Direct-to-consumer advertising is set for a sea-change, asmarketers embrace more targeted and digital-heavy media plans to push moremodest products and fewer mega-blockbusters through—not that you’d know it fromspending, which barely budged in 2007, apart from declines in newspaper, radioand outdoor spending. But the paucity of big new drug prospects tells the tale,as does the steady march of technology and measurement.

“The application of all these different vehicles ischanging,” says AstraZeneca’s Michael Kaplan, director of media strategy, usingthe example of cable versus network spending. “The technology is evolving tothe point where you can target specific people and households, and a lot ofvendors are popping up to allow you to do that.”

AstraZeneca is among the companies looking for means tomaximize its DTC dollars by replacing the scattershot approach of yore withmore focused and measured efforts, utilizing multiple touch points to reachconsumers wherever they may be.

“We continue to use traditional media—TV and print,” saysDenise Campbell, senior director of consumer marketing at AstraZeneca, “butwe’re getting better and better about using it in more targeted and efficientways and, in addition to that, we’re looking at ways to increase our investmentin new media to increase our reach and frequency to an appropriate targetedaudience.”

Spending continues to be driven by a handful of huge brandsand competitive categories—sleep aids, in particular, as well as allergy,asthma, erectile dysfunction, cholesterol and depression drugs.

“The battle of the sleep aids and the cholesterol drugs isreally keeping this thing moving,” says David Kweskin, healthcare practice arealeader at TNS Media Intelligence.

Digital dollhouse

But as the cash cows that have fueled a decade of boffo DTCTV and print campaigns go—one by one—the way of the dinosaur, with fewpotential replacements waiting in the wings, there are signs that spend istrending below the line, with increased emphasis on customer relationshipmarketing (CRM) and patient education.

“People are putting a lot of their marketing mix behind CRM,both online and offline,” says Jim Joseph, EVP and managing director of Saatchi& Saatchi Consumer Health + Wellness. “A lot of them are hitting later inthe lifecycle, thinking about that business differently and looking at how tokeep consumers engaged.”

McCann HumanCare managing director Andrew Schirmer seessmaller-scale, more focused efforts democratizing DTC by bringing in newadvertisers taking advantage of a broader menu of media options.

“Plenty of smaller players, both in terms of companies andcompounds, are realizing that DTC doesn’t have to mean over a million on TV,and if you watch a vertical cable channel like Lifetime, you’ll see productsdirected at women that you didn’t even know were doing DTC,” says Schirmer.“The production values are beautiful and they’re smart. They have a directcomponent to them, they have a website connected. They’re using more targetedbroadcast media effectively.”

AstraZeneca is getting smarter about its allocation ofconsumer-facing media, as well as more creative. The company, which last yearranked as the fourth-biggest DTC spender behind Merck, has added innovativeinteractive elements to recent campaigns. For Arimidex, the company sponsored“In Your Corner,” a support program for women living with breast cancer aimed,in part, at improving compliance and adherence, and “Celebration Chain,” a rareforay by a pharma company into viral marketing and user-generated content. Abranded site, Celebration Chain (www.celebrationchain.com) invites women tocreate a virtual doll celebrating the life of someone they know that is livingwith breast cancer and send it on via email.

It’s a classic example of the promise of digital media tomarketers— raising awareness of, and funds for, breast cancer through acreative, community-building endeavor while skirting the sore points of themedium and maintaining a level of control over content on the site.

“The industry in totality is wrestling with that,” saysSaatchi’s Joseph. “In many parts of the digital world, it’s still a fairlynormal course of action—in terms of substantiating claims, making sure you’reproviding the right information. It’s just longer-format and more content rich.The areas that are trickier are social networking and blogging, where you’reusing user-generated content as opposed to legally sanctioned,manufacturer-generated content. You can’t control what people say and yet youhave a responsibility to make sure what’s being said is truthful and reportadverse events.”

AstraZeneca has found a work-around to this tricky issue.Visitors to celebrationchain.com can create virtual dolls, but cannot postcomments, eliminating the main concern about user-generated content— adverseevents reporting requirements.

“User-generated content does not necessarily meandiscussion,” says AstraZeneca’s Kaplan. “Every single company is looking at howto explore and understand social media and how to leverage it in a smart, safe,responsible way. It’s a nascent media channel and it’s going to take everybodytime to figure it out. Pharma is not alone in that challenge.”

Statin wars

AstraZeneca has also ramped up its emphasis on diseaseeducation in recent years, placing it on an even footing with brandedadvertising for many of its products.

“One of the things we’re most proud about is how we’vebalanced unbranded disease state education with branded advertising,” saysAstraZeneca’s Campbell, pointing to balanced efforts for Seroquel and Pulmicortas well as Arimidex and Crestor. “We’ve really taken the time to understandwhat information patients are looking for and where at certain points in thehealthcare decision-making process, understanding those needs and what is actionableon our parts.”

Late last year, to raise awareness of the risk of breastcancer recurrence and encourage adherence to medical regimens, AstraZenecapartnered with the Entertainment Industry Foundation to launch a print andbroadcast PSA campaign starring actress Felicity Huffman. The ads, emphasizingthe importance to breast cancer survivors of following the treatment prescribedby their doctors, incorporated elements of AstraZeneca’s award-winning “If youwere my sister” campaign and directed viewers to getbcfacts.com, where theycould get an information kit.

For Crestor, the company last month rolled out new brandedcreative, with a focus on atherosclerosis (timely, in light ofMerck/Schering-Plough’s troubles with Vytorin, Crestor’s branded rival drug),having laid the groundwork with an unbranded campaign called “Us AgainstAthero.”

The two-pronged effort aims to make the most of the drug’sproven ability to slow the progression of atherosclerosis, a claim AstraZenecasagely staked out with last year’s METEOR study. But awareness ofatherosclerosis is poor, at best.

“There’s still a very low level of awareness of the roleatherosclerosis plays in heart disease, and we see a role to educate consumersabout the disease state itself, as well as the treatments available,” saysAstraZeneca’s Campbell. “It’s a campaign sharing the very specific-to-Crestorbenefits to patients with heart disease.”

In addition to a plush website, where visitors can view athree-minute Artery Explorer video or watch a clip of a cardiologist talkingabout the disease, AstraZeneca is taking its show on the road, deploying itsArtery Explorer, which looks something like an X-Wing fighter from Star Wars,in cities nationwide.

Social anxiety

AstraZeneca isn’t the only large pharma reevaluating itsmarketing plan. Everybody’s trying to get a handle on a fast-changing mix ofmedia channels—and products to market. As the focus shifts from one-too-manyshotgun blast channels like TV to more targeted one-to-one opportunities, the evolutionof social media is generating intense interest. Perhaps no media channel hasever offered such promise to reach patients with tailored messages—or so manypotential pitfalls.

“It’s hip to talk about blogs, social networking, pass-onvirals and these other things that are being talked about,” says McCann’sSchirmer, “but if you’ve supported something online and it gets changed orrepurposed in a way that you can’t control, you’re still responsible for thoseassets.”

A few companies have dipped their toes in the water. Inaddition to AstraZeneca’s Arimidex efforts, Fluvirin maker Novartis Vaccinesand Diagnostics experimented with virals through its FluFlix contest onYouTube, which invited users to create video sorts illustrating how flu affectsthem. GlaxoSmithKline’s Alli team has a blog, alliconnect.com, dispensingadvice on how to avoid oopsies with the OTC weight-loss drug, and Johnson &Johnson (jnjbtw.com) and its subsidiary Centocor (cnto411.com) maintaincorporate blogs. But for the most part, regulatory jitters have prompted pharmato keep their distance. 

And for all the buzz about social media, pharmas have theirhands full keeping on top of more established online channels.

“It takes an inordinate amount of time and money and upkeepto keep a site fresh,” says Schirmer of McCann, which developed a rich webpresence for Pfizer’s Viagra and Chantix, among other brands. For Viagra, theagency created an online effort linking seamlessly through to the otherelements of DTC, with flash versions of the TV spot in ads and on the site. “Sofor the guy who just caught a glimpse of it on TV, he’s getting reconnected tothe media that got him to the site in the first place,” says Schirmer. “Thebrand experience continues.” On Chantix, for which Pfizer offers its GetQuitsupport program, the site is a portal into both the product and the program,with equal emphasis on medical and behavioral solutions.

Many marketers still haven’t gotten their heads around thenotion of the web as a distinct media, says Debrianna Obara, VP media at AvenueA|Razorfish. “There’s still some confusion about how to maximize Internetspend,” says Obara. “Clients who simply pop a TV ad online are missing an opportunity.”

More broadly, Saatchi’s Joseph sees movement in thezeitgeist toward a more holistic health and wellness worldview—one which hiscompany incorporated into its name in a rebranding last year.

“We’re using the consumer as our inspiration, so when wetalk to them about health, we talk about exercise, food, sleep and hypertensionor high cholesterol—it’s full-spectrum health and wellness, not just pharma,”he says. “There’s a major shift toward wellness and quality of life as opposedto necessarily a rich life. The Boomers are driving that—they’re not old, andthey want to stay young and healthy, so that they can do the same things theydid when they were younger.”

Congressmen don’t do Tivo?

In 2007, advertisers won a major battle over efforts to regulatecommercial speech in the FDA Amendments Act, one of those epochal omnibuslegislative behemoths that can have far-reaching consequences for federalagencies and the industries they regulate. Pharma and advertising industrylobbyists managed to convince key legislators that provisions imposingadvertising moratoria on new drugs or mandating that drug companies share theirmarketing plans with FDA ran afoul of the First Amendment. They were scrappedin favor of a system of fines for false and misleading spots.

But the industry looks to be facing an ugly war of attritionin Washington , with a number of congressional committees embarking on fishingexpeditions looking into prominent campaigns for blockbuster drugs likePfizer’s Lipitor and Merck/Schering-Plough’s Vytorin. Inquests into thosecampaigns, if not particularly illuminating, proved embarrassing enough toprompt Pfizer and Merck/Schering-Plough to pull consumer advertising for thedrugs.

In the case of Lipitor, committee barons subpoenaed all recordspertaining to Pfizer’s ad campaign for the drug featuring artificial heartinventor Dr. Robert Jarvik, including financial records, contractualarrangements, emails, correspondence and scripts, as well as “any recordsrelating to the veracity of any claims made by Dr. Jarvik” in ads, “includingbut not limited to his use of Lipitor” and “all records relating to Dr.Jarvik’s professional qualifications and why Pfizer chose him as theirspokesman for Lipitor.”

And what ethical abominations did they find for all thiseffort? Well, that Jarvik isn’t a practicing physician, which was alreadyknown, and perhaps more importantly, that he isn’t quite the athletic typedepicted in the ads. Pfizer’s ad agency, Kaplan Thaler, brought in a stuntdouble to do the sculling scenes in the TV spot. Jarvik’s spudliness might notsay much about Lipitor’s efficacy, but the nugget, promptly tossed toreporters, generated enough bad press to scupper the spokesman. 

This sort of unprecedented scrutiny is giving marketers pause.

“I don’t know that I took from that ad that Lipitor wasgoing to make me an Olympic sculler,” remarks McCann’s Schirmer. “That’s justthe magic of television. Think about all those old movies where the leading manwas 5’8” and had to be put on a box. It’s not true, but is it harming anyone?So, that has me worried, and it will keep us on our toes. These discussions nowhave to work their way all the way into pre-production meetings, and not justhappen at the conceptual stage.”

Of course, TV spots, being the most visible form of consumerdrug promotion, have fueled most of the interest from congressionalinvestigators. All the more impetus, perhaps, to shift spending to moretargeted channels.

 

From the April 01, 2008 Issue of MM+M - Medical Marketing and Media