Medicine Avenue 2 The History of Medical Advertising from 1990 - 2008. Chapter - Digital Communications Emerge; written by Tim Pantello (Tribal DDB Worldwide) and Mark Bard (President of Manhattan Research)

1. MEDICINE AVE 2
Tim Pantello and
Mark Bard
T echnology has prompted significant and drastic
changes in the marketing and advertising world
over the past decade, and the world of pharmaceutical
advertising, sales, and marketing is certainly no
exception. Faced with a radically shifting consumer and
physician media landscape, coupled with often
shrinking marketing budgets, pharmaceutical
marketers and brand teams are now up against the
immense challenge of driving innovation in the face of
ongoing change. Perhaps the best way to describe the
path to success is the ability to adapt to a moving
target—and audience. After all, it is often not the
strongest of the species that survive but rather those
most adaptable to change over the long term.
From the industry perspective, the digital
revolution began in 1989 with the introduction of
desktop publishing via Apple’s Macintosh with Adobe
Photoshop. There was no stopping its ability to efficiently
produce work that would normally take weeks in just
days—a scary and exciting proposition for an industry
business model based on time and material contracts.
108

2. D I G I TA L C O M M U N I C AT I O N S E M E R G E
While traditional advertising agencies were reeling
from the seismic shift in their core business model,
the launch of Netscape, the first commercially available
Web browser, transformed the world’s ability to gain
access to information. Shortly thereafter, the new access
to information for patients and caregivers was supported
and accelerated by changes in the Food and Drug
Administration’s policy regarding direct-to-consumer
(DTC) advertising. Today, health information is one of
the world’s most searched topics on the Internet. In fact,
recent data show more Americans go online for health
and pharmaceutical information in a 12-month period
than go to visit their personal physician in the office,
and the Internet quickly is becoming a critical resource
for consumers seeking timely and convenient answers to
On-line Health Information Seeking Has Grown Significantly Since 2002
160
eHealth Consumers*
145.7
140
120
100
80
60
40
20
0
2002 2004 2006 2008
In Millions
*eHealth Consumers: Consumers who have conducted health information seeking activities online in the past 12 months for themselves or others.
Source: Cybercitizen Health™ 2002-2008 (Manhattan Research)
We’ve come a long way, baby! Cybercitizen HealthTM v8.0 shows us that
not only has overall growth in use of the Internet increased over the years,
but so has use of this venue specifically for health information. As seen
here, the number of US consumers going online for health-related
information—the eHealth consumers—has increased by 82 million since
2002, up to 145.7 million consumers.
109

3. MEDICINE AVE 2
pressing medical questions.
Through information access, the new age of
consumer empowerment became a perfect framework for
creation of a new marketing services offering, which
provides direct engagement with patients and caregivers
through new or non-traditional media. The speed of
change due to technological advances was revolutionary,
rather than evolutionary, and caught many traditional
advertising agencies off guard; they were slow to take
advantage of the opportunities afforded by the new, but
expensive, technology.
The new marketing and media paradigm shift
required development and integration of a completely
new set of functional capabilities, such as engineering,
information technology (IT), and information
architecture skills, along with skill sets in animation and
consumer copywriting. Such roles previously did not
exist in many of the traditional professional advertising
agencies. Further compounding the problem for
traditional agencies, new communications concepts based
on emerging technologies such as social media, mobile
media, and e-mail were always just around the corner.
Larger, better-funded agencies and their parent
networks moved aggressively into DTC television and
direct marketing space as natural outgrowths of their
existing business models. First, because their current
business infrastructures supported the delivery of those
services, and second, because their financial models
enabled them to quickly profit from those expansions.
The Internet was left to the entrepreneurial risk takers.
Two agencies were at the forefront of launching
themselves onto the Internet. The first was Medical
Broadcast Company (now called Digitas Health, a
subsidiary of Publicis), founded by pioneers David Kramer
and Linda Holliday. Kramer’s shop had been a film and
110

4. D I G I TA L C O M M U N I C AT I O N S E M E R G E
production business that specialized in medical
communications. Kramer himself recognized early on that
“digital changes everything,” and was famously known
to observe that “we drank the Kool Aid” to explain MBC’s
single-minded focus on the new media. MBC later added
traditional agency services to become a full-service
agency with particular direct-marketing strengths. The
second agency to fit the exclusively digital appellation
was SimStar, now called Rosetta Marketing Group,
headed by David Reim, its visionary founder.
These trailblazing entrepreneurs were not alone.
Many digital-centric or dot-com agencies surfaced across
the marketing services industry, but few had specific,
vertical healthcare practices. Several of the dot-com
agencies that invested in healthcare survived and thrived
through the ups and downs of the digital agency
Percentage of Consumers Online for Pharma Info Burgeons Over 6 Years
41%
36% 64%
59%
2002 2008
Consumers Online Specifically for Pharmaceutical Information
Consumers Online for Other Health Info
Source: Cybercitizen Health™ 2002, 2008 (Manhattan Research)
While the sheer volume of eHealth consumers is impressive, it’s the
shrinking gap between those online for any reason and those online for
health that is telling. Among consumers online for health information,
64% of them are online specifically for pharmaceutical information. In
2002, this same metric was only 41%.
111

5. MEDICINE AVE 2
revolution: IMC2, iFrontier, and Cadient Group are three
such examples. Larger ad agency networks such as
Razorfish, WPP Omnicom, Interpublic Group, and Havas
,
all started or acquired small interactive shops, viewing
this new media channel as a significant opportunity to
grow their business in different, innovative ways. But
none of these start-up divisions were able to match the
explosive growth of the independent, entrepreneurial
digital healthcare agencies.
The Internet Explosion
In 1997, restrictions on the use of DTC promotion
of prescription products eased. This unexpected regulatory
M
change suddenly created new promotional opportunities
to connect and communicate directly with patients/
any
consumers. For the first time, pharmaceutical marketing
digital-centric or dot-com
began to evolve from a “tell and sell to the physician”
agencies surfaced across
process, to personal interactions with patients and
the marketing
consumers. The Internet, a 24-hour-a-day, seven-days-a-
services industry
week information resource, fueled a major shift in human
behavior, changing the relationship that consumers have
with healthcare information and resources.
Today’s consumer media environment consists of
hundreds of television channels, Web sites numbering in
the millions, and several social media venues, all competing
for a consumer’s attention. Furthermore, consumers now
control media on their terms through on-demand
streaming services such as Hulu and time-shifting tools
such as Tivo, or by purchasing programs for a premium
through iTunes in order to view them with advertising
removed—1 hour of programming in an efficient 40
minutes. To be successful in this media landscape depends
on a combination of creativity, credibility and content that
engages consumers in meaningful ways, ways that cut
through the traditional clutter and noise of messages
112

6. D I G I TA L C O M M U N I C AT I O N S E M E R G E
embedded in ordinary advertising media. Today, there is no
question that the digital world is where health information
seekers begin their quest for answers to health issues, or
where they go to validate their doctor’s diagnosis—a free,
digital, “second opinion.”
The Internet Surpasses Doctors as the Top Source of Health Information
100%
Doctors
90% (2004)
Doctors
Pharmacists Nurses (2004)
80%
Consumer Satisfaction with Mentioned Source
70% Internet
(2008)
F
Family and Friends
60%
Relevance
Books, Magazines, Newspapers
50%
Internet
t
40% (2004)
Television
30%
20%
10%
0%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Reach
Percent of US Adults Using Source for Health Information
All values represent 2008 data except those labeled 2004.
Source: Cybercitizen Health™ 2004, 2008 (Manhattan Research)
Delivering health information that enhances health
and long-term compliance with therapy has long been the
mandate of the pharmaceutical and other regulated health
industries. The ability of the digital world to provide
personal experiences that evolve into an enduring
relationship is unsurpassed. Because of digital’s ability to
deliver personally relevant, tailored information, and to
respond to individual patient needs, digital creativity has
flourished. It has unlocked the potential to create value via
functionality and to move from a static message to an
engaging experience using sound, movement and emotion.
113

7. MEDICINE AVE 2
Finally, one trend that is increasingly clear as new
media become simply media, is that the online channel is
leading to better informed, more empowered patients.
Furthermore, it is having an immediate and long-term
impact on the physician-to-patient relationship. The vast
majority of physicians in the US now report they have at
least some patients bringing information from the
Internet to the office, and the encouraging news—for
patients at least—is that the majority believe that patients
bringing information to the office is a good thing.
Additionally, the early evidence shows that when
physicians treat patients who have brought online health
information with them, they end up spending more time
together as a result. In other words, the traditional one-
way conversation comprised of talking “to” the patient is
giving way to the world of talking “with” the patient to
optimize health outcomes.
The Professional Paradigm Shift
The Internet has become as indispensable in doctors’
offices as in consumers’ homes. Since 2001, the percentage
of physicians claiming the Internet as “essential” to their
professional practice has grown substantially. The ability to
conduct professional activities online, as opposed to off-line,
provides physicians an attractive service given their already
hectic daily schedules. In addition to the convenience of
online information access throughout the day, a growing
number are finding ways to integrate access into patient
consultations, where it has a direct impact on clinical
decision-making at the point of care.
Overall, the three most frequent online physician
activities are: 1) searching literature databases, 2) seeking
information about prescription drugs, and 3) accessing
drug reference databases. Before the Internet, each of
these activities might have been delegated to staff, who
expended valuable time physically searching through
114

8. D I G I TA L C O M M U N I C AT I O N S E M E R G E
Almost 9 out of 10 Physicians Report the Internet is Essential to Practice Today
100%
88%
80%
Percent of Physicians Agreeing That the Internet is
Essential to Their Professional Practice
60%
40%
20%
20%
0%
2001 2003 2005 2007 2009
Source: Taking the Pulse® 2001-2009 (Manhattan Research)
journals, textbooks, and articles for information. With
the widespread availability of the Internet today, the same
information can be located instantaneously by physicians
themselves, or more rapidly by office assistants. The
Internet has been the catalyst and the backbone of the
digital world. The blur between physical and digital
worlds holds tremendous creative potential. Professional
digital interactions result in more physical outcomes, and
the technology also has enabled professional community-
based experiences.
Given the pervasiveness and efficiencies of the
digital world, agencies and entrepreneurs continually are
creating new ways to engage with professionals and with
ultimate consumers. Four core trends comprise these new
agency offerings. The first is e-detailing (Internet-based
detailing) pioneered by companies such as Physician
Interactive, MyDrugRep.com (now called Lathian Health),
DotComAdvisors (now called Group DCA), and Medsite
(now owned by WebMD). Each of these organizations
created networks of physicians who agreed to participate
115

9. MEDICINE AVE 2
in online details. While a novelty in 2001—fueled by the
ability to offer honoraria to compensate for a physician’s
time—e-detailing is now an accepted part of an
advertising agency’s tactical planning process for targeted
points throughout the product life cycle. In fact, there is
a growing body of evidence showing that market demand
and physician value may be optimal at the beginning and
end of the product life cycle.
The second core trend—the introduction of the
tablet PC detailing aid—initially created tension and fear
rather than enthusiasm among traditional professional ad
agencies. However, since eight of the top 10
pharmaceutical manufacturers have now implemented
tablet PC detailing platforms, agencies have learned to
develop the multi-varied content that this new medium
uses. The new, digitally enhanced detailing platform
enables agencies not only to design and build a more
relevant, engaging physician experience, but also to
capture data about each encounter to use in an interactive
Electronic Detailing Trends Over Time
70%
Have Participated in eDetailing
60%
50%
40%
30%
20%
10%
0%
2001 2003 2005 2007 2009
Source: Taking the Pulse® 2001-2009 (Manhattan Research)
116

10. D I G I TA L C O M M U N I C AT I O N S E M E R G E
process to plan for more productive subsequent visits. To
date, three major tablet PC technical platforms have
emerged—Skura, ProScape, and Exploria. An agency’s
creative challenge is to build flexibility into the message
development process, since the tablet PC offers the
opportunity of tailored (customer-centric) detailing.
The third core digital trend is in the mobile space—
eg, smart phones and personal digital assistants (PDAs)
such as Treos, iPhones, and Blackberrys. Physicians are
increasing their utilization of mobile devices as drug
T he blur
between physical
and digital worlds holds
reference databases for medication alerts and to stay on tremendous creative
top of the latest medical news. This new digital medium potential
has also been embraced by a few savvy entrepreneurs
(Epocrates and Skyscape) and large publishing entities
(Thompson and Wolters Kluwer).
The fourth, final, and most interesting trend has
been the advent of physician social networking. The Web
2.0 environment harnesses the power of collective
wisdom, prediction markets and social networking
technologies. It enables physicians to discuss new clinical
findings and work together to dramatically improve
patient care. Physicians are using sites such as Sermo and
Medscape Physician Connect to ask and answer questions
of each other, to build consensus around the latest medical
trends, and to exchange medical insights about drugs and
devices the minute they learn about them, rather than
waiting to read about them in conventional news sources
or hear about them from a company representative. The
largest physician-only online community, Sermo today
boasts more than 110,000 physicians.
One challenge for both agencies and clients is how
to leverage these communities to gain insights and
knowledge about brand products and communication
strategies without arousing professional ire. Careful
concern for issues of intrusion and privacy through
117

11. MEDICINE AVE 2
appropriate opt-in or opt-out provisions is accelerating
the use of these new media. Qualitative and quantitative
market research that took weeks and months until very
recently, can now be fielded, data-captured, and analyzed
in just a handful of days.
Just as the professional channel and media mix is
evolving from the traditional to the digital realm, so must
the relationship between the physician, pharmaceutical
manufacturer, and sales rep. Physicians are no longer
captive targets in their office or willing to exchange
five minutes of their time for the latest set of novelty pens
and coffee mugs. They live in a digital world where they
can easily seek out the latest news, clinical trials, and
product updates 24/7—when and where they need it.
In light of this trend toward digital, pharmaceutical
companies in partnership with their agencies must
evaluate new skill sets and assets to transition sales
capabilities online and deliver customer service with
functions such as on-demand product and promotional
information, video detailing with a live rep, e-sampling,
and access to medical affairs staff on demand.
The Future—“It’s in the Clouds”
In the future, customer information will live in a
truly centralized database for most of our clients—“in the
clouds,” as the techies say. All digital media will be
integrated, allowing for real-time, customer-centric
marketing. Changes in individual customer behavior will
be tracked, allowing for more effective and efficient use of
media which, in turn, will inform future content
creation. Outcomes will not be judged on the basis of
how many customers your message hits. Judgments will
be made as to whether we are meeting customers’ needs
and developing enduring relationships with them on their
terms, and not on ours as marketers. The most valuable
currency in the digital agency world will be the ability to
118

12. D I G I TA L C O M M U N I C AT I O N S E M E R G E
gather insights from the massive amount of data that
will be collected from the multiple inputs and interactions
that we have with customers. Agencies will need to
employ planners who understand that the digital and
physical marketing worlds are no longer separate.
Creative technologists and experienced designers will
work alongside media experts, and art directors and
copywriters will become skilled at collecting and cross-
analyzing data from both digital and physical
interactions. The agency of the future will value analytics
and data mining as much as it values creative output.
The data will be available via cloud computing and
analysis. Our industry can soar to new heights of value;
whether it does depends not on how we market today,
but on the “clouds” of data that become the insights that
drive our creativity tomorrow.
US Pharmaceutical and Healthcare Industry
Search Engine Ad Spending, 2005-2008 (millions)
$488
$410
$349
$256
2005 2006 2007 2008
Note: The industry definition includes drug manufacturers and marketers,
doctors, hospitals and other entities that deliver health services, such as
health maintenance organizations.
Source: eMarketer, January 2007 www.eMarketer.com
119