You are a music lover. You see a magazine ad about a credit card-sized device that can hold 500, 1,000, even 3,000 songs. Music without fumbling through a host of compact discs? You resolve to buy it.
You are ill. You see an ad for a medication that treats symptoms sounding suspiciously like what you have been feeling. You resolve to buy it.
But you can't.
While you might seek the opinion of someone as to the taste of a DiGiorno pizza or the value of an iPod, those opinions aren't barriers to a purchase. But a consumer needs the explicit permission of a physician to buy a prescription medication.
Therein lies the challenge of direct-to-consumer pharmaceutical advertising: to tailor a marketing message to motivate people to see their doctor, while overcoming the obstacles inherent in the industry and also touting your own brands as a remedy to the problem.
And nobody does it better than Pfizer.
The world's biggest pharmaceutical company by any measurement, Pfizer is also the leader in its industry when it comes to communicating.
The company has risen to the top through a combination of factors that have included acquisitions, leadership in its marketing teams, the development of market-leading brands, innovations to its advertising and an enormous sales force.
"We've worked with Pfizer, and we've worked with nearly every one of the top seven or eight pharmaceuticals," says one healthcare ad agency president who asked not be identified to protect his existing relationships with other drug companies. "The best thing I can say about Pfizer, the thing I think is most complimentary, is that Pfizer really gets it. You know what I mean? More than anybody, they really `get' the whole idea of what healthcare marketing is all about."
According to Pfizer's J. Patrick Kelly, who's VP-president of the company's U.S. Pharmaceuticals division: "Communicating multiple messages effectively to multiple customers to achieve a single purpose is really what pharmaceutical marketing is all about." Pfizer wants to "prompt an informed conversation between patient and doctor, or a change in behavior, that can lead to appropriate treatment."
That's the mission statement that Pfizer's marketing teams stress again and again and again: Get the patient to the doctor. Of course, the unstated mission is that either patient or doctor will bring up a Pfizer brand during that meeting.
Pfizer, and the industry itself, is under fire from politicians and special interest groups on a variety of hot-button issues. Importation from Canada. Charges from politicians that DTC drug ads inflate prices. Democratic presidental candidates Howard Dean and John Edwards, who eventually ran as the vice-presidential candidate on John Kerry's ticket, based some of their respective campaigns on restrictions that would have effectively banned DTC advertising.
"It would be safe to say there is enormous attention on the industry in general, and we're doing our best to operate in a way that is responsible," said Greg Duncan, Pfizer's VP-U.S. Product Marketing. "What we do best of all is make a difference in the quality of people's lives, and we have to do a better job of telling that story."
There's also a bottom-line equation that the company doesn't stress, and that's the success of such drugs as Lipitor, the world's biggest selling medication, and Pfizer's seven other billion-dollar brands.
"Yes, we recognize that if we are effective in getting our message to the right people, it's going to be a win for us if that conversation results in a prescription for one of our medications," Pfizer spokeswoman Michal Fishman says. "We truly believe in our product ... But it does us no good to get a person on our medication if that medication isn't right for the patient."
Once considered a slacker in the industry, Pfizer is now the leader: $45 billion in sales, more than 122,000 employees worldwide, 13 market-leading brands and eight drugs with at least $1 billion in annual sales. Its drugs are marketed and sold in more than 145 countries. It employs some 13,000 scientists. And while Pfizer did spend nearly $1 billion in measured media last year to market its drugs, it spent more than seven times that-$7.13 billion to be exact-in research and development.
Charles Pfizer certainly wasn't thinking that big when he borrowed $2,500 back in 1854 to buy a building in Brooklyn to make chemicals.
But there's strength in those numbers. Because it is so large, because it has so many brands, Pfizer is not nearly as likely to suffer as much as its competitors from the loss of a drug due to patent expiration or research failure. Schering-Plough Corp., for instance, has struggled since its blockbuster allergy medicine Claritin lost patent expiration in 2002 and went over-the-counter.
Richard Evans, analyst at Sanford C. Bernstein & Co., New York, calls it "the Procter & Gamble model," referring to the consumer-goods giant with the multitude of products.
A compliment? Sort of. From Chairman-CEO Hank McKinnell on down to the receptionist at Pfizer's 42nd Street headquarters in New York, the company hates comparisons to package-goods companies, despises any references to its marketing prowess and is touchy about its enormous sales force.
That sales force, however, with some 9,400 people on the ground has a key responsibility: convince doctors of the efficacy of a brand. In turn, the marketer obviously hopes the doctor has enough confidence and faith in a particular Pfizer medication to write a prescription for it to the patient.
So far, so good. Pfizer medications account for 10% of the world's prescriptions.
Still, like many big pharmas-and, perhaps, more so because it is the biggest of the big drug companies and receives the lion's share of criticism-Pfizer and its sales force have been hit with the simple argument of why doesn't the company spend as much on its professional advertising as it does with its DTC?
"To date, [pharmaceutical marketing] has evolved from being focused on professionals to being focused on professionals and consumers," says Greg Duncan, VP-U.S. product marketing. "Relatively speaking, DTC advertising is in its infancy, and that will evolve and we need to do a better job of understanding how a consumer wants their information."
"This is the day and age of a paradigm shift, from when the doctor knew all to where people are taking the power into their own hands," says John Weyrauch, team leader-consumer strategy and planning for Pfizer's U.S. Pharmaceuticals business. "This is the generation of baby boomers who took birth control into their own hands....We have data showing that when people are asking for medication by name, they're more likely to continue with their therapy because they had a hand in the decision-making."
And as the paradigm shifts, Pfizer is striving to understand the evolving consumers and how they approach illness and remedy. "Historically, we've always been very research-oriented,"says Dorothy Wetzel, VP-consumer marketing group, "and we've just started to do more qualitative research in the last couple of years to have a better understanding of the emotional barriers, because that doesn't always come out in a questionnaire or over the phone. ... Our agencies are full partners in this process so that they can hear from the consumer what the consumer is feeling."
Just as DTC advertising took off in 1997 when the Food & Drug Administration loosened restrictions on pharmaceutical marketing, so did Pfizer.
A series of events vaulted the company to the top of the industry. First, Pfizer introduced erectile dysfunction drug Viagra to the world in 1998, using former U.S. senator and presidential candidate Bob Dole as its spokesman.
Two years later, Pfizer acquired Warner-Lambert Co. for $100 billion and took over sole marketing responsibilities for cholesterol-fighting Lipitor. Last year, Pfizer acquired Pharmacia Corp. for $57 billion and received the anti-arthritis market-leading drug Celebrex and its sibling, Bextra.
shouting its presence
Those moves shouted Pfizer's presence as a major marketer. Before that, Pfizer was often compared to a great athlete who didn't use all his talent. "They were a solid company, but for whatever reason-whether it was they didn't have the sales force at the time or they didn't have good marketing teams-they just didn't get to the next level," says another healthcare agency president. "I actually see it as a coach who had a good nucleus of players but was missing the superstar to take it from a .500 team to the playoffs. Clearly, the acquisition of Warner-Lambert changed that company."
Mr. Weyrauch, who's been with Pfizer since the early '90s, says a better comparison might be with the underachieving team and players who come into their own. "We were small, we were scrappy and we had to grow," he says. "That personality has continued to this day. There's an incredible amount of empowerment ... Here, the marketing teams are empowered to do great stuff, which is a great thing in that it drives a lot of energy."
One of the most interesting features of Pfizer's marketing operations is the RC, or review committee. Before the company turns out even the smallest piece of communication, it goes through a four-pronged review panel. It must be approved by someone from the company's medical, legal, regulatory and marketing teams. This is even before an ad is sent to the FDA's Division of Drug Marketing, Advertising & Communication for approval.
"Even before we get to the FDA, we make sure the information is understandable. says Margaret Shumel, Pfizer's senior director-team leader for U.S. marketing operations. "Is it medically correct? Legally, can we defend the things we're saying? From a regulatory standpoint, does it stand up to what the FDA and the government are going to ask? The RC is universal. Every brand has an RC."
The RC is something that even Pfizer's agencies have been known to sit in on, and for good reason. For the past seven years, Pfizer has gone to great lengths to work on the issue of health literacy. If the company's marketing mission statement is to motivate people to see their doctor and start a conversation, that mission statement is written at a level that everybody can understand.
74 pages of guidelines
Pfizer's "Clear Health Communication: A Handbook for Creating Patient Education Materials That Enhance Understanding & Promote Health Outcomes" is a 74-page handbook offering guidelines on how the ads should read. Among other things, it includes a lengthy list of "problem words" that Pfizer suggests its agencies replace, such as substituting "upset stomach" for "indigestion" or "can't sleep" for "insomnia."
"The eighth- and ninth-grade reading level is the average reading level in this country," says Lisa Dieter, director-consumer strategy and planning. "Our ads, our patient education material, are at that reading level. We've learned in our research that people need to understand what the benefits are balanced with the risks."
Pfizer has started other programs. "Ask Me 3" is a pamphlet that advises patients to ask three important questions of their doctor and not to feel rushed or embarrassed in asking: 1) What is my main problem? 2) What do I need to do? and 3) Why is it important for me to do this? The "Helpful Answers" and "Friends" programs help families who make less than $45,000 a year save up to 37% on Pfizer medications vs. what they would have paid at retail.
"None of these things is about selling a specific drug," says Doug Giordano, Pfizer's senior director of planning and business development-U.S. Pharmaceuticals. "There are 45 million Americans who don't have insurance. Layer that on top of another set of people who have insurance but not drug coverage, and the number goes to 60 million. These programs are designed to help people get access to those products."
But Pfizer did come up with a unique marketing program earlier this year with the Value Card, a frequent-flier style loyalty setup in which men who buy six prescriptions of Viagra get a seventh free. Will we see more innovations like that in the future?
"Over time, the delivery of healthcare information will become more targeted and more individualized," Mr. Kelly says. "We've come a long way in understanding consumer attitudes about health, and in creating information that is accurate, understandable and actionable.
"At the same time, regardless of how far we've come, there are still millions of people who are underdiagnosed and undertreated for serious, yet treatable, conditions. Over the next five to 10 years, I think you'll see a move toward gaining greater understanding about consumers and what motivates them to be involved in their health or, conversely, what prevents them from taking action.
"As a result, we need to continue to `crack the code' of healthcare marketing by coming up with new, creative ways to deliver health information and to recognize that there is no `one size fits all.' "