At the beginning of the Reboot Camp – held at New York City’s Alexandria Center on April 12 – Intouch Solutions’ CEO Faruk Capan declared the days of Don Draper effectively over. The route to patients’ hearts and minds isn’t Old Fashioned cocktails and intuition; it’s solutions based on patient, provider and payer needs, and making disparate data streams pool around brand objectives.

Katherine Patterson, global marketing communications manager, growth initiatives, GE Healthcare

Katherine Patterson, global marketing communications manager, growth initiatives, at GE Healthcare, gave the keynote address, which focused on clarity of mission in marketing execution, and the importance of marrying science and emotion for consumers. Marketers too obsessed with social media, or the newest digital platform, might impress only themselves. “It’s like peeing down your leg…hot to you, but nobody else,” said Patterson. In Japan, for example, GE Healthcare’s medical device customers “are moving back toward print” as a preferred marketing channel, although growth markets “want digital,” and they want it on their mobile devices, she said.

Citing Eric Topol, currently director of the Scripps Translational Science Institute, Ben Chodor, CEO at Happtique, said we’re not too far away from a time when physicians prescribe more apps than pharmaceutical drugs. Chodor is betting on Topol’s prediction; Happtique, a mobile health application store, will “curate” mobile apps for docs through a private, customized dashboard of Happtique-certified health apps. The company’s patent-pending software would allow physicians to electronically prescribe apps to patients. Chodor says he’s lobbying the SEC to reimburse medical apps, noting that some private plans already do.

Happtique doesn’t make apps itself, but Chodor appeared before the US House of Representatives’ Energy and Commerce Subcommittee on Communications and Technology in March to support FDA’s regulation and definition of mobile medical apps. “It’s relatively simple to take an app through FDA” [for a medical device designation], and it only costs between $10,000 and $20,000, he said, noting that 75 mobile devices/apps have already been approved. Chodor said the Affordable Care Act’s medical device excise tax – “the absolute worst tax ever” – should not be levied on smartphones or apps.

Asaf Evenhaim, co-founder and CEO of Crossix, reminded Reboot Camp attendees about the unfathomable amount of individual consumer or patient data that exists for marketers, while insisting on the importance of privacy and HIPAA regulations. His company collects this data to create “propensity scores,” which serve as the basis for highly specific predictive models. The models can then be used to predict healthcare purchase decisions.

Where does all that data come from? Some of it is volunteered, some is collected invisibly through cookies, Facebook and other online aggregators, and some of it – but not Crossix’s data – is gleaned from trolling social media channels and blogs. Passive data collection, said Intouch Solutions’ senior vice president David Windhausen, is revolutionizing pharma marketing and health itself. Windhausen said he looks at his Nike FuelBand in the evening, and if he hasn’t been active enough, it’s time to exercise.

Windhausen’s talk lovingly described the Sanofi mobile app “GoMeals,” an app for diabetics specifically, but also for anyone who wants on-the-go nutritional facts about nearby restaurants (among other things). An attendee representing Sanofi – which is an Intouch client – let slip that GoMeals, and possibly the iBGStar glucose meter, would start to integrate passive data from wearable tracker gadgets like Fitbit or the FuelBand as early as this year.

Capping off the Reboot meeting was Augustin Fou, founder and chief digital strategist, Marketing Science Consulting Group. Fou emphasized the importance of recognizing how patients’ habits, expectations, and actions – in the context of healthcare – have changed, and how they continue to change. He referenced a Capgemini Consulting report on “digital maturity” that placed pharma at the very bottom of the list.

Despite regulatory hurdles and because of an explosion in mobile technology, data capture, and the influence patient’s have on the delivery of healthcare, pharma marketers could use a reboot. But they’ll need to back-up some of the dusty old tropes of yesteryear, even those that precede Don Draper. As GE Healthcare’s Patterson noted, Aristotelian rhetoric, comprised of ethos, pathos and logos – in equal measure – works as well in a sales detail as it did in symposia. The occasional Old Fashioned might be okay, too.

Conducted across 46 states and with a group of 400 respondents, the sample was representative of just how many nurse practitioners, physician’s assistants, clinical nurse specialists and certified nurse midwives there are in the US. The demand for NPPs is leading to higher pay and an increased respect within the payer community. Aetna now considers nurse practitioners, for example, to be primary care providers and reimburses them for their services thusly.

When considering what influenced their behavior as prescribers the most, the survey found that NPPs tend to consider efficacy, their experiences with the drug, and price, in that order. As 82% of the respondents indicated they had no restrictions when dealing with sales representatives (17% had certain restrictions, and 11% said they were completely restricted), and that most respondents were open to support from them, why have sales reps and pharma by and large neglected to address this demographic?

Brenda Rizzo, author of the report and an advanced practice nurse herself, says sales reps make calls “based upon prescribing behaviors, and on that basis alone, NPPs are pretty much invisible.” Misconceptions about NPPs abound, according to the report, including that they prescribe based on a protocol set by their physician practice partners, that if they have the ability to prescribe, they rarely do, or that they are simply refilling prescriptions that have already been decided on by a physician. Pharma “doesn’t realize that this is an audience that makes independent prescribing decisions, and that having the right information to make those decisions is incumbent on pharma companies; to provide it to non-physician prescribers is equally important as it is to provide that information to physicians,” emphasizes Rizzo.

So what kind of information do non-physician prescribers want? As a group shown to be active attendees of national conferences and maintaining exchange of advice among colleagues and fellow professionals, first and foremost the information should be sharable and accurate to provide trustworthy resources that can further facilitate dialogue and be spread easily. Secondly, NPPs listed printed education materials from pharmaceutical companies as one of their top-rated tools when looking to improve patient compliance. More specifically, 61.3% of respondents, when asked about what kind of support they’d expect from pharma companies, said “Education about the pharmaceutical drug or medical device directed to the NPP for the patient,” 54.5% responded “Disease state information to educate the patient.” and 51.5% said “Assessment tools to help identify problems that can be addressed.”

NPPs, as this study shows, not only want to engage, but expect valuable engagement tools from pharma to help make their jobs easier. With primary care taking on a new definition that includes long-term, patient-focused care, the physician’s ability to orchestrate outcomes is increasingly being diluted and in need of help from nurse practitioners, physician’s assistants and other NPPs. As such, pharma needs to keep a keen eye on these providers: payers, private practices, and health care facilities have already gotten the memo.

To read the March cover story in the PharmExec digital edition, click here.

The line between physician marketing and consumer marketing has blurred as the facets of a brand campaign – from disease and drug-mechanism education to efficacy, safety and lifestyle claims – dovetail across the traditional physician-patient separation.

“We know that DTC advertising is often the catalyst for patients initiating conversations with their physicians about their untreated or undertreated conditions,” wrote Janet Woodcock, director of the Center for Drug Evaluation and Research, in an email on the changes. “The decision to restructure the divisions reflects our commitment to continue providing close oversight of DTC advertising.”

Before it got upgraded to a “Super Office” in 2011, OPDP was fondly (or sometimes not so fondly) called DDMAC (dee dee mac), which stood for the Division of Drug Marketing, Advertising and Communications. When DDMAC turned into OPDP, the office was split into two divisions: the Division of Consumer Drug Promotion, and the Division of Professional Drug Promotion. As OPDP, the steady stream of warning and untitled letters continued unabated, mostly chastising pharma marketers for misbranding, off-label, overstating the efficacy or minimizing the risks of a product, or the misuse of a color scheme, in one famous educational piece created for Novartis.

With today’s announcement, ODPD, pending final review, will rename its two primary divisions. They will now be called the Division of Advertising and Promotion Review I, and the Division of Advertising and Promotion Review II. Review of promotional materials will be separated and organized by therapeutic class, not by professional or consumer. “ODPP concluded that a structure that integrates the review of health care professional-directed and consumer directed promotion across the two divisions” would meet the stated goals of increasing efficiency, improving work distribution, and eliminating redundancy, wrote Woodcock.

“Our ODPD reviewers will continue to use a comprehensive surveillance, enforcement, and education program to foster superior communication of labeling and promotional information to both health care professionals and consumers,” she wrote.

Tom Abrams remains head of ODPD. For a list of the new review groups categorized by therapeutic area, click here.

If a patient or physician encounters pharma-created content that doesn’t pop with relevance or utility, it doesn’t matter how multitudinous the channels are that carry it. There is no patience online for bad content.

Pharma has the resources to create, or hire someone to create, great content. But the problem is that great content lies in the eye of the content beholder. Complicating matters further, that single set of eyes may find certain content relevant or useful in one channel on one day, but may have different needs or expectations in another channel, next week. Digital marketers hope the answer to the problem of effective mass personalization – a term that reads like an oxymoron – is big data and better analytical tools for parsing it. If enough data is compiled about a given patient, for example, it follows that sophisticated, real-time analytics will be able to predictably advise brand managers on precisely what information a patient needs at any stage of her journey, in whichever channel she prefers.

Needless to say, that level of sophistication hasn’t yet occurred in the healthcare industry. Speakers at the ePharma Summit in New York this week appear hopeful that it will happen soon, but many acknowledged the organizational changes that need to happen first.

Continuous questing for new data streams can be a quixotic endeavor, leading to “analysis paralysis,” said Nancy Phelan, VP, customer strategy and operations at Bristol-Myers Squibb. Internally, pharma needs to “think differently about the talent and skill set” needed on the commercial side, and organizations must liberate digital marketing from fixed events like budget cycles and calendar-based points of action (POAs). Companies should institute “real-time processes and decision-making” for digital marketing execution, said Phelan.

On a mobile health panel, Sharon DeBacco, senior director, customer communications and operations at Ironwood Pharmaceuticals (and formerly an AstraZeneca consumer marketing leader and brand director on Nexium and Crestor), said “mobile is a marketer’s dream,” but it’s stuck on the fringes of healthcare, in wellness and fitness apps on the one hand, and in sensors and devices for critical care on the other. Missing is the middle ground patient and his chronic condition. From a content management standpoint, mobile can be “challenging and confusing,” acknowledged Scott Wolf, EVP, sales, at Everyday Health. DeBacco said the challenge for mobile is how to combine the many transactional activities phones and tablets are typically used for, to develop first a greater understanding and then a unified program for consumers.

With regard to the future of professional promotion, “pharma needs to find its way back into doctors’ lives,” said Jordan Safirstein, an interventional cardiologist. “Taking a doctor out to eat and giving them journal articles is antiquated…it doesn’t work.” Sales reps are less effective today because “physicians have no say anymore in what drugs are on the formulary,” said Kecia Gaither, vice chairman, department of Ob/Gyn, director of maternal fetal medicine, at Brooklyn’s Brookdale University Hospital and Medical Center. “That decision comes from the chief financial officer,” and to a lesser extent, the head of pharmacy, she said.

Asked about what pharma can provide to physicians, Safirstein said embedding reference texts within EMRs is one opportunity. “The most common thing I see [in the hospital] is a resident walking down the hall, staring at a screen. Pharma must take advantage of this.” What about copay cards? “I’ve never heard a patient say, ‘Thank God you gave me that coupon card,’” said Safirstein, adding that the biggest innovation to the healthcare system in recent years was the launch of generic versions of Lipitor and Plavix.

Despite ongoing challenges in digital promotion on the consumer and professional side, 72% of the healthcare companies surveyed for a recent Best Practices report said they planned to increase their digital marketing budgets by more than 10% in the next two years. Even with additional resources, will pharma be able to craft relevant and useful messages for individual patients and physicians, and deliver them successfully? The best way to find out what questions a specific customer wants answered, right now, is to ask. The best way to meet that need is to provide an answer, fast. Whether big data, new technology and analytics can help pharma provide that kind of mass personalization – at an acceptable scale and in the context of strict regulatory controls – remains to be seen.

Over the last few years I’ve worked with pharma marketers trying to preach and teach the virtues of digital channels. It has been a thankless task, with bucket loads of blood, sweat, and tears of frustration. I have used a number of different techniques, from talking about the revolution in big forums to small softly, softly‚ “express yourself” type workshops (without incense sticks or trickling water).

Once the adrenalin rush dies down I try to analyze what impact this may have had.

To be fair, some glacially slow progress has been made as the median knowledge of the industry inches forward, but it has not been the tidal wave that some had predicted, or hoped for.

Should we be surprised? Probably not.

Looking back to my earlier days as an eBusiness evangelist in the late 90s, where a solid part of our strategic recommendations included “give your employees access to email”, we spent many a night conjuring projections with terms such as “dis-intermediation” and the like.

I recently took a fresh look at some of those crazy visionary presentations, and guess what: many of them were right, but nearly all the timelines were wrong.

So what went wrong then, and is the same thing happening now?

Nothing actually went wrong, it’s just that we all got a bit carried away with the media buzz out there, and forget that the majority of world is shackled with resistance to change. Some of that change is personal, some of it is organizational, some legal etc. It simply takes a long time for these to all be aligned for things to happen.

But if you peer through the mist today you can see that there is progress, and that there is no going back. To believe that the current models will not change is simply not accepting the evidence that confronts the observer, taken the avalanche of factors currently impacting our industry.

So if we all agree that the current model is broken, and that we need to be moving somewhere else why is progress still so slow?

There are many market research papers out there identifying the blocking factors to the adoption of digital tools as part of a multi-channel approach. Here are the usual culprits:

• Lack of senior management commitment
• Inadequate or incomplete strategy
• Lack of internal (and external) capabilities
• MLR resistance to risk or change
• Reluctance to reassign budget
• Elusive evidence of ROI

It is all of the above, but perhaps we’ve not looked at this through the right prism.

Senior management is there to make educated decisions based on the evidence at hand. They are tasked to steer the ship safely, based on limited information and gut feeling built on decades of experience.

If we are honest with our selves, we have been pretty weak at building the case for doing some of the stuff that we’re asking our stakeholders to adopt. Yes, in individual impact studies we can demonstrate that an eDetail, or a self-directed video, has a greater impact than none, but we’re only looking at part of the equation in an artificial configuration, and not even attempting to truly understand the influence and behavioral change attributed to the information coming from different channels.

To build traction and credibility we need to develop and demonstrate deep understanding of channel impact and attribution (including the sales force).

We need to harness this as a lifestyle, living and breathing multiple channels. Knowing what each channel can bring to the table, within the specific environment of each ‘business case’ and how to mix effectively a selected number of them in a congruent manner.

The title of this post is “Why won’t those damn marketers ‘do’ digital?”

Now that you’ve read this far I would postulate a different, and more appropriate cut on this:

Stop pushing the virtues of digital. If you can demonstrate that channel X and Y , used together, will drive the best business and customer outcomes, your marketers will sit up, listen, then beg to know more! Push will become pull, and the marketers will finally skill themselves up with the tools of tomorrow.

In conclusion, we need to become masters of channel selection, capable of building quantified scenarios based on desired outcomes and limited resources. And yes, that will take real investment, but senior management should acknowledge and invest accordingly.

Sven Awege runs the Pharma Strategic blog.

In the 12 month period to June 2012, Russia’s promotional spend increased 42% in comparison with the year before, followed by China with a 30% increase and Brazil with 22%. Commenting on the rising tide, Christopher Wooden, VP of Global Sales at Cegedim says, “In the last 18 months or so, these markets have leapfrogged some of the more conservative markets in Europe such as Spain and France in their use of digital.” This quick embrace of internet, mobile phones and even social media by physicians,  Wooden reports, is the result of laxer regulatory environments in emerging markets; by comparison, slower adopters in Europe are often simply suspicious of these platforms.

Nevertheless, markets across the board will see rises in digital spend, as digital channels are less costly in times where budgets are tight.  As Wooden points out, “the next generation of doctors just starting to practice are much more open to digital channels, because they’ve been exposed to it early on.” This trend, however, depends on how well drug companies adopt these technologies and integrate them into existing functions and organizational structures.  It remains a challenge to design and implement the tools in a seamless way.

The survey also points out that while digital spend is seeing an increase; companies are not necessarily scaling back on the more traditional methods of drug promotion. Sales representatives have a well-established share of the budget because physicians, who in a sense act as savvy consumers, want face-to-face interaction when weighing the decision to prescribe a new medicine. Spending has been diverted from more traditional channels not because they are less effective, but as a result of emergent technologies. So, in essence, pharma is still figuring out the perfect mix of channels, new and old, best suited to getting that brand noticed, in front of physicians.

As the New York Times’ Gardiner Harris has adeptly reported, newly-minted physicians emerging from their final rounds of a med school residency are much more likely to join up with an integrated delivery network (IDN) or chain of privately-owned clinics, than join or start a private practice. The reasons for this are numerous – private practices, for financial reasons, are being sold into aggregated networks, so basic job availability is one part of it – but importantly, lifestyle changes like the need to balance family responsibilities evenly between partners have made the prospect of working 60 or 80 hours a week to build up a private practice untenable, or at least undesirable, for many new doctors.

As a result, new cancer specialists (and many veteran oncologists) find themselves practicing medicine under the auspices of an authority higher than themselves, one with productivity measures and process requirements, in addition to policies around sales rep access. Even though 60% of oncologists say they prefer in-person visits with sales reps – 80% of community oncologists and 60% of academic oncologists say they continue to see reps on a daily or weekly basis – access is likely to continue getting squeezed, due to corporate policy or institutional mandate, according to The Complete Oncologist, a new report from MDLinx, an M3 company.

Physicians don’t like to be told how to practice medicine, and even if access to sales reps specifically isn’t what spurs a rebellion, “I think we are going to see these institution-based doctors begin to push back against the institution’s profit mandate,” says David Deutsch, global head of syndicated products at M3 Global Research. “One of the reasons [institutions] are restricting reps, in our estimation, is that it’s a time issue.” Managers at private clinics or institutions may feel that a physician ought to be seeing a patient instead of listening to a sales rep, says Deutsch. “It’s all about productivity measures in the larger IDNs, and particularly those practices that are owned by large chains that are not hospital-based, but are ‘industrial practices,’ as it were.”

While total sales rep headcounts across all therapeutic areas have slipped to around 70,000 or 75,000 – less than half of the roughly 150,000 reps working full time during the 2000 to 2005 heyday of professional sales – “fully 10 to 15%” of the current rep population represents oncology reps, a 50% increase over the last five years, says Deutsch. Pharma companies “believe they need to have more oncology reps to get more time with those doctors that they are still seeing,” says Deutsch.

When oncologists do go online, it’s probably not for a digital detail, and it’s almost definitely not for social media. According to findings in the report, 50% of the oncologists surveyed said they never use social media, and only 21% of community oncologists (and 10% of academic oncologists) said they visit online peer networks when seeking information about clinical decisions. Online, professional journals were the destination of choice for both community and academic oncologists, and communication with colleagues, in person, or by phone or email, was also cited as an important channel for clinical decision-making.

The Complete Oncologist is the result of surveys conducted with 385 oncologists. Almost half of them said they never visit pharma corporate or brand websites, and all of them see at least 100 patients per month, according to the report.

What is strictly legal in the context of sales and marketing practices, working with government officials in global markets, and running and reporting on clinical programs, may not always be the last word on how a company should act in these areas. In other words, companies often need to go beyond adherence to the letter of the law, and instead consider the broader implications of specific conduct, before a decision is made, or a policy developed.

As the role and function of compliance teams grows within pharma companies, different approaches to the law, and what it should look like in practice, can differ, which sometimes pits internal lawyers against one another. “Compliance wants to truly ferret out any wrongdoing that’s going on – that’s not to say legal doesn’t – but compliance wants to expose it,” says Tim Ayers, VP, chief compliance officer, at Dendreon, a biotech focused on cancer therapies. “Legal wants to wrap everything under privilege, not to hide things, but to deal with things from a very legal, mitigating risk perspective, whereas compliance wants to come in and say, ‘Listen, this is what we’ve done, let’s fix it.’”

Companies operating under a corporate integrity agreement (CIA) by necessity have elevated compliance officers to the c-suite, but in other companies that haven’t had to deal with Office of Inspector General (OIG) or Department of Justice (DOJ) investigations – and there aren’t many of these left – compliance teams are sometimes subordinate to legal departments, even though the members of both groups hold law degrees. It’s in the application of the law, where the hairs get split. “Legal likes to ask very narrowly tailored questions, specific to the legal issue,” says Ayers. “And it might be perfectly sound legal advice, but it might not make sense from a compliance perspective, at forty-thousand feet.”

So what is the right organizational structure for compliance teams, and the chief compliance officer? “I used to be of the opinion that it all depends on the company’s evolution and lifecycle,” says Ayers, who was formerly associate general counsel and executive director of compliance at Seattle Genetics, and who has also served as general counsel at Allos Therapeutics, Salix Pharmaceuticals, and as a regional attorney at Pfizer. “But now I’m becoming increasingly of the opinion that there is an inherent tension between legal and compliance, and if [compliance] is subordinate to legal, it’s inevitable that an issue will rise up which literally speaks to this conflict of interest.”

For more on the issue of compliance, and how companies are bringing compliance personnel into the upper echelons of senior management, look for PharmExec’s feature on the subject in the January issue. Additionally, Ayers and many other pharma compliance executives and government regulators will be on hand for CBI’s 10^th Annual Pharmaceutical Compliance Congress, to be held at the Ritz-Carlton in Washington DC on January 29–30.