Tales from the Hall

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We asked seven of the industry's greats to reflect on the past of pharmaceutical promotion. Their candid answers have much to say about the present state of medical marketing and where we're going.

Has medical advertising changed for the better or for the worse as the business has grown over the past quarter-century? Are advertisers more or less the same as they ever were? Physicians?

LEW MILLER: The sale of advertising has changed dramatically.  At one time, it was possible for publishers and ad salesmen to call on product managers and occasionally market directors of companies. Now it is almost impossible to see account managers at agencies. Ad sales are made to media directors, who follow syndicated printouts. Physicians have become more sophisticated and more interested in the evidence. The increased number of drugs, devices, and diagnostic products has made it more difficult for doctors to keep up. A doctor is fortunate if he can read two or three of his specialty research journals. In addition, he will try to read at least two or three review journals. The amount of continuing medical education has increased dramatically as well, and journals tend to be compared with CME courses. Editors must avoid suspicion of bias in the selection of authors—otherwise physicians will lose faith in a journal. Finally, the complexity of practice has grown exponentially. The number of forms to be filled out, and limits on compensation, the malpractice problems, etc., complicate the doctor's ability to provide patient care at a high level.

JACK ANGEL: DTC has been a mixed blessing. On the one hand it has, in some instances, enabled manufacturers to increase their sales. On the other, it has made them more visible in some very negative ways to both government and the public. Rather than the science-based institutional image they once enjoyed, they have become hucksters in the eyes of many. DTC can serve the interests of both companies and the public well, but we have missed that goal so far.

BILL GIBSON: It's grown much larger than I think anyone has figured it would grow. When I first started out, a brand that had $100 million was considered a very, very large brand. Now we're dealing with mega-brands worth billions. The number of sales people is far above what we ever dreamed it would be. Most of the big companies have two or three sales forces, so we are even competing with each other. Many companies have disappeared through mergers and acquisitions. Medical education overpowers the traditional advertising business in some areas.The influx of new communications tools are a major change from the old traditional journal advertising and direct mail.

AL NICKEL: The advertising is more complete and easier to read and understand and a much faster communication. Advertisers are more diligent and are watching the spend and ROI and carefully scrutinizing all communications to be certain they are clear, understandable and in compliance with all rules and regulations.

SAL DEROUIN: The industry certainly employs more people than we ever did. Rolf Rosenthal grew to 130 people and we thought that was a big shop. Now people like Tom Harrison have a thousand people reporting to them. People in the industry say advertisers have gotten meaner and deadlines have gotten shorter and they always say I was in the industry at the best of all possible times. Today's primary care physician has a bazillion patients, so you wait a little longer.

BILL CASTAGNOLI: I would have to say it has changed for the better because of greater patient involvement. In the old days, people didn't even know what medicines they were taking. They trusted the doctor completely. They'd say, ‘I'm taking brown pills.' It was an era of unknowing. That changed with the advent of DTC.

FRANK HUGHES: As companies have merged, that unfortunately fosters more and more sameness and less creativity. There was more individuality when there were a hundred pharmaceutical companies and they weren't all owned by these global corporations. There were also many different kinds of advertising agencies. Smaller, more individual companies were more fun to work for. They were more idiosyncratic in the way they looked at things and more tolerant of offbeat approaches to advertising. When I started, there were specialists in advertising. They really understood advertising, whereas today you have people who are maybe better marketers, who have their MBAs in marketing and that sort of thing—but that's not advertising. I remember a client telling me that a campaign I presented was very different, and he meant that in a negative way. I said, “That's what I'm trying to do—separate you out from the crowd! The fact that it seems a little strange to you is probably in its favor.” His response was puzzlement. That's that sameness of thinking, and it's an outgrowth of the mergers.

What was the industry like when you were starting out?


LM: Medical advertising was taking off because of the surge in new antibiotics. This put great demands on filling editorial pages, which had to match the number of ad pages. There were far fewer journals, and until we started Patient Care in 1967, there were almost no review journals, nor primary care journals. Even so, medical advertisers were skeptical of any new journal, saying “the last thing we need is another journal!”    

JA: I entered the business in 1970. It was a golden era. The industry was small, warm, and not particularly well known by the public at large. It was perceived as very a responsible contributor to the health of America, though many of the products of that era were nowhere near as effective as many of those we market today. Like the rest of the industry, the pharmaceutical industry grew large and the influence of Wall Street caused several to lose their way.

BG: There were a couple of really dominant companies: Pfizer, Hoffmann-La Roche and Ciba Geigy. Each specialized in its own therapeutic class. Roche was the psychotherapeutic house. Ciba Geigy was the antihypertensive house. Today, they're competing in many of the same categories—hypertension, arthritis, cancer.

AN: The industry was mostly focused on prescription drugs, and there were very few communication vehicles or media. It was all handled by professionals with good judgment, and they made decisions based on their expertise and business sense, not purely on “proven” research results.
 
SDR: When I got into the industry, it was the place where all the designers wanted to be. It's shifted. It drifted into television and that's a different animal as far as designers and art directors are concerned. At one point during the Estes Kefauver days they made it almost impossible for designers to continue to design, because advertising spending was suspect, and if you put out a really glitzy product it was frowned upon. Everything was scaled down. Ted Kennedy contributed to that too, with his rants about healthcare costing too much. I thought at end of that period, most ads looked like a memo from the government. So when you put in all those restrictions into an ad, there was no room for the image itself. It's amusing to watch it happen to TV. In a 30-second ad, 15 seconds belong to the government.

BC: Business was booming then. There was a lot more entertaining and a lot more camaraderie. All ships were rising. As one agency head said in the early '50s, you had to be a fool to own a pharmaceutical agency and not be successful. It was a very social business. I knew an ad exec at the Frohlich agency who prided himself on not paying for lunch for a year, since he was entertained by publication people and supplier people. That was common. It was a smaller business, and we all knew each other.

FH: The industry was full of small and large companies that weren't as market-driven. They felt it a part of their mission to take on products that would make little or no money. Wyeth had an anti-snakebite serum. Merck had a black widow spider vaccine. They never made any money on those drugs, but it was important, because if only 20 were used, that could be 20 lives saved. There were smaller companies that might have made one or two specialty products, and now these things are subsumed under the aegis of a big global corporation and don't get as much attention, because they have to have their sales people support a cardiovascular drug on which they've spent billions in research. I don't want to give the impression that they're less idealistic than people were 50 years ago, but the business has changed.

Has creative improved over the years, or has advertising become more homogenous with the advent of Photoshop and one-click stock? What impact has the decline of centralized, cross-channel, multi-brand planning had on advertising?

BG: It's deteriorated. Journal advertising isn't as important as it once was, and it's become very pedestrian. You have more regulatory requirements. Many companies have as many regulatory people as they do brand people.

AN: It's gotten much more creative. The advent of electronic capabilities allows for faster processing and more exact production, not only on the sketch and art capabilities of the producers. The multi-channel model has diluted the overall identity of many brands, so there is not an immediate connection to the master brand, as the producer of each medium has an innate desire to produce what they want, not doing what is demanded by the brand characteristics.

SDR: The advent of the computer has made everyone an art director. You send your work over to the client, he makes changes to both the copy and the visual, because he figures he can do it just as well as you can. I may have put a great deal of thought into a color decision, but he says, “I don't like it,” and Boom, it's orange. The magic is gone, but I imagine product managers like it.

BH: The homogeneity of advertising is not restricted to pharmaceutical advertising. Advertising is an art, not a science, but when people are afraid to make a decision, they want to make it into more of a science. Somebody who's afraid to go with their gut feeling is likely to do whatever market research says, and if it's fresh or new, it's going to get a bad score.

What would you say was the most profound regulatory change of your time in the industry?

JA: Current OIG actions place the government a bridge too far.  While there have been some very legitimate cases brought against the industry in the past where the resulting punishment was deserved, the current actions are at best bad health policy and at worst a violation of First Amendment rights. The recent case punishing a company for the distribution of off-label oncology information retards dissemination of knowledge in a life-threatening field and violates the right of commercial speech. There was no public good derived from that action.  

BG: The emergence of medical education and DTC advertising. DTC really changed the face of the business. The industry pushed for it for many years. It took a long time before the government permitted them to do that.

AN: The FDA approval of DTC advertising.

SDR: When they mandated the brief summary. Once something is government-mandated, it's going to be that way forever—even if there are better methods of delivery. At the time, it hurt a lot of the young upcoming pharma companies.

FH: The Kefauver hearings resulted in greater supervision of not only what the pharma companies were doing but their marketing and advertising. It wasn't one thing but many changes—a more scrupulous scrutiny of the industry. Any time people's health is involved, full disclosure is very important, so it wasn't a bad thing.

What was the single most transformative, game-changing event overall?

LM: The launch of Patient Care, creating a whole major field of mini-mass publications and bringing in millions of new dollars.

BG: The growth of sales forces, which has just been mind-boggling. None of us ever dreamed it would get that big. It's a testament to the fact that personal selling is the most important investment companies can make.
 
AN: The influx of managed care organizations into the system.

FH: The pairing of writers and art directors. This wasn't true for much of the history of advertising—it started in the '60s, at Doyle Dane, which did the first VW ads. The results were much better.

What's been the most humorous or embarrassing professional moment of your career?

LM: A major activity at Patient Care was the roundtable. We would assemble a few physicians to discuss a topic with one of our editorial staff. I watched with amazement as one female editor fended off the lecherous advances of one drunk proctologist.

BG: I don't think there was too much that was really humorous— we took the business very seriously. People today work harder than we did and don't have too much fun anymore. Because everyone was working in their own category, it was much less competitive than it is today.

AN: They gave me a roast to celebrate my promotion to president of the agency. The way they portrayed me was hilarious. They mimicked my multi-tasking compulsion by giving me a funnel with a tube attached so that I could brush my teeth and urinate at the same time.
 
SDR: Once, we were in Canada, and I had to make a presentation. I'd packed everything except shoes, so I had on my sneakers and a suit for an early morning presentation. Ogilvy & Mather sent me over to France to make a presentation, because I was bilingual. I rehearsed it in French. The evening before, they told me it would have more cache delivered in English.

What's the future of medical marketing and advertising? If you had it all to do over again today, would you go to work for an agency or a medical publisher?

LM: Only as my own boss!

JA: The challenges of tomorrow are great but the tools we have to deal with them are equal to the task. I would gladly do it again. It is still one of the finest industries in the country, one where we all contribute in some small way to saving lives.

BG: Medical advertising will continue to grow, and the business will continue to be driven by innovation. It's the most exciting industry in America. I would do it again, because the advertising business was really very exciting.

AN: I can think of no better industry to have dedicated my life to. It has been a fun and rewarding time for me and hopefully for many patients.

SDR: I had a great life. It provided me a lot of great luncheons, the people I worked with were funny, we had great clients.

FH: You met people who didn't think along narrow lines and who had interesting points of view. It was fun to go to work every day. Some people dread going to work.


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