DTC Report: Between Screens

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Consumer marketers aren't exactly turning off the TV just yet, but with budgets tightening, blockbusters going off-patent and DTC TV in disrepute, they are spending more time on YouTube and Facebook.

Consumer advertising spend fell to $4.7 million for the year to November, 2008 from $5.1 million for all of 2007, amid budget cuts, maturing brands and a paucity of prospective blockbusters to launch. With the sleep aid wars winding down and a series of safety scares and advertising scandals rippling through the cholesterol category, some big advertisers of recent years dropped off the screen. Print, internet, radio and outdoor ad spend languished, though anecdotal evidence suggests that spending on unmeasured digital media—from search engine optimization and website development to online video and social media—is booming.

“We're certainly shifting to more digital efforts,” says Tammy Smalls, senior director of consumer marketing at AstraZeneca. “It's largely a function of where consumers are. We see them more and more going online to get information about medicines.”

AstraZeneca spent $264 million in measured media on consumer advertising for the year through November, according to SDI data, most of that going to TV and magazine ads supporting brands like Crestor, Nexium and Symbicort. But the company has ramped up its efforts online, including Symbicort- and Nexium-branded channels on YouTube. 

For Symbicort, which had its US debut in mid-2007, the company launched MyAsthmaStory.com and a complimentary YouTube site in September. The sites feature video testimonials from Symbicort patients describing how the drug has helped them tame asthma, and they invite viewers to submit their own 60- to 90-second videos. The format allows a measure of interactivity with a built-in solution to the quandary of adverse events reporting requirements, since comments are disallowed and all submissions are screened by the company before being posted.

Also in February, Sanofi-Aventis launched an unbranded YouTube channel together with a companion site, GoInsulin.com. Abbott and Johnson & Johnson previously launched their own corporate YouTube channels. AstraZeneca updated all of its branded product sites last year, using market research on what features drive traffic and help hold viewers' attention to program new content and make them more easily navigable.
“People do come back to these sites,” says Smalls. “We want to keep refreshing them to keep them relevant and current.”

For Symbicort, the company added podcasts, as well as some mobile offerings through its Measures of Success relationship marketing program. Subscribers can get email or text message reminders about doctor visits, taking their medicine and refilling their prescription, as well as local pollen count and air quality information.

Lisa Flaiz, VP and head of Razorfish's national pharma practice, says content integration programs is the only digital channel in which she's seen a decrease in activity this year. “We're seeing increases in banner ads and rich media. Video is exploding. There's even been an increase in email lead generation.”

Coming soon: mobile marketing and advergames along the lines of Ambien CR's Silence Your Rooster or Viagra's Viva Cruiser.

“It wasn't so long ago that ‘online marketing' was basically code for having a website and doing banner advertising,” says Jim Joseph, EVP and managing director of Saatchi + Saatchi Consumer Health and Wellness. “We're just starting to scratch the surface of having web content be more robust and link to other sources. The online experience is becoming more rich, like you would see in packaged goods, food or OTC.”

Leveling the playing field for smaller, specialty brands
If digital media offers big, mass-market brands an affordable and targeted alternate means of reaching customers, it's a godsend for smaller companies and specialty brands that lack the budget for a traditional consumer campaign.

Acorda Therapeutics, a Hawthorne, NY-based biotech that specializes in developing treatments for multiple sclerosis and spinal cord injury, has taken advantage of this leveling force to promote Zanaflex, a treatment for spasticity in MS and spinal cord injury patients and the firm's sole post-market product.

“Everyone is under pressure in the current economic climate,” says Erica Wishner, director of consumer marketing for Acorda. “We're not a big company. We have one product on the market, one in development, several in the preclinical stage. Our motto is ‘Do More With Less.' That compels us to be a little more creative and find the best ROI for our marketing dollars and do it in the most cost-effective manner. For a few hundred dollars you can place an ad on Facebook and get hundreds of thousands of impressions.”

Acorda has tapped into the heavily networked online MS community through partnerships with patient advocacy groups and through a trio of websites. In addition to the product site, the company maintains two disease awareness sites: MoveOverMS.org, an online lifestyle magazine for people living with MS; and IWalkBecause.org, a partnership with the National Multiple Sclerosis Society. MoveOverMS, says Wishner, “goes back to the idea of trying to give voice to the patient community on topics that they feel are important.”
For IWalkBecause.org, Acorda brought booths to the top 10 Walk MS events and “created an interactive experience to give people voice on why they were walking,” says Wishner. At the booths, staffed by Acorda volunteers, participants could create videos or make T-shirts featuring a thought-bubble motif. Videos and pictures from the events went up on the website and were posted to YouTube, and have seen 50,000 downloads so far. 

“I think you're going to see, over the next year or so, a lot of people dipping their toes in the water on MySpace and Facebook,” says Wishner. “They're a really great way to reach a large audience of people without investing large sums of money, and you're talking to them where they are. They're already there talking to each other and creating these online communities.”

TV still on top
Of course, for driving awareness, TV is still king, and while the number of brands appropriate to the medium may be dwindling, spending is holding steady. For the year to November, TV spend was up—a scant .2%, according to SDI data, but up nonetheless in a year when everything else was down—and accounted for 62% of all DTC dollars.

By contrast, magazine ads, accounting for another 31% of consumer ad spend, were down 20% for the same period.

Agency execs say that while drug industry clients may not be fleeing from the tube, they are investing much more cautiously in TV advertising.

“It's perhaps being more scrutinized,” says Jim Joseph, managing director for Saatchi & Saatchi Consumer Health+Wellness. “Marketers are being a little more thoughtful and perhaps not planning out as far ahead. It's ‘Let's see if it's working and then we'll commit to it. They're looking at the role of TV versus digital versus CRM, and there's not that automatic set-aside anymore.”

“Everybody's struggling,” says Ellen Fields, global business director for DDB New York. “Companies are being forced to re-evaluate what they're doing, and we think that's a good thing.”

Pipelines are sparse, Fields notes. The blockbusters of old are drying up and being replaced by specialty drugs aimed at much smaller patient populations.

“As we look at the patient population and the financial potential of these drugs, it makes sense to shift their approach,” she explains. “Plus, people are consuming media differently, in a much more fragmented way.”

Speaking to the camera, and right at regulators
AstraZeneca has updated its TV campaign for Symbicort with new creative. While sticking with the core concept—a woman, cast in shadow so as to be almost silhouetted, talks about her asthma and how Symbicort has helped.

In refresher spots, which broke in January, AstraZeneca made her more confident and engaging while toning down background elements to keep the focus on her and her message—an approach that Smalls says aids in comprehension of risk information and brand messaging alike.

“We still see a lot of ads where the major statement is being presented, but there's a lot of activity going on in the background,” says Smalls. “You don't necessarily have to have someone looking directly at the camera to deliver it. Our intent is we want to make sure patients can clearly understand the message without being distracted. There are creative ways to do that, and we want to explore that and maintain engagement throughout.”

Distractions from risk information in TV ads is a topic the FDA is keenly interested in. Last year, the agency announced a major study, slated for completion in 2012, on the impact of distracting visuals on viewer comprehension of the risks and benefits of advertised drugs. “One characteristic of DTC television broadcast ads is the use of compelling visuals,” said the agency in a notice published in the Federal Register on August 6, 2008. “Many assert that the visuals present during the product risk presentation are virtually always positive in tone and often depict product benefits. A consistently raised question is if advertising visuals of benefits interferes with consumers' understanding and processing of the risk information in the ad's audio or text.”

“We are seeing a lot more scrutiny from FDA,” says Saatchi & Saatchi's Joseph. “It's not like they're trying to block anything, but they're taking longer, thinking about things more and asking more questions.”

Several powerful members of Congress have been asking questions, too—about whether or not DTC advertising drives up healthcare costs. Reps. John Dingell (D-MI), Bart Stupak (D-MI) and Henry Waxman (D-CA) have called for a moratorium on consumer advertising of up to several years after a new drug is introduced. White House chief of staff Rahm Emanuel warned the American Association of Advertising Agencies in September that they would have to choose between tax deductions for R&D spending or consumer advertising.

In an attempt to head off these and other draconian restrictions on consumer advertising, PhRMA tweaked its DTC guidelines, adopted in 2005, at the end of last year. The revisions, meant to assure legislators that the industry can police itself, sidestepped the moratorium question, instead encouraging members “to consider individually setting specific periods of time, with or without exceptions, to educate healthcare professionals” before launching DTC print or TV. Reps. Dingell and Stupak essentially pronounced it a stunt, “merely a rewording of prior policy that does nothing to increase consumer protection.”

Tough talk. And maybe just talk, but the industry's on notice, and that's impacting creative.

“Everybody's walking the fine line of needing to break through with a creative message and wanting to be appropriate within the regulatory environment,” says Anne Devereux, chairman and CEO of LyonHeart and TBWA/Worldhealth. “There's a heavy emphasis on education, and that can be fun, but lately it seems to be done in an exceptionally dry fashion. In the cardiovascular arena, people don't understand the difference between HDL, LDL and triglycerides. How do we make them understand that and break through that episode of House they're watching?”

Andrew Schirmer, of McCann HumanCare, sees a trend toward dull testimonials. “There has been some movement away from the iconic brand building, metaphoric advertising to a more testimonial, ‘regular person talking to the camera, telling their story' format,” says Schirmer. “I worry that we're at risk of falling into the template trap. We need to continue to figure out ways of making advertising that is incredibly relevant and clear and responsible, but we're still in an engagement medium, and like any good teacher knows, you can't educate unless you first engage.”

Economy weighs on sales, ads
The deep economic slump has upended the truism that the drug industry is countercyclical, immune to the ups and downs of the broader economy, as sales trends indicate many Americans are splitting pills or putting off filling prescriptions altogether.

Even before the economy went south, a number of companies began running discount and coupon offers, in addition to their access and affordability programs for the uninsured, aimed at consumers with insurance who might otherwise go the generic route or try to tough it out. With economically insecure consumers pinching pennies and taking a hard look at co-pays, the use of such offers has intensified. It's hard to find a big brand that isn't offering to shave a few dollars off sticker price these days.

For Symbicort, AstraZeneca offers up to $20 off per co-pay for up to 12 months, or $240 per year. Patients on Schering-Plough's Nasonex can save up to $10 per prescription or $120 per year through coupons. Sanofi-Aventis' Seven-Night Invite program offers Ambien CR patients savings of up to $100 on five refills of the drug.  

Bristol-Myers Squibb has done them one better with its Orencia Promise program, by which BMS offers to cover patient co-pays for the first six months (or eight infusions) of the drug—and to cover the first co-pay of another drug, up to $500, if patients are unsatisfied. Instead of being relegated to an afterthought in the voiceover at the end of a spot, BMS is leading on the program in its consumer advertising, with TV, print and online ads extolling the offer, available to first-time patients with moderate- to severe rheumatoid arthritis and private insurance that covers the drug. The consumer campaign broke in February, and the company is detailing physicians on its availability.

“It's a very straightforward, offer-driven campaign,” says Marc Weiner, managing partner at CommonHealth and head of the network's consumer business. “I think you're going to see more of that than ever before. Price promotions, offer-driven communications and guarantees are going to be much more the norm.”

One silver lining of the economic slump is that with many of the biggest-spending sectors in advertising—automotive, finance and travel—pulling back sharply, it's a buyer's market for those sectors still advertising.

“There's a lot of excess inventory, so a lot of windows have opened up for brands that would normally have small budgets for doing above-the-line work, and nothing beats TV for driving awareness,” says Tim Pantello, managing partner at Tribal DDB Health.

It's a boon for drug companies buying TV and print, but some worry about the optics, given the new and more DTC TV-averse regime in Washington.

“These last couple years, almost by default, pharmas are taking on ownership of more primetime and dayparts,” says McCann HumanCare's Schirmer. “We've got to be careful, because we do run the risk of dominating the airwaves, so it's more important than ever that we make sure we as an industry are acting responsibly.”
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