Pharmaceutical marketing and the internet

Pharmaceutical companies are capitalising on the advent of the internet and the development of new media forms to promote their products. Electronic detailing, interactive websites, email prompts and viral marketing campaigns using social networking sites such as YouTube, MySpace and Facebook are among the tools being used. Such campaigns are targeting both health professionals and the general public. The internet is helping to globalise and to change the nature of pharmaceutical marketing, and thus raises some new challenges for regulators.

The internet and related technologies have revolutionised many aspects of society. For the pharmaceutical industry, as for other sectors, this has brought new marketing opportunities. The internet can greatly expand a company's reach. For example, a popular video on You Tube may potentially be seen by thousands of people. Perhaps more importantly, internet-based technologies are enabling new styles of communication between the industry and its targets, including more interactive and customer-responsive campaigns. Consultancies have been established and books written¹to help the pharmaceutical industry develop internet-based marketing.

In the context of drug promotion, detailing has traditionally involved face-to-face contact between a visiting sales representative and a health professional. However, drug companies, especially in North America and Europe, are increasingly turning to electronic detailing or e-detailing for help in marketing their products. E-detailing includes diverse strategies, such as videoconferencing, the provision of electronic education modules, and the use of email and related technologies as prompts and to promote two-way communications. It has been used for disease-awareness campaigns, and for ‘customer relationship management’.

Presentations to a pharmaceutical marketing conference in Europe suggest that e-detailing is not popular with all doctors.²However, it is cheaper than traditional sales representatives and can result in a significant return on investment through increased sales. Some companies are providing financial incentives for doctors to participate in e-detailing, such as honoraria, product samples, practice tools, and patient education resources.³In Poland, for example, Sanofi-Aventis lent physicians internet-connected hand-held devices which were loaded with clinical support information, drug indexes, abstracts of clinical studies, information from key opinion leaders, and advertising and educational materials. In exchange, the doctors participated in a clinical trial of a Sanofi-Aventis drug and entered anonymous patient data into the device. The company aimed to build relationships with the doctors, to use the device as an advertising medium, and to gather feedback. The company also reported that these doctors then prescribed more of its diabetes products.³

An important aspect of e-detailing is that it enables ‘predictive marketing’. This means that companies can be more effective and timely in eliciting feedback from prescribers in order to tailor marketing strategies to their individual preferences and needs.⁴

The global reach of the internet means that Australians now have easy access to overseas blogs and websites promoting prescription medicines and other products, and even selling them. Safety concerns have been raised about the purchase of prescription, non-prescription and complementary medicines over the internet.^5,6

Companies are also using blogs and websites to develop customer relationships. As GlaxoSmithKline says on its corporate blog in the USA for a weight loss product (http://alliconnect.com), ‘it's a place for you to have a conversation with us about weight loss issues’. Such ‘conversations’ may enable companies to gather patient stories and feedback for use in positioning their products. The discussions are not only mined for information (http://pharmamkting.blogspot.com), but also ensure the repetition of marketing messages. Sometimes companies use multiple websites to promote their products and issues to different market segments. For example, GlaxoSmithKline also promotes weight loss issues at www.questioneverything.com

Websites are also used for patient support programs and education although it is not always clear from the website name who is behind it. In the USA, Pfizer runs such a program (www.get-quit.com) for varenicline users, providing regular emails and other prompts such as a personalised web page to support their product use. In Australia, the company's advertising and marketing campaign is backed by a consumer website (www.outsmartcigarettes.com.au) that includes prompts for questions to ask doctors. Meanwhile, a Wyeth Consumer Health Care website (www.caltrate.com.au) sounds the alarm on osteoporosis and encourages people to see a doctor if they answer yes to any questions on a ‘one minute risk test’, including the question ‘have either of your parents broken a hip after a minor bump or fall?’.

Company websites can link to other sites that may not meet regulatory requirements. GlaxoSmithKline's Australian website raising consumer awareness of genital herpes and treatment issues (www.thefacts.com.au) links to the Australian Herpes Management Forum but advises that external links such as this ‘may not comply with the Australian regulatory environment’. The Forum, whose board comprises prominent physicians, aims ‘to improve the awareness, understanding, management and control of herpes virus infections in Australia’, and is sponsored primarily by pharmaceutical and diagnostic companies.

Pharmaceutical companies are not alone in using the internet to market products and to conduct awareness-raising campaigns that may affect patients’ interactions with doctors. The complementary medicines company Blackmores, for example, has a sophisticated website (www.blackmores.com.au), while Nescaf- has launched a website (www.nescafe.com.au/hcp password: Coffee) supported by advertising in the medical press which promotes coffee as an agent that may help lower the risk of developing type 2 diabetes.

Social networking sites such as You Tube and Facebook have been successfully exploited by many consumer product companies for viral marketing campaigns. These campaigns are so named because the transmission of a marketing message through the networks is seen as analogous to the spread of a viral infection in a population.

It can be extremely difficult to identify who is responsible for content spread through such networks, and it is not clear how widely the pharmaceutical industry is using them. A recent search for ‘Champix’ on You Tube (accessed 12 November 2008) identified 46 videos, many of which appeared to be of ordinary viewers describing their experiences with varenicline. It was unclear whether any of these videos were commercially generated. However, the first one identified by the search (http://au.youtube.com/watch?v=Vx7baviT1DQ) linked to a website whose name suggests it is an individual's personal site (http://www.kims-website.info), although it appears in fact to be a commercial site. On the other hand, such networks are also being used for public health purposes, including promoting messages about the quality use of medicines. You Tube also includes, for example, a US Food and Drug Administration (FDA) video discussing potential adverse effects of varenicline.⁷

Even when listings are clearly commercials, as with a bizarre video on You Tube promoting a new medicine for insomnia, ramelteon, it is not necessarily clear who is responsible for posting them. The video features an insomniac chatting with Abraham Lincoln and a talking beaver over a chess board. These characters also appear in a direct-to-consumer television advertising campaign in the USA. The video was submitted to You Tube in 2006 by ‘lewisusauk’, who said: ‘New Rozerem Ad Campaign. Possibly the best prescription drug ad since the FDA relaxed the rules on drug advertising’. According to a pharmaceutical marketing blog by John Mack (http://pharmamkting.blogspot.com), lewisusauk is a ‘sock puppet - a false identity through which a member of an internet community speaks while pretending not to, like a puppeteer manipulating a hand puppet’.

Apart from disseminating company-generated content, social networking sites also offer opportunities for companies to insert themselves anonymously into conversations between site users through postings and comments on blogs. John Mack says some of the postings about the ramelteon video on You Tube smack of this practice, and ‘are attempting to hijack the conversation by submitting commercial messages (that is advertisements) disguised as genuine comments from ordinary citizens’.

Meanwhile, in the Netherlands, an industry-driven campaign conducted via Hyves (a Dutch equivalent of Facebook) gathered more than 80 000 signatures in only three weeks for a petition aimed at influencing decisions about funding for human papillomavirus vaccines. According to Dr Ruud Coolen van Brakel, Director of the Dutch Institute for the Proper Use of Medicine, it was ‘a very effective way to create public awareness and commitment to a commercial cause disguised as a public health issue’.

Pharmaceutical companies are also seeking to capitalise on medical social networking sites. Pfizer, for example, is reportedly collaborating with Sermo Inc, a web venture based in Cambridge USA, where tens of thousands of doctors discuss diagnostic and treatment issues in anonymous postings. The collaboration allows Pfizer's doctors to ask questions and respond to posts. Members can also rank postings, which will give insights likely to help the company's development of marketing messages. Sermo is said to be in talks with other companies as well. The site earns money by letting clients such as hedge funds monitor doctors’ anonymous conversations and thus gain insight into, say, the popularity of certain treatments. Sermo rewards physicians whose input is highly ranked by other members and plans to offer to pay doctors for participating in its clients’ surveys.^8,9

The Medicines Australia Code of Conduct attempts to regulate the promotion of prescription medicines on the internet. However, it is difficult to police the anonymous marketing of drugs on blogs and forums, or to regulate consumers’ access to information from countries where pharmaceutical marketing may be less regulated than in Australia.

The ongoing development of internet-related technologies is likely to provide pharmaceutical manufacturers with further opportunities to influence consumer expectations of health care and prescribing practices. It is also providing new opportunities for those concerned with the quality use of medicines and evidence-based education.¹⁰Much can be gained from constructive engagement with the world wide web, and 21st century doctors also need to understand its use as a marketing tool.

Note: Websites and links can change quickly. Those cited in this article were accessible at the time the article was accepted for publication.