A smiling, vibrantly healthy couple gambols through a field of daisies. A young-looking grandmother helps a little boy sail his boat on a sunlit pond. Handsome members of a multi-generation family bustle about, setting a striking wooden table, which sits in a meadow and rapidly fills with steaming platters and smiling guests. Then, incongruently, an authoritative male voice intones: Ask your doctor if Vertigru is right for you.

What? What’s Vertigru? Or Multimax or Xylolax, or whatever prescription drug is linked with the happy images? It’s enough to make the most somber television viewer giggle.

What would the reception be if anyone actually made the call? “I’m Mrs. Snidely,” a caller would have to say. “I’m Doctor Harris’ patient and I want to know if Vertigru is right for me. No, I have no idea what Vertigru is. No, I’m not sick. But I saw an ad on TV, and was told to ask.” Just how many of these calls could Mrs. Snidely make before being permanently dropped from Dr. Harris’ patient rolls?

What’s going on here anyway? Why do pharmaceuticals spend billions to slot these mysterious ads in prime time?

Lynn Benzing, president of 15-year-old Forrestal Village-based Patient Marketing Group, a pharmaceutical marketing agency, has the answer. Her agency specializes in direct-to-patient educational marketing as opposed to direct-to-consumer ads for television or print. The latter, she explains, is awareness advertising, casting a wide net for potential patients. While her agency does sometimes use mass market ads to pull in patients for its campaigns, most of its efforts go toward providing educational materials for people who have identified themselves as patients with a specific condition, using a specific brand name drug. And it’s prospering because of the same constraints that make many a televised prescription drug advertisement more puzzle than pitch. “Our time has come,” says Benzing, who speaks on Tuesday, September 25 at the Marriott Forrestal . Here’s why.

“Television advertising has to proceed with caution,” she says. “In 2005 the pharmaceutical industry adopted a voluntary set of guidelines.” Under the guidelines, set by trade group PhRMA (www.phrma.org), prescription drug ads on television that mention both a medical condition and the name of a drug should disclose all of the possible side effects of the drug. “It’s difficult to do that in a 30-second or 60-second commercial,” says Benzing. That is why some spots contain only the merest, nearly impossible to de-code, hints of medical issues.

While it can be challenging for pharmaceutical manufacturers to create full-featured TV ads for their mature products, it’s even worse for their newest offerings. The guidelines suggest that they sit on their hands when a new drug, the result of years of research and hundreds of millions of dollars worth of development efforts, finally receives FDA approval and hits the market. The PhRMA guidelines, says Benzing, suggest that “when a brand is launched, they have to give it a year before marketing to consumers.” That period of time allows for any unsuspected side effects to surface, she says, and means that, in most cases, no mass market ads can alert potential users that it is available.

Before 1997 the pharmaceutical industry was prohibited by law from aiming any advertising directly at consumers. When that stricture was lifted, advertising soared, with expenditures in the category now reaching some $4 billion a year.

Then came Vioxx. The anti-inflammatory drug, prescribed to treat the pain of arthritis, was heavily promoted to consumers by its manufacturer, Merck. When the drug was found to cause heart attacks in some patients and pulled off the market, criticism of direct-to-consumer drug marketing became intense. The industry decided that it had to do something to stave off mandatory federal regulation of its direct-to-consumer advertising practices, practices that are illegal in every industrialized country except New Zealand. The result was PhRMA’s voluntary guidelines, which, says Benzing, some “brands comply with, and others don’t. Individual brands decide for themselves.” But the guidelines have not ended vociferous criticism of what some groups condemn as little more than legal drug peddling.

Last spring Commercial Alert (www.commercialalert.org) and the National Women’s Health Network (www.womenshealthnetwork.org) sent out a press release naming 39 medical, health, and seniors’ organizations that are urging Congress to stop the advertising of prescription drugs to consumers. An April, 2005, article in the Washington Post revealed that, in a recent study, actors walked into doctors’ offices showing symptoms of stress and fatigue. The actors who mentioned Paxil were five times more likely to leave with prescriptions than were those who did not mention a drug by name.

Another concern, and one that is linked to over-prescribing when a brand name is mentioned, is that consumers may become enamored of a drug after seeing it touted on television, but may not be aware of all of the dangers that might be associated with taking that drug.

So, the pressure is on. Pharmaceutical manufacturers, which need approval from the FDA, are agreeing to be at least somewhat subdued about singing the praises of their prescription drugs, and at the same time are worrying that the federal government may impose even tighter strictures.

In seeking ways to communicate with customers, the pharmas are — more and more — coming to the Patient Marketing Group, and to agencies like it. “Pharmaceuticals need new ways to connect with patients,” says Benzing. “A lot of activity is gravitating to direct-to-patient. We create a connection that is stronger than with an ad, and more effective. Our niche is very much in demand.”

That niche involves what Benzing terms “tailored” marketing, directed at individuals at various stages of a particular chronic disease. The educational marketing, which generally bears the name of the drug sponsoring it, may be in the form of an interactive website, a phone call, a consultation with a dietitian, a brochure, or a piece of direct mail. It may offer guidance on coping with therapy, inspiration from others who suffer from the same condition, or concrete advice on meal planning and exercise.

The marketing firm, which was founded in 1991 and which Benzing was recruited to “take to the next level” in 2002, has in-house capability to handle every part of patient-marketing campaigns. It was launched in Pennington by John Eichert as Hastings Healthcare Group, and at one point it included Eduneering, now a 65-person firm at the Carnegie Center.

Currently Patient Marketing Group is privately owned by out-of-town investment bankers Benzing will not identify. It has “between 50 and 100 employees, consultants, and freelancers,” Benzing says, declining to nail down the number, but saying that the company has had “triple digit growth in revenue” since 2002. The company is profitable and is in hiring mode.

Patient Marketing Group, smaller than the mega-worldwide ad agencies which handle many pharma campaigns, is able to be flexible, says Benzing, yet can offer all of the services a client needs.

“We have full vertical integration,” says Benzing. “We have a HIPAA-compliant call center, a creative group, an implementation group, a technical group, and a production center. We design programs, write copy, set up phone facilities, create the software to run programs, implement programs, and manage programs in-house.” If there is a rush, her company can print brochures on-site. Within the past year it has expanded its dietitian hot line and has opened a dedicated on-site focus room facility, which, she says, is the only one in the Princeton area.

In a campaign for Nexium, the acid reflux medication from AstraZeneca, Patient Marketing Group has contributed a meal planning tool to a deep website that leads potential patients through symptoms of the condition with the help of a virtual doctor. Sites like this, says Benzing, are really hybrids, part direct-to-consumer advertising, and part direct-to-patient marketing. This is true of most Internet sites that the pharmaceutical manufacturers put up because in cyberspace it is generally impossible to know who will drop in.

Nexium’s site, full of purple, as in “the purple pill,” a color it is using nearly as well as UPS is using brown, contains a number of tools, all designed to either reel in a new customer or to keep a relationship with a customer going. There is a sleep tracker, which asks about how — and how often — sleep is interrupted by heartburn. If patients report that, indeed, they sometimes are awakened by symptoms, they are told that 72 percent of sufferers take medication for relief. If, in response to another question, they say that they are taking an over-the-counter drug for the condition, the virtual doctor suggests that they talk with doctor and ask if Nexium is right for them.

The section that Benzing’s company designed offers helpful advice for those suffering from heartburn. It asks how many calories a day the visitor wants to consume, what his heartburn triggers are, and whether he wants to adhere to a low-carb, heart healthy, veggie delight, quick and easy, or chef’s choice menu. Choose quick and easy, and a menu of dishes appears. The visitor can put them in descending order, based on cholesterol, carbohydrates, sodium, or calories with just a quick click of the mouse. He is given recipes and cooking instructions for each selection, along with complete nutritional information.

Benzing emphasizes that information like this encourages compliance with treatment, and thereby improves treatment outcomes. She acknowledges that it also has the potential to create brand loyalty.

The website includes a printable coupon for a seven-day supply of Nexium, and a reminder to refill prescriptions.

For Zyprexa, an Eli Lilly drug to treat schizophrenia, the Patient Marketing Group designed and implemented a six-month program to deliver “ongoing, tailored messages based on individual responses to surveys.” The goals of this campaign are to manage side effects of therapy, improve compliance, establish the brand as a category leader, and enhance the company’s reputation as a patient service provider.

The Patient Marketing Group did not design the Zyprexa website, but uses it as one point of communication with patients who sign up, generally through their doctors, for help in managing their condition. The tone of the Zyprexa website is suitably subdued — it uses a lot of browns and tans, and depicts patients running away from the camera and toward a hill rather than grinning at one another — and much of it is aimed at physicians. There is, however, advice for patients and for caregivers.

In addition to the website, the Patient Marketing Group uses phone calls and video to reach out to patients taking Zyprexa and to offer support and lifestyle advice.

Pharmaceutical marketing, whether direct-to-patient or direct-to-consumer, changes by the minute. “You have to match communication channels to the individual,” says Benzing. “There’s a lot going on in the Internet — live video, techniques within the Internet. There’s a push toward hand held.” Most demographic groups are now on the Internet to some degree, and pharmaceutical manufacturers have to use the medium, but she says, with emphasis, that the Internet is never enough. “Online became the big thing, but it’s about being multi-faceted.”

It’s also about knowing what customers — patients, in most of the campaigns Benzing oversees — are thinking. Thanks to chat rooms and blogs, which her company monitors, but does not use, in part because of the industry’s regulated status, “it’s easier than ever to monitor what’s going on in the public mentality,” she says. But sometimes great insights can be had in a real, rather than virtual, space. Benzing says that her shop uses focus groups extensively.

She recalls one made up of post-menopausal women. While “how to talk to your doctor” articles are rampant in magazines and on websites, Benzing enjoys recounting how her feisty focus group confirmed her own suspicion that they are silly. “These women got on a rant,” she says. “‘What’s with these people? I’ve been talking to my doctor for 30 years. I think I know how to talk to him!’” was the indignant gist of the discussion.

While this group may have quashed any plans to include this information in a campaign, it also typifies an evolution that is radically changing marketing. “People are smarter than it is assumed that they are,” Benzing says. “You can’t be condescending. It’s a different time. Medicine needs to be practiced in a more collaborative way. Know, or you miss the mark. Qualitative research (like focus groups) helps you get a handle on it. You delve into drivers and needs and concerns.”

Benzing’s own career drivers are smart and arrow straight. She grew up outside of Detroit, where her father worked in the automotive industry and her mother was a banker. “I’m a natural business strategist,” she says. “When I was 12 year old, I bought myself a subscription to U.S. News and World Report.” An “inherent entrepreneur,” she says that she also has “

a love of creativity.” She combined the two traits to pay for her

education when she formed a business that created newsletters for physicians.

A number of her friends, recent medical school graduates, were stressing over finding clients, so she photographed them, wrote descriptions of their specialties, bought mailing lists, and made brochures inviting prospective patients to talks the young doctors would give. The strategy worked so well that she soon had clients in five states and had paid for her business degree from the University of Michigan (Class of 1980).

While recognizing a demand and filling it got her started in a healthcare marketing career, a family crisis cemented her choice. “When I was 21, my father had a massive heart attack,” she says. “He was only 47. He wasn’t overweight. He wasn’t a smoker. He was playing racquet ball when it happened.” It turns out that her

father had high cholesterol, and didn’t know it. “He had open heart surgery, which was rare then,” she says. “He nearly died. It had a big effect on the whole family.”

An interest in providing the lifestyle information that can get people to see their doctors for check-ups, avoid risky behaviors, eat right, and exercise came out of her father’s heart attack. She takes pride in incorporating these elements into her marketing campaigns and seeing that they make a difference in patients’ outcomes.

She has built her career up to its current level, where she runs a firm that creates campaigns for top pharmaceutical manufacturers, by methodically getting to know each rung in the health care ladder. She has worked as a hospital administrator and as the group leader of a three-office medical practice. She has worked on the professional side, marketing to doctors and, on the consumer side, to patients.

Benzing earned a degree in health law from the Loyola University of Chicago (Class of 1990). She worked in marketing technologies to a number of industries, including the pharmaceutical industry, for R.R. Donnelly in Chicago, where her job involved quick turnaround trips to the Princeton area. “I would leave on a 6 a.m. flight and return on a 6 p.m. flight,” she says. “Those were long days.”

Moving closer to her client base of big pharmaceutical companies, Benzing took a job at the Princeton office of McKesson, where she learned pharmaceutical product distribution.

“This job is a culmination,” she says of her position at the Patient Marketing Group. Among its perks is the location of the company’s offices. Now a relative stranger at airline counters, she revels in short drives to see many clients, and quick train trips to see others. “We feel we’re in the heart of the pharmaceutical corridor,” she says. “Princeton is ideal. There’s so much brain power.” She likes the ease of recruitment and the access to experts that being in Princeton brings, and adds that “there are nice ethnic restaurants in which to entertain clients.”

While she is in a pharma sweet spot, geographically speaking, she is also in a pharma sweet spot in terms of business trends. With prescription drug television ads, radio spots, and spreads in women’s magazines under increasing scrutiny, she is able to offer a jittery industry all of the tools it needs to turn people suffering from chronic illnesses, and looking for information and help, into life-long customers — and she doesn’t have to do it in 60 seconds or less.

Patient Marketing Group Inc., 155 Village Boulevard, Suite 200, Princeton 08540; 609-779-6200; fax, 609-779-6201. Lynn Benzing, president. Home page: www.

patientmarketing.com.

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