity is big enough and the data clear enough to allow those companies to develop a firm and accurate understanding of the opportunity.

Asian American Health Issues Affecting Marketing For years I have been advising a variety of nonhealthcare clients (with great success) to look at the AA target as one mass, just as with African Americans and Latinos, in an effort to maximize ROI. In the healthcare category, as in all marketing, I still recommend this

“massification,” but with a difference. Research shows that genetic variation makes a significant difference among AA groups, so it is necessary to look at them as genetic, and possibly geographic, tribes, not necessarily as just a social/marketing construct. National health statistics have traditionally grouped all Asian American subgroups into a single unit when evaluating racial differences, precluding the evaluation of in-unit differences. Healthcare may be one of the few categories that I’d recommend looking at differences among Asian ancestry groups even more than focusing on similarities among AA groups.

The literature on race continues to have a primarily black/white focus, with a Latino addendum. Here are some specific examples of what I mean: • Severe aplastic anemia is a condition that occurs when bone marrow produces an insufficient amount of new blood cells. Asian Americans are at a four times greater risk for aplastic anemia than the general populace, and yet, they are the least represented minority in the National Marrow Donors Registry. This is further complicated by the fact that the largest sub-group of Asian Americans are “hapas,” or those with a bi-racial Asian/non-Asian background, requiring a donor of mixed descent. • Osteoporosis threatens to affect an estimated 50 million Americans aged 50 and older. Asian American women are at a higher risk of osteoporosis than the general public, partially due to a tendency to have a smaller boned frame and lower bone mass. One of the steps in optimizing bone health is a balanced diet rich in calcium and vitamin D, assimilated most commonly from dairy products. As many as 90 percent of Asian American adults, particularly those from East Asia, are lactose intolerant, limiting the ability to get calcium from food. However, dairy products represent a significant portion of the South Asian diet. • Cardiovascular disease is the leading cause of death among Asian Americans. Asians (in Asia) generally have lower low-density lipoprotein cholesterol (LDL-C or “bad cholesterol”) levels than the U.S. population average. Studies have shown when Asians moved to the U.S., their LDL-C levels increased, mostly due to dietaryinduced lifestyle differences. Statins are commonly prescribed as part of a cholesterollowering regimen. However, it has been found

Multicultural Health Marketing • FALL 2013

However, the Asian American market presents a unique set of problems, not the least of which are corporate perceptions about the community. Below are some actual quotes of executives in Fortune 500 companies:

11


WORLD ECONOMY PAGE TITLE

that Asian Americans taking rosuvastatin have twice the amount of the drug in their blood as Caucasian patients taking the same dose. In March 2005, a warning label was added to the label of Crestor about the increased risk of serious muscle damage (rhabdomyolysis) in Asian Americans and recommended a reduced starter dosage of 5 milligrams a day. While research shows that AAs as a whole are less likely than non-Hispanic whites to die of heart disease, Native Hawaiians and Pacific islanders are about 40 percent more likely to be diagnosed with heart disease than whites. Diabetes affects over 25 million children and adults in the U.S., with almost 19 million diagnosed cases and a predicted additional 7 million undiagnosed. Several national studies have shown that Asian Americans have a higher prevalence of diabetes relative to non-Hispanic whites, but lower than that of African Americans and Latinos. However, the first study to look at Asian subgroup differences in population found considerable variation in the Asian American population. Pacific Islanders, South Asians and Filipinos had the highest diabetes prevalence and incidence among all racial and ethnic groups, including African Americans and Latinos. Part of the strategy for battling diabetes in the Latino community is the use of studies that have illustrated the prevalence and incidence rates among national subgroups.

Multicultural Health Marketing • FALL 2013

What Now?

12

So in this short piece, have we made the Asian American market more difficult to understand rather than simpler? Good, as this means you’re ready for a “deeper dive” into understanding the target market in order to maximize return on your investment. However, here are two simple strategies to keep you enthused about the AA target. Invitations to Buy There is a considerable difference in telling consumers “it’s okay to buy our product” vs. soliciting an invitation to buy. One of the simplest ways of letting people know you’re inviting them to buy is by showing people who look like them using your products. This is especially true for the Asian American market, which has been relatively ignored by marketers.

Neuroscience tells us that we all respond to faces that are part of our own ethnic origin, true across all racial groups. Marketing research tells us that Asian Americans not only focus in on people who look like them, but have an increased measure of attentiveness and positive feelings towards marketers who reflect this fact in their communications. While we do not mean to say that simply putting an Asian face in your communications will win over the hearts and minds of the AA community, given the lack of “invitations to buy” to date, it’s a good place to start. In the beginning, Ignore the Conventional Wisdom The earliest AA “marketing experts” communicated ad nauseam that marketers must use their translation services due to the welter of Asian-originated languages. Not surprisingly, the result is market complexity that no one else can navigate. The simple argument that the majority of AAs are foreign-born seems to meld with the idea that they can only be addressed in their native language. After all, isn’t that how they handle the Latino market? The U.S. Census reports that while three-quarters of AAs spoke a language other than English, two-thirds spoke English well or very well. The American Community Survey reports an even higher percentage – 88%. Clearly, foreign language ability or even preference has nothing to do with English language performance. Despite the wide variety of native languages, English can be a common denominator, with increasing English proficiency a characteristic of every generation of the AA market. The minority that lacks English proficiency is fed by ongoing immigration with basic proficiency achieved in the first few years. The next generation is almost completely English dominant and often acts as the information seeker/translator for older generations. The Asian American community will continue to be viable, reachable and profitable to the right healthcare providers. In a time when accumulated minorities are the majority population in the U.S., marketers cannot ignore the special healthcare needs and thus marketing strategies reaching these groups. ■ Robert Kumaki is Managing Principal of the Ronin Group. With 30 years of global marketing experience in numerous product categories, he is recognized as one of the country's leading authorities on the Asian American marketplace and is author of Many Cultures, One Market: A Guide to Understanding Opportunities in the Asian Pacific American Market.


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WORLD ECONOMY PAGE HEALTH TITLE LITERACY

Children with Chronic Illness from Multicultural Families: Challenges and Solutions for Successful Medical Management via Health Literacy By Sandra B. Jones & Stephanie E. Jones

Multicultural Health Marketing • FALL 203

14

There is a direct impact on improved well-being, self – determination, and participation in health care...while reducing health care cost for the family,

the more the family

increases their health literacy.

P

romoting self- management in children from multi cultural families, with chronic illnesses, can be difficult for both the parents and the children. In many homes children from diverse cultures and religious beliefs, educational level, customs, languages, traditions, and family values, self-manage their chronic illness, improperly use medications which can ultimately increase their risk of illness, injury, and unfortunately death. Increasing numbers of children,

from multicultural backgrounds, are managing chronic illnesses such as obesity, diabetes, attention deficit disorders, depression, anxiety disorders, bipolar, heart disease, high cholesterol, or hypertension, and sickle cell disease, independently. Several of these diseases were unheard of in children 20-40 years ago. The scope of children, from diverse cultural backgrounds, who are managing their chronic illnesses, the cost of chronic illnesses, and how health literacy is as one of


the key strategies for parents and children who are self managing their chronic illness, will be discussed in this article.

Scope of Chronic Illnesses in Children

The rate of chronic diseases in children today has doubled in the past two decades. In twenty years, children are now engaged in medical problems that their grandparents are also combating. In analyzing studies in the American Medical Association, according to a 2010 study, some estimates suggest that 26% of children now suffer from a long-term health problem. The study further suggests more than half the children in their study have some type of chronic illnesses, an illness that limits their activities and abilities, or requires special medication and equipment. Many of these children suffering from the chronic illnesses are from vulnerable populations, such as African Americans, Hispanics, American Indians, and Asian Americans.

Heath Literacy Health literacy is the ability to read, communicate, and use information in health care either in the home or a medical facility. Low literacy may affect safety, compliance with medical regimes, diet, use of medications and medical equipment, quality of care, outcomes, and costs of medical care for 25-50% of US

adults and children.

In twenty years, children are now engaged in medical problems that their grandparents are also combating. Low health literacy in the United States impacts approximately 80 million adults (36%). However, the rates of low health literacy are higher in some segments of subgroups in the population such as minorities, individuals who have not completed high school, populations that are ESL (English Second Language), people living in poverty, children who may have missed substantial time from school, and children who are recent immigrants to the United States. The problem also lies in the approximate 2/3 of 8th and 12th graders who read below grade level¹. This low literacy compounds itself with children practicing self-management and parents of children who are also functioning at low literacy. Health literacy is a low risk/cost/easy way to ensure the many children who are self-managing their chronic illnesses to lower risk. Many children are self managing their chronic illnesses with

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Multicultural Health Marketing • FALL 2013

with

15


WORLD ECONOMY PAGE TITLE

prescribed and/or over the counter medications, information on the internet, television, smart phones, and peers, but not with a professionally trained individuals. As the number of children, from multicultural families, who are diagnosed with a chronic illness increases, it is time to empower their desire for independence and shift “responsible thinking," transitioning into better accurate engagement and confidence with today health care providers and the health care system. This can be facilitated with skills in health literacy. The parent is the most major influence that provides support, love, communication, education, and values, for interactions. Children in many ways learn the importance of diet, health, medical care, and the relationship with health care providers, through interacting with parents. A family is where a child begins to understand the value of health and compliance with medical regimes to support optimal health and curative factors. A family is also where the children may begin to learn and hear medical terms and become educated about various illnesses. There is a direct impact on improved well-being, self –determination, and participation in health care, while reducing inappropriate health care utilization, medications, medical regimes, and health care cost for the family, the more the family increases their health literacy.

Multicultural Health Marketing • FALL 2013

Bridging the Gap of Health Literacy and Self Management in Multicultural Families

16

There are many strategies parents can use to positively impact the outcomes in managing their chronic illnesses that are directly tied to health literacy: • Recognize the cognitive ability of the child who is self managing their chronic illnesses. Many times health terms and health information is written at a much higher level than the general public is able to decipher. Therefore, it is important to dedicate time to make sure the child understands what the health information means in their personal cognitive learning styles and terms. • Use methods to explain health information in terms or ways that are understandable to the children. For example, use pictures, drawings, as a means to ensure a greater understanding of the health terms, such as during teachable moments at the dinner table. • Meet the child at their readiness learning level. This means sometimes there is a lot of

information to comprehend at one time. As the family sits down to discuss the various health terms, be aware of the child comfort and confidence level in understanding the information shared at that time and assess their readiness to learn more. • Utilize community partners, such as pharmacists and the school nurses. These health care providers are important to support successful self-management of children with chronic illnesses. Many times pharmacists and school nurses can be instrumental in providing explanations to help educate youth about their medications, side effects from medications, usage of medical equipment, and other tools to support self management of a chronic illnesses. • Encourage your child to ask questions of their health care provider. By asking the health care provider questions, this gives the child some element of independence, ownership in their health care needs, participation in the care of their bodies, and a sense of self-esteem in being knowledgeable and confident about their selfmanagement. In summary, there are many variables that impact the success of children to self-manage their chronic illnesses successfully. Health literacy is the one variable that contributes to the successful outcome in the self-management of chronic illnesses immediately controllable in their home. Parents and children from multicultural backgrounds can impact cost and self management by incorporating health literacy practices. ■ Sandra Jones has 20 plus years of professional experience as a health educator at the Centers for Disease Control and Prevention. She has practiced in pediatric clinical settings; served a project manager in pediatric research; taught pediatrics in academia; served as a school nurse; provided evaluation expertise in public health settings; and published many articles with particular focus on public health issues, including health literacy. She can be reached at sandra@health-ettes.com Stephanie E. Jones currently resides in Atlanta, Georgia and is obtaining her master's degree. She is an aspiring author and high school teacher, who dabbles in science based fun on the weekends. She also is a free lance editor and you may contact her directly at: sjonesej0@gmail.com or via Skype:sjonesj0 References National Association of State Boards of Education, “From State Policy to Classroom Practice: Improving Literacy Instruction for all Students”, The NASBE Adolescent Literacy Network, April 2007. 1


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WORLD ECONOMY PAGE TITLE MULTICULTURAL MYTHS

Multiculturalism in the Healthcare Paradigm By Dr. Corey Hebert

Multicultural Health Marketing • FALL 2013

18

who thinks butter is the remedy for a fresh burn, or an Asian who feels that when air touches a tumor during surgery, the cancer will spread, people from all shades of the rainbow have different cultural health myths that they truly believe and live by. Invariably, people stop me all the time to ask me whether some medical “fact” they heard someone say over the years is true. So I decided to compile a list of some of these interesting myths from different cultures so we can debunk a few of them once and for all.

...People from

all shades of the rainbow have different cultural health myths that they truly believe and live by.

M

ulticulturalism means many things to many people. In business, it means to relate to the consumer, whether educated or not, that your product is worthy of their support. In medicine, it is a tad bit different. As a physician I believe that multiculturalism means to be able to get to people where they are in a culturally relevant fashion, to break imposed barriers, and save their lives. This is very hard to do sometimes as many cultures have many different myths about what “health” is and how to treat illness. Whether it’s an African American


How many times have you heard your mom say, “Put your jacket on or you’ll catch a cold!” You may not want to tell mama, but she was wrong. I was asked recently after an outdoors music festival…"Hey Dr. Hebert, can coffee sober you up after drinking too much alcohol?" I assumed that this guy had a vested interest in the answer….Well the real truth is if you’ve had too much to drink, no amount of coffee, soda, water or anything else is going to sober you up. The only thing that will do the trick is time. The liver can metabolize only about one standard drink, which is 12 ounces of beer, 6 ounces of wine, or 1.5 ounces of hard liquor per hour, so if you’re drinking more than that every 60 minutes, you’ll have alcohol in your system for some time. The idea of coffee’s sobering effect may have started because caffeine acts as a stimulant, counteracting the sedative effect of alcohol to a small degree. However, it has no effect on the amount of alcohol in the blood. So if you’ve been drinking, try to alternate a bottle of water between

Dr. Hebert speaks at the inaugural Multicultural Health National in 2012

drinks and spend your money on a cab instead of a cappuccino. This is a huge one that everyone asks….can too much sugar or candy make kids hyperactive? Many parents limit sugary foods, thinking they cause hyperactivity. It's right to restrict these treats, but the reasoning is wrong. These highcalorie foods offer little nutrition and can lead to obesity and other problems, but no scientific evidence illustrates that sugar causes hyperactivity. Sugar can provide a short-term energy boost, but that isn’t the same as hyperactivity. The children at a birthday party acting like little tornadoes, probably has more to do with the excitement of being around other kids, rather than the cake. And that unruly child in the grocery store throwing a fit with a sucker in his mouth and candy clutched in each fist? His parents probably haven’t set appropriate behavior limits, and they most likely give him what he wants–which is more candy which is why he’s acting out. With these few myths debunked, I hope that you will start to be able to navigate with a more keen eye through litany of non-culturally relevant health information that is being digested by your customers family and friends. ■ Dr. Corey Hebert is the Chief Executive Officer of Black Health TV (www.blackhealthtv.com), the only academically based health information website for African Americans in the world. He also practices both Pediatrics and Emergency Medicine at Tulane University Medical Center and works as on-air medical editor for the NBC television affiliate in New Orleans, Louisiana and the Gulf Coast, as well as contributes frequently to The Dr. Oz Show.

Multicultural Health Marketing • FALL 2013

The first one is “Can Cold Weather Can Give You a Cold?” How many times have you heard your mom say, “Put your jacket on or you’ll catch a cold!” You may not want to tell mama, but she was wrong. Viruses, more than 200 different kinds, cause colds, not cold weather. In order for you to catch a cold, the virus must travel from a sick person’s body to yours. This usually happens via airborne droplets you inhale when an infected person coughs or sneezes. You can also get a cold virus by shaking hands with an infected person or by using something where the virus has found a temporary home, such as a phone or door handle. Colds are more prevalent during the colder months because people tend to spend more time inside, making it much easier for viruses to jump from person to person. Just think about it, if cold weather really caused colds then people in Alaska would be sick all the time!!! Also, if you go outside after a shower people say that you will catch cold because your pores are open. What do we think, the viruses are gonna climb on your skin and into your pores and get ya….I guess you can tell by my tone that it’s not true either.

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WORLD ECONOMY PAGE LINGUISTICS TITLE

Healthcare Dialogue Analysis: Linguistically Tune your Target Message By Kaity Arctander and Carolyn Reed

Multicultural Health Marketing • FALL 2013

20

ethnographic approach, reveals the communication and cultural gaps that exist within exam-room dialogue. This fly-onthe-wall perspective allows for identification of solutions that inform targeted marketing efforts, improve physician-patient communication and affect healthcare outcomes even at the most culturally-specific level.

Medical

linguistics provides an unbiased way to determine how a population is likely to interpret and act on different leverage points...

T

he interaction between patients and physicians in the exam room often becomes an interaction between cultural, educational and social backgrounds. The language used by both participants reflects their unique backgrounds and reveals how they interpret and act upon healthcare information. Healthcare dialogue research, a linguistics-based


population, as it is used by another patient without any influence by his physician: Doctor: Been to the eye doctor? Patient: Yeah. Doctor: Said everything looks all right? Patient: Yeah, everything looked good, no damage or whatever.

Medical linguistics provides an unbiased way to determine how a population is likely to interpret and act on different leverage points... Damage, as it is used in these conversations, carries meaning specific to this disease state and to this patient population including: • A historical pattern of African Americans affected by this condition • A biological scenario resulting in blindness • This population’s pre-existing knowledge about vision loss. The natural question: what is the practical application of this medical linguistic analysis? We have just identified a concept that is so resonant within one population group that it is used by multiple members within it. This natural language concept used by both patients and physicians can now be used in marketing and advertising, patient empowerment campaigns, or patient educational materials, making an instant connection with your key customers and stakeholders. In-depth medical linguistic analysis offers comprehensive methods by which triggerwords and concepts like damage can turn into conversational leverage points for your marketing materials. Medical linguistics provides an unbiased way to determine how a population is likely to interpret and act on different leverage points, allowing you to effectively transfer your message into a patient group’s pre-existing knowledge system. When applied across Verilogue’s extensive database of physician-patient interactions, healthcare dialogue research and medical linguistic analysis inform and strengthen any marketing campaign by revealing unmet needs and identifying new opportunities within even the most specific population groups, allowing for more effective support from key stakeholders within the healthcare industry. ■ Kaity Arctander is a Linguistics Analyst, Client Services at Verilogue, Inc., an ethnographic market analytics organization that focuses on patient-physician dialogue. Carolyn Reed is a Senior Analyst, Linguistics Insights and Analytics at Verilogue, Inc.

Multicultural Health Marketing • FALL 2013

Diabetic retinopathy is a condition which the ADA states African American diabetics are 50% more likely to develop as non-Hispanic white diabetics. Identification of cultural elements, metaphors and narratives used when discussing retinopathy in the doctor’s office can help marketing efforts more clearly communicate a targeted message. In this interaction between an African American Type II Diabetes patient and his Primary Care Physician, the physician uses a variety of linguistic tactics to educate the patient on the risks of retinopathy and encourage compliance to an annual diabetic eye exam: Doctor: The reason why I keep your sugars under good control is that they don't soak in and poison you. High sugars will get into your arteries and your nerves and it'll cause damage. [...] We hope to avoid sugar soaking in and damage. One of the main causes of blindness in America is diabetes because there are blood vessels in the eye. And when it soaks into blood vessels, they can get damaged. You may not notice it if it's in your liver but you'll notice it in your eyes, so we go to the eye doctor every year, like you've done. Examining this excerpt of a real exam-room conversation from a medical linguistic perspective, you first notice that the physician encourages compliance by repeating the words “soak in” and “damage,” strengthened further by “poison.” These words and their use clearly outline for the patient a dangerous cause and effect scenario connecting sugar to the blood vessels. The physician then builds on the theme of damage and the possible outcome of this scenario by stating that “one of the main causes of blindness in America is diabetes because there are blood vessels in the eye.” This provides a tangible outcome for the scenario (loss of vision), but also suggests that retinopathy is a real problem which affects a much larger population. Finally, the physician directly connects the possibility of damage caused by sugars to the patient himself, “you’ll notice it in your eyes,” before encouraging him to continue with the necessary preventative care. This type of medical linguistic analysis gives an understanding of how awareness of risk is communicated to an individual member of a population, but how can we know if linguistic elements resonate across a larger group of similar patients and which messages to employ in our marketing efforts? The below excerpt is taken from an interaction with a different African American Type II Diabetes patient and another Primary Care Physician. We can see in this example that the concept of damage does resonate with a larger

21


CONTRIBUTORS/ WORLD ECONOMY PAGE TITLE AD INDEX

CONTRIBUTORS Kaity Arctander is a Linguistics Analyst, Client Services at Verilogue, Inc., an ethnographic market analytics organization that focuses on patientphysician dialogue. Kaity analyzes the interactions between healthcare providers and their patients across various disease states on topics including: interactional dynamics, physician and patient emotional and attitudinal profiles, uses of conceptual metaphor and descriptive analogies, disease and product sentiment and brand positioning. To read the article she co-authored with colleague Carolyn Reed, turn to page 20. Dr. Corey Hebert is the Chief Executive Officer of Black Health TV (www.blackhealthtv.com), the only academically based health information website for African Americans in the world. He also practices both Pediatrics and Emergency Medicine at Tulane University Medical Center and works as on-air medical editor for the NBC television affiliate in New Orleans, Louisiana and the Gulf Coast, as well as contributes frequently to The Dr. Oz Show. To read his article, turn to page 18. Sandra Jones, currently President at Health-ettes, has 20 plus years of professional experience as a health educator at the Centers for Disease Control and Prevention. She has practiced in pediatric clinical settings; served a project manager in pediatric research; taught pediatrics in academia; served as a school nurse; provided evaluation expertise in public health settings; and published many articles with particular focus on public health issues, including health literacy. She can be reached at sandra@healthettes.com. Turn to page 14 to read the article she co-wrote with Stephanie Jones.

Stephanie E. Jones currently resides in Atlanta, Georgia and is obtaining her master’s degree. She is an aspiring author and high school teacher, who dabbles in science based fun on the weekends. She also is a freelance editor and you may contact her directly at sjonesej0@gmail.com or via Skype at sjonesj0. Turn to page 14 to read the article she co-authored with Sandra Jones. Robert Kumaki is Managing Principal of The Ronin Group. With 30 years of global marketing experience in numerous product categories, he is recognized as one of the country's leading authorities on the Asian American marketplace and is author of Many Cultures, One Market: A Guide to Understanding Opportunities in the Asian Pacific American Market. Turn to page 10 to read his article. Katherine A. Margolis, PhD, is currently Director of Health Communication Strategy at inVentiv Health and serves as an Adjunct Professor at The College of New Jersey. Previously, she was Director of Health Behavior Strategy and Research with HealthEd Group. To download a free excerpt and purchase the report referenced in her article, visit: www.healthedacademy. com. To read her article, turn to page 6. Carolyn Reed is a Senior Analyst, Linguistics Insights and Analytics at Verilogue, Inc., an ethnographic market analytics organization that focuses on patient-physician dialogue. In her role, Carolyn identifies, describes and evaluates the relationship between physician-patient attitudinal and emotional characteristics and health behaviors and outcomes. To read the article she co-authored with colleague Kaity Arctander, turn to page 20.

Multicultural Health Marketing • FALL 2013

ADVERTISING INDEX & RESOURCE CENTER

22

Company

Page

Website

Phone

Contact

Email

Ethnic Media Print Group

2

epmg360.com

866-664-4432 Kelly Gloria x 237

kgloria@epmg360.com

Impremedia

9

impremedia.com

213-896-2095 John Buckingham

john.buckingham@laopinion.com

Interlex

7

interlexusa.com

210-930-3339 Leah DeLaGarza

leah@interlexusa.com

Latin2Latin

15

latin2latin.com

954-376-4800 Arminda Figueroa

Arminda@latin2latin.com

Prime Access

23

prime-access.com

212-868-6800 Anthony Marucci

anthony.marucci@prime-access.com

Telemundo

17

telemundo.com

212-413-5100 Patty Marreo

patty.marrero@nbcuni.com

Univision

13

corporate.univision.com

310-348-3689 Jorge Daboub

jdaboub@univision.net



Fall 2013