The mantra now is patient education. In a year marked by the impact of the withdrawal of Merck & Co.’s Vioxx, some pharmaceutical marketers diverted from direct-to-consumer advertising and focused more on professional health-care advertising. With the establishment of an advertising code of conduct by the Pharmaceutical Research and Manufacturers of America and with voluntary bans on DTC advertising by some pharmaceutical companies, marketers shifted some of their efforts from drug-awareness ads to patient education. In many cases, professional health-care advertising agencies benefited, and some established new divisions to offer more patient-focused programs to their clients.

According to Joe Carofano, president of CCA Advertising (see profile on page 172), delivering strategically creative work for the health-care industry has become much more challenging during the last few years. These challenges include the emergence of medical devices, diagnostics, and specialty products to treat diseases, the influence of drug-delivery technology and its impact on life-cycle management, disease awareness and education, and the new PhRMA guidelines, which are changing the way marketers can address their audiences.

"A successful brand can no longer be isolated and segmented away from the company behind it; in fact, a new convergence of brand, corporate, and disease awareness is beginning to shape the future," Mr. Carofano says. "A more solid overall platform for a product, derived from the characteristics of the corporation and with an eye toward owning the disease state and category, can make a long-lasting connection with patients and physicians in a way that trumps typical pharmaceutical messaging. This is not to say the traditional approach is no longer relevant, but it must adhere to a greater vision."

The PhRMA advertising principles released in July 2005 took effect in January. Under these voluntary principles, pharmaceutical companies have agreed not to run ads for erectile-dysfunction drugs at times when small children are awake, to obtain Food and Drug Administration review of DTC television spots before they run, and to avoid DTC advertising all together after a new drug is launched so that physicians can be thoroughly educated.

The result so far has been the disappearance of the 15-second reminder ads and the introduction of DTC ads that emphasized educating the patient about the risks as well as the benefits of a drug. Although some advertising executives say the changes have blunted the impact of drug ads and companies’ products are no longer differentiated, FDA is issuing far fewer warning letters about ads.

Some companies, such as Bristol-Myers Squibb Co. (bms.com), AstraZeneca (astrazeneca.com), and Pfizer Inc. (pfizer.com), have instituted their own moratoriums on DTC ads for newly launched drugs.

One effect of the renewed focus on patient and physician education is the increase of disease-awareness ads. On television and in consumer print magazines, these ads give patients a way to talk with their doctors about certain conditions and the drugs that could be used to treat them.

Disease-awareness ads for physicians in medical journals have increased. These ads are often for products that are still in development and are focused on educating physicians about specific diseases or a new way to treat a specific disease.

Because of the increase in disease-awareness ads aimed at health-care professionals, Med Ad News editors decided this year to honor the Best Disease-Awareness Advertisement. GSW Worldwide’s ad to educate doctors about the effects of hyperuricemia, for Tap Pharmaceutical Products Inc., was chosen as the best in the disease-awareness category (see GSW’s profile on page 38). Tap (tap.com) is developing febuxostat, which is awaiting U.S. approval for the management of hyperuricemia in patients with chronic gout.

DTC will remain part of the promotional mix, and because companies are demanding ranges of services from their agencies, some of the professional advertising agencies have been making arrangements to handle DTC. Longtime professional health-care agency Abelson-Taylor Inc. expanded its services in 2005 to include DTC advertising. The agency won three DTC assignments in 2005, including Takeda Pharmaceutical North America Inc.’s insomnia drug Rozerem. For each of the DTC brands, Abelson-Taylor is the professional agency of record as well (see profile on page 20).

Other professional health-care advertising agencies tap sister agencies within a network to assist clients with DTC advertising. Agencies in the CommonHealth network can call on Quantum to provide DTC expertise (see network profile on page 222). Agencies in the McCann Healthcare WorldWide network can work with McCann HumanCare (see network profile on page 236). This can result in a unified branding message for physicians and consumers, as with the promotion for the insomnia drug Lunesta. McCann HumanCare (see profile on page 130) holds the DTC account for the drug. Echo Torre Lazur (see profile on page 92) holds the professional advertising account.

As educating patients and physicians becomes more important, due to the beginning of drug benefits for seniors, health-care advertising agencies will have to provide these services to clients. Several of the agencies profiled in this issue have medical-education divisions or belong to networks that have medical-education agencies.

ven with this push toward patient and physician education, marketers will have to step carefully, which will affect the strategies of their health-care advertising agencies. In January, Senators Chuck Grassley, R-Iowa, and Max Baucus, D-Mont., continued to review drug-company educational grants to promote particular medicines and sought more details of the practice from several companies.

The senators are concerned that sales and marketing personnel — rather than medical professionals — continue to award drug-company money to medical-specialty groups and patient-advocacy groups to promote product use, especially off-label use. In 2004, pharmaceutical companies made $1.47 billion in educational grants, about 20% more than in 2003.

Although some agencies have made the decision to go into medical education, others choose to stay out of the category. According to Dale Taylor, president, Abelson-Taylor, "We know we can be the best advertising agency in the business, but would probably only be mediocre as a med-ed or PR shop." Mr. Taylor believes that his decision to keep the agency out of medical education is a sound one because of the difficulties faced by agencies who try to represent both sides of a brand’s business.

nother event that will have a long-term impact on the industry, and subsequently the advertising agencies, is the institution of the Medicare drug benefit in January. The introduction of the drug benefit expands the presence of the U.S. government as a pharmaceutical customer. Experts agree that pharmaceutical companies will need to refine their marketing techniques to reach those who make formulary decisions for senior citizens’ Medicare drug plans.

Marketers may take their cue for handling Medicare from marketers in Europe. According to Cutting Edge Information, pharmaceutical companies spend up to 13% less on advertising in Europe. Companies reduce their advertising budget because there is an absence of direct-to-consumer advertising in Europe. Another major difference between European and U.S. pharmaceutical advertising is the timing of budget allocations during the stages of a drug’s development. Of 16 brands analyzed by Cutting Edge, only three brands had advertising budgets before Phase III, compared with some U.S. blockbuster brands with advertising budgets beginning as early as Phase II.

"Brand teams approach marketing differently in Europe, putting more focus on thought-leader relationships, advertising, and other techniques to target influencer and prescriber networks," says Jon Hess, a project team leader at Cutting Edge (cuttingedgeinfo.com).

Many agency networks already have managed-market divisions focused on providing service specifically to third-party payers. Torre Lazur Managed Markets (see profile on page 215) provides targeted third-party payer programs such as pull-through materials and reimbursement strategies. Many of these initiatives are intended to affect the entire life cycle of a brand from pre-launch through post-launch, including publication strategies, burden-of-illness briefs targeted at payer medical and pharmacy directors, and educational initiatives aimed at raising disease-state awareness.

ith the growth in the number of approved biotechnology and other specialty drugs, agencies have reacted by becoming more scientifically oriented than ever before. Two agencies got their start in late 2004 and in 2005 to address the needs of these "high-science" brands: The Navicor Group (see profile on page 205) and Carbon (see profile on page 170).

Carbon describes itself as a high-science, problem-solving marketing-communications group with a focus on emerging companies, often in the specialty pharmaceutical/biotechnology arena with products in either high-science therapeutic areas or facing complex and dynamic markets. Carbon managers believe that these types of clients are looking for the focus of a smaller agency organization with specialized talents and unique expertise.

Navicor managers believe that specialty products, such as oncology or immunology products, require specialty thinking. The agency was founded specifically to focus on these types of products. Agency President Garnett Dezember spent 20 years at Bristol-Myers Squibb where he oversaw the marketing efforts for several key oncology and immunology products, including the launches of the chemotherapy drug Taxol and the HIV drug Zerit. Navicor’s medical director is Isadore Pike, M.D., a board-certified oncologist who came to the agency from Bristol-Myers Squibb, where he oversaw medical affairs and clinical studies for the oncology/ immunology division.

Carbon’s sister agency, Altum (see profile on page 166), also focuses on specialty communications for specialty markets. "As new and innovative therapeutic options in biotechnology, pharmacogenomics, and personalized medicine grow in complexity, the agency’s in-depth approach becomes an increasingly important selling point for them as they reach out to marketers with the Altum offering," Altum managers say.

Some agencies take pride in their reputation for work in specialty medicines. With almost half of its revenue coming from biotechnology companies, Abelson-Taylor claims to be the world’s largest biotechnology agency. Four of the agency’s six billion-dollar brands are biotechnology brands. "Biotech brands demand a very high level of scientific and medical sophistication and a mastery of strategy," Mr. Taylor says. "Our dominance in this market has been an important part of our growth."

he emphasis on patient-education initiatives has caused agencies to come up with new offerings for clients. GO INfusion LLC (see profile on page 196) has a proprietary offering called Medutainment. This offering is a specialized interactive format that engages a target audience by combining education with entertainment.

According to GO INfusion managers, the Medutainment participant is completely immersed in this media, which increases brand and message retention. Managers say Medutainment has proven its success through conventions, sales presentations, Web initiatives, and electronic mail.

The need for patient education, and innovative ways to reach physicians, has also given rise to interactive-focused agencies. Although these agencies have the capabilities to provide traditional advertising and promotion, the agencies specialize in the most cutting-edge interactive technologies.

Medical Broadcasting Co. (see profile on page 132), which was acquired in the beginning of 2006 by Digitas Inc. (digitas.com), is a full-service interactive marketing agency, which means that the agency offers a full range of interactive services as well as the means to extend and support these initiatives offline, including TV, radio, and print.

"We’re the largest interactive agency in the U.S. that’s singularly focused on the health-care market, and what a time to be in our space," says Larry Mickelberg, president, MBC. "There is a profound change that is coming to the consumer-marketing function in these companies, away from DTC television and very likely towards a new frontier online."

Mr. Mickelberg says MBC, which was founded 15 years ago as a television production company, is a leader in the use of rich media and streaming video in brand new ways for clients. "We see, and have started to deliver on, opportunities that go far, far beyond streaming television commercials online," he says. "We view this as a moment we’ve been waiting for since we were founded."

More recently established agencies such as Juice Pharma Advertising (see profile on page 114) are investing heavily in interactive capabilities. Juice plans to expand its digital offerings, including Tablet PC, Flash, and video technologies.

Another agency with a heavy focus on interactive capabilities is Ignite Health (see profile on page 109). The agency specializes in developing new programs that are at the forefront of communication innovations, including interactive simulators, customized customer-relationship marketing sales programs, and blog and word-of-mouth marketing initiatives.

Ignite’s work ties in the trends of technology, specialty markets, and patient education. Managers say the majority of Ignite’s new business growth in 2005 came from education-to-patient and patient-advocacy assignments. The agency plans to build on its success by focusing on clients who serve the needs of the chronically ill and those who care for them. Ignite specializes in creating messages that connect all the health-care decision makers — all of those who influence, prescribe, approve, purchase, or use a particular health-care product. Therapeutic areas that the agency specializes in are ophthalmology and HIV, and other chronic conditions such as cancer, diabetes, cardiovascular disease, and mental illness.

Agencies continue to expand their interactive divisions. CCA’s in-house studio, ’nition, has grown during the last year to offer high-end design services for all clients, including e-marketing strategies, interactive promotions, and Web design.

s the pharmaceutical industry reacted to change, there were some agencies that had to change in turn to meet their clients’ needs. The former Nelson Communications became Brand Pharm in 2005 (see profile on page 70). Agency executives say this change entailed much more than putting a new name on the door. Significant new talent was recruited, and the agency’s philosophy and operating procedures were totally revamped.

"There was a lot of confusion in the marketplace because originally one of the mainstays of Nelson Communications was a contract selling organization," says Lorraine Pastore, Brand Pharm president. "There was a lot of confusion in the marketplace about the brand and what it stood for. When we did some equity research, we found that that brand name did not have strong equity as an advertising agency. That was clearly a problem."

In addition, managers say because of the agency’s association with other things besides advertising, this led potential clients to believe that the agency lacked creativity. "As an advertising person for 25 years, I could not have that," Ms. Pastore says. "That was the impetus to look at things anew."

Plans for the future center on getting out the Brand Pharm message to more people in the industry. The agency launched a new corporate journal ad series in January, which is supported by a full-scale campaign to attract new clients.

Another agency went for a face-lift. In the 2005 agency issue of Med Ad News, The Hal Lewis Group (see profile on page 124) kicked off its new branding campaign. The agency’s tag line, "Growing greatness," is related to the agency managers’ belief that The Hal Lewis Group has an abundance of creative seeds — great ideas, great strategies, great brands, and great results.

he landscape of independent and network advertising agencies continues to shift. When the largest independent agency network sought to be acquired, the executives did not turn to a well-known network such as Interpublic, Omnicom, or WPP. Instead, inChord Communications Inc. (see profile on page 230) went with Ventiv Health. Ventiv, now known as inVentiv Health, acquired inChord in October 2005 for $185 million. The acquisition added pharmaceutical advertising, branding, and marketing business to inVentiv’s sales team, planning and analytics, compliance management, and clinical staffing and data-management businesses.

InChord (inchord.com) remains intact along with its management and its portfolio of 10 integrated brand-building companies: GSW, Palio Communications (see profile on page 144), Stonefly Communications Group (see profile on page 210), The Navicor Group, Blue Diesel, Cadent Medical Communications, CHS, RxPedite, Y Brand, and the newly formed DWA Health, an Italian health-care advertising agency.

The combined company serves more than 150 pharmaceutical, biotechnology, specialty, and emerging health-care companies, including 18 of the top 20 global pharmaceutical companies. As a wholly owned subsidiary of inVentiv Health (inventiv.com), inChord continues to be led by Blane Walter who retained his title of CEO of inChord and took on the new title of president of inVentiv Communications. Mr. Walter also became part of the inVentiv Health board of directors.

Some of inChord’s top clients include Eli Lilly and Co. (lilly.com), Tap, Roche (roche.com), Novo Nordisk (novonordisk
.com), Cephalon Inc. (cephalon.com), Abbott Laboratories (abbott.com), GlaxoSmithKline (gsk.com), Genentech Inc. (gene.com), and Astellas Pharma Inc. (astellas.com).

InChord managers say inVentiv was one of several companies interested in acquiring inChord, as were a number of financial sponsors and direct competitors. InChord chose to combine with inVentiv because of the strategic fit, size, customer fit, and cultural fit.

"The new combination will allow us to have a full vision around sales and marketing and how we can leverage those capabilities to help our pharmaceutical and biotech clients," Mr. Walter says.

InVentiv’s Health Products Research group is an example of one of the more attractive capabilities that inVentiv offers. This group specializes in pharmaceutical and biotechnology analytics.

"They work with clients to help with segmentation of their customers, targeting, and return on investment," Mr. Walter says. "We think bringing their quantitative expertise together with our qualitative expertise will help us make more sharp decisions for our clients, be able to make more effective and efficient solutions, as well as measure those solutions in ways we have never been able to do before."

InChord executives say a few months into the new relationship, the inChord/inVentiv combination is offering clients even more powerful services. The partnership has spurred almost two dozen collaborative projects with existing and new clients. Additionally, the acquisition has provided inChord with the capital needed to continue expanding, both geographically and through new capabilities.

As evidence of this, inVentiv Health acquired Adheris Inc., a provider of patient-compliance and persistency programs, in early 2006 and added the company to the inChord network. Through the acquisition of Adheris, inChord now claims patient adherence as one of its key capabilities and added a new location in Massachusetts and about 50 new employees to its ranks.

Mr. Walter’s business vision for creating the favorable acquisition by inVentiv helped earned him the Advertising Person of the Year Manny Award (see profile on page 232).