ADVERTISING, DISTRIBUTION, & SALES

Medical device market­ers today are harnessing novel approaches and cutting-edge tools to facilitate communication with their varied audiences. For this issue's roundtable discussion, MX called upon a panel of experts to provide their views about the current state of marketing for medical devices, as well as the value of new tools and techniques being implemented by companies of all sizes (see sidebar).

At what stage do medical device companies typically make their first contact with an outside advertising and marketing agency? And what do they usually say they want?

Mark Perlotto: Companies that engage agencies earlier rather than later end up getting more value for their dollars. By using an agency during prelaunch planning, companies can leverage the experience the agency has gained in working with other device clients and in other industries. Overall, however, companies are currently approaching agency partners a little late in the game.

Tim Sellers: Larger device companies are often pretty far down the path toward a launch before engaging an agency partner. That has to do in part with the fact that their launch processes are a bit more formulaic. However, our firm has been fortunate to be able to work with some smaller companies as well. In some cases, we've been involved from the very beginning—from product branding and positioning to helping move a product into clinical trials and evaluations. The extent to which agencies are involved depends on the degree to which manufacturers invite them to be a part of their businesses.

Steve, at what point is your company most often approached?Stephen Colucci: Well, as others mentioned, usually too late. Our firm emphasizes its technical depth, so we encourage companies to bring us on board early during R&D and product development. Certain companies have approached us with new products and asked us to help differentiate those offerings by emphasizing their positive values. Specifically, several orthopedic clients have approached us because they were having a difficult time explaining the nuances of their new products. In these cases, we were fortunate to be brought on early during the development stage.

Interestingly enough, we've worked with several start-ups that have been at such an early stage of development that they have come to us for help in developing the materials needed to attract investors in a second- or third-round financing.

Are large medtech companies typically more sophisticated in their marketing needs than their small-company counterparts?

Nancy Byrnes Beesley: Generally speaking, that's true. But part of the issue is a human question. A company's level of sophistication depends on its people. If you get people who have come from larger companies and are experienced in marketing, they understand what they need. And they are smart enough to divvy up their spending in a way that will enable the company to get what it needs. Of course, company size often dictates the size of your marketing budget. But if a company hires good people, it can do a lot with a little.

Are start-up medtech companies able to make use of outside agencies, or are they usually priced out of this possibility? And what is the fallback strategy for those companies?

Carolyn Morgan: Small companies aren't necessarily priced out of the possibility of hiring an agency. They just need to have a strong understanding of their needs and priorities. They need to have a firm grasp of the audience that they're trying to reach and the different media that can be used to reach those audiences.

Agencies often serve as an extension of a company's in-house marketing team. Sometimes smaller companies that approach our agency are looking for us to manage their marketing function while they build their team internally. The fallback strategy for small companies that don't work with agencies is to find experienced in-house marketers who are willing to be resourceful.

Perlotto: The key thing is to have someone at the head of the organization—whether that's the head of the marketing division or the head of the whole company—who has commercial savvy. That person needs to be steering the ship.

The biggest challenge a smaller medical device company faces is the need to have a certain degree of commercial knowledge among its leaders. If the company is run by engineers or scientists, that's a challenge. It's difficult to get engineers and scientists to understand the difference between what is valuable and important relative to the marketplace versus what is valuable in a scientific concept. Having someone in-house who has experience managing the marketing components of a company can help a company get the best value out of an agency partner.

What level of resources are medical device firms currently dedicating to marketing efforts, and how does this compare with the spending of their pharma counterparts?

Beesley: Medical device companies are slowly increasing their marketing budgets, bringing them a little closer in line with what we've traditionally seen on the pharma side. However, pharma is its own animal— its own category. The level of spending seen in the pharma industry, where the emphasis is on DTC, is firmly established. The pharmaceutical advertising industry is firmly established. On the other hand, the medical device advertising industry is still up-and-coming.

I think the average marketing spend for medical device companies is currently around 2.4% of sales. Of our medtech clients, about 50% spend right around that percentage, and the other 50% spend way below that. But we're starting to see that ratio change. Our clients are starting to see the value of spending more money on marketing. But there's a long way to go before medical device marketing reaches the levels of pharma marketing. The return on investment (ROI) for device marketing just isn't there yet.

There are a lot of specialized pharma marketing firms that traditionally have not worked in the device realm. In light of the recent hits that pharma has taken in the marketing arena, are you seeing some of these agencies begin to turn more attention toward potential medical device clients?

Sellers: I don't think the in­creased focus on the device industry is a result of any attrition from the business within pharma. The opportunity for firms to expand their portfolio into the device realm is a lateral move from pharma marketing. Device companies are becoming more interested in experimenting with direct-to-consumer approaches. Therefore, it's easy for specialized marketing firms that have supported the same tactics within the pharmaceutical industry to position themselves as a resource. However, when marketing firms have gotten the opportunity to work with device firms on such campaigns, they've generally found that their resources just are not at the same level that those firms are accustomed to working with.

Perlotto: I would agree. The underlying theme is that the margins in the medical device industry are generally smaller than in pharma. And that leads to a smaller percentage of investment. Most medical device companies just can't absorb the costs associated with the scale and scope of the campaigns that you traditionally see on the pharma side.

We run into this issue all the time. People often want to translate a successful pharma marketing tool into a device campaign. But we have to explain to them that the $300,000-a-year price tag might be more than a device company's entire marketing budget.

The slimmer margins seen in the device industry require those companies to make smart decisions when it comes to investing their marketing dollars. And some devices have less commercial potential than others, so companies have to come to terms with such realities and spend according to that potential. Device companies are often under more financial constraint than pharma companies given the scale of the revenue potential for their products. In addition, pharma companies are often more sophisticated in evaluating the revenue life cycle of their products. Pharma companies seem to have a better feel for the return to expect over the life of a product. When it is a drug with big dollar potential, pharma companies are often willing to deficit spend in the early years to establish the brand and ensure longer-term growth. However, the life cycles of devices tend to be shorter than with a pharmaceutical. So that consideration also affects device companies' ability to make large marketing investments.

How do medical device companies assign budgets for outside marketing activities? By individual product or product line? By stage in the product life cycle? Some other way?

Morgan: It's a mix. It depends on the company and its goals. Most often companies break it down by product line. Then the product or brand manager will further break the budget down by medium.

Where are medical device firms devoting the largest portions of their marketing budgets? How does this vary according to the type of product they sell?

Sellers: The biggest portions of device companies' marketing budgets are still anchored in surgeon education. The tools that sales reps are taking to market have shifted, but the focus is still on surgeon education. We're seeing a decline in print and trade marketing and much more emphasis on one-on-one training opportunities. We've also seen a shift toward electronic media, including online surgical platforms sponsored by device firms.

Colucci: In comparing pharma to medical devices, it's worthwhile to note that every physician can prescribe medication. But medical devices address a subset of physicians—and sometimes a very small subset, as in the cardiovascular sector. So device companies' main targets are the surgeons. There's no question about it. They have to get surgeons to adopt their devices. That is accomplished mainly through sales reps, but also largely through surgeon education—they love the peer-to-peer approach. Also, offering free continuing medical education (CME) credits online is another common way that medtech firms are getting their names out there.

Obviously marketing is a large investment. How savvy are medical device marketers in evaluating their returns on investment? What are some of the latest tools and techniques being used for measuring ROI?

Perlotto: This has always been a thorny issue. Everybody wants to measure ROI. But in a world of smaller marketing budgets, sometimes the methodology to measure ROI can cost more than the promotional spend that's being measured. So you have to be cautious.

The reality of healthcare marketing—whether it's pharma, device, or diagnostics—is that it's one part science, one part magic. There's a certain amount of marketing savvy and gut feel that is part of making the right marketing decisions—and that is the challenge.

One technique we have been using for our clients is to direct responses through different informational Web sites to measure response to a particular marketing program. So, for example, companies can use personal URLs to gain true tie-in measurements with marketing efforts such as direct mail. Direct mail can be used to drive physicians to microsites to learn more about a product than can be included on a mail piece alone. So there are a lot of different ways to measure ROI. But again, it's always a challenge to ensure you're not spending more on measuring than you are on driving your business.

Colucci: The only area in which we've been able to substantially quantify ROI is in sales training. For example, if a company is planning to bring in 40 salespeople for 10 days of training, they might consider creating an online pretraining course for those individuals. Such a course might reduce the amount of on-site training required. If a company can use this approach to cut its on-site training time by 20%, those are real costs that can be quantified and compared to the cost of developing and disbursing the online course.

Sellers: We've also seen a dramatic increase in the use of search marketing to drive traffic to surgeon locators on product Web sites. Those activities have been extremely useful in terms of monitoring the performance of promotional tactics and quantifying Web site traffic.

When compared with pharma, the medtech industry has been historically weak when it comes to data. In some cases, you might even say medtech has been unsophisticated by comparison. Certain companies have maintained weak data sets on surgeon interactions because they have historically worked through distributor-based sales forces. Now, some of those companies are moving toward developing independent sales organizations that enable them to gain greater control of those data. They're becoming much more in tune with how to use such information.

Branding Considerations

How are medical device firms currently approaching the issue of branding? And has this changed in recent years?

Beesley: Our firm has worked with Kinetic Concepts Inc. (KCI; San Antonio) to develop the marketing program for its vacuum-assisted closure (VAC) therapy system. VAC therapy is really a blockbuster when it comes to medical devices, and branding has been critical for KCI because the company created a new category with the technology.

For medical device companies that are doing things that have never been done before, building a solid branding strategy for their products is essential. Similar to the pharma model, these companies need to have their brands firmly established in the minds of doctors and other decision makers by the time the generics hit the market. In this respect, medical device companies are very savvy. They understand that branding is critical not only to the short-term success of their products, but also to the long-term success of the brand.

How has KCI approached branding? Is the company's corporate name a large part of its branding or is it generally focused on the VAC product line itself?

Beesley: I'm of the mind that people buy Band-Aids, they don't really buy Johnson & Johnson—but that's my personal opinion. Our campaign for KCI has heavily emphasized the VAC product more than the KCI branding. Doctors, nurses, and all of the other people who interact with the products consider them to be part of their everyday life. So we've made a concerted effort in branding the product. Over the course of six years, we haven't strayed. We've been pretty consistent in our messaging. We've refreshed the look over the years, but we've been very consistent in the message. We believe consistency in branding is critical as a medical product's market grows and evolves.

What are the benefits of corporate branding versus branding efforts focused on individual product lines? In what situations does each approach make the most sense?

Morgan: Unlike in pharma, where a lot of products draw customer loyalty, device customers have historically focused their loyalties on the companies—at least in our experience. If a company has one product or product line, especially if it's an early-stage company, it's very helpful to have an established corporate brand. In that sense, the target audience and the competition can easily understand what the company is bringing to the table.

Sellers: Most product-based communication is going to be benefit driven, based on the product's specific indication or application. However, based on our experience in working with NuVasive Inc. (San Diego), corporate branding provides an opportunity to differentiate a company's position in the market. In NuVasive's case, the company entered a device segment in which early adoption had already taken place. So the company looked to package its entire portfolio under its corporate branding, and, in a sense, that created a separate space for them. The corporate branding exercise for NuVasive has been interesting because it's the continuity of the branding that has helped position it among its clinical targets.

Whether you're dealing with a publicly traded company or one that is going through a funding exercise, continuity among product messages in a portfolio and overall corporate differentiation are important considerations.

From a creative perspective, what are the key elements for establishing effective brand recognition in the medical device space?

Perlotto: It begins with the need for a company to identify what makes a particular brand distinctive. It's not a matter of coming in and overwhelming the competition by spending lots of dollars. You have to get down to a product's core offering and how that product is distinctive, and these attributes need to be leveraged to catch the eye, ear, and mind of the customer you're trying to reach. Device marketing needs to engage the mind as well as the senses. So the copy attached to a product is important. But marketers also need to visually break through the clutter and ensure all elements of a campaign are tied together strategically.

I see many campaigns—not just in healthcare but also in other industries—that feature visuals that only serve as eye candy. They might not have any specific direct relevance to the product—they're just designed to capture the eye of the reader. But medical device and pharma audiences are a lot more savvy than that. We can't just create a campaign for the sake of catching the audience's eye. We have to make sure the visuals are tied in strategically to the message.

A medical device company's message has to not only be distinctive, but it also has to be communicated in such a way that it tunes in to the right audiences. In some cases, it may not be the end-user who is the key influencer. So a campaign must creatively appeal to the people who are going to affect the selection of the brand. If it's not a surgeon, it may be a hospital director or someone at another level.

Marketing Essentials

What creative techniques are device marketers using to boost the appeal and effectiveness of traditional marketing media, such as print ads and brochures?

Sellers: Historically, marketing communications for devices have been very engineering-driven from a product launch and positioning standpoint. But we're seeing a shift. The messaging is becoming much more dynamic. When discussing a product, the messaging is shifting from discussion of metal fatigues and items of that nature to the qualitative ROI in terms of patient outcomes and the presentation of real patients. There's a much more emotional emphasis being placed on the true benefits of the product.

That shift is in alignment with the move toward the direct-to-consumer approach. But today's marketing is also about positioning products and companies as partners to physicians who are focused on the restoration of healthy living. Today's marketing elevates the use of true patient testimonials and focuses on the restoration of healthy, active living.

Colucci: To get very specific about new approaches to existing marketing techniques, we've had several clients add lenticular postcards to their traditional marketing media. Those are the little postcards with grooved plastic overlays on them that enable a person to view a six-frame product animation by shifting the angle at which the postcard is viewed. So that's one tool being used to differentiate traditional marketing media.

Medical device companies in many sectors are facing increasingly crowded marketplaces. What tools are marketers using to differentiate their products from those of their competitors?

Morgan: Our focus has moved away from en masse marketing communications toward creating one-to-one experiences. We're focused on finding meaningful ways to interact with customers.

Most campaigns start with the need to identify the unique attributes of a company or product, and then you look at how you can convey that visually. But great creative is just the cost of entry at this point. Medical device marketing has gone beyond that. Companies now look at how they can create an entire brand experience that builds loyalty. And that means you have to use the right tools for the right audience.

There's no longer one cookie-cutter approach for creating interactivity with a customer. Every customer is unique, and each person can control how and when he or she receives information. Companies need to conduct fundamental research to understand how each of their target segments prefers to receive information and then customize their approaches accordingly.

Beesley: Our firm does a lot of work with sales forces. And according to some of the most recent statistics, 93% of sales calls last less than three minutes. So our challenge is to try to come up with ways to differentiate products from a marketing perspective and then enable sales reps to convey information that's of interest to doctors, surgeons, nurses, and other decision makers.

Our firm's research has found that people like to learn through video games. So we've been working on generating doctor interactivity through gaming. Instead of receiving a standard sales pitch, doctors seem to like to learn through an interactive model. Some of the projects we've developed in this area have been very well received by the clinical audience.

Perlotto: We've had a lot of success applying interactive marketing principles beyond sales force interactions. We've extended that interactivity to professional media relations. Focused marketing agencies are different from traditional PR companies because their knowledge as agencies is more focused on the MD user. Traditional PR agencies tend to focus more on the investment community or the public at large.

We've focused heavily on devising ways for our clients to gain exposure in the professional media. One way would be through interviews with key opinion leaders regarding a product. We've also had luck with patient success stories, whether those are delivered in print or over the Web in the voice of the actual user. Our device and diagnostic clients have used these strategies very successfully.

Marketing campaigns for medical devices are often complex, multipronged efforts. How are device firms and their agencies identifying and prioritizing the audiences they need to reach, and how is a typical campaign rolled out?

Sellers: Companies evaluate their marketing objectives based on the life cycle of the product. The allocation of resources needs to be based on what we're trying to accomplish, whether that's creating a relationship with the surgeon, driving patients to the surgeon, or dealing with the reimbursement community. A product's core benefits must be translated into a value proposition for each audience. The actual implementation and the use of media are determined based on those terms.

Colucci: Our clients usually have a pretty good grasp on which audiences they want to reach. And it's often the same primary audience: the surgeons. But additionally, many companies must fight for mind share among their sales reps if they work through outside rep firms. To this end, our firm creates interactive content and animation that tells a product's story. Such content can often be repurposed for trade show and sales training, and the salespeople use the same learning tools to present to surgeons. Presentations can be made on laptops, over the Web, or, most currently, on a handheld device so they can approach surgeons while they're walking down hallways.

Going Digital

How are device manufacturers and their agencies translating their conventional marketing strategies for the Internet age?

Colucci: Many companies are repurposing video and animation for the Web and developing interactive online patient modules. They're using virtually every platform available, often repurposing content to reach different audiences in different ways. For example, Ethicon Endo-Surgery (Cincinnati), a Johnson & Johnson company, has launched a site where patients undergoing the company's gastric band procedure can track their progress and the improvement in their comorbidity as time progresses.

Certain digital formats are shifting as well. For example, CD-ROMs are on a wane and are being replaced by DVDs that can have greater capacity.

What are some of the latest e-marketing tools and techniques, and where does the medical device industry stand in terms of adoption of these new tools?

Beesley: There are many exciting things going on right now. The challenge, of course, is that a lot of the new tools represent new waters for a lot of companies, even our pharmaceutical clients.

Our agency is doing a lot of customization work. We have a product called ForceBook that is essentially a customizable Web site that sales reps can build and use for their physician targets. When dealing with centralized marketing tools, it's hard to customize materials based on a specific target's needs. Every physician's needs are different. Every surgeon's needs are different. Every nurse's needs are different. But as reps, they know what their customers' needs are. So ForceBook is a way for reps to build their own customized Web sites where they can provide content that's relevant to their own customers. They can post data, experiences, and case studies that their target physicians can visit. That's what the Internet enables us to do: customize content.

We're also doing a lot of work around health blogs. After all, it's become apparent that the number one thing that people are searching the Internet for is information related to their health. So for companies to be efficient in their communications, they need to talk directly to consumers and physicians in their own voice. Blogs are a great way to convey unbiased information online.

Sellers: Companies are often competing for share of voice within sales organizations. Our use of Web-based tools has been heavily focused on better equipping sales reps and making their learning and presentation cycles more efficient.

We're pushing content to surgeons through electronic paths, and we're also trying to drive patients to surgeons through increased search marketing activity. In terms of direct Web-based surgeon communication initiatives, there have been a couple of situations in which we've created product- or platform-based communities to enable surgeon-to-surgeon dialogue for evaluating and monitoring patients and sharing surgical technique guidance and tips and tricks. But to a much greater extent, our firm's implementation of online tools has focused on putting these tools into the hands of sales reps.

The rise of online communications within the healthcare arena can raise privacy concerns. Are device manufacturers addressing these concerns up front, and how are such issues being addressed in online communities?

Morgan: It depends on the audience that you're drawing. We've created physician-to-physician communities, and these individuals are adept at sharing their tips and techniques online while being careful not to share any private information. They're mindful of the need to comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

The same principles apply when we go directly to consumers. Our marketing helps to drive consumers to physicians' sites. We give them control over the kind of information they decide to share, and they're sharing with the healthcare professional.

As a marketing organization, you have to understand what you can and can't say. You must make it easy for physicians and consumers to participate in a campaign without providing information that they wouldn't otherwise want divulged.

Medical device manufacturers communicate with a wide array of audiences. Based on your experience, which audiences are most receptive to e-marketing tools and techniques? Are there certain audiences that still require more-traditional means?

Perlotto: It depends a lot on how an audience consumes media. Even different professional audiences consumes media differently. For example, our research has indicated that interventionalists tend to be a bit more savvy regarding electronic media than general surgeons. That's a broad generalization, of course. But in general, it's a matter of comfort with technology.

Obviously age skews people's comfort levels to a great degree. Technology comfort levels among physicians vary greatly depending on age and years in practice. As we're able to get more information about audiences' willingness to change their techniques, devices, and approaches, device marketers are becoming more targeted and selective in their use of media. We have a couple of clients who are applying an age skew to their use of electronic media because they realize that some audiences are consuming certain media at different rates, despite the fact that all audience members are professionals in the same specialty.

And Steve, what's your take on that? Your company develops fairly specialized electronic training tools. Are there still audiences out there who aren't ready for certain media?

Colucci: Yes, definitely. As a matter of fact, we include 2-D layouts for print in our marketing tool arsenal. No matter how advanced electronic delivery systems become or how interesting the tools are, there's always going to be somebody asking for a paper copy or something else they can carry with them and hand out. So print is going to be around for a long time.

One-on-One Marketing

Many medical device firms invest heavily in their trade show presences. What are some of the latest tools and approaches you've used in developing trade show marketing materials and displays for medical device firms?

Perlotto: In the past year or so, we've used some innovative video techniques within trade show booths. For example, we've incorporated live cameras that insert passersby into particular scenes or visual elements within the booth. It creates greater engagement with attendees who may be casually walking by and suddenly see themselves in the booth's environment. That's worked very well. We used that technique with at least one client last year, and we're looking at revamping that technology for usage a little bit later this year in another arena.

A key consideration with trade show marketing is figuring out what will have some permanence beyond the convention itself. Our goal at trade shows is to create a user experience that lets you somehow tie in attendees and carries beyond the actual convention floor interaction. We've experimented with several things. The idea is not to just hand a physician a gizmo—it has to be something they really want to take back home with them. Thankfully we're also beyond the days in which you walk out of a convention on the last day and there are 400 mugs in the trash can because nobody wants to carry the extra weight home in their luggage.

Beesley: Coming back to the gaming trend, for an upcoming convention, we've created kiosks with a question game focused on KCI's VAC therapy. The product's been around a long time, so the attendees at this convention are very familiar with it already. So we decided to create a game in which people come into the booth and play for the highest score. For example, nurses can compete against each other to see who knows more about the therapy. In initial tests, it's been very well-received because people want to test their own knowledge. But at the same time, we're able to educate them on facets of the therapy that maybe they don't already know. And it's a forum that enables KCI to continue to grow its therapy and the knowledge surrounding it.

The game also generates a lot of excitement and buzz at the booth. It's not about giving away something—it's about giving them an experience. That's the key at trade shows: creating an experience. If you want to drive traffic to a booth to encourage one-on-one conversations, you must create something exciting and new. That can be hard to do.

Colucci: I completely agree. We've seen such demand for gaming interactions that occasionally lines of people will form. In some cases, a company will decide to also give away a prize to the person who has the highest score within a given period of time. That type of promotion encourages physicians to hang around and get involved.

It's very pleasing to see lines form to play a game. A common setup we use is to have attendees play on a laptop computer, with a large plasma screen overhead that mirrors the action. That setup tends to attract a crowd.

Beesley: Exactly. We display a scoreboard so that everybody can see the name of the leader for the day. It's fun. Everybody's competitive, no matter what market you're in. People like to compete and see their names in lights. We need to capitalize on that more.

Colucci: As soon as device manufacturers start talking about creating video or animation, or even an interactive application, the first thing we'll ask is whether they're going to use the tool at a trade show. If so, we ask if they're going to rent a widescreen plasma screen to display the animation. Because if they're planning on displaying something in a widescreen format, we need to know that up front. If dimensions and formats aren't specified before an application is designed, a company could be disappointed when it tries to display it in another format.

Morgan: We really focus on one-to-one marketing. Interactivity goes beyond just a Web site. It's the focus of everything we put together from a campaign standpoint. For example, we developed a campaign for Abbott Diagnostics called Labs Are Vital. It was focused on reestablishing a connection between the company and its audience.

We launched the campaign at the American Association for Clinical Chemistry conference. We constructed a separate Labs Are Vital booth and invited laboratorians to have their photos taken. Then we created personalized ads that featured their photos and individualized messages. The ad headlines were pithy. For example, "Because of me, 14 kids won't get cats, and 11 moms are very happy. I run allergy tests." Throughout the conference, the ads were displayed on a plasma screen at the top of the booth. And we brought our own writers into the booth to help laboratorians develop personal messages for their ads. People were lining up and walking away with their own ads. And many of them took those ads back and hung them up in their hospitals. It was great.

Let's move beyond the trade show floor. When it comes to one-on-one interactions, device manufacturers frequently partner with their agencies to create sales force and physician training tools. What are some of the latest approaches you've taken to developing such tools?

Colucci: We use many different approaches. One common tool for surgical training is an application—either online or in CD-ROM format—that demos a procedure that involves a number of tools. As the demo proceeds, users click on and drag surgical tools onto the screen to let the animation continue with those tools. That's a common training tool that companies have been using for years.

Some of the applications we develop involve role playing. The exercise might feature a simulated physician who asks the users questions and they have to choose the best answer.

In addition, we produce a lot of attractive animations coupled with video that tell the story of a device and its use. Salespeople can train on these applications and then use the same tools to present to physicians. They might walk through it with them one-on-one or hand it over to the physicians who can interact with the software on their own. We've found these tools to be extremely effective. For one, sales reps want to be confident in their knowledge of a product before discussing it with a surgeon. The last thing a rep wants to do is embarrass himself in front of a physician. And also, sales reps want to have a consistent message in an attractive format to present to physicians.

Growing DTC

What marketing channels have proven to be most effective for reaching patient and consumer audiences for medical devices?

Sellers: This all goes back to the comparative resource levels that device companies—especially device start-ups—have compared with pharma companies. In our experience, the most effective marketing strategies for device companies are to collaborate with regional centers of excellence and to equip those centers with media tools that enable them to generate local press. Such collaboration, combined with limited use of regional print, is effective.

The biggest DTC investment we've seen on the device side is the use of search marketing. If a manufacturer has a product with dramatic comparative benefits, what better place to speak to a consumer than in an online environment that they're using to explore alternative treatments? Patients are highly consumptive when it comes to online information, especially when it comes to procedures such as spine surgery. The use of search marketing combined with highly targeted PR—most of which should be executed through surgeon partners—is a highly effective strategy.

My firm has helped develop the marketing campaign for a surgical procedure that shortens recovery time from a two-week hospitalization to roughly 36 hours. In a case like this, when you have a unique story, being able to pull online traffic to a surgeon locator is beneficial.

To date, which device sectors have made the most-effective use of DTC marketing, and what lessons can companies in other sectors glean from these efforts?

Perlotto: For a number of years, everybody in the device world was waiting for the other shoe to drop—namely, for a device company to put a significant investment into the DTC space. Pharma has been doing it for a long time. The first device campaigns to really catch everyone's attention were the ones rolled out in the joint replacement segment.

These orthopedics campaigns underscored the same tenet that the pharma industry discovered. Products related to lifestyle—drugs and devices that can affect a patient's lifestyle or operational capabilities—are the ones that are most likely to drive an inquiring patient to their physician in a nonadversarial manner.

For this reason, joint-replacement devices are probably the devices that are most likely to achieve success through DTC marketing. Patients with decreased mobility who are not able to do the things that they once did are more likely to be motivated to talk to their physicians. Devices to treat asymptomatic conditions are a much more difficult DTC sell. But patients who can't work or run or play golf or play tennis the way they used to are more likely to see the benefit of talking to their physician. Patients with asymptomatic cardiovascular disease may not be as motivated.

Most people are all too familiar with TV commercials for pharmaceuticals. But to date, only a small handful of device companies have pursued television advertising. For those that have, how have their approaches to the medium differed from their pharma counterparts?

Beesley: Device manufacturers in the diabetes space, such as those that produce blood glucose monitors, have done a very good job with DTC advertising. They operate in a highly commoditized marketplace. So you see companies bringing in B.B. King and Aretha Franklin to try to get patients to connect mentally with their products and choose their brand name over another. Distinguishing your company in a commoditized market is a big challenge for a medical device manufacturer. DTC can help do that.

Even in sectors in which DTC marketing seems a natural fit, the costs can be prohibitive. How can medical device marketers make the most of their budgets in this area?

Morgan: Companies can manage costs by segmenting and understanding their patient populations. By examining data from across the country, manufacturers may be able to identify cities with high-risk patient populations where they can target their efforts.

Online channels can be a cost-effective way of reaching patient populations as well. Looking forward, companies in sectors with large patient populations are going to be increasingly exploring DTC approaches. And as the prices for DTC go down and personalization becomes more important, companies are going to be evaluating ways to interact with consumers through whatever channels make the most sense. Again, as costs come down, the opportunities explode.

Medical device companies considering targeting consumers directly face an even graver concern than finances: the possibility of isolating physicians. When reaching out directly to consumers, how can device marketers avoid alienating their physician customers?

Sellers: As mentioned, joint-replacement device manufacturers have been very active in DTC channels, and there has been some backlash. Surgeons appreciate and enjoy having educated patients directed to their practices. But they don't like patients specifying brands. Demanding a certain brand of device isn't like requesting a brand-name pharmaceutical prescription. Having a patient demand a specific brand of device flies in the face of what the surgeon considers to be his craft.

A lot of the consumer-directed marketing campaigns that we've done have been regional initiatives done in collaboration with the centers of excellence or physicians who are available to patients in that region. Device DTC has shifted toward strategies focused on bringing the physician community into the loop.

Colucci: I have a tough time reconciling DTC for joint replacement without alienating surgeons. For example, if a DePuy surgeon is approached by a patient who says he or she wants a Zimmer knee, that surgeon is not going to give them a Zimmer knee. He isn't trained on it, he doesn't prefer it, and it requires a whole new set of tools. So he's going to have to argue against what the consumer saw on television. The same goes for implants and other devices from other manufacturers as well.

Perlotto: I agree. And I think to some extent, these dynamics apply in the pharma world as well. Physicians have always reacted very negatively to brand-specific requests. For example, patients started coming in asking for 'the little purple pill'—regardless of the condition they had. That really drove physicians over the edge with direct-to-consumer advertising and created a lot of negative backlash. There are two rules of thumb that should be applied in DTC advertising. The first rule—which pharma took a long time to learn—is to always let the doctors know in advance if you're going to launch a DTC campaign. Doctors don't want to have 15 patients suddenly show up at their doors demanding a little purple pill or a Zimmer knee. Make sure the doctors know about the campaign up front so they're not blindsided. They shouldn't feel like they have to do the soft-shoe to get around their patients' questions.

The second rule is to avoid brand-specific advertising for a device that is selective and technique-driven. If only a select group of surgeons is trained on the device, DTC marketing is probably not going to be the most effective way to go. Educating patients that there are options out there can motivate them to seek certain treatments, but it's critical for them to be able to effectively discuss options with their physician. That's an issue that pharma is really struggling with right now. Industry players are evaluating whether they want to pursue more brand-specific marketing or whether it would be more effective to market around a specific condition. Marketing around a condition is great if you're the leader in the marketplace but difficult if you're a challenger brand. So sometimes marketing rules have to be broken, and companies need to evaluate the risks and benefits of the approach they choose.

Sellers: Some device companies, particularly large orthopedic companies that have extensive portfolios, have shifted their direct-to-consumer initiatives in an attempt to establish an earlier therapeutic relationship with patients—before replacement surgery is required. They're promoting some of their noninvasive techniques and products. So in those cases, consumers don't even have to make the decision as to whether or not to consult an orthopedic surgeon on a device.

Perlotto: Some device companies are marketing their products by using physician locators to direct patients to physicians who are trained on or use their products. It gives their products a sense of exclusivity. On the down side, those companies risk alienating physicians who haven't been through that particular training program. But again, that goes back to the risk-reward decisions that companies have to make when it comes to engaging the consumer. In some cases, companies are realizing that they can't rely on all physicians to make their brand the number one product on the market. But they may be able to achieve their sales objectives by assisting physicians who have adopted their product gain a greater share of the potential patient pool for that condition.

Morgan: That's a strategy we had a lot of success with when we launched the Inamed—now Allergan—silicone breast implants. We knew that surgeons needed to get certified to implant the product right away. So as soon as the company received approval from FDA, we started directing surgeons to a Web site that helped them get certified. Then we sent in-office promotional materials to them. Once the surgeons were ready, we launched an interactive campaign that directed patients to the company's site. A lot of patients had safety concerns, so the Web site allowed them to ask questions and get information. And once the patients were ready, we could direct them to a certified physician. So it was a one-two punch. We helped surgeons by making it as easy as possible to get certified. And then we did everything we could to support them and their practices in directing these patients to them. In that respect, we approached the campaign as a partnership.

Adapting for the Future

In your opinion, what are the greatest untapped marketing opportunities for medical device manufacturers? How can they capitalize on these?

Beesley: The Web is a developing opportunity. Most agencies are working through online channels and helping to develop new tools. But everyone is still a little anxious to see how certain tools are going to unfold, especially for devices. There are still questions: How are we going to talk to patients on the Web? How are these communications going to evolve? The Web is still a somewhat untapped opportunity for device manufacturers, and agencies are going to have to be smart in the way they help allocate budgets. No agency wants to be the first person on the block to spend their client's money on something brand-new to find out it doesn't work.

Colucci: Device marketers have to be aware of evolving technologies, such as smartphones that can search the Web and play video. That type of technology is evolving all the time—iPods, podcasts, etc.

Beesley: Yes. We just created a custom ringtone for one of our medical device clients. There are so many emerging trends and technologies, and marketers have to stay on top of them.

Perlotto: We've all witnessed the Web's evolution. It's gone from being mainly text to text with visuals to static banner ads to moving banner ads to rich media. Now there are links to microsites, all sorts of things. There's always going to be new technologies entering the marketplace. And quite honestly, in most cases, the medical world will probably trail behind the consumer world in terms of adoption. So keeping an eye on what's going on in the consumer world and the marketing technologies that are evolving there will lead medical marketers to new opportunities that can be applied in medical device marketing.

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