Catch up with the digital doctors

pharmafile | December 17, 2008 | Feature | Medical Communications, Sales and Marketing |  digi, doctors, technology 

Few things more graphically illustrate the conservative nature of pharma marketers than the slow birth of e-detailing. Ten years ago, the present writer spoke at a conference on e-detailing. Cautious optimism was expressed that e-detailing would be added to the marketing armoury, but no one held out any great hope, even then, that it would happen any time soon.

So fast-forward a decade, and most companies are still in test phase, but the missing link that bedevilled early attempts to start e-detailing, which was a complete lack of evidence, has now gone.

Most companies have run some sort of trial, and yet the evidence doesnt seem compelling enough for senior managers to authorise larger spends.

The advantages seem obvious, at least on the surface, with fewer doctors seeing reps. The case for e-detailing, offering doctors the opportunity to get drug information at a time that suits them rather than the rep, seems pretty conclusive.

Reports by researchers Eularis, Datamonitor, Millward Brown and Frost & Sullivan, all point to slow and relatively steady adoption but agree that generally, the industry has been so slow to adopt the new technology that it is now behind its customers.

Defining e-detailing

First of all, though, what is e-detailing? In a report by Eularis, a pharma analytics company, Dr Andree Bates points to three main flavours: virtual live e-detailing, scripted e-detailing and e-detailing through a portal for doctors.

Says Dr Bates: "In virtual live e-detailing, doctors are given a PC pre-loaded with software and a webcam and provided with incentives. In return for this, many models ensure doctors are obliged to contact sales reps a set number of times a month, although the timing and duration of the e-detailing session is controlled by the doctor.

"During the session, the doctor can interact with the rep via real time video and audio. Alternatively, only the rep is viewed or only audio and data slides are shown, depending on the wishes of the doctor."

Dr Bates says that this model has been associated with more cost effective and longer interaction with the doctor, compared to face-to-face, so that the number of rep calls and doctor interactions are increased. However, there is no independent data on the impact of such e-detailing on the numbers of prescriptions issued.

The second option, scripted e-detailing, is where the doctor views a series of interactive screens, usually through an internet or intranet site. This format is closer to a conventional website. There is no live interaction, but the doctor has the option to contact a rep by e-mail or telephone. It can deliver clear, well-structured messages to doctors in sessions that can last 5-10 times longer than face-to-face but at a reduced cost.

Doctors like the convenience of the 24 hours a day, seven days a week availability of this model. Unlike the other models, some forms of scripted e-detailing have been found in independent studies to grow prescriptions which can be directly attributable to the e-detailing.

The third option, using a portal for doctors, is quite visible in the UK at the moment, thanks to the profile enjoyed by GP portals such as Doctors.net.uk, OnMedica.net and detaildirect.com.

These portals offer access to ready-made communities of doctors and can be used to deliver broad, sponsorship marketing messages or more product-specific ones more like traditional detailing.

Potentially, doctor portals can provide access to hard-to-reach specialists though, for most portals, the number of active users is usually significantly smaller than the official membership list. Portals can usually provide online statistics that give insight into doctors web habits and interests.

"There is no doubt that detailing directly to the doctor serves an important purpose. Doctors want and need information from the sales representatives  but on their own time terms," says Dr Bates.

So there is a lot going on, even in the UK, but one of the problems lies in interpreting the information. Did a doctor spend 10 minutes looking at a web page because he was interested or because he was bored and took a break to do something else whilst the web page was open?

"Nevertheless, pharma needs to react to evidence that doctors are using the web more extensively than ever," says Datamonitor analyst Dr Sandra Reynolds, author of Reaching Doctors and Patients through New Digital Media, published last April.

Customers are already using the web extensively to meet their information needs and will continue to do so at quite a sophisticated level.

"The onus is on pharma companies to get up to speed and use the web in conjunction with existing marketing practices to bolster their share of voice," she says.

"Doctor-centred prescribing has historically been pharmas main focus, but now it must take into consideration emerging customer targets such as formulary panels and nurse practitioners," adds Dr Reynolds.

Datamonitor's study was global, with particular reference to the US, but this willingness by doctors to use e-detailing is supported by UK research among doctors.

In their April 2008 GP survey Milward Brown found that GPs are receptive to online marketing, but that pharma is slow to exploit digital marketing strategies.

Again, the survey showed healthcare and pharmaceutical marketers are failing to fully exploit digital marketing strategies as mounting evidence shows doctors spend more time in the day working online, turning to blogs, social networking sites and websites for information and advice.

Nearly all (97%) GPs questioned said they use the internet at least once a day and for an average of 12 hours every week.

Respondents claimed that half of their time online was work related and that after e-mail, search engines are the most used feature of the internet.

Over half (59%) of GPs said they enjoy surfing the internet for information on medicines.

But not all is lost for the field force. Only one in five GPs surveyed said they would prefer e-detailing to face-to-face rep visits, but that's more for the social interaction with a well person rather than because they value the information they get.

Give me more objective data

Mike Lane, a London-based GP and member of the executive committee of the largest PCT in London, said:

"I still prefer face-to-face visits from reps. E-detailing is a good use of time but does not allow me a nice break in my day to speak to a healthy person over a cup of tea and a sandwich.

"These meetings, though, seem to be more like cosy chats than structured exchanges of information. Only a tiny minority of doctors have any faith in what reps tell them, with just 5% of GPs trusting the information given by reps, and only 5% (possibly the same ones) feeling that information provided by reps is fair and balanced."

Dr Mike Lane added: "When reps know their subject and can provide me with objective data, I get a lot more value from the visit. I'd like to see more information online about healthcare products, in particular full reprints of clinical trials."

But its not just websites that are getting the attention of medics. So-called Web 2.0 developments, such as social networking sites and blogs, are getting increasing traffic from doctors. Sites like these provide doctors with opportunities to network with their peers all over the world, and the collaborative ethos of medicine finds expression through these forums, so they give a perfect opportunity to spread knowledge through the most powerful marketing tool of all: word of mouth.

Word of mouth campaigns were highlighted by the survey and the panel debate as another area of digital marketing that could be better exploited by healthcare marketers. Of the GPs surveyed:

– 69% said that they enjoy giving advice to colleagues on what medicines to prescribe.

– 13% of GPs are using message boards, blogs and social networking sites for advice.

– And 15% of GPs say they will use them for medical information more in future.

Social networking and blogs

"As more patient websites appear each day, healthcare and pharmaceutical companies need to realise the word of mouth value that blogs and online patient support groups bring," said Fergus Hampton, chief executive of Millward Brown Precis, which monitors and evaluates media campaigns including consumer generated content. 

One crucial opportunity that seems to be going begging is the chance for pharma to put their side of the case when negative or hostile information about their brands appears online. There are an increasing number of negative reports about prescription drugs appearing online. Healthcare and pharmaceutical brands need to listen and measure what is being said about their brands offline and online. Even though more than 80% of WOM still happens offline, when its online, its magnified.

But the key question still remains: can e-detailing be proved to work?

Dr Bates of Eularis points to one study, which showed 39% of doctors after partaking in a 10 minute e-detail session requested to see a rep and 70% asked for samples. Another showed that after the implementation of an e-detailing programme the products market share increased by 10% (against a control group of 3%) where each percentage point equalled $40 million in sales.

In the US, a study by e-detailing Lathian Systems found that doctors participating in two e-detailing sessions increased brand prescribing by 51%, and a group participating in one e-detail increased brand prescribing by over 19%.

Back in the UK, one pharma measured impact on Rx in four groups who were matched on a variety of variables:

– practices with no rep or e-detailing

– practices with only reps

– practices with only e-detailing

– practices with a combination of rep and e-detailing.

The combination of rep and e-detailing was found to be 71% above the baseline group (seeing neither reps nor e-details) and 39% above the groups where rep detailing was done in isolation.

The future for e-detailing

At present, says Dr Bates, the main emphasis of an e-detailing programme is to directly and quickly increase prescription rates, rather than cut costs or build branding relationships online. However, in the future we expect that it may be used to measure brand loyalty.

Studies have shown that doctors are rational prescribers early in the life cycle of a brand, then they become heavily emotional prescribers in mid-cycle, and then become more rational prescribers again late in the life cycle, presumably as new competitors appear, demanding a rational approach.

However, given that branding can effect emotional prescribing by doctors, and an e-detailing programme can reinforce the brand, this branding component could become part of the e-detailing equation.

Box: Closed Loop Marketing

Closed loop marketing is the latest concept in salesforce technology, and has been a buzzword in pharma and other industries for several years now.

At the heart of Closed Loop Marketing (CLM) is the idea of a self-contained system in which marketers constantly adapt their communication with its customers based on their responses and feedback.

The thinking goes that the speed and scale and flexibility of electronic communication (such as marketing via e-mail) allows marketers to regularly monitor how customers react, learn about their preferences and respond accordingly.

This closed or feedback loop system has the potential to allow marketers to build up detailed customer profiles, and segment their audience more effectively than before.

However, as with all previous salesforce automation and CRM models, if the data is not captured frequently enough or in the right way by the salesforce, this can undermine efforts to analyse customer behaviour.

Kevin Dolgin, a senior principal with IMS and a professor of marketing at the University of Paris told EyeforPharma.com earlier this year: "The most efficient marketers in the future are going to be those who can gather and continuously refine their segmentation approach and ways to contact individual customers. That effectively is closed loop."

Dolgin says it is possible for European pharma marketers to achieve this closed loop. It can be done in Europe, Dolgin says. There are more barriers [compared to the US] but those innovative and dedicated enough to do it have greater competitive advantage.

Pfizer, the worlds biggest pharma company, has declared its belief in the closed loop concept, and is currently developing its own model in the US.

There are a number of companies offering CLM software and expertise, but two of the biggest names are Proscape and Agnitio.

Wyeth was one pioneer of the CLM concept in the UK and published details of its successful deployment in 2007.

The company's sales teams used the software platform from Proscape on Lenovo ThinkPad Tablet PCs in the promotion of 11 brands.

Raj Saujani, senior product manager for Wyeth told last years EyeforPharma Conference: "The results we have achieved to date have exceeded expectations, especially in the critical areas of physician interactions, unaided message recall and cost-savings, adding that Proscapes technology also gave the company a platform for expanding the system in other countries."

Meanwhile Janssen-Cilag Germany recently announced a new pilot project with Agnitio to support their field force.

The company, like its peers, is putting in place a new salesforce structure and wants to test out how CLM can boost performance.

Christian Ruppenthal, leader, health care affairs at the company says: "Today, detailing physicians is not only about pushing your brands. It is about establishing relationships with customers, giving them valuable service offerings surrounding your brand. This requires multi-skilled sales reps, and we believe that with the Agnitio CLM solution, we have chosen a system to support our sales reps in order for them to deliver this kind of service to customers, without compromising our sales goals."

Case Study: TESTIM Market Research

Auxilium Pharmaceuticals is a new company, founded in 1999 to develop and market urology and sexual health products. Their flagship product is TESTIM 1%, a testosterone gel for treatment of low testosterone.

In 2006, Auxilium wanted to quickly gauge doctor response to a promotional campaign for TESTIM. They wanted to test four concepts at a reasonable cost and within a limited time period, to better focus their overall concept testing.

Lathian developed an online marketing survey to test the four promotional concepts on subsets of their target market, including primary care, endocrinologists, and urologists. Auxilium chose Lathian to recruit 150 doctors into an online branding survey about TESTIM.

The information was quantified in two days, recruiting 171 doctors for the online survey, asking 23 questions, including general inquiries into respondents specialty, practice, and specific questions about each brand concept, and ranking the concepts in order of effectiveness.

The programme provided key customer insights to identify a clear-cut winner in terms of what promotional campaign to implement.

John Hosken is principal consultant at Information Advisers and also a qualified business coach.

For more information e-mail: jhosken@hotmail.com or visit: www.john-hosken.com