Dr. Gina Nick10.01.04
How To Gain Market Share
Examining some of the tools Big Pharma uses to promote drugs may be helpful in the promotion of nutraceuticals.
ByDr. Gina Nick
There is no doubt that Big Pharma does good work and receives well earned appreciation. Pharmaceutical products continue to be looked upon as miracles of modern medicine, and so long as the FDA keeps rein on their excesses they will continue to enjoy the respect of an admiring public (ignoring for the moment the growing complaints about price gouging and side effects). But quality products are not the only key to market success. Delaware Punch was delicious, but without advertising it disappeared from the marketplace. Big Pharma’s promotional expenses are comparable to those for R&D, and they utilize every advertising “gimmick” in the book, many they invented themselves.
Peer-reviewed journals are a major advertising venue for new pharmaceuticals, which includes paid advertising, but more importantly journal papers/articles presenting research that has been sponsored by the drug’s owner. (Sponsorship appears in tiny type where it is rarely read.) Research thus achieves a dual purpose: It earns FDA approval, and it promotes the product. This research begins years before the drug reaches the market, first announcing the discovery of the drug, then the Phase I testing, then Phase II and finally Phase III. Many studies even publish interim results whenever the data are analyzed to detect early termination criteria. Thus, any promising new pharmaceutical is well known to, and eagerly awaited by, the medical community.
In addition to sales reps visits, catered discussion groups, journal articles and paid advertising in peer-reviewed journals, physicians are also the targets of direct mail advertising campaigns. On average, Big Pharma spends about $1 million PER DRUG, PER QUARTER on advertising.
It has been less than a decade since Big Pharma began advertising prescription drugs directly to the public. They started with Disease State Awareness campaigns first, closely followed by consumer-focused drug awareness campaigns. This distinction is important to note because not only did they market their drugs to consumers, they also marketed the disease state associated with the use of each drug. There was considerable discussion over the ethics of that change, but capitalism prevailed over more lofty concerns. As such, consumer-direct marketing flourishes today, mostly for drugs that compete for common indications like allergies and cholesterol imbalances.
In every instance, research articles published in medical journals are vital to a drug company’s promotional plan—and every article must pass muster to be published in a respected journal. It is now possible to see the multiple ways in which practitioner-based research can pay off, both in the longer term and immediately. As soon as a protocol is formulated, the plan can be published along with a thorough discussion of the background and rational behind the project, the active agents being used, the entire research protocol, the subject inclusion criteria, the length of the study, and as much ballyhooing about the expected results as might be swallowed by those who read the article.
In addition to journal publications, the pharmaceutical giants have enormous sales forces. It is not unusual for their top selling drugs to be promoted in person nationwide to every physician who might possibly use the product by sales reps who have undergone many weeks, even months, of training on that individual drug. The expense is phenomenal. On average, pharmaceutical companies spend $70 thousand per sales rep on training just to get them started. Field reps visit doctors’ offices every two weeks. They host 45 minute long catered roundtable discussions every week—about 10 doctors per discussion. This approach must work, or they wouldn’t be doing it.
Along with physician office visits and roundtable discussions, regional sales reps also arrange lavishly catered meetings in expensive hotels wherein “Key Opinion Leaders” (KOL) chair discussions of the product. These are known as peer-to-peer advisory sessions in the pharmaceutical industry and are being employed successfully in the nutraceuticals industry as Natural Product Advisory Sessions (NPAS™), with some modifications, the most important being a reasonable cost to the sponsoring company, with a guaranteed return on investment. The KOL is usually an entertaining physician researcher who has participated in the development of the product. The latest research supporting the product is presented at these meetings and peers are encouraged to talk among themselves about the clinical relevance of the product, while a highly trained moderator guides the discussion and takes detailed notes. Additional promotion takes place through presentations at annual medical and specialty society meetings, targeting the specialties that would most likely use the product. New research is presented before it is published, being sure the participants have summaries to take home with them and free samples if the product has been approved by FDA.
KOLs, or “thought leaders,” who present the material, can be powerful tools in creating a connection with the practitioner market. The thought leaders must have some or all of the following traits: superior training, specific experience with the product(s) being promoted, a convincing presentation and a high profile. Research credentials are also quite valuable. These traits allow them to communicate well with other practitioners and earn respect and trust.
KOLs often serve as the seed crystal for developing a research and marketing team for a particular product or group of products. The team, once created, plans and executes research, including practitioner studies and subsequent journal publication, while simultaneously directing and participating in marketing programs. The synergy of using the same expertise creates economies through efficiency. A large and effective thought leader team, involved in both research and marketing, will create new accounts and drive existing accounts into higher sales.
The power of authority figures has been well documented, both in industries like ours and in the media in general. Consider the following: An authority published in the New York Times can create a 2% change in public opinion nationwide, while an authority on national TV can change public opinion by 4%. The power an authority has on changing opinion is extraordinary. Perception is the key to sales, and a perception is only an opinion. Imagine a group of people working with you that had the consistent ability to change perceptions in your favor and create strong customers who believe in your product. Remember that “practitioner” clients are thought leaders themselves in the eyes of their patients and are often able to change a patient’s perceptions.
The criteria for selecting thought leaders depends on other factors as well, such as target practitioner segment, product focus and current market position (compared to competitors). The thought leaders must be cultivated like any other marketing tool. They should be selected carefully, trained on presentation methodology, and continually involved in product research, studies and development, and kept abreast of all pertinent new information. Cultivation may include helping practitioners become more active in research and publishing. With help, some practitioners could earn prominence in their fields.
Thought leaders and participating practitioners alike must have a belief or passion about the products before being approached for this type of role. Once selected, this “team” can be brought together in person or electronically through the use of online phone or video conferences. The energy created when passionate practitioners gather greatly reinforces their enthusiasm and inspires productivity.
It is clear that the peer-to-peer NPAS mentioned earlier can be an effective point of origin for a complementary medicine clinical protocol. Merely announcing that such a study is being considered, then inviting interested physicians, particularly KOLs, to attend regional discussion groups in order to formulate and fine-tune a research protocol will attract great attention. There then follows in progression articles on the protocol, meetings of potential clinician researchers, more articles on the definitive protocol, preliminary results, perhaps alterations in the protocol as early data comes in, spin-off studies directed by the progress of the original study, and, of course, the final results, which can be milked forever if the data set is expansive enough. Every step of the way will attract attention, and most of the attention will be respectful provided that the protocol is convincingly scientific and the airings are objective and professional, at least as much as those from Big Pharma.
Let’s take a look at some of the ingredients an initial research protocol ought to contain, or perhaps one should consider a family of protocols for simultaneous research into several areas of health affected by nutraceuticals. Timing is a primary consideration. Although most of the major claims made for nutraceuticals deal with reversing the effects of aging and chronic disease, and thus require something approaching decades for meaningful results, there are other products whose benefits can be seen in publishable time spans. Hyaluronan, for example, has shown results in animals in matters of months and stands high on the list of possibilities for a major research effort in humans. But hyaluronan is but a single agent. This scheme ought to make an attempt to get as many products, at least high volume products, into the practitioners’ offices as reasonably possible. So perhaps one protocol could study the effect of several agents on degenerative arthritis in a double-blind, crossover set up. Preliminary results could be published at each switchover, and the doctors would have several arthritis products to hand out. If a relatively short term arthritis protocol were matched with a longer term project that studied some other currently fashionable chronic degenerative disease like Alzheimer’s, the dual nature of the new direction would be more pronounced, and there would be that many more products available to the practitioners. In order to emphasize the uniqueness of this new direction, consideration should be given to starting it off with a completely new product line—available to practitioners only, more highly refined, narrower tolerance for dose variation, a new level of quality control, and other similarities to pharmaceuticals.
December’s Healthcare Practitioner Marketing column will discuss how to develop the “ideal” practitioner-only line of products along with technology solutions for practitioners—in-office patient/protocol management software, integration with supplements, and the use of on-line training/continuing education initiatives to minimize inconvenience to doctors. It will include results from the LTP Practitioner Survey, which sought to discover what practitioners today are looking for in a supplement company.NW