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While every company’s ideal promotional mix is unique, what most companies have found over the past few years is that the ideal implementation of an edetailing program is one that is seen as a complement to sales force efforts, as opposed to a sales force replacement.

That said, edetailing does have certain benefits over a sales rep interaction. Edetailing is convenient for today’s busy physicians, which is critical. We see in our research that physicians are most likely to conduct edetailing programs during the hours of 8pm and midnight – hours when the sales rep is not likely to have access to the physician. This is a huge benefit to the sales force – they are actually able to have access to the physician through edetailing during a time when they would not otherwise be able to get in front of that physician.

In the early days of electronic detailing, there was a conception among the sales force that edetailing was going to take their job away – and while that was perhaps the hope of some programs in those early years, that is not in line with the reality of what we’ve seen in the market. In fact, physicians are more likely to report that they actually spent more time with a pharma sales rep as a result of conducting an edetail – very few physicians report taking time away from the rep because of an edetailing program.

In addition to providing access to physicians during a time when you wouldn’t otherwise be able to see them, another benefit of e-detailing can be the level of information about a physician that can be gathered from an electronic detail. In an ideal world, there is truly closed loop communication between the various promotional channels – and the rep would be able to glean information from an edetail to better target the next visit with the physician. Of course, it’s important to avoid the “creepy factor” of specifically telling the doctor that you know the concerns they reported during the edetail … but reps can certainly leverage data gathered during an edetail to inform the direction of future conversations with a physician.

We’ve come a long way since the early days of PDF and PowerPoint versions of the detail aid. Pharmaceutical, biotech, and device companies have become much more creative and strategic in the types of content available through an edetail – to the point that there is often much debate over what constitutes a true “edetail” today.

Some of the types of edetailing used today include dynamic self-service websites in which physicians are able to browse through a variety of types of information; flash animated details with interactive content; webinars or video presentations from a detail rep or key opinion leader; and even live videoconferencing with a sales rep.

In terms of esampling (electronic sampling), some companies are offering physicians the ability to order samples online. In some cases this is tied to completion of an edetailing program.

As an overall statement, we are seeing many companies moving away from looking at edetailing as a standalone event, and toward figuring out how to develop an online relationship with physicians. Traditionally the pharmaceutical or medical device company’s relationship with the physician was primarily through the rep and perhaps the occasional dinner meeting – but as physicians are increasingly relying on the Internet for a variety of personal and professional activities, we see that the Internet is a new channel for companies to use in developing and extending their relationship with the physician.

Over the past few years, a combination of forces have conspired to create a large and growing group of consumers who are extremely empowered when it comes to the business of their healthcare. Between industry-wide efforts toward consumer-directed healthcare and the wealth of online health information resources consumers can use to educate themselves and inform their healthcare decisions, many consumers are beginning to view their relationship with the physician as collaborative rather than deferential.

We see evidence of the degree to which consumers are becoming empowered and taking charge of their healthcare decisions in looking at a variety of behavioral metrics we’ve been tracking over the years. First, we have seen a drastic increase over the past few years in the number of consumers who are going online for healthcare information – in fact, the number of eHealth Consumers has more than doubled in the past five years, with almost 132 million consumers online for health information today.

We’ve also seen an increase in the number of consumers who turn to the Internet for more information after they’ve seen a DTC ad, demonstrating that consumers are increasingly doing the research themselves, and using that information to start an informed conversation with their physician.

Other evidence of this trend toward consumer empowerment can be seen in the increase in consumers using their health insurer’s website. While this trend is also driven by the expanding range of features on health insurance company sites, the recent trends toward consumer-directed healthcare have really forced consumers today to take ownership of the business of their healthcare.  

The answer to this question really does vary depending on the type of product and the lifecycle stage of that product – and that many brands are successfully leveraging the benefits of both of these approaches.

In terms of an online DTC strategy, or the online component of any DTC ad campaign, today’s empowered eHealth Consumers are increasingly likely to be accessing a wide variety of online resources for information in making a treatment decision.

We see today that consumers are, in some cases, more likely to go to a search engine or health website for information about a product after seeing a DTC ad than they are to go to the website for a given product. This does present a challenge for marketers, as it’s increasingly difficult to know how to “be where they are” when it comes to online health information resources. This is where targeted segmentation information and an understanding of the online behaviors of your target population become critical for creating a successful online media plan.

In terms of unbranded educational websites, we are seeing these sites gaining traction for a handful of products that have used the unbranded site in a strategic way in conjunction with their overall DTC efforts. Some of these sites were very successful as “conversation starters” for building awareness and giving consumers some introductory information about a condition – as well as being useful for building a relationship with the consumer who is concerned about a given condition (often in the form of opt-in direct response types of registration programs). However, it is important for marketers to remember that a broader content and brand positioning strategy is necessary, as consumers are not using the pharma-sponsored sites as their only source of information once initial awareness has been achieved.

The Internet is one of the best places to access the highly valuable group of consumers who are most likely to take action and go on to request a product from their physician – in fact, nearly three-quarters of the prescription requests generated last year were by consumers who are online for health information. But how this impacts budget spend depends on the individual brand and the target segment for that product.

In fact, it the time has come for marketers to reconsider which sources are most effective for reaching their target audience of consumers. For many of today's consumers, staying up-to-date doesn't mean reading the morning newspaper over breakfast or watching the nightly news -- it means Google alerts or a quick check of their My Yahoo! homepage. So how do these shifts impact today's marketers?

As consumers are increasingly turning to alternative media sources instead of traditional media sources such as television, advertisers are beginning to call into question the relative role -- and value -- of the traditional 30-second television DTC commercial and its ability to reach the desired segment of consumers.

A recent study from Manhattan Research shows that some segments of consumers are more reliant on the Internet for media than they are the television. For these segments, it is critical that marketers begin to re-evaluate their overall promotional mix to be sure it is in line with the media consumption habits of the audience.

As such, Manhattan Research devised a DTC Innovation Index, which is designed to help marketers assess the relative level of online health engagement across a broad spectrum of therapeutic categories, so that marketing budgets can be optimized across a portfolio of products.

Top 10 Conditions based on DTC Innovation Index

1.       Women taking Prescription Birth Control (pill, patch, shot, ring)

2.       ADD/ADHD Patients

3.       Inflammatory Bowel Disease Patients

4.       Eczema Patients

5.       Bipolar Disorder Caregivers

6.       Acne Patients

7.       Diabetes Caregivers

8.       Migraine Patients

9.       Influenza or Flu Patients

10.     Bipolar Disorder Patients

Source: Cybercitizen Health v7.0

For additional information on the DTC Innovation Index and how it impacts the relative role of online marketing for a given segment, please contact ask@manhattanresearch.com.

More than 80 million people researched pharmaceutical or prescription drugs online in the past year. What are these consumers looking for, and how can companies be sure they are providing the information consumers want?

In a recent study by Manhattan Research of 5,000 consumers who use the Internet for drug information, we uncovered some of the top resources that consumers are using when investigating a potential treatment option. These findings really comprise a “how to” list for creating a product site or information center that gives consumers the information they are looking for.

A few of the top resources that consumers demand include:

-       Information about how a product works: Today’s eHealth Consumers are savvy, educated consumers who are really taking charge of the business of their healthcare. They are looking for tactical, detailed information that will help them understand the treatment options available to them.

-       Pricing or formulary information: Although this would be nearly impossible to include on a product site, marketers should be aware that cost or formulary coverage are, in many cases, one of the key decision-making variables of importance to today’s consumers. As consumers are increasingly bearing the burden of their medication costs, they want to be sure that they are choosing the option that makes the most sense for them – medically and financially.

-       Comparisons against products within the category:  One of the largest unmet demands for today’s consumers is the availability of easy-to-understand information about the differences between various products within a given therapeutic category. As consumers are faced with these difficult formulary decisions, it is difficult to really understand why one product is different or better for them than another. Although this type of product-to-product comparison is extremely difficult to provide in the absence of approved clinical trial information, it is nonetheless important for marketers to understand that this is one of the key resources of interest to today’s consumers.

There are a number of different ways to answer this question, and ultimately, the answer would depend on the behavior you were most interested in profiling, be it overall likelihood to research health information seeking, frequency of health information seeking, or a certain type of online health activity or research. However, as a general metric we use to help clients understand the relative role of the Internet as a information-gathering channel for a given population, we use the Internet Relevance Ranking (IRR) which ranks various therapeutic categories in terms of likelihood to research health information online:

Top 10 Condition Segments for Online Health Information Seeking Based on Manhattan Research Internet Relevance Ranking (IRR)

1. Women using prescription birth control (such as the pill, patch, or ring)
2. Inflammatory bowel disease patients
3. Eczema patients
4. ADD/ADHD patients (Adult)
5. Caregivers to someone with ADD/ADHD

Source: Manhattan Research, Cybercitizen® Health v7.0


However, another way of looking at this would be to look at the conditions most frequently researched online:

Top Three Conditions Researched Online

1. Diabetes
2. Cancer
3. Obesity/Weight Management

Source: Manhattan Research, Cybercitizen® Health v7.0


Now, some might find this list surprising, as these not the most common conditions in terms of incidence, nor are they the most active patient groups online. So why are so many people researching these conditions online? First, it has been a very active year for diabetes treatments with new findings about Avandia, Pfizer pulling Exubera from the market, and new treatments like Januvia -- so there's a lot of information to stay up to date. The consumers researching diabetes online are caregivers, patients, individuals interested in prevention, and those who are researching information for a friend or family members.

In summary - every condition is different in terms of motivators to research a condition, sources used by the patient or caregiver base, and types of information researched at different points along the treatment continuum -- so naming one condition as the "most active online" is nearly impossible!

Fewer than one-fifth of all physicians report taking advantage of electronic prescribing (eRx) today, and only a handful of such physicians are doing “true” electronic prescribing -- where the system connects directly to the pharmacy computer for end-to-end order entry. In fact, the majority of physicians reporting to eprescribe are simply connecting to a fax at the pharmacy, or even just a printer in the office and handing the patient a printout.

Despite low overall adoption of e-prescribing, we have seen considerable growth for electronic prescribing from just a few years back and believe this trend will continue as the benefits of the technology are brought to the forefront and as government initiatives flourish.

A majority of physicians forsee adoption of an eprescribing system within the next ten years; generally those who do not forsee adoption within this time frame are those for whom the investment doesn’t make sense -- such as older physicians nearing retirement.

You are not alone -- many companies today are starting to respond both to physician demand, and the industry standards established in other industries by developing so-called customer service portals (or full service portals) for physicians to use to access a variety of materials and information from the company.

Traditionally the pharma company’s relationship with the physician was primarily through the rep, and perhaps the occasional dinner meeting – but as physicians are increasingly relying on the Internet for a variety of personal and professional activities, we see that the Internet is a new channel for companies to use in developing and extending their relationship with the physician.

Banking is an oft-cited parallel to the situation pharmaceutical, biotech, and device companies currently face. Many consumers find it easier to withdraw money from an ATM and pay bills online – but they prefer to talk to a live person when taking out a mortgage. That said, consumers are seeking out an online relationship with the bank because the bank is actually providing a service that makes life more convenient.

Today’s busy physicians expect the same from the companies with whom they work on a regular basis. But wary sales forces should take note -- the ready availability of ATMs and online banking did not spell the end of bank tellers and other bank employees; nor does a physician’s online relationship with a pharmaceutical company mean the end of the rep relationship.

Over the next few years, pharmaceutical companies will be forced to meet physician demand by moving toward a new way of looking at how to use the online channel to interact with the physician. The next generation of the “e” relationship will expand beyond just edetailing of promotional material for physicians, and toward providing a truly integrated online and offline customer service experience. Here are some examples of these full-service portals:
http://www.pfizerpro.com/
http://www.merckservices.com/
http://www.rocheexchange.com/

Finally, in terms of the top features of interest to physicians, we see wide variation depending on the specialty and profile of the physician, however, as a general statement, the highest demand is for one-stop shopping for product, treatment, and pipeline information; links to professional disease education or patient education; and in some cases, access to more advanced features such as electronic sampling (esampling) or live rep visits.

What are your thoughts on developing a podcast with disease content for patients?
Submitted by... C. Bartolomeu - Wayne, New Jersey USA

To listen to news stories about the upcoming release of Apple’s iPhone, one might think that Apple’s iPod device were nearly ubiquitous for today’s consumers. But the fact is that less than a quarter of U.S. adults age 18 and over own an MP3 device (such as an iPod)– so the iPod-toting public is actually still the minority today. That said, MP3 device ownership has increased drastically year over year – in fact, we saw 65% growth in MP3 device ownership between 2005 and 2006.

This growth, combined with the omnipresence of Steve Jobs on magazine covers and news websites, has led many companies to consider the role of podcasting and other iPod-related content strategies in their upcoming marketing plans. But before considering such a strategy, it is important to have a realistic understanding of the current market opportunity for such content. One of the primary predictors of iPod ownership today is income. With even the smallest iPod – the Shuffle – retailing for about $70 – most MP3 devices are still somewhat cost prohibitive. In fact, today’s MP3 device owners have an average income of nearly twice that of U.S. adults who do not own an MP3 device.

Additional evidence of the degree to which ownership is more strongly correlated with income as opposed to age can be seen in looking at MP3 device ownership among today’s physicians – nearly half of practicing physicians – which excludes residents – own an MP3 device today. MP3 device owners are also slightly more likely to be male; are an average of about 15 years younger than those who do not own such a device, and are twice as likely to have graduated from college. So before you decide to create an aggressive podcasting strategy, it is important to consider your audience.

Take migraine patients, for instance – a group that is known for being extremely active online. Among adult migraine patients, we see that 30% own an MP3 device, and only 4% have subscribed to a podcast.

What about insomnia patients? As helpful as a relaxation or meditation podcast might be for this particular ailment, only 17% of insomnia patients have an MP3 device, and 4% have subscribed to a podcast.

Finally, what about type 2 diabetes patients? We see that only 7% of type 2 diabetes patients own an MP3 device, and less than 1% have subscribed to a podcast. This is interesting, especially when you consider the types of podcast content you can find in iTunes.

A quick search of the ITunes store found less than ten podcasts devoted to headaches or migraines; a few dozen related to sleep or relaxation, and over 100 related to type 2 diabetes. In summary, it is important to understand adoption of these technologies among your target audience before pursuing an aggressive podcasting strategy. In fact, in many cases, there is probably a stronger argument for creating a podcast for physicians than there would be for creating a podcast for a given patient group -- another strategy to consider.

 In its true definition, Web 2.0 is defined by the use of user-generated and user-contributed content and technology. Of course, the idea of leveraging user-generated content presents a variety of logistical and legal difficulties for pharmaceutical companies right from the start: With the stringent regulatory requirements surrounding indications, efficacy claims, and adverse events, it can be very difficult for pharma to participate in creating truly collaborative online content.

However, the Web 2.0 phenomenon can still inform decision-making when it comes to online marketing and content. It is important for marketers to keep a few of the principles behind Web 2.0 in mind when developing online content:

• Consumers expect up-to-the-minute content–-so if there is news released surrounding a product, consumers will visit your website for information-–and information should be available to them on that site as quickly as it is available through Reuters.
• It is important to understand the key media outlets your target audience is using--for instance, if there is a consumer or physician blog your target audience relies on, such blogs should be seen as media outlets worthy of PR efforts in their own right.
• There are some interesting content opportunities in the broader sphere of “new media” content, if not user-generated content. AstraZeneca recently featured a podcast with content for acid reflux sufferers on About.com. The great thing about podcasts is that once a user subscribes, he or she automatically receives updates through iTunes or another podcast distributor-–creating an ongoing touch point with the customer.

One great example of a pharma company taking advantage of the popular Web 2.0 medium of video can be seen in this viral video by GSK UK entitled “My Daddy’s Got Restless Legs”. Of course, this is a tough act to follow in the viral video space-–but it demonstrates some creative thinking of how to take advantage of today’s content trends.

 Social networking sites present a variety of opportunities for today’s marketers.

Most importantly, these networks provide a chance for companies to gain insight into the concerns and opinions of today’s consumers--and while insight gleaned from such sources regarding consumer opinion cannot be considered true market research that is representative of the opinions of the entire target population–-it is nonetheless critical to be aware of what the consumer opinion leaders who typically post on these sites are saying, as their opinion is likely to have an extended impact on friends, family, and, of course, those reading their comments online.

Additionally, online social networks can be looked at as a viable media outlet for certain segments of consumers. For instance, some companies have sponsored bands on MySpace, or conducted media buys on similar sites. An example of such a sponsorship can be seen here: http://www.wngti.com/.

For physicians, one recent newcomer to the space is the physician network site Sermo http://www.sermo.com/-- a community site where physicians can post and network with peers.

 Surprisingly the answer is a resounding "no"--in today's world, DVR owners have higher ad recall -- when it comes to pharmaceutical DTC ads, anyway.

The continuing popularity of digital video recording (DVR) devices such as TiVo, or the DVR boxes which are offered through cable providers, has many marketers worried: Besides allowing consumers the convenience of recording programs to watch after their scheduled time slots, they also allow owners of the technology to fast-forward through commercials. As DVR technology becomes more commonplace, marketers and the television networks who depend on advertising dollars are understandably concerned--how will widespread DVR ownership impact the efficacy of television advertising?

In looking at the demographics of this group, we see that DVR owners are are younger, more likely to be male, and have a higher income than the average U.S. adult. They are also a technologically savvy group-–80% are online, and nearly half use the Internet to gather pharmaceutical information. These high metrics for online health information seeking bode well for the viability of other channels, such as the online channel, for gaining the attention of the DVR owner. However, the data suggests that it’s not quite necessary to give up on accessing these DVR owners through their television just yet. In fact, DVR owners are more likely to have DTC ad recall in today's marketplace--and are also more likely to have taken action after seeing a DTC advertisement (as compared to their DVR-less counterparts).

Despite this widespread hypothesis that DVR ownership will yield lower recall and response to DTC advertisements, in looking at today’s DVR owners, that does not seem to be the case. As DVR ownership becomes more commonplace and consumers become more familiar with the capabilities of the DVR functionality, we may start to see these numbers decline-–but for now, DVR owners appear to be highly media-savvy consumers who are still tuning in to DTC ads.

 One of the key trends in pharmaceutical consumer marketing in the past few years has been the emergence of the unbranded website as a way to drive condition-level discussions in a product’s area of focus. With the continuing popularity of this approach, many have been left to wonder: Is this approach working?

We see that the unbranded sites driving the most traffic are related to depression – with depressionhurts.com driving the most visitors in the past twelve months. Many of the other sites in the top ten unbranded sites visited are associated with some of the most aggressive DTC campaigns over the past year-–while others, such as bipolar.com, diabetes.com, and depression.com (all owned by GSK) may be reaping the benefits of their valuable domain names.

Evidence of the success of some unbranded ad campaigns can also be seen in consumer reasons for researching certain conditions online. When asked why they researched various conditions, consumers were most likely to report they researched restless leg syndrome, smoking cessation, erectile dysfunction, acne, and Human Papillomavirus (HPV) because of a television advertisement they saw.

Despite the success of many of these campaigns in driving condition awareness, unbranded advertising is not a one-size-fits-all approach that is right for every brand out there. In many cases, an unbranded campaign can be a risky move: Unless you are the first to market (or have some other competitive advantage)--unbranded advertising could end up creating awareness that benefits your competitors.