ARE DTC ADS BUILDING BRANDS? IT'S STARTING, BUT RX ADS FACE SOME SPECIAL BRANDING CHALLENGES

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When people write about direct-to-consumer marketing of prescription products, the point is always about its explosive growth -- how media spending is doubling every year, how pharmaceutical companies are jumping in with both feet.

The stories written about DTC invariably celebrate the quantity of it. Little is said about the quality of it: the advertising itself and, most importantly, the brands behind the bucks.

This is ironic because if any category is capable of creating powerful brands, of making an emotional connection, it should be one that pulls you out of depression (Prozac) or resolves your impotence (Viagra). But aside from these two cultural phenomena (whose public image has been shaped more by the media than advertising) and a handful of other Rx brands, lots of media spending has yet to translate to lots of branding.

One reason is that brand creation, through advertising, takes time; most of the current DTC campaigns are fewer than three years old. Other reasons have to do with the peculiarities of the products and how, historically, they have been marketed. However, when the client/agency team know what they are doing, the complexities of Rx drug marketing are surmountable and amazing success can be achieved by using it.

PRODUCTS THAT CAN HURT

By law, consumers are reminded of the problems of prescription drugs every time they see an ad that mentions the brand name and what it's for. The price for lowering your blood pressure isn't just the $10 co-pay; it's the dizziness, diarrhea or "dry mouth" that go along with it. The impact that Food & Drug Administration-mandated "side effects disclosure" has on TV advertising can be especially counterproductive. Images of healthful bliss can be spoiled by warnings of "potential liver damage" rolling down the screen.

So what's to be done? How do you get the collective positives to outweigh the collective negatives? For both regulatory (FDA) and ethical reasons, obscuring the required disclosure is not an option. Neither is stretching the truth on product performance.

The solution is to develop a more compelling brand message, driven by a profound understanding of how illness and disease affect men and women. In the many years medical agencies have been doing DTC, we've learned about:

* Fear and denial, and how people with all the classic signs of diabetes and cancer refuse to get tested.

* Stigma, and how chronically sad adults won't consider the use of prescription anti-depressants because they feel it will label them.

* Embarrassment, and how incontinent adults will often avoid confiding in doctors, concerned their problem will be trivialized.

* Desperation, and how adults who are highly skeptical of prescription weight-loss products will clamor to try the newest drug.

* Irrationality, and how one in five people with kidney transplants fails to take medication designed to prevent organ rejection despite being told that their noncompliance will lead to additional operations or death.

DEEP-ROOTED REASONS

The psychology of the beer drinker, business traveler and luxury car buyer may be complex but the psychology of those with health problems runs particularly deep. The best counterpoint to "leg cramps, irregular heart beat and unusual redness" is to accompany those required disclosures with unusual sensitivity to people's anxiety. Brilliant empathy doesn't always lead to brilliant creative but, without the former, there's little chance of the latter.

The most quoted statistic in DTC marketing is that doctors will almost always accommodate patients who ask for a specific drug by name. While true, the total number of brand-specific requests isn't as big as you might think; only a minority of patients say to their doctor, "Please give me brand X."

The more common scenario is that a patient will say to the doctor, "What do you think of brand X?" In fact, DTC advertising typically generates four times as many patient-doctor discussions than brand-specific requests. As such, the doctor's endorsement of the product being discussed is critical. Making sure the doctor is ready for that discussion is also critical. That usually means delaying the start of consumer advertising until the sales reps have called upon key prescribers at least once. Most doctors welcome "What do you think?" questions from patients but, if they aren't prepared to answer them, what should be a conversation becomes, from the doctor's point of view, an ambush.

MIRACLE OR HYPE?

Several new drugs make the cover of Newsweek with the promise they will revolutionize treatment for a particular medical problem and, occasionally, it's true. Unfortunately, most "miracle remedies" fall short of the hype, and consumers abandon them as quickly as they embrace them.

When confronted with extensive (and, seemingly, positive) media coverage, marketers might think they don't need consumer advertising. Ironically, they need it more than ever; not for driving awareness and preference but to temper consumers' expectations. That's done with a message that the new drug, while wonderful, is not that wonderful: Will the new weight-loss drug help you lose 20 pounds? Sure. For some, it can. 100 pounds? No way.

MANAGING EXPECTATIONS

Asking a traditional consumer agency to deliver a modest (rather than a dramatic) promise is like asking the defensive team in an intra-squad football scrimmage to lay off the quarterback; self-restraint runs absolutely counter to their nature. But, as medical agencies have learned, motivating consumers to take action while, simultaneously, managing their expectations is critical.

Despite the boom in DTC, some Rx marketers are still wary of the proposition. They want proof that this year's $50 million media budget is going to deliver $150 million in incremental sales pretty much within the same (12- to 15-month) time frame.

Our clients' request to "show me the money," a request made by many consumer marketers and not just pharmaceutical companies, gets translated to "show me the model."

Constructing a useful return on investment model for DTC requires a thorough understanding of the purchase decision chain in pharmaceutical marketing. In addition to quantitative research that predicts the probable level of consumer interest in your product, you need data that predict how physicians likely will react to that interest. Physicians' "willingness to prescribe" can vary dramatically depending on whether they consider the patient "a good candidate" or "a bad candidate." A number of other variables also has be factored-in.

As with all models, it's not a guarantee; but it's superior to shooting from the hip.

The concept of branding may have been popularized by Madison Avenue but it wasn't invented by Madison Avenue. When the late John O'Toole of Foote, Cone & Belding described the ultimate form of advertising as a one-on-one conversation between the brand and the consumer, he was paying homage to salespeople.

In the doctor's office, the sales rep is not only the voice of the brand, she is the brand. Concrete product benefits, when articulated by a good rep, translate to a sell that connects at both a rational and emotional level. When the doctor likes and trusts the sales rep and preferentially prescribes her products, it's branding at its best.

SALES CHEMISTRY

If personal selling, as we call it, is your experience and orientation, it's easy to overlook the fact that advertising, in addition to communicating concrete benefits, must replicate the chemistry the sales rep achieves so effortlessly and intuitively when selling live. To create brand-beautiful DTC, pharmaceutical marketers simply need to transfer and apply the principles that worked so well for them when they were out on the road.

In many ways, the principles of effective branding apply no matter what category you're talking about. To create Coca-Cola-like charisma, it takes a wonderful idea, well executed and supported with a ton of money year after year. But with Rx drugs, that's not enough. In DTC, you've got a greater responsibility to be honest and to show compassion for your audience. You also need to embrace the doctor, manage the media and justify, with rigorous detail, your media budget.

That might be a tall order for the "poets" of our business, who abhor the idea of measuring advertising effectiveness and complain that advertising is being taken over by dollar-conscious "suits." But for us suits in medical advertising, creating great brands while being fiscally and ethically responsible is right up our alley.

Mr. Barrett is senior VP, Klemtner Advertising, New York.

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