I was a strong supporter of the Novartis heart failure disease awareness ad. This was the one with the man in the room with water pouring in and filling up the room. It was criticized by some doctors for being alarmist. I never thought so myself, as heart failure is about as serious cause for alarm as there can be.
The disease ad was a precursor to a branded ad for Entresto, which I can’t stop thinking of as Ernesto. This ad is the polar opposite in tone to the disease education campaign. While the message of preventing heart failure is the same, the branded ad takes an uplifting approach.
The ad uses the song from Annie, “Tomorrow” which I guarantee you will sing for at least 24 hours after seeing it. It is a series of patient vignettes where the actors sing parts of the song. The message is that Entresto will help make more tomorrows possible. The commercial is beautifully simple and engaging.
I have to give Novartis and their agency, McCann, a lot of credit for a combination of disease and branded ads so different yet entirely complementary. The disease ad really stopped you in your tracks alerting viewers that heart failure is something to watch out for and act on. While deadly serious in tone, I think it was entirely appropriate. They could have used the same idea for the branded ad but they smartly chose to play up the positives. It is better to promise in the branded campaign hope about living longer than warning about early death.
What was necessary in the disease ad to get your attention was not the best approach in the branded ad. Instead showing a world of family and friends that you can enjoy longer if you treat with Entresto was a good approach. I am sure the doctors critical of the disease ad had the opposite reaction to the “Tomorrow” campaign.
I am not sure whether the criticisms from the medical community affected the branded strategy. Maybe that led to the decision to go more upbeat. In any event, whatever the reason, Entresto is a solid ad that is memorable and positive
I wanted to explain why after 16 years of developing conferences we decided to run one solely on tv and print this fall. It seems odd that the media with the most spending seems to get the least discussion on the agenda. Our DTC National offers a wide array of topics but most are in new media. I always ask people to submit speaking proposals on television and print but few are received. While drug marketers are anxious to learn the latest on new media, there is a lot that can be improved in the meat and potatoes category.
-Bob Ehrlich
Most of our speakers are on digital, big data, patient relationships, point of care, and technology. While this may be the DTC future, the overwhelming media allocation remains in television and print. After 20 years maybe there is not much left to learn in mass media. I kind of doubt that.
We are seeing great new creative in mass media so clearly agencies and clients are learning how to constantly improve their ads. We are also learning so much more about patient receptivity to ads depending on day part, show type, and where the ad is in the show. We are seeing FDA doing many studies on elements of advertising from supers, cartoon images, how risk is narrated. We are getting new research that dissects effectiveness to new levels of detail.
We are also experiencing growth in mass media for drug categories that never would have used it a few years before. Cancer and rare diseases have decided that the ROI is positive using mass techniques. So there seems to be a renaissance in expanding use of mass media.
We also see print titles doing quite well. DTC ads dominate some magazines. I have always believed there is tremendous opportunity to improve the creative impact in print. Too many ads are still missing a dominant headline or visual, choosing dense copy and too many sub headlines. While FDA mandates make print more difficult, there is no reason any ad should not be visually arresting.
My guess is every media plan can be 10-20% more effective with some simple tweaks. Better creative, more pre-testing, more targeted media planning, and more robust evaluation are all possible and affordable. In 20 years of being involved in DTC I have seen many campaigns that I know are weak, yet somehow they made it on air. Mediocre ads get through for many reasons. It can be bad copy strategy, testing the wrong objectives, rushed creative, forgetting the competitive set, group think, overloading information, or many other factors. Sometimes there is so much testing that the marketers are overwhelmed and miss the need to simplify for consumers.
So in October we will do an entire conference that never mentions social media, mobile, relationship marketing, or personal fitness devices. Instead we will focus on making our tv and print ads better, spending more effectively, and doing better analysis. I am not pushing mass media over new media, just recognizing that if more than 80% of our budget is spent there, we might as well strive to do it better.
Treato, an online consumer insights company, released a survey on DTC 4/18. It was done with 529 Treato.com consumer users. The headline in their press release that said “Treato Finds DTC Pharma TV Advertisements Have Little Influence”. They cite a result that only 7% of respondents asked their doctor about an advertised drug this year compared to 21% last year.
When you do a survey and get some strange results like a decline from 21% to 7% you have to ask why. There is no reason that consumers would react so differently year to year. You have to question the methodology, the panel who responded, or some other factor. People would not find 2015 advertising so much less influential than 2014 advertising.
Treato did not analyze what TV ad influence means in terms of ROI for drug companies. Television ads payback, and the evidence is overwhelming. Whether the real consumer request number is 7%, 21% or anywhere in between, the drug makers look at the value of consumers who do request based on their ads. For many branded drugs 7% would be a great number.
The drug industry does not expect their ads to influence a majority or even a large minority of consumers. They know most consumers rely entirely on their doctor to tell them which drug to use. The drug makers hope a large enough segment of a potential user population see an ad and ask their doctor.
I remember the launch campaign for Lipitor had a marginal share boost. That marginal boost, however, was a great ROI on our investment. So Treato may be correct that TV has less influence than the DTC critics give it credit for having. Maybe Hillary will see that DTC is not the force for evil she contends in her speeches.
When you examine any blockbuster drug performance DTC has a marginal influence. Lipitor spent about 100-150 million on DTC in its peak days. It was doing over 5 billion in sales. So it probably generated 200-300 million in incremental sales from DTC. Maybe it had 4-6% influence. I think that percent would be a fair estimate for most billion dollar plus drugs doing television DTC.
Treato suggests that drug companies look for other ways to influence consumers. This statement misses the ROI truth. Drug marketers will use any medium that pays back. Television may not be seen by media pundits as innovative, but drug marketers are evaluated on ROI success, not how much they experiment. Television ROI is less than some other more targeted techniques like Point of Care. Drug companies do both to achieve their goals.
So Treato’s headline has some truth despite the odd decline they state from 21% to 7%. Their term “little influence” has very different meanings to drug company marketers and DTC observers. A little influence can generate a great ROI on premium priced drugs. For most brands’ mass media plan it is 1.5 to 3 to one. Pharma lobbyists should tout this survey to DTC critics showing there is no need to be concerned that consumers are being hypnotized by television into mass use of drugs.
As I wind down my career I wanted to reflect on my favorite project. In 2000 I thought there was the need for a well organized meeting of DTC professionals. At the time there were several attempts made by conference companies to run DTC meetings. The problem I had with them was they were developed by companies that ran many diverse topical conferences across many industries. They had no real inside knowledge of what mattered to DTC professionals.
After Pfizer acquired Warner-Lambert in 2000 I decided to try to go out on my own and focus on DTC. Having worked on Lipitor and Rezulin, both major advertised drugs, I had a good working knowledge of DTC issues. In 2001 we started the DTC National in Las Vegas. It was a success but I had many ideas to grow it and in subsequent years it grew each year as DTC spending grew.
As I looked through past agendas I am proud of our diverse group of speakers, many were drug industry critics such as Ralph Nader, Howard Dean, Joseph Kennedy, and Henry Waxman. I always welcomed the anti-drug side because we as an industry need to be open to criticism and change. One of my favorite moments was the debate between Ralph Nader and Pfizer President Pat Kelly, when sparks flew as Nader held nothing back.
Another great moment was when David Kessler, former FDA Commissioner admitted he was wrong to oppose DTC. Much discussion over the years centered on political threats to DTC, which are never more relevant than this year.
Many of our media gurus over the years have lambasted the industry for being too slow to adopt digital media. Most of these experts predicted the end of television but most have been wrong, at least to date, as the media spending numbers prove. While media futurists are always interesting, they are often wrong.
What is most gratifying about the DTC National is it brings industry practitioners together to network. Most of us change jobs fairly often and having a broad contact base is essential when one is merged put of a job, or when a job change is desired. I urge all DTC professionals to get known in the industry. Speak at industry events, write articles for the trade press, join a panel or just come to conferences and be friendly. To my pharmaceutical marketing colleagues I recommend you get to know suppliers and agencies, as one day you will need them for job contacts. As someone whose company was acquired, I know that having a strong industry wide reputation goes a long way.
So for those of you who have never been to the DTC National, I welcome you to try it out. While everyone can find reasons to stay in the office, the three days spent learning from your peers will be well worth the time.
The FDA is becoming very active in DTC research. By my count they have identified ten studies that are in process to be fielded. Their glacial pace of completing their studies is well known so I am not sure when these ten will be completed and published. I know the people doing the studies are well qualified professionals who are hampered by government procedures that slow down the process. They go through numerous mandated public comment periods and have to get budget approval from Office of Management and Budget bureaucrats. It is unfortunate that after 20 years of DTC, FDA is still doing basic research that should have been done 15 years ago.
FDA is doing some important studies and some that I question for their usefulness. On the positive side they are doing an important study on shortening the risk statement to focus on the major risks rather than the long litany of risks in many ads. They are also doing important work in the area of price discussion in DTC ads. FDA is also studying how to convey quantitative clinical information in understandable visuals. A fourth study which is important is how to measure the impact of superimposed text on the screen, as to size, contrast to background, and use on mobile devices.
FDA is also doing a major consumer attitude study on DTC, which was last done in 2002. This is long overdue and might be the most important of all their proposed studies. With all the criticism from payers, politicians, and physicians it is critical to get comprehensive consumer feedback.
There are a few studies I find less useful. One is measuring DTC television ads impact on the hard of hearing. One can assume that anyone who cannot hear well will have trouble with the audio and have less comprehension. This is one of those studies without a practical purpose. What are drug makers supposed to do differently? Are they supposed to have special ads for the hearing impaired?
Another study is one done with teens on ADHD drugs. Does it matter what teens take away from DTC ads? Their parents and physicians are the gatekeepers. Again what is a drug maker supposed to do when advertising ADHD drugs? Are they expected to make sure teens understand risk/benefit?
One thing FDA needs to do is better communicate the research results to the DTC community. Their findings should be announced and summarized in user friendly formats. It is ironic that an agency dedicated to improving consumer communication does a mediocre job of organizing and releasing their data. They need to have an easy to understand summary chart of each study with objectives, findings, conclusions, and next steps. No business person would accept the current way of communication and neither should FDA. Hopefully their web site will be better run and targeted to the people who actually are expected to act on their research.
For many years media pundits have predicted the end of broadcast/cable television as both a dominant medium and as a successful seller of ad space. As a DTC information provider we at DTC Perspectives are media agnostic. We believe in DTC but do not choose one advertising medium to favor. That neutrality has us question the media pundits that say television is a dinosaur waiting to be hit by an extinction event. Every year at the DTC National I ask new media presenters why drug marketers still spend so much on mass media if digital/mobile is replacing it. They usually say drug companies are slow adopters and their agencies steer them to television because it is easier to buy.
I usually push back to say drug marketers and their agency associates are smart folks and would not use a medium that does not work. After all, their career success is based on drug sales response to their media selections. They use television because it generates a strong ROI and can have a fast market share impact. It also puts pressure on insurers to cover reimbursement and motivates doctors to learn about a drug faster.
Despite the dire predictions, television use for DTC advertisers has never been stronger. The latest Nielsen data show television got 68% of the spending in 2015. Nielsen does not measure point of care and understates Internet spending. If we add those numbers which trade sources say are about $500 million for point of care and around $250 million for Internet, then we have about $6 billion in total spending with television still comprising 59%.
Why has television remained dominant when other industries have spent much more in digital? There are several reasons for the wide use of television for DTC advertisers. Most important is the age of the majority of prescription drug users. The largest drug categories are dominated by older users. They do use the Internet a lot but still watch more television than younger folks. Second, drug ads can be executed well in the 60 second television ad unit and still meet regulatory requirements. In other words television allows for motivating messages. Third, DTC is serious information and that is why the drug makers dominate network, and cable news shows.
I should mention that print spending is still quite healthy. FDA still requires a print brief summary source be mentioned in the television ad. While print titles are declining those that remain are seeing over $1.5 billion in revenue from DTC advertisers.
The health of television does not mean drug marketers are ignoring digital and point of care. New techniques are growing in each area. Point of Care has exploded, and digital is finding a way to introduce drug and disease awareness despite FDA limitations.
I am sure many media pundits in 1997 would be surprised to see television so strong in 2016. Time shifting through DVR devices, Netflix, on-demand options, as well as competition from game apps were predicted to drastically reduce broadcast television use. While teens and millennials may be watching less, and shifting to watching their television on demand, the drug using baby boomers and their parents still watch a lot of broadcast and cable. Of course eventually the pundits may be correct and television as we know it will be extinct, but it looks like a decades away event.
What drug company executives have realized is that DTC is only one of many things critics hate about them. They know that if they stopped doing DTC to appease Al Franken, then he would still demand European prices, shorter patents, less detailing and sampling, and less tolerance for side effects. Therefore, drug makers have gone all in on DTC. They recognize that offering to give up their right to advertise a lawful product serves no purpose.
Instead politicians like Franken make the mistake of thinking the consumer is too ignorant to understand drug selection. It is a scary thought that FDA vetted advertising claims are considered dangerous and must be stopped. The rationale that $5 billion of advertising is too much in an industry that has $374 billion in sales is shaky logic. There is no impact on drug prices resulting from advertising. Advertising creates competition and consumer and doctor awareness of competing brands keeps price competition alive. Banning advertising means established brands face no DTC challenges from newcomers. Advertising certainly speeds up adoption as providers are pressured to learn about newly advertised drugs.
The drug industry cites numerous studies about advertising causing more diagnosis of disease earlier. That is a very positive benefit. Drug companies should not be afraid to also say they advertise to sell more drugs. That ability to advertise gives drug companies incentive to speed up drug development knowing they can tell the world through mass communication what they have discovered.
I know Sanders, Clinton and Franken would prefer some all knowing government agency overseeing drug development, testing, selection, and pricing. In that world of central planning, we as consumers, would have no say in drug selection. Advertising is just one source of consumer information and is of course designed to create brand requests. That is why the FDA reviews the ads for accuracy and why there are hundreds of health web sites to offer reviews of those drugs. Let’s err on the side of more not less information.
While consumers may complain about drug ads most learn about new drugs from advertising and I doubt they want to go back to the pre-1997 era. FDA is planning its first comprehensive consumer attitude survey since 2002 and I welcome that study. That could be fielded in late 2016, or 2017 as FDA moves at a government agency pace.
At the DTC National this April we will be discussing what the drug industry should do to respond to the latest threats and how marketers can influence public policy. Drug makers need to carefully balance the public concern while maintaining their right to advertise.
DTC spending continued its strong comeback in 2015, following a strong 2014. Spending was $5.17 billion in 2015 according to Nielsen, the best performance since 2007 when $5.33 billion was spent. Fueled by many new product launches, DTC advertisers spent heavily in 2015. Some of the biggest newer spenders were Xifaxan, Toujeo, Belsomra, Breo Ellipta, Harvoni, Trulicity, Jardiance, Namzaric, and Brilinta.
The new spenders are across a wide array of categories including irritable bowel, diabetes, insomnia, COPD, Hep C, Alzheimer's, and blood thinners. Returning to the $5 billion level is a strong recovery from $3.47 billion in 2012. In 2013, the DTC recovery began with $3.8 billion followed by $4.53 billion in 2014 and $5.17 billion in 2015.
The recovery has been fueled by both new products and a realization by drug companies that DTC is essential to drug success. DTC has largely been used for large incidence categories like cholesterol, depression, and diabetes. What has been a new trend is use for more limited incidence diseases like advanced stage cancer, Hep C, binge eating, sleep disruption for the blind, and advanced heart failure.
Many drugs with high annual price tags have started to use DTC heavily. Provenge, Harvoni, and Opdivo are a few of the drugs, costing up to $100,000 a year, to begin using DTC in the past few years. DTC is now seen as a way to raise awareness of premium price drugs which are harder to get on formularies. Ads create demand and put pressure on insurers to cover those premium priced drugs.
DTC spending should continue to grow in 2016 but likely will slow its growth rate. It is entirely possible we will see the 2006 record of $5.4 billion eclipsed. This is welcome news to media companies who have counted on DTC as a key revenue contributor. With higher spending comes more criticism from the army of drug company bashers. Despite the constant criticism, drug companies are eager to advertise because DTC works in creating consumer awareness and eventual higher sales.
In 2012, some industry observers and a few pharma executives were saying DTC was dying. That pronouncement was obviously premature given spending increases in 2013, 2014, and 2015. We who work in DTC have to continue to defend the use of consumer advertising. Critics will try to take away the right to advertise and our industry must provide the positives of advertising to politicians, the media, regulators, and consumers. Clearly drug companies have shown the desire to allocate more resources to DTC and should continue to do so in 2016 and beyond.
