Going to the doctor

Despite the rise of DTC marketing, it's vital that physicians remain part of the mix.

Despite the rise of DTC marketing, it's vital that physicians remain part of the mix.

Direct-to-consumer (DTC) campaigns became the new frontier last decade and changed the stakes in physician communications.

Savvier consumers and the 24-hour news cycle have raised the bar on outreach efforts, and doctors, who are more squeezed for time than ever before, are having trouble keeping up with patients.

Where doctors used to be the gatekeepers of healthcare information, the media and healthcare companies have now stepped into this role.

Those changes have left physicians feeling powerless, notes Ame Wadler, chairwoman of the global healthcare practice at Burson-Marsteller.

"[Physicians] were really the knowledge brokers in healthcare with the authoritative voice," she says. "They are now being asked to be an authoritative source when the information gets out before them."

A news story about a revised warning label on a popular drug will flood a doctor's office with calls, Wadler notes. And if the media beats the drug company in breaking this news, doctors and their office staff could be at a loss when faced with patient inquiries.

"As PR people, we think about the 24-hour news cycle all the time, think about the burden that it might be to physicians," she says. "From a communications perspective, I'm not sure if we're reaching out as well to the individual practitioner."

Camela Stuby Morrissey, who heads Chandler Chicco company Biosector 2, also notes that the flood of DTC marketing has left physicians feeling overwhelmed.

As a physician, "you're no longer the conduit [for healthcare information]," Morrissey says. "At some point, they're overwhelmed. It's not unreasonable to anticipate some backlash."

Biosector 2, she notes, has been undertaking more grassroots efforts to return a greater amount of control to physicians. Doctors are encouraged to express their opinions through forums with their colleagues and to learn about information on their own schedule.

"We recognize that it's hard to be a physician these days," she says.

Morrissey points to "off-label" drug use as an area where there's a danger of consumers getting information before the medical community.

The Food & Drug Administration prohibits companies from marketing drugs for unapproved, off-label uses. But the media still reports on this data.

"We want [doctors] to have accurate information because consumers have that information, too," she says, adding that clients can still educate physicians about studies on off-label use.

Reaching physicians

PR pros also have been borrowing consumer tactics for physician campaigns. Clients and their agencies are expending more effort on building brands for new products, and pharmaceutical companies are as worried about their reputations among physicians as they are among consumers.

"I think sometimes we underestimate how much of an emotional connection there is from a clinician's perspective," says Marybeth Belsito, president of Belsito & Co. "We've neglected that a lot on the medical side. We think of [physicians] clinically; we don't think of them emotionally."

On the consumer PR front, virtually all products have become fair game for DTC outreach. And because of this shift, direct-to-physician PR is no longer practiced in a silo, but is integrated into the overall campaign.

"If you can't bring them together," Belsito says about doctor- and patient-focused PR efforts, "you won't have that robust initiative."

Betsy Merryman, SVP at FischerHealth, notes that even if consumers are the intended audience, doctors are the influencers in a healthcare campaign.

"No matter what, if there is a plan with a DTC strategy, you can never leave out physicians," she says. "You don't want to leapfrog them."

Patients bring "reams of information" about new therapies to their doctors, who are then challenged to determine whether a course of treatment is appropriate, Merryman notes.

"Physicians pass their opinions and biases along to the patient," says Lee Duffey, president of Duffey Communications. "Patients rarely second-guess or debate with their physicians."

With physicians more time-stretched than ever, some companies are turning to creative measures and new technologies to get their messages across.

Successful campaigns often bridge clinical issues - such as treating disease - with practice issues, such as saving time in the operating room, Merryman notes.

Wadler says that technology, including websites and e-mail, is one way of having around-the-clock access to physicians. She adds that companies should also include a doctor's technicians and receptionists in their outreach.

"Arm their office staff," she says. "The office staff are the gatekeepers."

Much of direct-to-physician PR is still tied to medical meetings and continuing medical-education courses. But even among all the competing exhibitors at a typical medical conference, it is still possible to stand out.

Merryman recalls launching a new drug into a market where the competitor had a monopoly in the disease category. "It was like David fighting Goliath in launching this product," she says.

FischerHealth launched its campaign at an annual obstetrical meeting. To get physicians' attention, the drug company offered to donate money to charity in return for five minutes of the doctors' time. It also used an innovative booth design to emphasize the theme of "out with the old, in with the new."

"It always depends on the conference because some conferences are very scientific, but at other conferences, you can get more creative," Merryman says.

Duffey notes that tried-and-true physician tactics still remain the gold standard for marketers.

"Physicians are rarely swayed by what we call consumer marketing," he says. "Clinical evidence is paramount in this area; it's very hard to replace that by anecdotal evidence of the same weight."

If consumer healthcare PR has only recently begun to court influencers, physicians have always been swayed by peer-to-peer communications.

Companies regularly reach out to early adopters to pen articles on a new product and talk about it during medical meetings, Duffey notes.

"That's not necessarily breakthrough, but it's fact," he says. "It's a communications aspect that's often overlooked for the dog and pony show of drug marketing."

Building trust

Belsito doesn't discount what doctors refer to as evidence-based medicine, the idea that medical decisions should be guided by science. But she notes that physicians must also trust the companies that make the products they use.

"The medical community now is very conflicted. On the one hand, they recognize that medical advances are born by the pharmaceutical industry," she says. But, "I don't think the pharmaceutical companies and medical communities are in a comfortable enough marriage."

Physicians are as influenced by concerns about drug pricing issues as their patients, she adds.

Wadler notes that drug companies lost their biggest supporters when physicians were no longer the authoritative source of new medical information. She also predicts that companies will begin to see improvements in their reputations if they can keep doctors ahead of the news media.

"Before the days of managed care, before the days of DTC, one of the most vocal advocates of the drug companies were the doctors," she says.

Belsito notes that some drug companies are beginning to return authority to the medical community - and are reaping the PR awards.

When Eli Lilly helped create the Values, Ethics, and Rationing in Critical Care task force, critics wondered if the group would simply be a promotional arm for a new emergency medical product.

But Belsito, who works with the task force but doesn't serve on it, notes that Eli Lilly agreed from the start to stay one step removed from it.

"Then you had a group of 20 leaders acknowledging publicly, in the media, that Lilly did something great," she says. "Lilly just created a group of champions."

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Peer-to-peer power

Doctors tend to be most influenced by peer-to-peer communication, including with pharmacists, who have advanced drug knowledge.

For example, pharmacy benefit manager Medco had always promoted the benefits of generic drugs as a way to reduce healthcare costs. But this year, results from a survey solidified the necessity of including physicians in the PR effort.

The survey, which examined patient attitudes toward generic drugs, found that only about half of respondents had gotten information from a doctor about switching to a generic. But of these, 94% had been receptive to switching from the brand-name product.

Ann Smith, director of public affairs for Medco, notes that physicians make the final decision about which drug patients take.

Since 2000, therefore, Medco and Coyne PR have been working to reach physicians through its "Generics First" campaign.

The outreach effort uses some of the same face-to-face and drug sampling techniques that the big pharmaceutical companies employ. But instead of sales representatives detailing drugs, pharmacists have been dispatched to make office visits.

"We had tremendous success in that we used pharmacists," Smith says, adding that doctors will have longer conversations with a pharmacist than with a traditional sales rep (three to five minutes versus one to two minutes). "They bring to [physicians] both a clinical and a savings message."

Coyne PR estimates that each of the 12 pharmacists has saved Medco's clients about $1 million in drug costs for every year of the program.

Smith calls the response from physicians "phenomenal."

"They have become more and more interested in the companies-saving message. Physicians are interested in doing the right thing."

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