DTC Environment
Implications of headlines for DTC marketing
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If DTC marketers don't feel that the recent rash of negative headlines (Oxy Cotin maker lied about addiction, J&J and Amgen possibly promoting higher dosing of medications) is going to effect their campaigns then they are living in a fantasy world. These stories are going to continue to chip away at the credibility of pharmaceutical companies to deliver relevant information to patients and cause more consumers to research all treatment options.


The headline in NBC News last night could not have been more dramatic: The maker of Oxicontin lied and has to pay a $600 million fine. The front page of Wednesday's New York Times details how doctors are making a lot of money by prescribing anemia drugs. Welcome to the world of information where everything is transparent. Unfortunately most DTC marketers will continue to live in their own world oblivious to the damage these headlines do to their campaigns. They believe that consumers can be "sold" and that we see something on TV and then go ask our doctor for that medication. Rumor has it that they also believe in the tooth fairy !

These headlines do have implications for DTC marketers regardless of what the polls or research say. With the current political climate, gas reaching $4.00 a gallon and a impending change at the Presidency consumers are going to be even more skeptical of anything that corporate America has to say. Here are some possible implications for marketers;

-Consumers are going to do a hell of a lot more research. They may not trust their physicians recommendations anymore if they believe the physician is motivated by drug industry dollars. Consumers will seek out more health information online with credibility of content being a key driver.

-New Products: Wait and see? Some patients may take a wait and see attitude on new products to ensure that they are indeed safe and effective. However patients may ask the FDA for speedy approval of new products that may extend life for potential fatal conditions such as cancer.

-Separate credible information from promotional information: Don't sell too hard let consumers make up their minds. Present the facts and let consumer be your jury.

-Be transparent: If their are issues surrounding your product admit it upfront and inform the public what YOU are doing to address these issues.

The power continues to shift from markers to consumers and as along as the pharma industry continues to screw up and is driven by corporate greed consumer will become more and more skeptical of marketers product claims.
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I'm a DTC Marketer
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I'm a DTC marketer and proud of the job that I do. There are principles that I live by and maybe it's time for others to think about their own principles before making decisions that could impact the lives of thousands of patients. At some point in everyone's career you are going to have a draw a line in the sand for what you beleive. It could be a matter of getting a paycheck or losing a job but we all have to held accountable to the highest standard; ourselves. Here is a list of the principles which I use everyday in my career as a pharma and health DTC marketer.



My Guiding Principles:


1. The customer is at the center of everything I do: If it doesn't benefit my customer then why do it in an age when consumers have all the power?


2. I believe my job is to educate and inform customers about my brand in a relevant and meaningful way.


3. I will inform my customers about the good and the bad in language they understand. I will try to simply the label language so that they can understand their risks of using my product.


4. When is doubt about conveying information put yourself in your customers shoes and ask "would I want to know if I was using the product".


5. Everything I do I do just like a customer was sitting in my office looking over my shoulder.


6. I will separate the promotional content from factual content.


7. I believe that my product when used correctly can improve the quality of my patients life.


8. I will provide my customers with fair and balanced information and won't try to "sell" them. Customers are too smart for sales and marketing talk.


9. If my patients/customers are concerned than I am concerned and will do my best to let them know what is going on.


10. I will listen to what is being said by my customers and try and use resources at my disposal to provide them with answers that matter.


11. Finally, if I feel that someone is risking my customers health by manipulating or holding back data I will speak up and create waves. I will ensure that everyone in the organization puts themselves in our customers place and asks "what would they want to know". At the end of the day I will not compromise my customers health for financial gain.


We all have to make choices at some point in our careers and I have made the decision that I will not compromise my beliefs or principles. I have worked with marketers who are more interested in shining their own stars than doing what is best for patients but in the end their stars will burn out. DTC marketers need to think about what they WILL and WON'T do in the interest on their customers. At the end of the day it's not about company slogans or marketing positioning statements it's about being held accountable at every level of the organization.

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DTC National: The blind leading the blind
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The DTC National just wrapped up and although I didn't attend it seems that once again it's the same old show with DTC marketers. More case studies, more "we did this" and this was the result. There were some people who tried to make DTC marketers aware that the familiar landscape is changing and changing dramatically but I am sure that most of this fell on deaf ears. DTC marketers haven't yet realized that the power has shifted to consumers and that marketers messages are largely being ignored. Still with TV dying a slow death the media buyers should be thankful that there are so many stupid people in DTC marketing who continue to worship the almighty TV spots
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More and more people are getting used to time shifting thanks to Steve Jobs and Apple. You see time is the new currency and consumer like watching things according to THEIR schedule not the TV Guide. More and more people are using DVR's and of those people most skip commercials (DUH!). Of course DTC marketers continue to pontificate the end of the 60 second spot and wonder what they can do to break through the clutter. Cialis commercials continue to run (yawn) as well as Neulasta (double yawn) and the competitors in the cholesterol category. Marketers continue to analyze the impact of these spots and manipulate data to show outrageous ROI's (400%?) to senior managers who all too often don't understand consumer marketing.

DTC Marketers Still Behind the Mainstream

As more and more premiere marketers, like P&G, allocate more money to the web and less to TV DTC marketers produce really bad DTC spots like Rozerem. I once asked why this was happening but after talking to a number of colleagues in phara marketing I think I have a pretty good idea as to what's going on. Here are the reasons that DTC marketers continue to ignore the web as I see them:

1. They don't understand the Web: The web is a pull channel and marketers just can't get that through their heads. They would rather expose you to TV spots on the website or lengthy videos that take a long time to load even with broadband. If consumers don't like what you say they are gone with a click of the mouse.

2. They don't understand how to measure the impact of online programs: Web analytics are getting more and more sophisticated. They can tell you how people are thinking when they come to your website and what information drives conversion. The key is that you have to have people who are eMarketers not IT people set up these measurement criteria because a basic understanding of consumer behavior is needed.

3. The budget drives the strategy: More and more marketers are spending a lot more online and with the basic laws of supply and demand premium placements on websites is becoming more and more expensive. Media planners don't know how to integrate the Web or measure the impact of online ads or purchased key words.

4. Once the website is launched I'm done: If anyone ever tells you that then you know they are talking from ignorance. As you learn more and more about your customers needs and what information drives conversion you need to continually optimize the website to make it more user friendly and drive business objectives.

5. TV is glamorous: When programs like American Idol are number one you know that TV programming has gone down hill. Lots of money very little ROI.

6. Hire eMarketing people who are passionate about what they do: I'll take a passionate person over a "competent" person any day of the week. I can't tell you the number of basic eMarketing questions I get from people that cause me to ask "what is going on here?".

OK, I've ranted enough but frankly how many more times do DTC marketers need to attend these events and listen with closed ears. Agencies continue to present compelling reasons to move more dollars online but marketers are either too stupid to listen or just don't get it. Maybe there should be a moratorium on DTC marketing so DTC marketers can have a chance to catch up on a consumer drive world that has passed them bye...
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A world without DTC
A bill currently in the house would prohibit pharma companies from doing DTC for three years after a drugs initial approval. But what are the implications of this? Far reaching I'm afraid. DTC advertising drives consumers into physicians to ask about medications and raises awareness of disease conditions that, left untreated, could lead to major health issues. Has the House and Senate thought of these issues? Of course not because it's easier to get on the bandwagon then to approach prescription drug advertising with reason and logic.


If this bill were to become law consumers would be the losers. Rather than learn about new drugs through innovative advertising (of course there is very little of that in DTC today) they would have to rely on their physicians to inform them of choices. They would not be able to research prescription drug choices because they would not be aware that there were in fact choices. Click stream analysis in our industry clearly shows that consumers are comparing medications because they want to have choices when it comes to their healthcare choices. Congress would have us believe that consumer are too dumb to make their own choices and are influenced too much by DTC ads. What a bunch of garbage !

TV networks will also be big losers if this bill becomes law. The only increase in TV advertising has come from the pharma industry. The majority of the billions of dollars spent on DTC is on TV and if a moratorium went into place networks would lose a valuable source of revenue.

Then of course there are the pharma companies. At a time when costs are increasing to develop and bring drugs to market they would essentially be handcuffed from maximizing their ROI for 36 months. That's a big bite out of the revenue pie and one has to wonder if in fact less drugs would go through the pipeline because the ROI model would change.

What will happen? That's anyone guess but like I have said all along the environment for pharma marketing is changing. The pharma industry needs new blood in the DTC marketing departments and more importantly a new leader who can lead the industry into the next era of challenges.
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Good talent is hard to find in eMarketing
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eMarketing is fast becoming a highly demanded position. Good eMarketers, people who understand marketing and the strengths of the Internet, are hard to find. Some pharma companies are putting IT people into eMarketing roles and this is a huge mistake but shows how little these companies understand the Web and its ability to connect with customers.


IT people are great for actually implementing Web initiatives but to develop an integrated online Internet strategy you need someone who understand marketing, the Internet and more importantly Web analytics. Too often I still hear that pharma companies are building websites as an after thought putting all their time and effort into developing DTC strategies and testing and retesting messages. The fact that so little effort is being allocated to the Web tells me that most DTC marketers are still living in the past and don't understand the Webs unique ability to deliver targeted messaging and connect people with each other.

This week I had a chance to go to one of the ED boards on Yahoo! and Web MD. What I found really surprised me..there were men talking about Levitra, Cialis and Viagra. One person said "stay away from Levitra it gave me a really bad back ache and my nose was so stuffy I had to use nasal spray for 2 days". Another talked about Cialis and said "I like the fact that Cialis lasts 36 hours but after I have sex I don't want the drug in my system". There were also numerous posts from women asking how other women got their husbands to go to the doctor and ask for ED medications. Then there were numerous posts asking about the comparison of the side effects between the three medications. What a gold mine of information yet DTC marketers have no idea how to harness the power of consumer generated media and still are not aware that people are talking to one another on the Web.

Given that most pharma companies are matrix organization that require a ton of meetings to do ANYTHING the continued ignorance of the Internet is nothing short of abysmal. Cialis had returned to TV yet their website is stagnant. Levitra, after doing some extensive testing, is also back on the air with the same spots they used before while their website remains as a 'push information" site. Ohhh by the way I love the
video of the old guy on Cialis.com under "talk to your doctor". I am sure a LOT of 40 or 50 somethings can relate to someone who looks to be in his mid to late 70's.

I guess I am one of the exceptions because I have a passion for the Internet and its capabilities. I know that the balance of power has shifted from marketers to consumers in a wired 24/7 world. Maybe there are just too many DTC marketers who see their jobs as jobs rather than a chance to make a difference in patients lives or maybe its because there is no lifeguard on duty in the DTC marketing talent pool.
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Customers don't get respect
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When I first arrived at Lilly to begin my DTC career one of the Directors said to me that we should always act like one of our patients/customers is sitting with us in our cube. I have tried to carry that forward with me in everything I do, but mostly on websites. I learned via research with customers that they want information they can understand and "don't want to be sold" with product expectations that the brand may not be able to deliver to them.


I now work with a target audience consisting mostly of Type-1 diabetics. We uncovered some great information such as..

-Don't try and "sell us" give us the good and bad about your product.

-Physicians know a lot about diabetes but not about the different treatment options.

-Don't compare us with Type-2 diabetics. We can't control whether we get this disease through diet and exercise.

They told us in simple terms "don't sell me", give me the good the bad and let me decide if your product is right for me. It all comes down to a simple concept: respect for your customers. You see in this wired information age people talk to each other via consumer generated media (BLOGS, VLOGS, Chat Rooms, Message Boards) and have a wealth of websites to get information on health choices. Most DTC marketers haven't learned this. They would rather use their websites to over promise and sell rather than treat customers with respect and acknowledge that they have choices and a wealth of knowledge at their fingertips.

This is a major problem with pharma product websites. It seems that in order to do anything online marketers have to justify their dollars via an ROI and if they can't then they don't get the money. That's too bad because that mentality negates corporate slogans like "answers that matter". It should read "answers that matter if you can cut through our promotional messages".

I got into DTC because I believe it empowers people to make better health care choices. I want to treat my customers wit respect because I know they have choices. You only get one chance to make a first impression unfortunately too may DTC marketers are business people first and patient advocates second.
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The times are a changin'
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Marketers spend a lot of money trying to get patients to ask their physician for medications but sometimes physicians will lead patients down another path. Those days maybe coming to an end as patients spend more time online researching health conditions and talking to other patients about therapy choices. In addition many websites now allow patients to rate their physicians which could lead to a change in their health care choices.


Baby-boomers, the biggest demographic segment, are reaching that point in their lives when they are going to start having health problems. The psychographics of this generation is quite different than other segments. They are quite skeptical of "the establishment" having grown up with scandals and war. Now it seems that nothing has changed; we are in another war that is dividing the country and more corporate scandals are in the headlines everyday. How does this translate to the current state of DTC marketing? Many ways...

First, customers are going to be skeptical about your message. They are going to go to your competitors site and talk to others to determine which product is right for them. Second, if their doctor doesn't truly engage them in their health care discussion they may look elsewhere for treatment. Now this is a change ..we have heard before that the "doctor" is in fact the gatekeeper of health treatment recommendations but the landscape is changing. I heard it loud and clear in my research last month with Type 1 diabetics: their doctor is a good choice of information on the disease but not on treatment options.

Why is this happening? Well let's look at from the patients point of view. I asked my research participants "how many actually sit down with their doctor to talk about different treatments or review their current overall health?". The answer was very few. One person in fact said "I'm lucky if I get more than 5 minutes with my doctor I seem to spend more time than that with the nurse". Another said "I came in with a host of questions about my medications and my doctor told me to go to one of the health websites for more information". I knew this was coming but the comments from my research subjects caught me by surprise. I expected this trend to be evolutionary but now it seems that it maybe more revolutionary.

It's tough to be a doctor today. In addition to overhead like staffing the costs of malpractice insurance has skyrocketed with the increased litigation. In order to make a practice profitable physicians have to see as many patients as possible, they just don't have the luxury of spending a lot of time to hear patients concerns anymore. Let's also remember that insurance companies limit what physicians can charge for most medical procedures as well.

I predict that the changing of the guard, the power shift from marketers and physicians, to patients is going to continue and grow faster than we anticipated. Here are some things that DTC marketers can do to meet these challenges:

1. The good and the bad- Patients want to know the good and bad about taking your medication. Be upfront clearly explain the side effects and more importantly what percentage of patients get these side effects. The higher the value equation the more mistrustful your audience is going to be.

2. Connect your patients to each other- People want to talk to other to see what their experiences are like. Experience marketing is about connecting patients to each other so that they get a feel for what it's like to chose your therapy and answer questions that marketers may not have thought of.

3. Move away from mass marketing to mass customization- TV is great for increasing awareness of your brand but once that awareness is at a certain level target specific patient segments with specific messages via the Web using behavioral targeting.

4. Refine the message- As your product moves through the life-cycle refine your message as you identify triggers for treatment. Learn all you can about people who are your customers; "why did they chose your product?", "what advice would they give to others who were searching for treatment choices?"

5. Finally, take off your marketers hat and think like your customers. Understand that there is way too much clutter out there and it's going to be hard to get your message to your audience. Do more with less !

Yes the times are a changing but the problem is that DTC marketing is still relatively in it's infancy. DTC marketers are still learning but the lessons maybe outdated before they are taught.
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Listening to my customers
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This week we conducted two days of qualitative market research to listen to our customers. Although I believe that a lot of marketers spend way too much time and money on market research it's great to get out and listen to our customers to see what's on their minds. What I found was that they are more than willing to share their opinions and insights about diabetes, today's health care environment and the Internet.




Nearly all of the people participating in the focus groups turn to the Internet for health information but they also seem to be frustrated with the "clarity" of that information. All too often they find the information confusing and hard to understand even on sites like Web MD. We also heard that they tend not to trust manufacturers sites because "they will only tell you the good things not the bad". We heard this both days from all our groups. They want to be able to compare products against each other and are very frustrated that they usually have to go to a number of different sites to get that information. Content is king on websites and we heard from a number of people that a lot of the content on product.com websites is hard to understand.


We then did an interesting exercise, we let them design our new website home-page and then they presented the home pages to the other people in the groups. This was enlightening because the Web is about what users want not what marketers want them to see. What was funny was that they quickly switched hats from consumers to marketers saying things like "we want our visitors to go here". One thing became apparent though..I want what I want and if I can't find it on your site I am going to leave and go elsewhere.



Not Happy With Their Doctors


One would think that their physicians would offer advice on medications and or medical devices but we found the opposite. All too often HCP's just gave patients brochures or told them to go to the Web to answer their questions. In fact on woman was as bold to say that "all doctors are whores" when asked about getting health information from their HCP's. Obviously she has had a bad experience with her doctor but people want to talk about their health issues and more importantly talk to each other. This is where the Web can play a big part in bringing people together to share their experiences. Our subjects continually expressed the desire for patient testimonials but only if they were real and not "edited". "I want to know what happens the good and the bad experience" said one person, and the others were quick to agree. The Internet can be that channel to bring these people together but I am sure that the legal and regulatory people are going to have something to say about that. Still I am going to move forward with this goal..I went as far as to invite a person from my legal team to the research and she said that it was "highly enlightening" and that I was right we have to find a way to make it happen for the benefit of our patients. For the benefits of our patients....that to me is what it's all about.
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Building Trust with a skeptical Congress and Public
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Well obviously the New York Times is trying its best to persuade public opinion against pharmaceutical companies. Today on the first page of the Business section the Times has a story titled "Showdown in Congress over DTC". Forget for a moment that the story is one sided and takes a very myopic view of DTC advertising, you would think that because of DTC people are taking medications they don't need and that patients could save real money if only DTC could be reigned in. How many punches does it take before the pharmaceutical industry gets up and starts fighting back?



The pharmaceutical industry is known for doing a wealth of market research and development of messaging before launching branded ads. Why the industry doesn't band together and take this same approach to inform and educate consumers is beyond me. Instead we have the CEO of Merck talking about breakthrough products and Pfizer spots highlighting their R&D at the same time we read about Vioxx litigation and record profits for pharma manufacturers. This approach is about as credible as the oil companies charging us $3.50 for a gallon of gas.


The key question is "does DTC serve a public purpose?". The answer to that according to research is YES. Most of us want to have choices in our healthcare, including prescription drugs we put into our bodies. We want to be able to maximize the limited time we spend with our doctors asking educated and informed questions. DTC advertising can help make more people aware that certain conditions, if left untreated, can lead to a decreased quality of life not to mention adding a financial burden to our healthcare system. How many people have statins saved from coronary heart disease? How many people have beat cancer thanks to early detection influenced by advertising? These are all questions that need to be addressed when the government looks to reign in DTC.


ACTION PLAN

Here is what I believe needs to be done to address the skeptics in Congress and take a proactive approach to DTC enforcement;


1. Moratorium- Have a 120 day moratorium on DTC advertising for newly approved prescription medications. This would give pharmaceutical companies a chance to educate and inform HCP's about the new drug in preparation for a "hard launch". However, if a product is truly a breakthrough and could save lives than pharma should be allowed to ask for an "exception" and start DTC when the drug is approved and the spots have been approved by the FDA.


2. FDA Adds Staff- The FDA needs to add people to review all DTC advertising, especially people who are familiar with the Internet and message development.


3. Continued Research- The FDA needs to continue to sponsor ongoing market research to determine the effects of DTC on the public, including pharma-economics. This research plan needs to have buy in from skeptics in Congress so that they can quantify the effect of DTC on our healthcare costs.


4. Pharma Needs to Build Trust- Start from square one and build trust with a skeptical public and media. Invite reporters in to observe the DTC process and compliance training. Educate the public on how much it costs to develop a new drug and how many actually make it to market. Show the numbers of how many people are living a higher quality of life due to prescription mediations.


5. Allocate more money to disease awareness- The more people we can educate on early signs and dangers of certain conditions the more the industry can benefit.


6. Work closer with physicians on DTC -Yes, that's right ask for physicians input when developing DTC spots. Share research with them on what consumers and patients are saying about branded ads. Believe it or not physicians want to know more about their patients behavior and attitudes when it comes to healthcare choices.


Only when the industry bands together for the good of its patients will they be able to take that first step towards building trust with a skeptical public and media. We have a long way to go but sometimes the first step is the hardest.

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If Monet worked in pharma
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The DTC Marketing environment is quite unique in today's matrix pharmaceutical organization. So what would Claude Monet have had to do in order to paint one of his masterpieces if he worked in pharma? Well read on it's not pretty but it's what a lot of DTC marketing people go through when they launch campaigns.




Well let's see before he could start painting he would have to spend time with market research to determine if the scene he planned to paint resonates with his target audience. Then they would take a picture of the scene and do some qualitative research to determine which one communicates the feeling behind the image more clearly. Now that Claude has gone through that he is ready to paint right? Not so fast...what size canvas should he use? Ooooops gotta go back and do some more market research to determine which size canvas has the right look and feel with our audience.


Well now after 3 or months of research Claude is ready to settle down and finally paint. He begins to paint the beautiful scene before him but as he is painting the manager who is funding the painting tells him that there is too much green and can we get some new talent to replace some of the colors. Well Claude is getting upset now and tells the manager that this is art but the manage says that research has consistently shown that people like pink in paintings so we need more pink.


The painting is completed and Claude finally shows it to the team upon which the market research person says "OK lets do some more qual to see if it talks to our audience". So the painting is shown to focus groups around the country and they give some input.."Hmmm one person says..I really like blue and there is no blue in the picture". A week later the DTC manager communicates to management that the research went well although there was a consensus that more blue is needed (she likes blue as well). So they send Claude back to the studio and tell him to add more blue.


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Finally after months of touching up the painting they are finally ready to show to millions of people. The picture is aired on TV to huge crowds and everyone likes it but after showing the beautiful painting for a while IMS has shown that the orders have not increased for Monet paintings?


"Oh our objective was awareness of colored Monet paintings not to sell any" the DTC manager states . "If we want to sell them than I need more money for a bigger painting on another TV special".


So Claude is informed that he has to go through the whole process again and develop some more paintings. Claude is naturally upset, "this is art not science" upon which the DTC manager responds.."hmmm interesting let's research that in our next qual group" !






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Why I love working in DTC marketing
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Another year is about to enter the books as history and I believe that that that the future of DTC advertising is needed more now than ever. I believe that there is value in DTC advertising. It allows me to make better and more informed choices when it comes to my healthcare so that I don't always have to rely on my physician. I can work with her to chose the medication that I believe will be best for me.



I love the challenge of DTC marketing in an era when more and more boomers are reaching ages when they are going to require more Rx's to help them maintain a better quality of life. Even when I was marketing Cialis I believe, as I still do, that it's the best treatment for ED on the market. Although lifestyle drugs have gotten somewhat a bad rap in the press they play a role in bringing people closer together. I remember ,during some qualitative research with women (partners of ED suffers), how one person in particular made me realize the importance of what we do. Her husband had ED due to diabetes and they had not had intimate relations for over a year. After dealing with some internal issues (i.e. "it's my fault") she finally talked him into going to see their doctor and ask for Viagra. She planned a special weekend away and rented a cabin in the woods and had arranged for relatives to take care of their children. When her husband came back from the doctor he came back empty handed because he was too embarrassed to ask their physician for an Rx for Viagra. When she told this story there was pain in her voice and you could clearly see that the lack of intimacy was having an effect on her and their marriage. That is when I learned that ED is not just a mans condition but a couples condition and I wanted to do as much as possible to reach these people to try and communicate this along with steps they could take to address this issue together.



DTC marketing at its best can provide answers to both the physical and emotional aspects of health problems. At its worst it can be intrusive and overly promotional but I believe that most DTC marketers can find that balance. DTC marketers have to believe in what they do and what they are selling. You can't take someone who used to work for Coke and put them in a DTC marketing position and expect them to excel, at least that is what I believe. When you ask yourself "what am I selling?" the answer should always be "hope and health". We're not selling purple pills or blue tablets..we're selling a better quality of life and that is what America's pharmaceutical companies need to communicate to the public.



There will be no doubt that changes are in store for DTC as we approach another year. We have a new head of the FDA who must take an agency under siege and prioritize issues facing the public with a newly elected skeptical Congress and House. Vioxx litigation continues in the news and the recent series of story on Lilly's Zyprexa are all sure to keep the media spotlight on the pharmaceutical industry. Maybe I am an idealist but I will continue to believe that DTC marketing is an essential strategy for reaching consumers. I will continue to develop DTC programs that provides answers and as I develop and implement these program I will do so just as if my patients were looking over my shoulder because in the end it's all about them not us..
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