Thursday, December 01, 2005

PLUGGED IN (Great article)

Many analysts believe that interactive agencies will displace the consumer DTC agency as the main agency of record. The shift in total drug promotion is predicted to favor more targeted efforts, such as those online, in place of traditional advertising methods. In response to public outcry, the new focus of pharmaceutical marketing is informed patient care.”




Plugged in (MED AD NEWS Nov 2005)

In the wake of regulatory pressure and public scrutiny, the pharmaceutical industry has begun to recognize the merits of interactive advertising campaigns. The traditional marketing model has been blown away and replaced with one that features advertising agencies playing a more strategic role in launching products and sustaining sales in an increasingly competitive arena.

Industry analysts predict a shift away from traditional drug-promotion and mass-awareness tactics, such as direct-to-consumer television advertising, in favor of more targeted efforts that support informed patient care. Industry experts believe that the rise of high-speed Internet penetration has created unprecedented opportunities to convey complex health condition, treatment, and brand messaging using broadcast-quality Web content.

Pharmaceutical marketing budgets are being reallocated to make room for new media approaches, including online-based programs. A decline in return on investment and the inability to get the right kind of copy on television are two factors partly responsible for the redistribution of marketing resources.

Internet advertising totaled more than $2.8 billion in the first quarter of 2005, according to the Interactive Advertising Bureau and PricewaterhouseCoopers. The first-quarter 2005 revenue figure represents a 26% increase compared with $2.2 billion in revenue generated in first-quarter 2004. First-quarter 2005 was the highest reported quarter in nine consecutive growth quarters.

"Marketers continue to recognize the relevance of interactive as an integral part of their marketing mix," says Greg Stuart, president and CEO, Interactive Advertising Bureau ( "The continued and steady growth we have experienced during the past two years is a clear indication that this medium delivers results and is fast becoming accepted as part of the mainstream."

As the online audience expands and broadens, the TV audience continues to fragment, even as the cost of advertising spots rises, according to Tom Hyland, partner and new media group chair, Pricewaterhouse­Coopers ( "Add the growth of broadband in the home, which enables advertisers a platform to deliver rich media, and brand advertisers have a new mass audience to target," he says. "The economics are too compelling for marketers to ignore."

Online marketing programs are cost-efficient, allow for measurement methodology, and produce a solid return on investment. The Internet allows pharmaceutical brands to reach millions of high-value, health-conscious consumers and drive product demand in an extremely cost-effective way, according to Deb Deaver, managing partner, director of client services, CDMiConnect (

In 2004, pharmaceutical companies spent more than $30 billion on promotion, almost $5 billion more than in 2003. Spending on the DTC portion of pharmaceutical promotion topped $4.3 billion in 2004 — up more than 32% from a year before, according to analysts with Verispan (

The Internet is predicted to become a larger piece of pharmaceutical-company spend. Beginning in 2006, the dollar amount spent on online-based programs is going to double or triple, according to Kelly Gratz, president, Blue Diesel (

As customers demand change in the industry, the communication requirements of pharmaceutical suppliers will need to adapt. In the days when press ads, mailings, and detail aids were the main output of health-care advertising agencies, the job was relatively simple and very visible.

Promotion of pharmaceutical brands needs to meet the evolving needs of target audiences. Today’s consumer seeks a depth and breadth of information about products and conditions that a one-page print advertisement, a 30-second TV spot, or a 60-second TV spot simply cannot deliver. The traditional forms of brand marketing have been broadly beamed to a passive audience rather than using the opportunity to engage interested consumers.

Even as recent events reduce, to a certain extent, the huge dollars spent on major market media such as DTC advertising, the pharmaceutical companies will still have the dollars to spend and will need to find an outlet.

A good portion of pharmaceutical marketing budgets will be directed toward alternative media, such as interactive campaigns, according to Buzz Woods, executive VP, CCG Metamedia Inc. ( The high level of sensitivity to DTC will mean that a greater proportion of money will be directed toward promotional programs targeting medical professionals. Most importantly, he believes that the focus will be on high-quality promotional education programs, resulting in an improved knowledge base for medical professionals.

Interactive agencies are adding to their capabilities such as new media, e-detailing, brand Websites, and market-shaping activities, approaches that have historically been associated with medical-education companies.

The Internet is predicted to be just what the doctor ordered. After receiving a prescription from a physician, about 64% of patients visit the brand Website in pursuit of more information, analysts say. This is a new consumer behavior called "pull," where a patient obtains a prescription for a drug or a diagnosis from his or her doctor and then goes online to look for more in-depth information.

More interactive patient education will be key to promoting new drugs in the absence of the major media. Television advertising must take a back seat for the first six months a drug is on the market, as outlined in the voluntary guidelines from the Pharmaceutical Research and Manufacturers of America in August. The Internet, however, is poised to rush in and fill the void.

Drug promotion shift

Many analysts believe that interactive agencies will displace the consumer DTC agency as the main agency of record. The shift in total drug promotion is predicted to favor more targeted efforts, such as those online, in place of traditional advertising methods. In response to public outcry, the new focus of pharmaceutical marketing is informed patient care.

Simply stated, television advertising is a cold medium and the Internet is a hot medium, according to Frank Saia, managing director, Hyphen ( Television ad campaigns broadcast to a passive audience, whereas the Internet engages an audience that is actively seeking specific information.

The role of the interactive agency, according to Mr. Saia, is to be ready to offer new ideas and variations on the earlier ideas that worked for clients. He recognizes the change in the way pharmaceutical products are being advertised and believes that the trend began in 1999 when GlaxoSmithKline ( added the Website for its antidepressant Paxil to the brand’s TV spots. GlaxoSmithKline transformed a message on TV — the cool medium — into a hot experience by directing consumers to the Internet. The Website address is now a standard component of TV advertising.

"Moving the passive audience members to becoming active and potential buyers is something that everyone is trying to do," Mr. Saia says. "Now is the opportunity for us to make it a targeted, interesting, interactive experience."

A study about consumer attitudes toward health-care information conduc­ted by Nielsen//Net-Ratings in first-quarter 2005 found that the Internet is viewed as the most trusted media source for consumers, surpassing offline media when consumers want credible health information. Sponsored by Medical Broadcasting Co., the study data was based on the input of 991 respondents gathered during a 30-day period.

Consumers trust their doctors’ opinions of health-care information most, however, patients are more frequently using the Internet to shape the doctor-patient dialogue. Nielsen//NetRatings’ analysts found that 42% of the survey respondents trusted health information they found on the Internet, compared with 16% for information found in other forms of media. Consumers are taking advantage of the great depth of health information on the Internet. More than 85% of respondents said they look at two or more Websites when searching for health information, according to NetRatings Inc. (

The Internet is an increasingly preferred tool for finding health-related information, according to Peter H. Nalen, president and CEO, Compass Healthcare Communications ( "The Internet can provide a personalized experience for each user, offering an almost limitless amount of information," he says. "The interactive capabilities of online communications offer marketers a medium to ‘show’ as well as ‘tell.’"

For physicians, the Internet has evolved from a complex annoyance to a useful tool. In 2005, the number of physicians who believe that technology is essential to the way they practice medicine has grown to more than 380,000 physicians, a 233% increase from 114,000 physicians in 2002, according to Manhattan Research ( In 2002, 87% of physicians considered the Internet a critical resource for information on prescription drugs and treatment options, and 73% of physicians believe that the Internet influenced their prescription-writing habits, according to a poll by Harris Interactive (

"If you think about the last few years, the Internet was in its infancy," Mr. Saia says. "Everybody rushed in, and some people made mistakes and did not really know how to use the medium. Right now what we have, especially with technology catching up, is more people getting on broadband. What remains is a more robust, healthier Internet where you can provide validated content, and that’s more important than the sizzle and the flash of years ago. The Internet provides a soapbox for a lot of people."

Instead of existing as an adjunct to television efforts, interactive initiatives via the Internet have become the first-line method of reaching patients with critical information, according to industry experts. The Internet is a communication medium that effectively serves multiple target audiences economically and with a depth of information not possible with most offline communication tools.

The Internet is empowering and user-friendly, says Brad Aronson, executive VP, Avenue A | Razorfish (avenuea-razorfish
.com). In the past, when consumers called 800 numbers, they found the automated phone system frustrating because they were unable to quickly find the information they wanted. The Internet, on the other hand, allows consumers to control their own experience as they access information and tools.

"If you look at offline, when people are listening to the radio, the average person changes the station when an ad comes on," Mr. Aronson told Med Ad News. "When someone is watching TV, they change the station when a commercial comes on. If they have a digital video recorder, there’s an 80% likelihood they’ll fast-forward through the ads. Consumers are used to being in control in consuming the content how they want to consume it and when they want to consume it."

By getting a product’s message across using the Internet, the pharmaceutical company can test ideas, receive feedback, and hone its approach in a far less costly approach than promoting on television or in print, according to Mr. Saia.

"A more targeted campaign is the way of the future for a lot of reasons," Mr. Saia says. "Television isn’t as efficient, it’s not an efficient media buy because of the high cost and the low ROI. Targeted campaigns are reaching the people that are truly interested in a specific type of therapy, and they have higher CPMs and higher ROI."

How the drug-promotion shift will change the face of health-care advertising depends on the brands and the therapeutic category. Smaller niche brands that have specific targets will never benefit from traditional broad-scale promotional campaigns because broadcasting the product’s message to large segments of the population via a print ad or a TV spot to reach 1% of an audience with the specific condition is not cost effective, Mr. Nalen says.

Biopharmaceutical brands and many medical-device procedures have smaller, clearly defined target audiences, such as health-care professionals or patients, and also need to provide more in-depth communications to explain what the product does and how the product works. Traditional promotion tactics can never provide that level of specific education, according to Mr. Nalen.

"What we’ve seen from our clients are significant shifts in the amount of budget that they’re spending online," Mr. Aronson says. "Instead of clients making a buy just to reach a demographic, they buy an ad in a women’s magazine or on Lifetime TV. We see clients thinking about how they can reach people based on their mind-set."

When a patient searches for allergy information on Google, for example, he or she is thinking strictly about allergies at that point in time. Unlike viewing a 30-second TV spot or another offline advertising approach, patients engage with a client’s content on the Internet and digest deep and customized information that contributes to their understanding of a disease or a product, Mr. Aronson says. Furthermore, consumers can control the experience and what information is relevant and decide how deep they want to go with the content.

"We have consumers who spend five to 10 minutes reading our clients’ content and getting engaged, which is helpful in educating them and making them more qualified and able to be more successful on their medication than the broadcast advertising," Mr. Aronson says.

Aside from traditional product Websites, many interactive agencies have produced other Internet-based programs for clients to boost advertising campaigns. At Avenue A | Razorfish, one of the focuses of the creative team is search-engine optimization. About 40% to 60% of consumers who are looking for health information online begin with a search engine. The agency stresses the importance of having their clients appear on a search-engine list. For clients, the agency invests in paid searches, which are the listings that the agency buys, and organic searches, which help the clients come up with the editorial listings.

Avenue A | Razorfish executives have found that becoming partners with large content Websites, such as, can be extremely effective. Consumers log on to and similar Websites because they trust the brand. "If we can take our clients’ content and put it within the framework of the WebMD brand, it’s extremely credible, and we’re achieving the same results as if we sent them to our own Website," Mr. Aronson says.

Among the many specialties of interactive agencies are Web portals for continuing-medical-education efforts, physician portals, slide kits, launch Websites, patient-education Websites, indication-extension Websites, and nonbranded patient-awareness Websites.

"When you talk about interactive media, you’re not just talking about the Web," says Larry Mickelberg, senior VP, marketing and media services, MBC ( "There are probably three, four, or five interactive channels that an interactive agency has to manage on behalf of a brand. So right now, it’s probably and rightfully the Web, but there are other venues that will become increasingly important as time goes on as part of an integrated approach."

Experts predict that launch Websites will become an influential tool because physicians will seek ways to obtain product information during the six-month period when pharma companies are advised to not advertise. The launch sites can give physicians vital information they need about newly approved medications. This method will allow physicians the luxury of getting up to speed on the latest drug and understanding its functionality, safety, and efficacy before a patient asks for a prescription.

Doug Levy, president of imc2, attributes the shift from traditional marketing to more targeted efforts to the decline in TV viewership and the increasing cost of TV advertising. "I was looking at a statistic from a Forester report recently, and recall of TV spots in 1960 was 40% and in 2003 it was down to 5%," Mr. Levy says.

Mr. Levy believes that at a time when the public image of pharmaceutical companies is so low and trust in pharmaceutical companies is so poor, focusing on education is beneficial. Interactive programs are an effective way to focus on disease-state education and validate the industry.

Mass-media awareness ads that exist solely to drive patients into doctors’ offices will be replaced by long-term online and offline education programs, Ms. Deaver says. These programs should evolve depending on where the patient is in the treatment cycle and what the patient’s experience has been with a specific treatment.

Linda Holliday, president of MBC, says many of the major educational in­stitutions have increased their online continuing-medical-education programs to include patient-friendly features. One interactive feature allows patients to view a walk-through of a surgical procedure in order to gather information and see first-hand what the procedure will entail.

MBC has built television-like Websites to educate and train key opinion leaders and other health-care professionals. This new medium is intended to replace in-person meetings and training sessions that cost clients millions of dollars. "We saved one client $6 million this year alone by transitioning their speaker training to an online module with greater completion and retention rates than even the in-person meetings," Mr. Mickelberg says.

The agency developed and launched a Website,, for Wyeth featuring Cheryl Ladd. The Website teaches a consumer how to talk to her doctor about menopause. The Cheryl Ladd initiative is an integrated, public-education campaign for Wyeth ( that includes print and television vehicles. The 30-second television spot, however, has become a commercial for the Website. The Website carries through the same live motion look and feel of the TV spot, featuring Ms. Ladd in a loft talking with the consumer about her health situation.

"That’s a pretty revolutionary idea in pharmaceuticals that you do not use the television spot to impart information, you use it as a trailer for the Website where all of that stuff lives in much greater and richer detail than it ever could in a flat print ad or a 30-second TV spot," Mr. Mickelberg told Med Ad News.

Long-format video has emerged as a big opportunity for pharmaceutical companies, Mr. Aronson says. As a supplement to the content on a product Website, long-format video allows the patient to hear testimonials from other patients or a physician talking about a condition, thus increasing the impact of the brand knowledge. In addition, this vehicle can illustrate mechanisms of action, for instance, how to prepare and use a needle if the patient has to inject a product.

"There’s a shift in the skill set here even on the Internet, from old Internet to new Internet, which was more about navigation and interaction design and now it’s going to be more of a television-oriented skill set," Ms. Holliday says.

Mr. Mickelberg believes that there is an important distinction between the old Internet and the new Internet. With this in mind, interactive agencies cannot be classified and lumped together because there is a wide spectrum of capabilities for the new era, and some interactive agencies are not equipped to thrive in this new era.

To illustrate the wide spectrum of interactive-agency capability, Ms. Holliday refers to digital cable versus regular cable. Once a consumer experiences digital cable, there is no reason to return to traditional cable. Similarly, once a consumer has experienced a true interactive Website experience, there is no reason to return to a text-based Website.

"It’s almost an entirely new educational channel that wasn’t available to them from an efficiency or a reach perspective even just a couple years ago," Mr. Mickelberg says.

From analyzing client Websites, Avenue A | Razorfish executives have learned that about 20% of the people who visit their Websites are patients who have already been prescribed the brand. Mr. Aronson believes that catching the patient just after being prescribed a brand is the perfect time to get the consumer involved in an adherence program because he or she is thinking about the product and wants to know more.

Like any advertising campaign, media planning is a major piece of the whole Internet experience. "You can’t just build a Website and think people are going to find it," Mr. Saia says. "There are many new and innovative ways that are getting people information."

Podcasts, for instance, have a become a huge way to disseminate information in the past few months, Mr. Saia told Med Ad News. Another new vehicle is direct-to-desktop technology where pharmaceutical companies are equipped to push information to consumers. Specifically, content that is of interest to the consumer is delivered right to their desktop and is DVD-quality material. Consumers opt into this technology, and the uptake has been significant, especially in the physician market.

Mr. Nalen says in the prelaunch stage of a product, a pharmaceutical company can launch a small placeholder or "coming-soon" Website of one-to-three pages. The placeholder site can serve two main functions: beginning to establish the brand and the brand’s Website address with search engines and giving proactive brand searchers a place to go to find information about the product, at which point the brand can initiate a relationship by opting them into a Website database. Compass Healthcare has two Websites that are serving as placeholders, and

Pargluva is awaiting approval for the treatment of type 2 diabetes and is being developed by Bristol-Myers Squibb Co. ( and Merck & Co. ( Zelapar is awaiting approval for the adjunct treatment of Parkinson’s disease. The product is being developed by Valeant Pharmaceuticals International (

Postlaunch, the marketer needs to evolve the placeholder Website into an information resource and conversion vehicle for both consumers and health-care professionals. Placing the product Website address on all marketing materials, from journal advertising to sample packaging to sales aids and patient brochures, is also an important strategy.

If consumer and physician target groups are motivated to search online for the brand, marketers can capitalize on this proactivity by capturing their e-mail addresses, according to Mr. Nalen. This is useful for market research and, at launch, for sending e-mails informing consumers that the product is available. E-mail is a direct way to deliver targeted information to those who are interested — consumers and health-care providers. This procedure is testable, measurable, scalable, and costs less than $2 per name, Mr. Nalen says.

When the need is greatest

Pharmaceutical companies have begun to see the benefits in reaching customers much earlier in the need-state cycle. As a result, companies are reaching consumers before they achieve diagnosis and before they have started thinking about product decisions. For instance, imc2 worked with Pfizer Inc. to launch a Website for the age-related macular degeneration product Macugen called This Website was launched before product approval as a way to start reaching out to customers and getting across education about the disease state.

"One of the important messages [of the Website] was to try to talk about early diagnosis and the importance of treatment before you start losing vision," says Hensley Evans, VP and pharma practice leader, imc2 (

Unlike static, general DTC television spots, interactive campaigns allow the pharmaceutical companies to reach consumers when they need the information most. When pharmaceutical companies began direct-to-consumer advertising, the campaigns were focused on reaching customers very late in the need state cycle, according to imc2 executives. Traditional DTC campaigns typically reach patients after their symptoms have surfaced or, in many cases, after they have been diagnosed with a condition. Interactive, on the other hand, can provide early information on a certain condition or tools to manage a disease once a patient has been diagnosed.

This past year, Blue Diesel developed for UCB Pharma’s epilepsy drug Keppra. The agency built a tool called the "Seizure Diary," which a consumer or a caregiver can download and then track through the disease state. Once the agency launched the tool, the executives received calls from the Epilepsy Foundation asking if they might use the tool on their own Website because of consumer demand. "Consumers will begin to see more of those types of tools out there versus traditional Websites — of here’s the product, here’s what’s happening, and then a disease-state side," Ms. Gratz told Med Ad News. "You’ll see more interactivity, more interactive tools that are being developed for consumers to utilize."

Ms. Gratz says the agency’s objective is to create tools for the caregiver or the patient to gain control of his or her disease. "We want to create a sense of empowerment for the patient to manage his or her disease," she says. "This is an approach that will resonate from a consumer perspective as well as a physician perspective. You can take a pill, but you can also do other things to manage a disease. There is not one solution to each problem so our Websites are a comprehensive view of the disease state."

The role of a brand Website is to provide information and lessons that answer patient questions, motivate patients to seek treatment, and support patients in their compliance. Although Websites may be promotional, because the focus is on education, there is a balance in the presentation of the message and a wholeness to the presentation of the information that better meets the spirit of the PhRMA guidelines, Mr. Nalen told Med Ad News.

The Internet, however, is not just a DTC medium, Mr. Nalen says. In some cases, for some brands the Internet is not even primarily a DTC medium. Therefore, interactive agencies must not only support brands’ efforts to communicate with consumers, they must also reach out and support physicians, nurses, and pharmacists via online programs.

Industry challenges

As the demand for interactive programs skyrockets, agencies will be met with many challenges such as competition, technological advancements, client cooperation, and employee retention.

One of the biggest challenges identified by many interactive agencies is finding and staffing the right people to meet the clients’ marketing and strategic expectations. As more brands, physicians, and consumers come online, the need for smart, strategic use of the Internet has grown, therefore, the employee component will become crucial.

According to Mr. Aronson, as the industry expands, there will be fewer qualified people and therefore, greater need for training programs.

"Successful traditional agencies provide their clients marketing solutions, not TV solutions or patient-brochure solutions," Mr. Nalen told Med Ad News. "In the same way, interactive agencies must provide marketing solutions."

Another challenge for the interactive agencies in coming years is staying ahead of emerging technologies. According to Steve Stratz, media director of Avenue A | Razorfish, interactive agencies have found themselves back in the same position the industry was in around 1997 and 1998, when the Internet was just emerging.

"When online advertising was getting its start, people were trying lots of different things," Mr. Stratz says. "We saw the 25 ads on one page kind of a deal. And obviously that didn’t work."

There are so many opportunities for the industry now, just as there were in the late 1990s, that agencies are having difficulty figuring out what will and will not work. "You have video on demand and interactive television and you have stuff going on like podcasting and wireless still being that wild card out there," Mr. Stratz says. "There are so many digital-media avenues emerging that it’s a pretty exciting time to be testing and seeing what works and what does not."

Going forward, agencies and their clients need to remember to keep a watchful eye on the data, Mr. Aronson says. "We’ve spent the last nine-and-a-half years figuring out how to get consumers to do what we want them to do online," he says. "How to make it easiest for them to consume information, how to get them the information they want, leveraging all of our history and all our campaigns. That’s key to continuing to perform great things for clients."

As always, the challenge will be to keep coming up with new ways to engage the doctor and move the product’s message, Mr. Woods says. "As new, young doctors enter the profession, they are harder and harder to impress," he says. "For many of us, we were in pharmaceuticals first and then witnessed the arrival of interactive multimedia. For the newer generation, they were raised on multimedia then became doctors and nurses. The accepted quality standard is continually being raised."

Journal advertisements have remained largely unchanged for decades aside from a few new creative touches. The multimedia world, on the other hand, changes at least every six months. What may have been innovative and interesting only a year ago has become old hat.

Ms. Holliday says keeping creative, strategic, and technology skill sets in harmony in the same organization is very difficult and will remain a challenge for years to come. The harmonization of skill sets requires a level of professional management that most agencies do not possess. "The agency business can be kind of simple, but when you add in all of this infrastructure and technology, it’s a different kind of value system, a different background, different training, etc.," Ms. Holliday says. "Then the business becomes a lot more complicated and it requires much more seasoned and hands-on management."

Ms. Holliday believes that the learning curve is another ongoing industry challenge. An abstract Website can be difficult to make accessible to a new visitor. This is usually a long process relying on a lot of user feedback and a lot of mistakes until the agency identifies the sensible approach.

Mr. Mickelberg says a health-care Website cannot be built using a template. Each Website must have its own unique look, navigation, and feel. "We’ve got very, very distinct segments of folks who are visiting Websites for any disease," he says. "There isn’t a one-size-fits-all, very techcentric approach, which inexperienced agencies who are new to the interactive space are going to perpetuate a bit."

Agencies must never allow the interactive experience to overwhelm the message, Mr. Woods says. An interactive program needs to be impressive and gripping, but never overpower the story being conveyed by the site.

Another challenge for the industry is competing with the spin-offs of traditional agencies, Mr. Saia told Med Ad News. These are agencies that have either spun off an interactive agency or agencies that have hired a few technical people and claim to be a hot interactive shop, he says. When these agencies fail to deliver, the credibility of genuine interactive agencies who truly understand the science is harmed.

Many companies are discovering that a true, dedicated interactive multimedia agency is the only one up to the task of producing high-quality interactive programs, according to Mr. Woods. "Interactive multimedia is a specialty and not something a traditional agency can do with consistent high quality," he says. "If your world revolves around journal ads and reprints, it’s tough to focus on the specialized technoid world of animation, Internet applications, and computer programming."

Mr. Saia is confident that, in a few years, interactive health-care initiatives will be much more targeted, provide much better and more quality content, and will be able to provide qualitative and quantifiable return on investments.

Mr. Levy suggests that pharmaceutical companies imagine interactive marketing as a big toolkit. The companies should select tools based on the application and the intended message. He says a lot of companies, not strictly pharmaceutical, consider developing a product Website as the only interactive component. He believes that health-care companies would be well advised to step back and look at the breadth of tools that they can use, including disease-state sites, online promotion, rebates, online newsletters, and community building tools.

Another challenge is communicating to the clients that interactive programs are not static promotional pieces. Blue Diesel uses the term, "close loop marketing," meaning that the agency ties all of its tactics back to the brand strategy and then creates tools for the brand teams to measure what the client is trying to achieve with the tactics. "We keep them on strategy," Ms. Gratz says. "If we build a Website, we have to keep them focused on measuring, what is going right, what is going wrong. It is an investment that they have to keep tracking."

With the amount of activity that is going to surface in 2006 in the interactive arena, maintenance, or the ongoing evolution of these ideas and big ideas, has to be in the forefront. Agencies have to continue to press their clients and change up the marketing mix around a tactic to drive new traffic to the Website.

"In our methodology, the last step is evolve," Ms Gratz says. "You cannot just build a Website and expect that the consumer is going to come. You have to drive traffic to it."

Clients adapt to change

Health-care advertising agencies have witnessed mixed reactions to this rapidly changing environment, according to industry experts. In general, most clients are embracing the shift to interactive advertising because they are seeing results, however, some clients are skeptical of the new approach.

Mr. Woods explains that due to its cautious and conservative nature, the pharmaceutical industry has been slow in embracing the Internet compared with other industries. This may in part be due to budget woes and concerns of significant return on investment.

"In pharmaceuticals, you will always have hesitation of spending big dollars on a project," Ms. Gratz says. "The client has to take risks, different approaches, with the understanding that it will pay off. But it’s not on a pharmaceutical company level, but on a brand level, and how do you spend those dollars. Keep the target audience in mind and where are they, and what is the most relevant place to go find them that is easiest for them."

According to Mr. Nalen, clients are split between skepticism and curiosity. He says many of Compass Healthcare’s clients have either experienced or heard of the mistakes made in the formative years of online marketing. Agencies took advantage of naive, unknowledgeable clients and built big, complex, and overpriced Websites without any marketing goals or plans to measure use or demographics. After being launched with overdeveloped expectations, the Websites delivered mixed or no results.

Curious clients are those who are not very familiar with the medium but who are curious about what interactive advertising is and how to achieve marketing results for their brands. For the skeptical and curious audiences, Compass Healthcare executives have found great success with a "prove and move" approach. Product managers can do small-scale test programs to see if online communications can be successfully integrated into marketing programs. There are many small, measurable online opportunities to prove value to the brand. If the results are positive, these online programs can be expanded and integrated into the brands’ overall marketing plans to ensure the brand is reaching all their target audiences where they are today.

For the most part, pharmaceutical companies are cautious about the change but are moving forward nonetheless. "Our clients are cautiously proceeding with an open mind," Ms. Deaver says.

Many companies have found that the Internet gives them a great way to compete. In fact, the Internet allows a small or mid-size company to compete with much larger pharmaceutical companies that have deeper pockets.

The large consumer-driven brands will likely be the last to commit entirely to interactive campaigns, thus providing more leverage for the niche therapeutic brands. "The erectile-dysfunction drugs are a great category that is on every billboard," Ms. Evans says. "You go to Times Square and there’s one for Levitra and one for Cialis. This is interesting because they’re going to be the last ones to come out of that mass channel."

Avenue A | Razorfish executives say the agency’s clients are very cooperative, but that the means of communication have evolved. In the late 1990s, the agency worked with the clients’ information-technology departments because the Internet is more of an IT function. Now, the agency works with brand people or e-business people who are a part of and partners with brand teams. "When our clients think about online now, they’re not thinking of it in a vacuum," Mr. Aronson says. "They’re thinking, here’s my overall marketing mix and online is one piece."

CCG Metamedia managers have seen an increase in the number of smaller biotechnology companies requesting high-end interactive multimedia campaigns. "It’s the midsize companies that are taking the longest to come around," Mr. Woods says. "They assume such programs are cost prohibitive, but of course they are not. One thing is for sure: once clients develop their first interactive multimedia program they always want more. That, more than anything else, has to be a testament to interactive media’s effectiveness."

Agencies team up

Pharmaceutical companies will continue to employ interactive and traditional agencies. Traditional agencies do not have the inherent expertise to develop online marketing solutions, and interactive agencies do not have offline development expertise. Most good marketers recognize that no single agency can be an expert in everything.

For some brands and therapeutic categories, there will always be a need for traditional off-line communications, such as print, television, and radio ads, to generate broad consumer awareness of a brand. Online communications can complement and enhance these forms of promotion. For other, more niche category brands or those not in the position to compete with brands that have large offline budgets, the Internet provides a targeted, efficient medium for reaching and converting customers.

Mr. Aronson believes that pharmaceutical companies need to have both traditional and interactive agencies because offline advertising approaches will always play a part in the marketing mix. Online is one part of the marketing mix and a good marketer needs to have a comprehensive plan that looks at all the different vehicles for reaching and influencing consumers.

Because advertising campaigns will always blend online and offline tactics, the challenge will be determining the total solution and then allocating dollars appropriately. Whether a company spends 10% of its budget or 40% of its budget on interactive, will be an individual decision.

"I don’t think the traditional full-service agency is ever going to be replaced," Mr. Saia says. "And we’re not looking to replace it."

Mr. Saia is confident that there will be a place for traditional and interactive agencies. He believes, however, that pharmaceutical Websites, launched by traditional agencies, that merely mirror print-collateral materials are an unproductive use of the Internet.

Worse than a Website designed by a traditional agency, however, is one developed by a tech shop where no one understands the science. Tech shop-designed Websites boast a lot of exciting features, but there is no focus on patient or physician learning. That is where interactive agencies, who understand the science and the technology, are paramount.

Ms. Evans says the reverse is true, in that interactive agencies are not necessarily the best agency to design in-office and patient-education materials. "Even if you have a program online, you’re likely to have collateral that you’re producing for the sales force to hand to the physician or the office staff," she says. "There’s definitely a role for both."

At many of the interactive agencies, medical doctors sit side by side at the same table with the agency’s strategists, creative directors, and technologists to develop the most appropriate possible solution. The outcome is a highly collaborative and finely tuned process that cannot simply be copied.

"It’s not either/or, but it’s a question of whose share gets a little bit bigger," Mr. Mickelberg says. "And with our clients, we have this notion of who is the lead agency."

Historically, the lead agency, particularly in the pharmaceutical industry, has been the DTC consumer television agency. That particular agency set the tone for messaging, branding, and all the follow-on initiatives across the board. In some cases, DTC campaigns have been regulated away or voluntarily shelved by clients. As a result, the notion of who is the lead agency has shifted to the logical successor, the interactive agency.

"That is not to say that there will not be a consumer TV agency, because there very likely will be," Mr. Mickelberg says. "But in terms of an organizing principal and a lead strategic partner, logically it will be the person who is managing the interactive channels going forward."

Taking cues from other industries

A similar Internet-over-TV phenomena has occurred in other industries. In the automotive industry, for example, leading automotive advertising agencies are using television by and large not to drive people into the showrooms but to drive people to the Websites where they can see high-definition product overviews and comparisons and all the tools car buyers need to make an informed decision.

In the automotive industry, about 90% of car purchases are researched online, and now 15% of purchases are made online. "There’s an industry that’s being turned upside down," Ms. Holliday says. "General Motors’ recent problems were half caused by the fact that they maintained a high retail price so they could discount to get people into the showrooms. But the high retail price online was a huge disadvantage. So since a lot of the purchasing went online and they looked at online, they weren’t getting their share of online purchases."

In response, for 2006, General Motors revisited their entire pricing structure to a "value pricing," and they slashed 3% to 7% off of their inflated retail prices. The company changed the whole way they price in response to people buying online.

To illustrate this point, Ms. Holliday uses the example of walking through a mall and entering a store because the consumer sees 20% off signs. But when a consumer is online and can watch all the cars side by side with their prices right next to them, the price is what matters, not the discount.

"They got caught behind that trend and it was a tragic business oversight for them for a couple of years," Ms. Holliday says.

The pharmaceutical companies are in a parallel position. The consumers and physicians are going online to look up product information. The companies, however, are not treating the power of the Internet with the amount of seriousness that their consumers already are.


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