Journal Advertising A Powerful Medium November 2005 According to experts at the AMP, the high level of physicians’ responses to this year’s TDC reaffirms the role medical journal advertising plays as an information source for physicians about pharmaceutical products. Medical journal advertising remains fundamental because it resonates with how doctors learned medicine — through the printed word — and because it continues to fulfill doctors’ interest in old and new therapies and drugs. The Doctors’ Choice (TDC) Awards bears this out. Conducted by the Association of Medical Publishers (AMP), the awards highlight the advertising that doctors say communicates clearly and helps them with clinical decision making. “The best ad overall — Colazal — was not from one of the major companies or from one of the big name umbrella agencies; it was a very strong creative approach provided by a small company and a small agency,” says M. James Dougherty, president of the AMP and group VP of The McGraw-Hill Companies Inc. “This is consistent with research that we’ve seen. It isn’t only about how much is spent; it’s about how well the creative is executed. We have research that demonstrates the point that an effective campaign has to be properly funded and properly executed to be truly effective. The TDC research coincides with these findings.” According to Charlie Hunt, a research consultant to the AMP and managing director at DeSilva & Phillips, studies show that while advertising works, good advertising, executed properly, works very well. “The creative has to be believable, the ad has to communicate information to the healthcare professional, and then the message must be executed at a level of frequency that makes it effective,” he says. “This is not a surprising conclusion, but one that must be reinforced to marketers. When an advertisement is proven to be credible, informative, and applicable to the physician’s practice, the advertising campaign has had a positive increase on both new scrips and market share.” “Numerous studies indicate that medical publications rank among the highest for sources of information and credibility,” Mr. Dougherty says. “Professional advertising in journals and online provides marketers with the opportunity to reach the broadest possible audience many times in a short period of time at an economical cost per exposure. This nonpersonal promotion is extremely effective at building awareness for a brand or a new indication. Professional advertising also can reach physicians who no longer see detail representatives in their offices, a phenomenon that continues to increase. Professional ads are also extremely effective at reinforcing the messages that are delivered by the detail force.” Robert J. Osborn Jr., president of the professional division at Dowden Health Media, says there’s a tendency to make the incorrect assumption that journals don’t sell product, which is not the point; journals leverage all of the other promotional vehicles. Because credibility is such an important factor in communicating information to the physician base, journal advertising continues to be an effective medium. “Surveys consistently show that healthcare practitioners find journals a highly credible information resource,” says Peter N. Slack, president of Slack Inc. “Practitioners also report that journals are a preferred means to obtain education. Combine these attributes with the effective reach and frequency that journals provide, and the power of the medium becomes clear.” Because there are many information sources competing for their time, physicians have developed a unique relationship of trust with medical journals. They appreciate the peer-review process in journals; they appreciate the trusted format. “We hear this often in conversations with readers and in focus groups,” says Jonathan Bigelow, group VP and general manager at Cliggott Publishing Group, CMP Healthcare Media LLC. “This sentiment also is reflected in the findings of several studies. For example, research by ACNielsen in 2004 showed that more physicians identified journals as their top source of clinical information than any other modality; research by Accenture in 2003 found clinical journals were the leading source of information that influences prescribing decisions; and a 2003 study by the American Academy of Family Physicians that asked family physicians to rate the value of clinical information sources found medical journals ranked highest.” Will Passano, president of the Medical/Dental Division of Ascend Media LLC, says journals remain a powerful medium for promotion because they work. “Physicians still rely on literature for the latest information on their specialty, and the society publications and controlled publications have established themselves as credible voices in their communities,” he says. “The only drawback is that journal advertising is not very sexy.” Mixing it Up Medical publishers agree that all of the major promotional approaches — detailing, DTC, physician meetings and events, journal advertising, nonjournal advertising — are effective when used properly. “What’s sometimes forgotten is that the mix of approaches is critically important,” Mr. Bigelow says. “A growing body of research, including the Neslin RAPP study, the Wittink ARPP study, the PhRMA Patient Assistance Program study, and additional work by ACNielsen and others shows that for products in many categories the marginal return on investment from journal advertising is high and often much higher than the marginal return on additional investments in DTC or other modalities. More attention to journal advertising can make DTC and detailing more effective.” Mr. Osborn agrees that different types of marketing efforts do different things. “Educational meetings or promotional events provide physicians with a very intimate understanding of what the pharmaceutical company is trying to get across in a memorable way but at a very high cost,” he says. “Journal advertising is a very cost-effective way to leverage all of the other forms of promotion.” Art Wilschek, executive director of advertising sales for the New England Journal of Medicine, reemphasizes the point that with a good message that is executed properly and coordinated properly with other aspects of promotion, journal advertising works very well and becomes the foundation for all other tactics. “Journal advertising is one of the few promotional avenues where there is total control of what is being said,” Mr. Dougherty says. A Bright Future It’s no surprise that experts anticipate that the recently issued PhRMA guidelines regarding DTC restrictions will have a positve impact on journal advertising advertising. The guidelines suggest limiting DTC ads until a new product has been on the market for a “significant” amount of time. “Professional advertising volume has spiked considerably in the two months since the PhRMA guidelines were introduced,” Mr. Dougherty says. “This growth is, in part, being driven by professional advertising for newly launched products, which can no longer deliver DTC messages during their launch months. We all know that it is critical for pharmaceutical companies to capture share in the first few months of a product’s life, and marketers can no longer use brand-specific DTC ads to create demand. Professional advertising will continue to benefit from this self-imposed industry guideline.” Mr. Slack believes that because of the shift in DTC advertising guidelines, companies have the opportunity to focus on educating and informing the physician before the public. “This will help advertisers recommit to, and for some rediscover, the value and effectiveness of journal advertising,” he says. Mr. Passano would like to think that marketers would shift their promotional resources toward journal advertising from DTC, but he is not confident that this will, indeed, happen. “No one ever gets promoted for running another journal schedule,” he says. “DTC is just a lot sexier.” Mr. Osborn believes there is going to be a shift in resources from DTC to direct to patient. He says there is a big opportunity for the pharmaceutical industry to focus on the point of decision and to encourage a dialogue between the patient and the clinician that is intelligent and informed and journals can be a part of that discussion. Tangentially, recent research from JP Morgan reported that total promotion in the United States declined significantly in the first half of 2005 compared with the same period in 2004. This decrease is attributed to the most significant portion: detailing, which was 9% lower compared with first-half 2004. The pharma companies with the greatest percentage decrease in detailing were: AstraZeneca, Pfizer, GlaxoSmithKline, Bristol-Myers Squbb, and Wyeth. Sanofi-Aventis’ detailing increased 13%, driven by an 87% rise in detailing of the sedative drug Ambien. “Virtually all of the major pharmaceutical companies have announced reductions in their detail forces in recent months,” Mr. Dougherty says. “A recent study by ACNielsen demonstrated that the addition of professional advertising can increase the perception of the volume of detailing, even if no change in the actual volume of detailing took place. As physicians become more difficult to reach via the detail force, marketers are beginning to understand the true value of professional advertising, which is the ability to extend the detail force by reminding the audience of the key product benefits and competitive advantages for patients.” According to PERQ/HCI’s Journal Ad Review, there was a reported 10% increase in ad spending for medical/surgical journals in 2004 compared with a 3% growth increment in 2003. Many publishers expect this growth trend to continue based in part on the constraints being placed on other pharmaceutical marketing practices. According to Mr. Bigelow, new product launches involving advertisements with substantial unit sizes were the biggest driver of increased journal advertising in 2004. “The year 2005 began on a down note with the end of promotion of several major products, notably the COX-2 inhibitors; delays in new product launches; and a general sense of pressure and confusion in the industry and at the FDA,” he says. “But the final quarter of 2005 will be a strong one for journal advertising. We expect the momentum to continue into 2006, boosted by a new round of major product approvals and increased recognition of the importance of journal advertising in the promotional mix.” “There is evidence from research done over the past couple of years that journals have a high ROI and that there is an underspend relative to other forms of promotion,” Mr. Osborn says. “There is pressure on pharma in terms of the amount of money spent on promotion. In the past when budgets were quite large by industry standards, companies could afford to do things that were not necessarily efficient. There is pressure today to find more efficient ways to disseminate messages, and I think journals offer that efficiency. I would also suggest that there was a tendency on the advertising agency side of the business to not push the creative envelope in journals because historically journals pushed back. They didn’t want gatefolds or other creative treatments, such as mylar inserts. Today, many publishers are very open to these types of treatments. There’s an opportunity for agencies to be far more creative and get the message out in an engaging and fun way.” Mr. Dougherty says creativity isn’t just about bells and whistles. “Research shows that physicians react positively when the message is kept targeted and concise,” he says. “Ultimately, keeping the creative to one or two points is better than having nine points crammed into a four-page double-gatefold ad.” Another point that marketers need to remember is to pretest their ads. “This is especially important if the same message is being used with the salesforce,” Mr. Wilschek says. “Companies spend millions of dollars on advertising, and it makes sense to allocate a couple thousand dollars to protect this investment.” PharmaVOICE welcomes comments about this article. E-mail us at [email protected]. The grand prize winner with the highest overall score was Salix’s Colazal. Created by Raleigh, N.C.-based MedThink Communications, the ad also won top honors in the gastroenterologicals and single-page ad unit categories. The ad, which has the headline, “Total colon coverage,” conveys the effectiveness of the drug in the treatment of ulcerative colitis. Doctors rated more than 300 representative ads that appeared in 2004. More than 7,560 physicians responded, evaluating ads appropriate to their specialties based on their ability to communicate, provide information, gain attention, and encourage action. Colazal Category: Highest-Scoring Ad Marketer: Salix Agency: MedThink Communications Zyvox Category: Highest-Scoring Ad (Two Pages) Marketer: Pfizer Agency: Cline Davis & Mann Valtrex Category: Highest-Scoring Ad (Three Pages) Marketer: GlaxoSmithKline Agency: FCB HealthCare Avastin Category: Highest-Scoring Ad (Four Pages) Marketer: Genentech Agency: Harrison & Star Enbrel (4 pages) Category: Antiarthritics Marketers: Wyeth/Amgen Agency: Saatchi & Saatchi Healthcare Zyvox (2 pages) Category: Anti-Infectives Marketer: Pfizer Agency: Cline Davis & Mann Vytorin (3 pages) Category: Cardiovascular Marketers: Merck/Schering-Plough Agency: Corbett Accel Enbrel (6 pages) Category: Dermatology Marketers: Amgen/Wyeth Agency: Saatchi & Saatchi Healthcare Lantus (2 pages) Category: Diabetes Marketer: Sanofi-Aventis Agency: Euro RSCG Metamax Colazal (1 page) Category: Gastroenterology Marketer: Salix Agency: MedThink Communications Lidoderm (1 page) Category: Neurology Marketer: Endo Agency: FCB HealthCare Fosamax (1 page) Category: Obstetrics/Gynecology Marketer: Merck Agency: FCB HealthCare Avastin (1 page) Category: Onocology Marketer: Genentech Agency: Harrison & Star Restasis (1 page) Category: Ophthalmology Marketer: Allergan Agency: Regan Campbell Ward Floxin (1 page) Category: Pediatrics Marketer: Daiichi Agency: Bruce Leeb Lexapro (7 pages) Category: Psychiatry Marketer: Forest Agency: Grey Healthcare Spiriva (3 pages) Category: Respiratory Marketers: Pfizer/BI Agency: Euro RSCG Chelsea Uroxatral (1 page) Category: Urology Marketer: Sanofi-Aventis Agency: Dudnyk Sound Bites From the Field pharmavoice asked representatives from some of the leading professional journals, publishers, and associations to discuss why journal advertising is such a powerful medium, the impact that the recent dtc guidelines will have on journal advertising, and what role creativity plays in successful journal campaigns. Jonathan Bigelow is Group VP and General Manager, Cliggott Publishing Group, CMP Healthcare Media LLC, Darien, Conn., which delivers information to healthcare professionals via a diverse range of communication vehicles, including publications, Websites, and special projects. For more information, visit cmphealth.com. “The backlash against DTC, however painful it may be in the short run, could serve the industry well if it prompts a long-overdue reconsideration of the return on investment of different promotional approaches. ” M. James Dougherty is President of the Association of Medical Publications, Westfield, N.J., a nonprofit organization with 23 member publishing organizations, representing 225 publications, and Group VP at The McGraw-Hill Companies Inc., Minneapolis, which drives the financial services, education, and business-information markets through leading brands. For more information, visit amponline.org and mcgraw-hill.com. “Professional advert sing is easily targeted. Publications can offer editions directed at each of the 34 regions offering Medicare Part D Prescription Drug Plans (PDPs). A marketer could target physicians in each of the MMA regions with a different message, depending on the product’s formulary status in those geographic areas. ” Charlie Hunt is a Research Consultant with the Association of Medical Publications, Westfield, N.J., a nonprofit organization with 23 member publishing organizations, representing 225 publications, and Managing Director at DeSilva & Phillips, New York, an investment bank specializing in media transactions. For more information, visit amponline.org and mediabankers.com. “The creative has to be believable, the ad has to communicate information to the healthcare professional, and then the message must be executed at a level of frequency that makes it effective.” Robert J. Osborn Jr. is President, Professional Division, at Dowden Health Media, Montvale, N.J., a health media company that specializes in communicating to both consumers and physicians through peer-review publishing, including journals that reach more than 300,000 physicians each month. For more information, visit dowdenhealth.com. “I would suggest that the purpose of creativity in advertising is to engage the reader or the viewer to help them understand the point of the message. Creative visuals help physicians understand what patients need to improve their quality of life. ” Will Passano is President of the Medical/Dental Division at Ascend Media LLC, Jamesburg, N.J., which is positioned in the business-to-business media environment with a unique focus on medical, healthcare, and business services industries. For more information, visit ascendmedia.com. “Having gone to one extreme with the move to DTC, it appears that the physician is being put back into the place of power and at least, for new drugs, will receive the full promotional treatment. Then as the drug becomes established, companies can move some promotion to DTC. ” Peter N. Slack is President of Slack Inc., Thorofare, N.J., a provider of healthcare information, educational programs, and meeting and exhibit management services worldwide. For more information, visit slackinc.com. “Companies realize that journal advertising is a safe and accepted way to communicate a credible product marketing message.” Art Wilschek is President Elect of the Association of Medical Publications, Westfield, N.J., a nonprofit organization with 23 member publishing organizations, representing 225 publications, and Executive Director, Advertising Sales, at the New England Journal of Medicine, Waltham, Mass., a weekly general medical journal that publishes new medical research findings and editorial opinions on a wide variety of topics. For more information, visit amponline.org and nejm.org. “When a good message is executed and coordinated properly with other aspects of promotion, journal advertising becomes the foundation for all other tactics. ” More than 7,560 physicians returned questionnaires sent by the Association of Medical Publications (AMP) as part of the nonprofit association’s third annual The Doctors’ Choice (TDC) Awards, which honor excellence in medical journal advertising. Through an e-mail survey, practicing physicians were asked to rate more than 300 representative ads that appeared in 2004. To assess physicians’ responses to journal advertisements, TDC research asked doctors to rate the ads by six standards: communicates clearly and quickly, has immediate appeal to gain interest, prompts seeking more information or re-examination of treatment, helps with clinical decisions, adds to information provided by company representatives, and reminds about value of product prescribed. Doctors were notified of the program via e-mail and journal ads, which directed them to a Website. Most ads were evaluated by hundreds of doctors; sample sizes of more than 300 were common among the ads researched. The winners, including pharmaceutical manufacturers and their advertising agencies, were the result of a selection process among 314 medical ads representing the 200 most widely advertised products in 2004, with awards going to both the company and the agency. Awards were presented in 14 drug categories, from antiarthritics to urologicals, and four page unit categories. (See box on page 54 for a list of the winners.) Salix’s single-page unit for Colazal, the grand prize winner with the highest scoring ad, also won top honors in the gastroenterologicals and single-page ad unit categories. Created by MedThink Communications, a healthcare agency located in Raleigh, N.C., the ad, which has the headline, “Total colon coverage,” conveys the effectiveness of the drug in the treatment of ulcerative colitis. Pfizer also walked away with three top honors: two in the specialty areas of anti-infectives (Zyvox) and respiratory therapy (Spiriva, which is marketed by Pfizer/BI jointly), and one for the highest scoring two-page ad (Zvvox). Merck (Vytorin for cardiovasculars, jointly marketed with Schering-Plough, and Fosamax for obstetricals/gynecologicals), Sanofi-Aventis (Lantus for diabetic therapy and Uroxatral for urologicals), and Wyeth/Amgen (Enbrel for both anti-arthritics and dermatologicals) won two awards, each in their respective drug categories. On the agency side, FCB HealthCare’s three awards included two in drug categories (Lidoderm for neurologicals and Fosamax for obstetricals/gynecologicals) and one, Valtrex, for the highest scoring three-page ad unit. Cline Davis & Mann (Zyvox), Harrison & Star (Avastin), and Saatchi & Saatchi Healthcare (Enbrel) garnered two awards each, winning awards for the same product in both drug and ad page-unit categories. The Association of Medical Publications honored excellence in medical journal advertising at the third annual Doctors’ Choice Awards held at The Lighthouse in New York City. More than 300 industry executives gathered for the ceremony to celebrate this year’s winners. 1. The MedThink Communications team — Scott Goudy, Greg O’Donnell, Sean Frederick, Tom Marcotte (Salix Pharmaceuticals), and Will Clarke –accepts the top award for the winning Colazal ad. 2. Carleen Kelly of Corbett Accel accepts the award for the agency’s winning ad for Vytorin. 3. Johanna Schlossberg and Don Matera from Cline Davis & Mann stop for the camera after being presented with the award for their ad for Zyvox. 4. Anna Buckley from CMI and Gerry Lanzilotti from Medical Media Services share a moment during the evening. 5. Megan Duncan, Suzanne Botvinis, Melanie DiMuro, and Becky Frederick from Conectics show their support. 6. Adam Cohen from Saatchi & Saatchi Healthcare picks up the award for Enbrel.7. Jim Dougherty, President of the AMP and Group VP at The McGraw-Hill Companies, presides over the festivities. 8. The other half of the Cline Davis & Mann winning team — Jason West and John Hasting — share the limelight. 9. Mary Skoyles from Medical Media Services and Dan Gowan of American Family Physicians enjoy the evening.

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