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By Elisabeth Pena ROI Return on the Internet The ability for pharma marketers to track online consumers’ reactions to Internet advertising is limited, but as the medium matures, tools are evolving to make it easier to measure return on investment. John Racik The days of click-throughs and banner ads everywhere are over and rightly so. Like any other communications tool, the Internet is being fine-tuned and honed, and people are acknowledging the fact that it is one of the most powerful tools. The power of the Internet as an advertising and marketing channel is evident. More than 93 million Americans have gone online at least once to seek health information, according to a Pew Internet and American Life Project report. Additionally, the number of Web-savvy physicians is increasing each year. “The conversations about interactive media have changed,” says Jules Korzeniowski, president of The Conectics Group. “In the 1990s, the question was ‘Why should I invest in online activities? I am not sure physicians are online.’ This question has gone away. We know that our target audiences are online, and there are a lot of data to show what they are doing. Pharma is beginning to realize there is value.” Setting Standards While indicators point to an increased use of online sales and marketing tools by the pharma industry, the age-old question of return on investment (ROI) still looms large. An important part of determining ROI is to clearly define metrics, particularly in reference to the purchase of ad space. A lack of clarity in the definitions of key terms, such as ad count, impression, and click-through, has made it difficult for media buyers to know exactly what they are purchasing when placing an insertion order for Web space. In response, the Media Rating Council (MRC), the American Association of Advertising Agencies (AAAA), and the Interactive Advertising Bureau (IAB) are collaborating to develop a set of guidelines for interactive advertising campaign measurement. The new guidelines are a follow-up to initial parameters established in January 2002 by the IAB, the MRC, and the Advertising Research Foundation with support from the AAAA and the Association of National Advertisers (ANA). (For more information on this initiative, see box on page 26.) “Doing a deal online in the early days took a lot of work; it was virtually impossible to get a sense of how to predict ROI,” Mr. Korzeniowski says. “Marketers couldn’t just pull up a service that could give those numbers; the simplest plans would take days to put together. The IAB and other groups are doing the right thing by simplifying and lowering the transaction cost of online planning.” According to Adam Gelles, director of industry initiatives at the IAB, the trade association and its members are revisiting the guidelines because the technology underlying the systems has changed. A clarification of the guidelines can prove to marketers in all vertical markets that there is a standard for how ad impressions are sold and measured. “We recognize that when marketers buy other media they can trust the numbers they are seeing,” he says. “We need the same trust in our space.” The new set of guidelines will establish a consistent definition of how to count an ad impression. Currently an impression is defined as “the measurement of responses from a Web server to a page request from the user’s browser, which is filtered from robotic activity and error codes, and is recorded at a point as close as possible to opportunity to see the page by the user.” Experts say currently the value of that impression is vague, with the relative value of an impression of ads at the top, bottom, and side of a Web page being uncertain. “For pharma marketers who are already making significant commitments to interactive advertising, this will provide a level of consistency and reliability that will then enable them to make their optimization much more effective,” says Marc Blumberg, senior VP at imc2. “In today’s marketplace, unless a company is closely monitoring those metrics and creating its own consistent system of measurement, every data set is measured using a different methodology. The standards will get marketers more for the dollars spent and justify increased spending in the future.” “Because many different methodologies are being used, people are not doing an apples-to-apples comparison,” says Sundeep Bhan, CEO of Medsite Inc. “By having standardized guidelines, there will be a much better comparison to evaluate the different ways of marketing a product and the efficacy of each channel.” Additionally, the IAB, MRC, and AAAA are developing an auditing and certification process that will enable advertisers and their agencies to have confidence in the impression counts across multiple ad-serving technologies. “Working with the MRC, we get educated on the audit process that other media follow, and we have the opportunity to educate the MRC and its membership on interactive’s unique capabilities,” Mr. Gelles says. “As a result, we need to refine our previous guidelines to conform to the MRC’s rigorous standards.” “Improving these guidelines is a positive step,” says John Racik, president and CEO of Blue Diesel. “The guidelines are a good rallying point and a foundation for those who plan to do online advertising. There are growth opportunities for the Internet, but marketers want guidance on exactly where and how to spend the money.” Nevertheless, industry experts say while steps to standardize terminology and develop an audit process are welcome and add another level of credibility to the Internet as a viable marketing channel, they are unlikely to encourage the pharma industry to shift large amounts of advertising dollars to the Internet. “Consistency in any facet is a good thing, but I don’t think standards are going to be enough to change the gravitational pull of traditional advertising,” says Craig Douglass, managing partner at Cadient. “There is a clear bias in the market for that which has been done before. Breaking this pattern requires richer data and data that are closer to meaningful brand outcomes, not just advertising metrics.” According to Mr. Bhan, another big issue is how much is being spent for Internet marketing, not how Internet ROI is being measured. “For some innovative brands, budget allocations for online marketing have doubled every year for the last three to four years,” he says. “Most e-pharma marketing programs have been an after-thought, filling the holes after a brand has allocated its budget. Now they may be spending $250,000 and achieving an ROI of 200% plus. For a $1 billion brand that is a drop in the bucket. I believe this is the year in which pharma companies will focus on scale, along with ROI, for their online marketing initiatives and look toward the Internet to reach physicians and deliver big dollar results. Marketers need to look at e-pharma marketing as an integral part of their brand marketing mix and set higher objectives. It is completely realistic to expect 15,000 physicians to 20,000 physicians to participate in an interactive program.” the holy grail Marketers in many industries have latched on to the Internet as a medium for selling products. But since selling online is not an option for marketers of prescription pharmaceuticals, pharma companies have had to focus instead on building programs that capture patient profiles as consumers move from online health research, to diagnosis by a doctor, and finally to prescription fulfillment. Knowing whether online programs lead to actual prescriptions, however, is the challenge and a point of interest for pharmaceutical marketers. “The ultimate ROI is to tie a message to a prescription; that is what I would call the holy grail,” Mr. Korzeniowski says. “No one to my knowledge has been able to make a direct one-to-one connection between the two.” “All companies want to be able to tie prescription-writing data about an individual to their interaction with marketing,” Mr. Blumberg says. “With the exception of rebate programs, there are numerous issues associated with this connection. From a privacy standpoint, it creates challenges because it would need to be done by a third party. And, in most cases, the amount of data collected regarding Internet advertising interactions and pharmacy prescription fulfillments would not pass statistical validity testing.” Without the ability to move the consumer through to an online sale, pharmaceutical marketers are limited to providing information about a product or to offering tools for the consumer to use during a visit with a doctor. Though sale and privacy restrictions are a challenge for pharma companies in the online space, companies can nonetheless gather some valuable information about the consumers who visit their Websites. Human Behavior As the Internet matures as a marketing medium, many are working to develop consistent, reliable ways to measure not only ROI, but the effectiveness of the online tools marketers employ beyond showing a direct increase in prescriptions from online marketing. “When pharma marketers look at pure ROI, they want to know how many prescriptions are written as a result of their marketing activities,” Mr. Blumberg says. “We need to overcome this challenge, because making a direct connection is so difficult. We direct our activities on measuring the influence a marketing program has on a user or a healthcare professional and the behavioral changes that the marketing program spurs, be it a consumer deciding to go to a doctor or a consumer choosing to take a prescription that was already written for him or her.” This is where measuring behavioral ROI fits in. Tools are now available that assess the consumer’s mindset before and after viewing a Website. These tools provide marketers with information about whether their online offerings are working to move the consumer toward requesting and filling a prescription. “From an online advertising standpoint, the first goal was getting people to the Website,” says Matt McNally, media director at Insight Interactive Group. “Then CRM databases became huge; people were measuring online advertising by how many names were captured with minimal thought placed against ongoing CRM. We are moving a step further and identifying what specific Web pages motivate a patient or loved one to take action, to talk to his or her doctor not only about a disease state but to request a drug/procedure by name. Additionally, studies can be done that ask people what their intended actions are. Recontact studies are used to measure whether the person actually took that action and if so, what was the healthcare provider’s response. Ultimately, this creates a stronger ROI.” According to Mr. McNally, this measurement of behavior/action is the next step in evaluating the Internet’s potential. Although marketers may not be able to track an online consumer to the doctor, experts say the Internet offers them more information about consumers than any other medium. For example, tools that allow a marketer to watch a consumer’s use of the Web in real time are distinct advantages for the medium. The amount of consumer data captured is a valuable metric for marketers to consider when investing in their online marketing strategy. “Pharma marketers are trying to find new ways to use the Internet to drive branded requests from the patient,” says Ian Cross, CEO and cofounder of I-SITE. “One of the biggest challenges has been establishing a measurable call to action that reaches beyond awareness.” While standard online advertising metrics such as click-throughs and ad impressions provide an initial gauge toward conversion/brand awareness, they don’t tell the big story. “The next gauge is developing post-click analysis,” Mr. McNally says. “After the click-through, different actions are required. The actions that consumers take at this point become qualified leads. The tools they downloaded or printed, the pages of content they interacted with, and the user path through the brand site are important data. These data can help provide valuable insight not only into the success of an online advertising campaign, but moreover, provide valuable insight into audience segmentation, individual segment needs, interests, and value of site content. All of these data can be applied to the development of future online and offline marketing programs.” Companies such as Johnston, Zabor, McManus (JZM) Inc. and Usability Sciences have developed tools that give marketers more detailed information about the actions that occur during the consumer’s visit to a Website and how the consumer is influenced. The JZM ROI Tool provides ROI analysis and statistics through a survey that is programmed to appear on the site at customized intervals and that track intended and actual behavior. “Our ROI tool measures behavioral intentions and then the outcomes of those intentions for individual consumers,” says Wm. Scott Brown, Ph.D., manager, measurement solutions for the Internet at JZM. “We are not looking at what information could be tracked from server logs as people navigate a site or click through, we are doing an intercept interview.” Through online surveys that are presented during a site visit, JZM’s tool can potentially determine what the person’s mindset was before he or she viewed the online content and how the Website changed his or her attitudes and, potentially, behavior. JZM has found that between 7% and 15% of people who visit sites that contain intercept surveys participate. ConversionMonitor is a site-value measurement tool that Usability Sciences is developing in collaboration with imc2. When applied to Website visitor feedback, the tool measures how well a pharmaceutical Website is able to move a consumer along a product-adoption continuum, from never purchasing a product to becoming a loyal user. ConversionMonitor uses Usability Sciences’ WebIQ, an intelligence-gathering technology that is triggered from a client’s site to collect voluntary data from site visitors. Site visitors answer entry and exit survey questions and agree to allow their click stream path to be tracked and recorded. According to Jeff Schueler, founder and CEO of Usability Sciences, visitors to a Website using this tool are invited to participate in a survey through a separate browser window screen when they reach the home page. If they agree, they complete a brief entrance survey and are then free to accomplish what they came to the site to do. When visitors leave the site, another screen appears inviting them to answer exit questions. Mr. Schueler says this measurement tool has a 5% to 12% opt-in rate and, of those who answer the entrance survey, 65% to 75% answer the exit questions. The process of gathering behavioral metrics data can be slower than that of ROI measurements from ad impressions and click-throughs. “Marketers are asking for proof that they are spending their money effectively,” Mr. Douglass says. “ROI, however, tends to be a short-term measurement, whereas evaluating behavioral marketing requires a slightly longer timeframe because the investment is in knowledge, learning, and improving performance over time.” More than Numbers Improved measurements and metrics will certainly benefit the industry and aid in media purchasing, but experts believe this is only one piece of the ROI puzzle. Learning about the customer and working with that knowledge to improve campaigns is another key to success. “It is good that guidelines are being improved and that they are encouraging more opportunities for marketers to advertise, whether it be different size banner ads or with different formats,” Mr. Cross says. “But that means little if marketers aren’t directly addressing the needs of Internet health seekers.” “At the end of the day the ROI question is: ‘Are my online activities working?’ Then marketers say, ‘tell me in a way that helps me to defend my budget,'” Mr. Douglass says. “Confidence is best managed by explaining that the dollars are working now and, more importantly, the investment is expected to yield better results over time because of the experience and the insights gained with the program. This is very different from an advertising model.” Although improved tools and a better set of guidelines are expected to build the Internet’s credibility as a marketing tool, some believe that too much reliance on numbers and ROI measurements could stifle the industry’s creativity. “Data can act as a safety net, but this can also be a double-edged sword,” Mr. Racik says. “Data are there to allow people to make informed decisions, but if creativity and intuition are taken out of the picture, the art of communications is sometimes lost. It is important to have data as a foundation to work from, but this foundation shouldn’t be used as a crutch. Intuitive marketers need to base decisions on a broader set of criteria that includes their own intuition and experience.” “At times, it’s easy for marketers to singularly focus on measuring the program to the detriment of the creative and strategic aspects,” Mr. Cross says. “Lacking right now across the industry is a direct correlation between online traffic generation and sales. We can measure the ROI of an advertising campaign, but how does that translate into prescriptions? Ultimately the issue is larger than just measuring the ROI on advertising.” Overall, industry experts agree that when trying to measure the success of online advertising and marketing, marketers need to look at all the aspects of the site and learn from all the marketing information that the medium can provide. “Right now opinions about measuring ROI are all over the board,” Mr. Racik says. “One of the most interesting methods is to evaluate the ROI of a potential customer rather than the ROI of a particular project. This approach allows marketers to measure the effectivenss of multiple tactics – both online and offline – that are being used together to reach a specific audience. Marketers can more accurately determine whether the right money is being spent per target and whether the content is correct for each target. Because this approach offers a much broader look at the marketplace, it is a strategy that the pharma industry should embrace for the best return on its investment.” F PharmaVoice welcomes comments about this article. E-mail us at email@example.com. Sundeep Bhan How many people actually look at ROI for traditional marketing? Since online marketing is still a relatively new way to market products there is more scrutiny on how well it works. Coupons and Purchase-Based Sweepstakes Offers Coupon redemption is a common means of getting “hard” ROI, but it falls short of capturing the total value, since many consumers either don’t use coupons or never get around to redeeming them. According to Donna Wray, director of marketing intelligence, at SimStar, there are two methods that provide a more complete picture of a program’s value: sweepstakes offers and a predictive model of purchases based on a data match against pharmacy records. “The appeal of a coupon offer is mainly based on the consumer’s pharmacy-benefits plan,” she says. “Sweepstakes offers are biased on a demographic basis, which is easier to measure and control in future calculations. Sweepstakes also offer a cost advantage, since moving to a sweepstakes program can increase the participation, while lowering the incentive cost to pennies a person. They do need to be based on a confirmed purchase, to reduce unwanted traffic. ” When sign-up information from coupons or from other offers is available, a data match of the personal information against pharmacy records can be done. “This is expensive and time-consuming, but it allows marketers the ability to validate more nimble methods as a yardstick for ROI,” Ms. Rays. “For example, marketers can determine of the people who print the frequently asked questions (FAQ) how many actually end up filling or refilling a script for that product. And then moving forward, the FAQ prints can be used as a rough yardstick of prescription purchases.” A popular offline method for gauging impact and estimating ROI is pre- and post-testing. An equivalent online metric, allows marketers to serve a message before or after a site visit. “Remarkably, when asked nicely, people are very willing to complete a survey with no incentive,” she says. This provides an ideal environment for simple pre- and post-tests at no incremental cost, other than perhaps a slight dip in attention to other areas on the site. “Early on, we tried to use a group that received the survey twice as a control group, but this proved hopeless,” she says. “Although people are very willing to answer a short survey once, very few are willing to answer that same survey again. In lieu of a control, look for demographic biases between the pre- and post-test groups.” This gave Simstar a new method of delivering the surveys that provide statistically equivalent groups. In the meantime, offline consumer market research has evolved, so that we can take self-reported data and plug it into a sales funnel model to predict how many self-reported patients will actually see their physician, how many of those physicians will prescribe the product, and how likely the resulting script is to be filled. Marc Blumberg Pharma marketers are asking us to prove that their Internet investment is generating more prescriptions. they know this is a tall order, but they always ask for it. New Guidelines Will Establish Consistent Definitions, Audit Processes, and Compliance Rules In September 2003, The Media Rating Council (MRC), the American Association of Advertising Agencies (AAAA), and the Interactive Advertising Bureau (IAB) announced new, more detailed guidelines for interactive advertising campaign measurement. The guidelines are a follow-up to initial parameters established in January 2002 by the IAB, the MRC, and the Advertising Research Foundation with support from the AAAA and the Association of National Advertisers (ANA). “The MRC is pleased to participate with the IAB and the AAAA on this initiative, particularly narrowing the definitions in the original IAB guidelines and adoption of an industry-driven auditing and certification process similar to other media,” says George W. Ivie, executive director and CEO of the MRC. “This will put interactive advertising more firmly in the equation in today’s competitive multimedia planning and buying environment.” The new set of guidelines will establish a consistent definition of how to count an ad impression. Additionally, the group will develop an auditing and a certification process that will enable advertisers and their agencies to have confidence in the impression counts across multiple ad-serving technologies. The IAB, the MRC, and the AAAA are endeavoring to improve the existing guidelines and during the process intend to provide periodic status updates to the industry. The process will include the development of consistent industry definitions, an MRC regulated audit process, and actual compliance to these definitions by many of today’s publishers and third-party ad servers. Until the new guidelines are unveiled, current guidelines remain in effect. “This is one very important part of our broader commitment to work on ways to improve the process of buying and planning interactive advertising,” says Greg Stuart, president and CEO of the IAB. “By developing guidelines for measurement, we are offering the accuracy and reliability, which is a critical component in evaluating the effectiveness and efficiency of an advertising medium. I applaud the publishers and technologies that have come together with a very serious commitment of time and resources to make the changes needed to continue to make online advertising measurement more accurate than even other media vehicles.” Heralding 2003 as the year where the tide turned for interactive advertising, Mr. Stuart, announced that the IAB had succeeded in launching an unprecedented number of initiatives during the year than in any other time in the history of the association, which was founded in 1996. Mr. Stuart recognized the efforts of IAB members as the driving force behind this success and in working together to create real change within the industry. Mr. Stuart positioned 2004 as the “Year of the Creative,” where many IAB programs and events will feature the theme of “creative” with the overarching goal of making interactive advertising easier to plan, buy, and sell thus encouraging greater adoption by marketers. Mr. Stuart cited several key factors that contributed to IAB success in 2003, most notably the IAB “Acceleration Plan,” where 11 IAB members prepaid membership fees of $5.8 million to hasten the growth of the industry. Evidence of industry turnaround and success was clearly reflected in the gradual increase of interactive ad revenue, capped off by a 20% third-quarter increase compared with third-quarter 2002. Third-quarter 2003 registered the highest total of interactive advertising revenue reported -$1.75 billion – since third-quarter 2001 – $1.77 billion. Matt McNally Pharmaceutical marketers want to know what their online investment is getting them from a brand standpoint. They want a clear definition of what ROI is. A click isn’t good enough and a visit to the Website isn’t good enough. Ian Cross Even though a lot of marketers have intuition that their Internet program is contributing to product sales, The bottom line is there’s a responsibility from those of us in the industry to demonstrate value with hard numbers. Jeff Schueler The primary measure of effectiveness for us is the success of each visit to the Website. We quantify this by intercepting Website visitors when they come to the site and when they leave. If upon exiting a site, they reply that the visit was successful, then the Website was effective for that particular visitor. Experts on this topic Sundeep Bhan. CEO, Medsite Inc., New York; Medsite is an e-pharma marketing company that forges mutually beneficial relationships with physicians and the organizations that want to reach them via a suite of products and services. For more information, visit solutions.medsite.com. Marc Blumberg. Senior VP, imc2, Dallas; imc2 is an interactive marketing agency dedicated to helping clients achieve objectives through interactive solutions. For more information, visit imc2.com. Wm. Scott Brown, Ph.D. Manager, measurement solutions for the Internet, Johnston, Zabor, McManus Inc., Research Triangle Park, N.C.; JZM provides business solutions through strategic application of marketing, relationship, and communication research. For more information, visit jzm.com. Ian Cross. CEO and cofounder, I-SITE, Philadelphia; I-SITE is a full-service Internet consulting and development firm specializing in the online marketing of pharmaceuticals and consumer products. For more information, visit i-site.com. Craig Douglass. Managing partner, Cadient, Conshohocken, Pa.; Cadient is dedicated to building pharmaceutical brands online by managing life-cycle success and activating consumers. For more information, visit cadient.com. Adam Gelles. Director, industry initiatives, Interactive Advertising Bureau, New York; IAB represents the leading companies in the interactive space and evaluates and recommends standards and practices, fields interactive effectiveness research, and educates the advertising industry regarding the use of interactive advertising. For more information, visit iab.net. George W. Ivie. Executive director and CEO, The Media Rating Council, New York; the MRC is a nonprofit industry association whose charter is to maintain audience research confidence and credibility with the goal of securing audience measurement services that are valid, reliable, and effective. For more information, visit mrc.htsp.com. Jules Korzeniowski. President, The Conectics Group, Parsippany, N.J.; The Conectics Group, a CommonHealth company, provides digital development, research, media, and planning services. For more information, visit commonhealth.com. Matt McNally. Media director, Insight Interactive Group, Philadelphia; IIG is an interactive marketing agency that specializes in the healthcare and pharmaceutical industries. For more information, visit insight-interactive.com. John Racik. President and CEO, Blue Diesel, Westerville, Ohio; Blue Diesel, an inChord company, is an interactive agency dedicated to providing solutions that integrate form and function. For more information, visit bluediesel.com. Jeff SchueleR. Founder and CEO, Usability Sciences Corp., Irving, Texas; Usability Sciences assists designers of technologies in gaining insight into the experience of their users. For more information visit usabilitysciences.com. Jessica Seilheimer. Senior program manager, Clinical Connexion, Newtown, Pa.; Clinical Connexion is a full-service education and communications agency committed to providing services to the healthcare industry. For more information, visit clinicalconnexion.com. Greg Stuart. President and CEO, Interactive Advertising Bureau, New York; IAB represents the leading companies in the interactive space and evaluates and recommends standards and practices, fields interactive effectiveness research, and educates the advertising industry regarding the use of interactive advertising. For more information, visit iab.net. Donna Wray. Director of Marketing Intelligence, SimStar, Princeton, N.J.; SimStar is a leading interactive relationship marketing agency serving the pharmaceutical, biotechnology, and consumer healthcare industries. For more information, visit simstar.com. Michael Wysocki. Senior account manager, Newton Gravity Shift, Pennington, N.J.; Newton Gravity Shift is an e-marketing and integrated learning agency. For more information, visit newtongravityshift.com. Dr. Wm. Scott Brown If people are aware that pharma manufacturers are acting in their best interest, then they will be more willing to share information, as long as there is a reciprocation or exchange of content for the information. Michael Wysocki This case clearly proves that site- awareness initiatives can successfully direct physicians to credible online educational resources. Jessica Seilheimer Requiring physicians to register with the site gave us an opportunity to communicate directly with our core users and learn from their usage patterns to improve the site. Creating Value for Physicians – DiabetesRoundtable.com Site-awareness programs for an online educational resource resulted in more than a 300% increase in physician page views. “Our charge was to create a Website that would provide educational resources specific to insulin therapy for physicians who treat patients with type 1 and type 2 diabetes,” says Jessica Seilheimer, senior program manager at Clinical Connexion, a medical communications agency. The resulting site, diabetesroundtable.com, was created by the agency and its technical programming and e-marketing partner, Newton Gravity Shift. A key value for physicians is clinical credibility. Washington Hospital Center, a provider of continuing medical education, accredited by the Accreditation Council for Continuing Medical Education (ACCME), collaborated with Clinical Connexion to produce the content of the Website. Washington Hospital Center is part of MedStar Health, a nonprofit healthcare organization serving Baltimore and Washington, D.C. “An average of 26% of registered users completed one of the CME courses on the site,” Ms. Seilheimer says. Key site features include CME courses, an “eGrand Rounds” section with patient case studies specific to managing the disease with insulin therapy, and a slide library divided into four categories containing almost 100 slides. “We know the slide library is a popular feature because during the first three months post-launch, an average of 61% of the physicians registered downloaded slides,” says Michael Wysocki, senior account manager at Newton Gravity Shift. The online slide library application is based on Newton Gravity Shift’s i-prism Presentation Manager, which allows users to select any slide for an individual, downloadable PowerPoint presentation. CME, eGrand Rounds, and the Slide Library sections require physicians to register for access. “This gives us an opportunity to communicate directly with our core users and learn from their usage patterns to improve the site,” Ms. Seilheimer says. Clinical Connexion uses these data to keep the content fresh, relevant, and targeted to the needs of the physicians who visit the site. Diabetesroundtable.com also includes a diabetes news feed, a compilation of links to diabetes resources, a review of the past month’s top diabetes literature, and a diabetes-related calendar of events. Because the mission of the site is to ensure that physicians are as informed as possible about insulin therapy, launching the site was just the first step. An ongoing awareness program is being conducted to boost site traffic and registrations. The site-awareness programs combine both online and offline initiatives, and the success of both are clearly demonstrated by the metrics. “When the site was first launched, it was search-engine optimized (SEO) so that the spiders and bots of the major search engines would see the diabetes-related keywords and content and list the site during diabetes-related searches by physicians,” Mr. Wysocki says. “We also conducted an e-relations initiative to link diabetesroundtable.com to other credible diabetes Websites, because the more in-bound links there are, the higher the ranking.” But what really produced results was mailing announcement postcards to physicians and purchasing click-through ads tied to diabetes keywords on Google and Overture. “The month after the postcard mailing and ad placement, we witnessed a 365% increase in total page views and an 842% increase in registrations,” Mr. Wysocki says. Craig Douglass Demonstrating that a click turned into a visit to the doctor and ultimately into a prescription and or refills is the most significant challenge, and it dwarfs all other challenges. Adam Gelles Marketers are seeing more value in online marketing and recognizing that the Internet is a more mature medium with sets of standards so building content isn’t as difficult as before. Jules Korzeniowski With the Internet, the cost of printing and other things that the pharmaceutical sponsor used to pay for are passed on to the user. The user pays for the computer, pays to print out the forms, pays for access to the Internet, and for the infrastructure. Marketers have to pay for putting information online, but that is much less expensive than print and much more dynamic.