Campaign report on healthcare

All advertisers sometimes need a helping hand. That, after all, is partly what their agencies are there for - to help them sell those products that struggle to sell themselves, writes Richard Cook.

It’s just that healthcare

advertisers have needed this sort of assistance more often than most

over the past few years. But then it’s easy to understand why. The

market has changed radically over a relatively short period and it

continues to confound most expectations.

In fact, these changes started more than a decade ago with the first

blurring of the distinctions between prescribed and over-the-counter

medicines, but they have moved further and faster since that upheaval

than almost anyone could have predicted.

One painful result of this is that, nowadays, a healthcare agency

professional is expected to combine the branding skills of a Procter &

Gamble marketer with the knowledge base of a typical medical

professional. They have, in short, to be au fait with a bewildering

array of marketing and medical terminology. Even if they happen to be up

to speed on their cost-per-thousands, they can’t afford to struggle over

the uses for Imidazoles, for example, or worry about the fact that what

the medics call a ’sustained release dextromethprphan’, ordinary mortals

are more likely to call Beecham’s Cough Caps.

’The skills needed to do this job are changing all the time because more

products are now sold to laymen,’ explains Brian Kelly, the managing

director of Young & Rubicam’s healthcare specialist agency, Sudler &

Hennessey, who is also a doctor. ’In the past, there were those people

who knew what the drugs were and their properties and so forth and, on

the other hand, there were the admen who knew how to shift fmcg brands.

There was absolutely no crossover between the two. That’s all had to

change.’

For example, a product called Hyosine Butylbromide is, with the best

will in the world, not going to leap off the shelves at your local

pharmacy, no matter how impressive the advertising idea or how strong

the campaign.

Of course, this type of medicine wasn’t originally designed to be sold

that way. It was designed to be pushed directly and discreetly to

doctors.

But no longer: as more products have been freed up for over-the-counter

sales they are having to take their chances in the rough and tumble of

the free market. In fact, Hyosine Butylbromide is actually the name of a

common treatment for irritable bowel syndrome which was, until five

years ago, available on prescription only from a local GP.

The marketing push in those halcyon days consisted of persuading the

doctor to write a brand name on their prescription - in this case,

Buscopan - rather than its generic drug description. Now anyone can pick

up the drug from their local chemist, and patients will be looking to

their pharmacist rather than their doctor for advice. Clearly the target

of the advertising has, to a large extent, had to change. As, of course,

have the drug companies’ expectations for the brand’s performance.

The classic case study of the drug that has made its way from the dusty

jars at the back of the local chemist’s shop to international super

brand is, of course, Nurofen. Born out of necessity when its Ibuprofen

patent expired in 1983, the painkiller is now a multinational

best-seller.

’There are two rules for the drug company making the switch from

marketing a prescription-only drug to marketing one that is freely

available,’ Angus Lister, the business development director for Saatchi

Healthcare, says.

’You’ve got to get there first and you’ve got to make your presence

felt.

You need impact. Nurofen has done such a good job of this that, in

tests, customers actually now say that the Nurofen works better than

other rival branded drugs that have exactly the same active

ingredient.

’In some ways, we faced a similar challenge with Immodium. The fact is

that there are lots of Loperimide product on the market, and new ones

are launching on all the time. But, importantly, Immodium got out there

first and we have started supporting the brand with TV ads, which is

really helping increase impact. The result of all this is that, despite

the market becoming more competitive, Immodium is actually increasing

its share.’

When it was a prescription drug, television advertising was a foreign

country for Immodium, and the Medicines Control Agency still doesn’t

allow ads to mention branded products if they are delivered on

prescription.

Nonetheless, restrictions are being relaxed all the time, as the medical

market continues to re-invent itself as a global branding

opportunity.

’It’s difficult to see how the market and especially branding within it

might go, because there have been so many changes in such a short space

of time,’ Anna Grint, the account director at Paling Walters Targis,

points out. ’But the model from the US suggests that speaking directly

to consumers is a powerful way forward, even for prescription drugs. The

regulations there have already been relaxed and I think there is

powerful evidence that the general public is far better informed about

medical and healthcare matters these days and more willing to make

choices.’

How the changes that the MCA is now planning will affect that remains

unclear. It is responsible to the Secretary of State for Health for all

medicines and its MLX 239 proposals could bring an additional

legislative burden to bear on advertisers which, until now, have relied

on a series of voluntary codes, administered not by the MCA, but by the

relevant industry bodies. The Proprietary Association of Great Britain,

the body that administered the self-regulatory system for

over-the-counter drugs, had already set the wheels of change in motion

by establishing a Code Review working party under the chairmanship of

Bron Gorny as long ago as December 1996, having identified that the

consumer code they had adopted was ’too restrictive’. Since then, the

co-operation between the MCA and the PAGB is helping to ease the

legislative framework for advertisers.

Already the number of clauses in the Consumer Code has been reduced and

the language simplified, and there is no longer any need for both the

PAGB and the MCA to approve medicine packaging and in-store leaflets

while, from January, medicine packaging will not need PAGB approval at

all.

For the moment though, and certainly in Europe, doctors - the

traditional target of ethical drug ads - are still the most important

constituency for practically all healthcare advertising, but the shift

of emphasis from ethical to OTC has forced the industry to cast its net

wider and embrace more diverse marketing techniques.

This diversification has meant that the once legendary margins on

prescription pharmaceuticals have now been almost completely eroded.

Four years ago, these margins averaged 30 per cent and many were

considerably more. One single drug - Glaxo’s anti-ulcer treatment,

Zantac - was famously responsible for more than half of the company’s

overall sales.

Government intervention, rather than macro economic forces, soon put an

end to that. The problem is that the health of the pharmaceutical

industry bears little or no relationship to that of the economy as a

whole.

Throughout the 80s and the first couple of years of the 90s, the

pharmaceutical companies saw record profits, growth and expansion and

there was plenty of money to go round. Nowadays, that same industry is

emerging from a period of savage consolidation and cost cutting, as it

comes increasingly under fire from government and consumer watchdog

groups over rises in prescribing costs. The cost of drugs is now

estimated to constitute 10 per cent of the entire NHS cost base, and it

is being squeezed with the same vigour as all the other

constituents.

’In some respects, marketing has had to come at last to an industry that

historically has operated outside any real market - the Govern-ment now

is regulating the price of drugs, the profits of the drug companies and

the amount of those profits that can be spent on advertising.’ Mark

Goldstone, the chief executive of Euro RSCG Healthcare, says. ’It means

there is a huge opportunity for us all to add value to over-the- counter

products, to create brands, on the one hand.

But it also means that many prescription products will have an even

tougher time of it.’

Increasingly, that opportunity is to be found internationally. The drug

companies have positioned themselves across borders to take advantage of

economies of scale and their agencies have had to do likewise.

’Agencies are finding that they are not just having to adjust to a whole

new marketing culture in healthcare but also to a growing

internationalism,’ Lister explains. ’In the past, the fact that

healthcare legislation is so different in each country was seen as an

insurmountable problem. But restrictions are being relaxed all the time

and a good product message will work just as well in Timbuktu as New

York.

’But the real impetus behind this international trend is cost-based.

We estimate it costs as much as dollars 500 million to take the typical

ethical drug from research through to launch, and because of the new

pressures on how much they can charge for this drug, the manufacturers

are now having to try and leverage these drugs multinationally just to

make a return on their investment. Increasingly, they are also trying to

make the same sort of savings on their agency arrangements. At Saatchis,

for example, we now handle Johnson & Johnson for the whole of Europe and

Eastern Europe out of London, which wouldn’t really have been possible

before.’

The revolutionary change that enabled this kind of radical overhaul of

agency working habits was the formation of the European Medicines

Evaluation Unit two years ago. Essentially, this gave the green light to

international campaigns that had hitherto floundered in a sea of

paperwork. It managed to provide a route around the labyrinthine

legislation then in force. Previously, each country in the European

Union had its own regulatory body responsible for the awarding of

licences for new drugs, and for all the product claims, warnings and so

on. The EMEU cut through that bureaucracy at a stroke, and is now going

even further by tying up deals with the Japanese regulatory body and

with its equivalent, the Federal Drugs Administration, in the US.

It should put an end to anomalies in which certain products are

effectively barred from crucial international markets.

The nicotine substitute, Nicorette, for example, was first made

available over the counter in 1991 in this country. Europe took a little

longer but the FDA only permitted pharmacists in the States to sell the

product this year.

’There are still very few true international brands, although this is

changing and will continue to change thanks to the likes of EMEU,’ Grint

points out, ’and what healthcare agencies will now have to start taking

account of is client conflict. It’s part of the reason that we were

formalised into the Targis network last year, and why Healthcom has been

formed so that we can position ourselves for the big multinational

accounts that will be an increasing feature of the healthcare

future.’

Despite all the changes that have taken place, one thing remains the

same. The health practitioner is still crucial to the development of all

this advertising, both for prescription and over-the-counter

products.

They are the perfect brand spokespeople, after all. But reaching them

effectively has never been more difficult. Doctors are almost too

accessible - it is estimated that every doctor in the UK has been

researched more than 100 times. Their direct mail isn’t carefully sifted

- it’s weighed and, because of the ever-expanding market, drug company

reps now have to form orderly queues outside surgeries.

’It’s got to the point where even the receptionists in health centres

have now become a valuable target market in their own right,’ Grint

explains.

’They aren’t bombarded with the same amount of stuff that doctors are

and so are easier to reach, and yet they will offer advice

on over-the-counter medicines over the telephone. And because that

advice comes from the doctor’s surgery, it is often acted upon.’

Nevertheless, doctors remain the holy grail of health-care

advertising.

Unfortunately they are becoming almost equally elusive.

’Agencies have had to start to dev-elop skills they didn’t know they

had, because of the changing circumstances of the market,’ explains

Sudler & Hennessy’s Dr Kelly. ’And that means taking on responsibilities

that might have been left to a PR company before.

For any medicines, whether over-the-counter or prescription, the most

important thing is to target the healthcare professional effectively.

Everything spreads from there. Currently, by far the biggest challenge

facing healthcare agencies is how to do this and you have to say that

those agencies that aren’t able to be flexible and find the right way to

do that in the future will be dead meat.’

One surprising new medium is assuming an increased importance. All

healthcare professional have to take part in a basic minimum healthcare

education programme every year as part of their contract. So, if a

doctor needs to brush up on, say, asthma treatments, he can go to a

seminar - conveniently organised by an asthma drug company and which

will certainly meet all the educational requirements. It’s a way for the

drug companies to add value to their message, a message, after all, that

is going to one of the most keenly targeted groups of people to be found

anywhere. How the drug companies best handle these events is a problem

exercising the finest minds in healthcare advertising.

’It’s our responsibility both to generate that medium, and to make it

work,’ Kelly explains. ’Now that we have invented the billboard, so to

speak, it’s up to us all to invent the appropriate message to go on it.

And we have to come up with a really creative solution because doctors

aren’t going to be persuaded by anything less. I think this is quite

simply the major challenge facing healthcare agencies at the

moment.’

TOP 15 HEALTHCARE AGENCIES RANKED BY DECLARED BILLINGS

Rank   Agency                                           Declared

97                                                      billings

                                                       (pounds m)

1      MEDICUS UK                                            35.0

       Clients: Crookes, Hoechst Marion Roussel, Reckitt &

       Colman, Sandy Winthrop, SmithKline Beecham

2      BRAY LEINO HEALTHCARE                                 29.0

       Clients: Information withheld

3      McCANN HEALTHCARE UK                                  24.0

       Clients: Information withheld

4      PALING WALTERS TARGIS                                 17.0

       Clients: Information withheld

5=     SAATCHI & SAATCHI (HEALTHCARE)                        15.0

       Clients: Johnson & Johnson MSD, Pharmacia &

       Upjohn, Ralston Purina, Roche, Schering Plough

5=     GREY HEALTHCARE                                       15.0

       Clients: Evans Medical, Nutricia Clinical Care,

       Procter & Gamble, Schwarz  Farmer, SmithKline

       Beecham

7      EURO RSCG HEALTHCARE                                  13.0

       Clients: Information withheld

8      HERMAN BEASLEY HEALTHCARE                             10.0

       Clients: Abbott Laboratories, Johnson & Johnson

       MSD, Rohne-Poulenc Rorer, Seven Seas,

       Shefaro Proprietories

9      MATTHEW POPPY HENNIG DICKINSON                         9.2

       Clients: Abbott Laboratories, Bristol Myers Squib,

       Janssen-Cilag, Novo Nordisk, SmithKline Beecham

10     VB COMMUNICATIONS                                      8.0

       Clients: Abbott Laboratories, Bristol Myers Squib,

       Glaxo, Pharmacia & Upjohn, Rhone Poulenc Rorer

11     LANE EARL & COX ADVERTISING                            7.5

       Clients: Astra, Eli Lilly, Napp Laboratories,

       Novarpis, Parke Davis

12     AZURE                                                  5.5

       Clients: Eli Lilly, Janssen-Cilag, Napp

       Laboratories, Parke Davis, Wyeth

13     BRADER PERRYMAN                                        5.3

       Clients: Astra, Hoechst Marion Roussel,

       Searie, 3M

14     SUDLER & HENNESSEY                                     4.2

       Clients: Astra, Novartis, SmithKline Beecham,

       Unilever, Wyeth

15     WILLIAMS BLAKE REAY                                    1.5

       Clients: Boehringer Ingelheim, Hoechst Marion

       Roussel, Pharmax, Scholl, Yamamouchi Farmer

Footnotes: Table shows agency name, supplied billings in pounds m

and five major clients selected from the agency’s roster in

alphabetical order.

TOP TEN HEALTHCARE ADVERTISERS RANKED BY AC NIELSEN MEAL OCTOBER

’96 - SEPTEMBER ’97

Rank  Agency                             Total   Television        Press

      Selected Market              125,956,091   66,203,058   53,654,786

1     SmithKline Beecham

      Healthcare                    11,663,876    9,738,864    1,453,539

2     Whitehall Laboratories         9,613,436    3,852,085    5,737,698

3     Roche Nicholas Consumer

      Healthcare                     9,353,023    7,048,017    2,126,871

4     Warner Lambert Consumer

      Health                         8,731,031    6,909,686    1,239,147

5     Pfizer Consumer Healthcare     6,573,998    3,894,646    2,679,352

6     Reckitt & Colman

      Pharmaceuticals                6,374,764    5,553,269      791,496

7     Crookes Healthcare             5,803,259    4,418,544      326,641

8     Novartis Consumer

      Healthcare                     5,137,375    1,994,687    3,104,435

9     Seven Seas                     4,290,700    1,974,660    2,266,582

10    Stafford-Miller                3,945,725    2,847,806   1,097, 919

Rank  Agency                             Radio      Outdoor       Cinema

      Selected Market                4,055,098    1,764,660      278,489

1     SmithKline Beecham

      Healthcare                       280,560      190,913            -

2     Whitehall Laboratories                 -       23,653            -

3     Roche Nicholas Consumer

      Healthcare                       178,135            -            -

4     Warner Lambert Consumer

      Health                           568,652       13,546            -

5     Pfizer Consumer Healthcare             -            -            -

6     Reckitt & Colman

      Pharmaceuticals                   29,999            -            -

7     Crookes Healthcare               113,197      934,398       10,479

8     Novartis Consumer

      Healthcare                        38,253            -            -

9     Seven Seas                        30,378       19,080            -

10    Stafford-Miller                        -            -            -

TOP FIVE HEALTHCARE MEDIA BUYING SHOPS RANKED BY AC NIELSEN MEAL OCTOBER

’96 - SEPTEMBER ’97

Rank  Agency                             Total   Television        Press

      Selected Market              125,956,091   66,203,058   53,654,786

1     CIA Medianetwork UK           16,251,316    7,385,624    8,863,283

2     MediaCom                      12,069,919    9,925,688    1,630,831

3     Media Business Group           9,174,826    6,941,387    2,132,393

4     BMP DDB                        8,275,595    6,581,433      682,788

5     J Walter Thompson              8,123,252    6,323,583    1,222,451

Rank  Agency                             Radio      Outdoor       Cinema

      Selected Market                4,055,098    1,764,660      278,489

1     CIA Medianetwork UK                    -        2,409            -

2     MediaCom                         322,487      190,913            -

3     Media Business Group             101,046            -            -

4     BMP DDB                           76,976      934,398            -

5     J Walter Thompson                563,672       13,546            -