Take-off for e-detailing?

pharmafile | October 24, 2003 | Feature | Sales and Marketing |  e-detailing 

It started last autumn with a complaint. An anonymous GP protested to the ABPI's Prescription Medicines Code of Practice Authority about an e-detail for GlaxoSmithKline's Avandia. Then, earlier this year, the PM Society rewarded the e-detailing of Novartis' Diovan with its Geoff Brook Award for Innovation. Two events, but both indicate, for different reasons, that e-detailing in the UK is beginning to find its feet in the mainstream pharma marketing world.

A complaint, which led to several breaches of the Code of Practice being ruled, might not seem cause for celebration but it does show the medium is having an effect. It is also an indication that e-detailing should be viewed alongside field-based sales representatives, journal advertising, promotional literature and all the other components of the marketing mix that are regularly referred to the industry's self-regulation board.

Indeed, a solitary complaint could be judged a success in the context of the amount of e-detailing pilots that have been and continue to be conducted. As with other such complaints it focuses the minds of the industry on how best to use e-detailing as a marketing tool.

E-what?

Electronic detailing is traditionally used to refer to a wide range of on-line or electronic promotional activities. Sometimes these are carried out with the rep and doctor in the same place, sometimes with the rep talking to the doctor by phone while the doctor looks at the e-detail and sometimes the doctor views the e-detail independently of the sales rep altogether.

The promise of e-detailing tends to be that it will be cheaper and more effective than using traditional field-based sales representatives. There is a greater potential for targeting particular segments of the doctor population and therefore companies can better design their fleet of detailing materials for maximum effect. Moreover, it can provide a 24/7, open-all-hours accessibility and convenience – allowing e-details to be viewed by doctors at home when their working day ends – that field-based reps cannot compete with.

Andy Sarfas, Head of E-business Development at Crookes Healthcare, sees e-detailing as a tool with the potential to be very useful in getting at a specific subset of healthcare professionals. "A lot of our products are aimed at a specific area, such as dermatology, and there are a limited number of experts in the field. So this is potentially a very good route to get high quality information to those people," he says.

Why that flight path?

The pressure on pharma to change the direction of its marketing has been building up since the dawn of the new millennium. The industry has been stung by a series of patent expiries and there are fewer new products coming to market to generate similar revenue levels. The number of new drugs submitted to the EMEA for approval last year fell to 31, down from 58 in 2001 and 54 in 2000. A similar drop was seen in the US where the FDA approved just 16 drugs in 2002, down from a record high of 53 in 1996.

Sales of those products already on the market, while not necessarily falling, have failed to keep up with investment in field-based sales representatives. For years there has been a strict correlation between field force size and product sales. It didn't matter what the therapy area was, how it fitted into the overall product portfolio or where the reps were operating; the more reps you ran, the more sales you made. Now, the industry is seeing the cost-effectiveness of its existing reps fall and that adding new reps brings fewer returns than before. The top 40 pharma companies have doubled the size of their salesforces in the last five years but prescribing has only increased by 15%.

Added to this, doctors have less time to spend with reps. In the US, doctors have already reached the point of what Cap Gemini Ernst & Young call 'time saturation', with UK and European doctors predicted to soon follow suit. There are, after all, only so many hours in the day and only so many reps that doctors can possibly see  let alone want to – and still get their work done.

Dr Amir Hannan, Information Management and Technology Lead for Tameside and Glossop PCT and e-learning GP 'expert' for the North West, is in favour of the medium. "It's short but detailed," he says, "as opposed to a rep who could talk a lot but not impart much information and I really like the idea of being able to look at information at my pace, and potentially be able to store it, review it and forward it to others as I see fit."

As with most things of an IT nature, pharma lags behind other industries with regards to e-business in general and UK and European pharma tends to lag behind the US. In an industry more used to 10 to 15 year timelines in product development, immediate change often seems as likely as carrying off a handbrake turn in an oil tanker.

The US lifts off

So far, the US has been at the forefront of e-detailing. This has been due to greater uptake of technology among healthcare professionals, the very different regulatory environment and the fact that, as the worlds biggest single pharmaceutical market, it presents the prime location for any new marketing initiative. However, these very factors mean that US successes with e-detailing don't directly translate to this side of the pond.

"The US market is so different that it is very difficult to draw any meaningful comparisons," says Andy Sarfas. "I know there is an awful lot of activity going off in the States on e-detailing but it doesn't cut any weight over here I'm afraid."

Nevertheless, the outcomes from the US are encouraging. Baxter Bioscience recently completed a number of small-scale pilot studies, which it found to be very positive. "We had a really good experience of e-detailing in the sense that in one of the pilots we had about 27% of the doctors that were reached and actually responded were doctors that would not have seen a sales rep," says Brian Bertha, VP, Strategy and Ebusiness at Baxter Bioscience.

The method will likely need to be proved all over again in Europe, with all its different operating environments, before companies here are convinced.

UK and European countdown

Last year, most of the big pharma companies were trialling e-detailing initiatives in Europe and anecdotal evidence strongly suggests that the number of pilots is now rising across the board. The UK, along with Germany, is at the forefront of European e-detailing.

This has come after about two years of people thinking that e-detailing sounded like a nice idea but not a pressing business need. Now, within the last nine months to a year, more and more companies are approaching technology vendors seriously prepared to look at e-detailing.

The important thing, according to Dr Amir Hannan, is whether the information being provided through an e-detail is relevant. "My feeling about e-detailing, or for that matter seeing a rep, is that they are able to highlight things that a busy clinician might not otherwise have time to sit and read through or come across," he says. "There is a lot more opportunity, given the medium, to be creative and not just copy the details that reps already have. If its stimulating and interesting from my perspective I'm more likely to open it up," he adds.

A number of companies, having conducted small pilots in Europe and the UK, are now moving onto the next stage and rolling out initiatives over several different brands and geographical areas. But as to who is doing what – at the moment its all in the realm of confidentiality and non-disclosure agreements. However, companies such as Aventis, Novartis and Pfizer are understood to be among those to have invested heavily in e-detailing programmes.

Down to earth

As a new marketing medium for the industry there may be some disquiet as to how it should fit within the ABPI's Code of Practice. I joke that it is a good thing for complaints to be made, because it proves that e-detailing is being taken as seriously as other promotional means, but in reality no one wants to defend themselves from such complaints if it can be avoided.

The underlying law on which the Code is based doesn't actually refer to electronic advertising or the Internet as such, which plants a seed of confusion in some people's minds. However, the European directive and UK regulations that are the basis for the Code apply to advertising, whatever format it is in. Indeed, the Code of Practice was this year updated with a special clause to cover the Internet in pharmaceutical marketing.

Essentially, the Code of Practice in its entirety applies to all advertising, whether in an electronic, verbal or hard copy format. It therefore doesn't matter how information is presented – any claims made must be capable of being substantiated – so the fact that something is being e-detailed doesn't drastically change anything.

The PMCPA, which has had a number of enquiries form pharma companies in this area, suggests going through an electronic detail and checking it as if it were a hard copy detail.

Returns

Where is the return on my investment? Its always a tricky issue in marketing, but calculating RoI in any e-business initiative is particularly difficult given the newness of the medium and the consequent scarcity of data.

A lot of the available measurements have been 'soft' ones – qualitative rather than quantitative data  that don't look at the bottom line of why pharma should use e-detailing. Andre Bates, Founder and Managing Director of pharma consultants MedNetMedia explains: "People tend to look at increasing the length of the detail or increasing the effectiveness of the detail, which are well and good, but they also need to look at increasing the number of prescriptions and potentially decreasing salesforce costs as well."

Returns may also depend on where in its lifecycle a product is. "E-detailing seems to be better for products at launch and products that are very mature and at the end of their lifecycle," says Andre Bates. Given the range of variables, therefore, there seems to be no quick answer to e-detailing RoI. But as Brian Bertha points out: "There is always a lack of hard data with advertising."

E-detailing in the marketing mix

Whatever its future, no one, not even the technology vendors, expects e-detailing to take over from visits by traditional sales reps. The advantages of face-to-face selling are simply too great and doctors, like anyone else, tend to buy from people. They like the contact and interaction they get with visits by good reps and the chance to go over things as they occur to them that might not be on the detailing script. But given that things need to change in pharmaceutical marketing, e-detailing could be an important supplemental practice, adding something to the overall marketing mix and strengthening the hand of sales reps.

Dr Amir Hannan likens it to the contents page of a text book, with its summaries of the issues that can then be discussed as necessary with a sales rep. "It has advantages and there is a place for it," he says, "which is different to that that reps give. But I wouldn't go so far as saying its instead of reps – it supports what reps do."

Andy Sarfas agrees: "E-detailing will never replace face-to-face but I think it can be an important supplementary tool. Effectively it allows you to put your best representative in front of a much wider group of people."

The e-detailing space ahead

E-detailing is predicted to emerge as a core component of the marketing mix by 2006. Early adopters can look forward to knowing what to do, what will work and how to use it when the time comes to roll out large-scale, country-wide schemes.

The lack of publicly available hard evidence is prompting some companies to adopt a wait-and-see approach. Andy Sarfas says: "We looked at using e-detailing about six months ago and the main barrier was the lack of hard evidence of successful e-detailing in the UK. It's very difficult to get a handle on how many healthcare professionals can actually access the system and how many would access the system." But he is optimistic for the future. "If doctors can access information on demand through a system that delivers then I think we'll see an explosion [in e-detailing use]."

The industry is currently negotiating an impasse worthy of the chicken and the egg. Investments in e-detailing are held up until its efficacy can be proved, but efficacy can not be proved until the medium is tested, which requires investment. Positive results are coming from the US, but they are no match for trialling in your own market and making it work on your terms, and that requires considerable thought on what you want to do with it.

Perhaps it is still true that 'no one ever got fired for choosing IBM', but in a changing business environment it will soon be more than just the innovators that need to stick their necks out and try something new. Code of Practice complaints are always a possibility for any marketing effort and you might instead be rewarded for your efforts.