May 2007
	Can an e-Marketing & Communications Platform Replace the Pharma Sales Force? I remember, distinctly remember, a number of years ago when the Internet first came on the scene in general, and as related to pharmaceutical marketing in particular. With several colleagues, I had the opportunity to run some of the earliest seminars in our industry on the topic of the Internet. At the time, we had to start out each seminar by defining what the Internet was, since many of the 200 to 400 people attending each session had no clue! Nonetheless, interest in the Internet was at a fever pitch, with many of the attendees having been given strict orders by their bosses to get a Web site for their pharmaceutical product up and running as soon as possible but with most of them having little or no idea how to begin, let alone complete, such a task. Presenter after presenter at such conferences opined that almost overnight we would see traditional TV commercials, print advertisements, etc., for all pharmaceutical products dry up, predicting that the World Wide Web would become the only promotional game in town. At the time, “surfing” the Web was a popular activity, with people not just using the Internet to seek out specific information, which was in fact rather difficult to do given the nature of the search engines available at the time, but rather simply wandering from site to site, looking for offerings that were “cool” and “sticky” (i.e., made people spend significant amounts of time on a particular Web site). Pharmaceutical companies proudly offered sites with mission statements and histories, often preceded by graphics that downloaded with painfully slow speed given the dial-up connections used at the time. Things started to get more organized and more complicated, with WebMD and Medcast competing to become the “one-stop shopping” electronic site for physicians and their use of the Web (WebMD eventually beat out, and acquired, Medcast in the process). Special systems, such as IPNI, were introduced that used dedicated hardware to let physicians communicate directly with live representatives. The cost of the hardware severely restricted the scalability of the system, however, and the fact that the banter offered by reps-in-a-box simply replicated the presentations being offered by the physicians’ own territory representatives made many doctors quickly lose interest in yet another exposure to the same detail. The company failed. On the consumer/patient side of the equation, people were making increasing use of the Internet to collect information for purposes such as self-diagnosis and management of “high involvement diseases,” such as cancer, AIDS/HIV, etc. Search engines improved, and people developed preferences in their approach to searching for healthcare information. Additionally, pharmaceutical marketing research, with physicians and patients alike, began to be conducted on the Internet as the penetration of the technology began to reach a substantial number of households and the “Are people who use the Web representative of the population at large?” question began to disappear. In fact, on a fairly timely basis, the Internet replaced telephone interviewing and mail questionnaires as the methodology of choice for collecting quantitative information. But! Much of the pharmaceutical marketing world remains unchanged. E-detailing projects are conducted on a “one-off” basis, are not seen as being tremendously effective, are utilized by only a relatively small percentage of physicians and have definitely not replaced the territory representatives, who until recently have grown dramatically in number over the years. Meanwhile, on the patient side we see active use of healthcare-related sites, with some getting tens of millions of visitors a month, but there is little or no evidence that their use has improved persistence with chronic medications or any other measure of improved health. Again, pharmaceutical company spending on Internet messaging to patients still pales in comparison to that which is spent on Direct-to-Consumer advertising through television and print, thus demonstrating a situation again in which the new media, while receiving active support, use and spending, have failed to replace the old. Likewise, in marketing research the use of streaming video, which has now largely supplanted video conferencing as a means for viewing qualitative marketing research remotely, is being actively employed by some pharmaceutical marketing researchers. Our clients tell us, however, that they often find it difficult to concentrate on the depth interview or focus group streaming on their desktop computer, and thus will often still make the long and expensive journey to sit in the dark back room to watch focus groups and depth interviews ad nauseam. What is most surprising is that while use of the electronic media continues to grow by leaps and bounds, its application in healthcare in general, and in pharmaceutical marketing and marketing research, seems to have stalled. While I get four or five desktop-published brochures a day recruiting my attendance at paid industry conferences sponsored by CBI, IIR, SRI or some other commercial organization (parenthetically, let me note that I have largely stopped attending such conferences, finding them to be boring and a cost-ineffective use of my time), I have received only one or two in the last year focused on electronic pharmaceutical promotion. Moreover, when I examine the agenda in these brochures, I find presentations that are grinding over the same material that has been covered for years, e.g., e-detailing, disease management Web sites, etc. I guess my question is, “Is that all there is?” While consumer media are constantly shifting qualitatively, with new applications like video podcasts being introduced virtually every day, have we as an industry given up on taking the development of the electronic media through to the next steps? With the pharmaceutical industry falling on increasingly hard times, and taking “bold” steps like several companies’ reducing their sales forces by 10 percent or more, I am forced to ask the unthinkable question, “Why not reduce sales forces by 100 percent?” If we as the pharmaceutical industry took the resources we have dedicated, and largely continue to dedicate, to supporting pharmaceutical sales representatives and directed the money instead toward generating an electronic solution to communicating with our healthcare stakeholders, I genuinely believe that we could provide a platform that would be substantially less intrusive (think of all the doctors’ offices, let alone major institutions, that are increasingly refusing to see representatives, and the pathetic 30-second encounters that typically ensue when a pharmaceutical sales representative is successful in getting to see a doctor) and more rapid and responsive to the information needs of practitioners. When a significant new drug is launched, get physicians together for a videocast and make the same information available to them on webcasts and podcasts with genuine experts presenting the information and taking questions. Using such a process, rather than sending thousands of territory representatives out to make brief and often less than completely medically informed presentations will help ensure the timeliness, completeness and consistency of information being offered. Because of the inclusion of asynchronous media, this approach will also help ensure the undivided attention of the physician, since it can be viewed at his or her convenience rather than constituting an interruption in the flow of treating patients during office hours. When sample supplies are required by physicians, there is little trouble in providing them via Internet-based services. Several agencies already provide this service over the Internet, and do so on a more timely and less haphazard basis than territory representatives. And when physicians have questions, we could simply make more user-friendly the systems that are already in place to let them communicate with the pharmaceutical companies’ medical departments, with each sharing experiences in the real world, etc. As I have written and commented many times before, ePocrates has become ubiquitous and popular because it answers physicians’ FAQs (Frequently Asked Questions) quickly, completely and conveniently. Several other benefits would accrue from establishing an electronic, rather than feet-on-the-street, based link with our physician and other healthcare provider constituencies. First of all, such issues as the reporting of adverse effects and avoiding the promotion of a product off-label, etc., are quickly and well taken care of without any special “policing” action being required. As a pharmaceutical marketing researcher, my favorite benefit of establishing an electronic link with our customers is that we can simultaneously establish an electronic dialogue. That is, rather than breaking down our need to collect information from physicians into artificial “questionnaires,” we can analyze their requests for information, samples, etc., include a few questions in each of our contacts with physicians and develop a real-time understanding of their knowledge, attitudes and practices, both in the aggregate and at the individual physician, or micromarketing level, that is far better than anything we have been able to construct previously. Several important things should be kept in mind while pondering the recommendations made above. First and most importantly, they can all readily be accomplished using technology available today. No sci-fi assumptions are required to make this vision a reality. Second, such an approach would create a win-win situation, with the physician being relieved of the tedium of “reminder details” and the pharmaceutical industry being relieved of the huge expense of maintaining and increasingly policing its sales force. Then why hasn’t all of this already been accomplished, or at least why aren’t we moving aggressively, or at least moving, in these directions? Quite simply, the answer is fear. Today’s pharmaceutical marketers are often yesterday’s pharmaceutical sales representatives, and thus carry with them the baggage of the way things have always been done. Even in an era in which drug selection is heavily influenced by managed care and other forces, these marketers still believe that it is the individual representative’s relationship with the physician that is a key driver of prescribing choice. Therefore, forays into areas such as e-detailing, e-sampling and the other initiatives discussed above have all been handled as a series of “nickel bets,” i.e., minimally funded by pharmaceutical companies as experiments in addition to, as opposed to fully funded as replacements for, what have historically been the mainstays of pharmaceutical marketing. Even the retrenchment currently under way is relatively minimalistic, with relatively small reductions in field and home office staff being employed instead of fundamentally reconsidering the way business is done and more fundamental movement in the “e” direction. Look for all this to change in the near future. Major players at some major pharmaceutical companies with some major money to invest are beginning to ask the right question, i.e., not: “How can we jigger with pharmaceutical marketing as it has long been practiced to save our way out of a growing disaster?” but rather… “If we were to start with a clean slate in 2007, what would pharmaceutical marketing look like?” Look for work to begin in this direction very soon, for some very serious effort and funding to be put behind it and for pharmaceutical marketing and marketing research to change rather significantly and rather quickly as a result. Richard B. Vanderveer, Ph.D. Group Chief Executive Officer GfK U.S. Healthcare Companies