The Upside of Relationship Marketing: Not Rolling The Dice

There’s been a fair amount of controversy throughout the pharma blogosphere in the last few days about the revelation that Dr. Robert Jarvik, star of Pfizer’s Lipitor ads, is not actually a licensed, practicing physician. Blogs weighing in on this issue have included Pharma Blogosphere and John Mack’s Pharma Marketing Blog. At the time the Jarvik ads first appeared, they were a big deal because Jarvik was allegedly the first "real" doctor to be used in a pharma ad.

To us, this incident points up another major difference between relationship marketing and conventional DTC advertising, whether it’s for pharma or, for that matter, anything.

Stackofdice Using Jarvik is, basically, using a celebrity. This tactic, which is as old as adverting itself, can be very effective, but also comes with serious risks. A celebrity is a person, and people have the habit of doing very human things. This was beautifully illustrated in a terrific book on advertising with the somewhat unpolished title Hey, Whipple, Squeeze This!, by Luke Sullivan.

Obviously, Jarvik’s issues, or nonissues, are trivial, if they even exist. But they point out yet another benefit RM has over conventional DTC. RM does not rely on borrowed interest, or celebrities. It’s a direct, patient-centric communication between the pharma company and the customer.  There is never the risk that something may change in the celebrity’s image that will negatively affect your brand.

This happens more often than you’d think outside the pharma world. Think of Michael Jackson’s brief, unhappy, very expensive tenure representing Pepsi. Or O.J. Simpson. As the reach, sophistication and budget of DTC in pharma expands, this kind of thing will happen more and more often.

A lot of DTC is about the product, or the pharma company. RM is about the patient. Which makes all the difference, and often, prevents a lot of risk.

Remember, You’re Marketing to the Physician, Too

Perhaps "DTC" should be redesignated as "DTCBWFATOUSP". Give up? "Direct to Consumer But Without Forgetting About the Overworked Underpaid Physician." If you want to confirm this, read Dr. Sandeep Jauhar’s new book, Intern, which the Wall Street Journal’s Health Blog wrote about today. Becoming a doctor is neither fun nor easy, and these physicians have an immense role to play in pharma marketing.

Jauhar, who also publishes a nice blog, describes the process by which medical students become doctors as a kind of trial by fire, with patients in the middle. Interns work incredibly long shifts, there is often poor communication between doctors — even in the same hospital — and the overall sense one gets from the book, at least as the Journal describes it, is of unrelenting pressure, inadequate resources, and physicians, as a species, who are severely under the gun.

What does this mean for marketers? It means that in a world where there is a screaming lack of primary care physicians, where the average patient spends under 10 minutes talking with his physician, and where profitable, procedure-driven specialties that don’t require long or late hours, anything that can make the physician’s life easier will be embraced. We are NOT, and never were, in the business of simply pushing pills. We are in the business of making patients’ lives better, and their treatments more successful.
I’ve already written about how service and information are the coin of the realm in pharmaceutical marketing. Ultimately, the relationship we develop with patients has to inform them, empower them, and help lighten the physician’s burden. Not only is an informed patient more likely to stay on therapy and experience a better result, but she’s also going to be less of a load on her doctor.

We have to make sure the doctors are aware of this. The pharmaceutical company, and the dreaded pharmaceutical sales rep has long been portrayed as just slightly less immoral than, say, the leader of a Satanic cult who sacrifices infants on the altar of Molloch. This perception needs to change. particularly as relationship marketers, we can help, we should help, and we do help. We just need to remember who to tell about it.

Raising the Bar of Service

Dear Pharma and Biotech Brand Marketers:

Here’s something to
think about: efficacy doesn’t mean what you think it does.

The dictionary definition of the term is simple: it’s the power or capacity to produce a desired effect. In the case of drugs, historically that’s meant "Does it work? How well?" For decades, efficacy has been a matter of chemistry and medicine. But now we all need to consider the
next level of efficacy: servicing the patient.

Most pharma and
biotech marketing folks grew up professionally inside the industry. This gives
them a wealth of knowledge and a deep understanding of the
medications they market and the complexity of the multiple channels
they need to serve, from managed care to professional to patient.

what many miss is that patients — as consumers — are used to and expecting more and more: "If I buy your product, you will service
me like a customer." They get this everywhere they go — from the phone company to airlines to Enterprise Rent-a-car. In all kinds of industries, the service bar has been raised. A lot.

It’s time for us to do the same. We need
to stop thinking by channel but instead by need.

People need
support in nearly all decisions they make — and none more so than those related
to health. And a brochure, a Web site and a direct mail piece that
comes six weeks after you ask for information, just is not looking at
what patients need — what HUMANS need — in the right way.

has done a good job of understanding that you need to make yourself
accessible to answer patients’ questions and provide that service — you
see a face and a phone number on all their Web sites.The point is made again and again that GSK is a company of people.

happens when your drug is fifth to market, or a blockbuster threatened
by generic switching — what can you do? Service the patient, make it
easy for them to build some trust and do not be afraid to answer their
questions. After all, with an average of 4-8 minutes a visit, the
doctor no longer provides the answers people need.

So, can an industry that acts like scientists and manufacturers become experts at service? The short answer is "maybe". The longer answer is "they have to."

Printers, Razor Blades and Pharmaceuticals

In 2006, Hewlett-Packard had revenues of around $90 billion, give or take a few billion. Of that, around one-fourth came from their printing and imaging division. You know, laserprinters. There’s a lesson in HP’s strategy for pharmaceutical marketers. In a sentence, HP doesn’t want to sell you a printer. HP wants you to use it.

Keep reading.

In a post today in Pharmalot, it was revealed that pharma DTC spending declined by around 7% in the third quarter of this year, after a long run of steady increases. Television was hit especially hard. What do we learn from this? Well, television is a great, albeit expensive, medium for launching a drug. But it takes something more to keep the momentum going.

What does this have to do with Hewlett-Packard? Everything.

Sitting right next to my desk are two printers. They’re both from HP. One is an oldish black-and-white laser printer, that’s the office workhorse. The other is a color injet printer that I use when I, you know, need to print something in color. Both were impossibly cheap to purchase. I don’t remember the exact amounts, but I recall being pleasantly surprised at how little they cost.

And unpleasantly surprised at how fast they seem to chew through ink cartridges. The color printer has six different cartirdges, they cost the earth, and they seem to be in need of replacement about every ten days.

This is not an accident. Some genius at HP figured out a long time ago that the real money is not in selling printers. The real money is in selling replacement cartridges. The revenue stream goes on for years, the profit margin is higher, and once someone’s purchased your printer, they’re also going to buy your cartridges for a long, long time. Razors work the same way. Gillette makes money on the blades, not on the razors.

In some verticals, the same is true for pharma. DTC, particularly television, is great for launching a new drug. You can get an enormous amount of awareness very quickly using television, and get a new drug off to a great start.

But particularly with patients with chronic conditions — diabetes, arthritis, respiratory problems, depression — the key is to keep them on the regimen. And television isn’t the answer. Part of the answer, yes. But once a patient begins taking a drug, they develop a whole new perspective on it. They are interested in understanding how the drug, and the condition it treats, fit into their daily lives. They want to know what it means to them.

A television commercial is not going to do that. By definition, television is a mass medium. A sixty-second spot cannot have the information content necessary to help a patient who’s on a drug understand why she should stay on it.

As pharma marketing moves forward and evolves, more and more marketers are coming to realize that one size does not necessarily fit all. We have a large, and ever-increasing set of tools, and television is only one of them. To quote Alanis Morisette, for pharma companies seeking to develop long-term, profitable relationships, DTC television really is ten thousand spoons when what you need it a knife. And it looks like a lot of people are beginning to figure that out.

Want Fries With That?

There was an absolutely fascinating variation on relationship marketing written up in yesterday’s Wall Street Journal Health Blog. The post, which was written by Shirley S. Wang, described a commentary in JAMA that suggested making the healthier choice the default option for patients in some situations rather than one choice among many. For example, automatically schedule a follow-up appointment or a colonoscopy rather than reminding the patient to do it. If they want to, they can change or reschedule it, but if they do nothing, the healthier option happens.

On one level, this is the most obvious thing in the world. On another, though, it’s a wonderful example of the most basic principle of relationship marketing — taking into account how the actual patient with the actual condition actually behaves, and then accomodating that, rather than vice-versa.

IFrench_friesf you’re designing a car, you build in cupholders, because people drink coffee while they drive. If  you’re developing a voice-activated telephone response system, you base the options on what people tend to ask. If you’re Princess Diana, and you’re getting married to the Prince of Wales, and you have a thirty-foot train behind your wedding gown, you have a couple of bridesmaids on hand to help you with it. All of these are Blinding Flashes of the Obvious.

And in healthcare, you pay attention to how patients — your customers — behave, and you use that information. Getting patients to stay on their medication regimen takes a lot more than having some doctor tell them to. Patients are human, and therefore influenced by all kinds of factors, many of which are irrational. This is what we do for a living here at TrueHealth. We build programs around what patients actually do, not what they should do. It appears that behavioral economics supports this.

One legendary example is the now-ubiquitous question asked at thousands of fast-food counters every day: "Would you like fries with that?" Because people naturally, automatically, unthinkingly tend to respond with a "Yes" or "Sure", the simple act of asking that question has resulted in billions of dollars in extra revenue for McDonald’s, Wendy’s, Burger King et. al. Whoever thought of that should have been given an island in the Carribean.

Another one, as noted by the JAMA commentators, is people’s inherent bias towards inaction. If the options are "do nothing" vs. "do something" the former has a distinct edge. If you use this fact, and structure things so that "do nothing" results in a healthier outcome, everyone wins.

Some Things You Just Can’t Outsource

"“Who hasn’t dreamt of having someone to do all that stuff?” said Kim
Levy, the Morristown, N.J., woman who used Brickwork to scour the
current literature and come up with a report on health care dynamics.
Ms. Levy is the vice president for strategic planning at Micromass
Communications, a 120-person company based in North Carolina that helps
medical businesses with marketing."

-Personal Assistants On Call, Just Not In The Next Office
The New York Times
November 14, 2007

Well, here at Ryan, we did our own study of health care dynamics, too. With all due respect to our esteemed competitor, we just did it a little differently.

In our opinion, you pick your outsourcing partners very carefully, and you don’t pay them $15 an hour. We’re not looking for an overview or a summary of what’s already out there. We wanted to really dig, to get as primary as possible, and to discover something new. We did.

So we didn’t outsource it to India. We outsourced it to ICom, who has been doing healthcare research for twenty years. They surveyed over sixty thousand patients, in a dozen disease categories. We developed with survey with a multidisciplinary team that included a pharmacoepidemiologist, two behavioral psychologists, a research analyst and a marketing team. We then had the resulitng data analyzed by the Ryan TrueHealth Consumer Insights Group.

That’s how we do a study here. And the results are fascinating — really critical information for anyone marketing pharmaceuticals, particularly to patients with chronic illnesses.

If you’d like to see a copy, email me. And yes, I’ll respond to your email personally. No outsourcing to to New Delhi.

Make the Patient the Hero — and the Director

I make my living thinking about patient-centric marketing. As non-pharma marketers have known for decades, the key to effective advertising is to make the product or the brand the star. Think, for example, of the Jack-in-the-Box fast food chain. Their advertising features a walking, talking, suit-wearing character who actually is the brand — Jack.


Effective pharma marketers need to go one better. You can’t, for obvious reasons, make the product the star, although AstraZeneca’s Nexium DTC campaign did as good a job as possible. Even the website is branded —

Instead, you must make the patient the star of the campaign. The campaign must be about the patient’s experience, symptoms and issues, and the campaign absolutely must reflect those issues in as objective a manner as possible. A recent, exceptionally effective example of this was the marketing thinking behind Merck’s HPV vaccine Gardasil.

The website for the vaccine isn’t particularly good. However, the DTC advertising, particularly the commercials, are fantastic. Not only do they make the patient — in this case, adolescent girls and young women — the star — but the ads themselves are shot and produced in a way that not only makes them about the patient, but they seem to be created by the patient.

This is tremendous Web 2.0 strategy. Patients in this age group are increasingly familiar with all the vehicles for creating content themselves — Facebook, Youtube, MySpace, and so on. While some ads depict members of this group asking questions about the vaccine, answering questions, and so on, one actually seems to have been created, including voiceover, by a patient. This ad is presented as a kind of documentary, in which the student who appears in the video mentions her friend "Steven" who she asked to help her make the short film. In this one, young girls talk about the virus and the vaccine, and and at one point, refer to one another’s statements, as if they’re all participating in the project.

Both commercials are shot in the herky-jerky style of home videos, complete with natural lighting and occasional mistakes. They’re extraordinarily effective, because not only do they create a relationship, they assume one. Patient-centric marketing, in this campaign, has been transformed into patient-created marketing.

And this campaign was incredibly effective. Part of it, of course, was the political debate around the vaccine. But much of it was the impact of just plain effective DTC marketing. The spots in this campaign were highly nuanced advertising conveying subtly different, compatible messages at young women and girls versus mothers as adults and medical decision makers. The campaign messages were built on empathy, peer influence and the women’s emotional connection to one another. The result was a powerful word-of-mouth campaign based on womens’ real relationships. In assessing the campaign’s impact, one ObGyn said she had never before seen any pharma campaign drive nearly 100% of her patients to ask about a product.