Live, http://www.pmlive.com)..) This is partly due to a
desire not to limit the market by ‘niche-ing’ the
product. Larger markets are easier to enter, but are
also subject to more fierce competition, and co-
marketing of one product by two or more phar-
maceutical companies is an approach used more
frequently. Marketing capability is largely based
on the size of the sales force, which has been inc-
reasing since the early 1990s, but has now prob-
ably reached a size that is subject to the laws of
diminishing returns. This drives a need for alter-
native approaches, such as online marketing.
One study of marketing activities for a branded
drug in the United States found that marketing
efforts generated 22% of prescriptions. Of this,
television generated 12% details (sales people vis-
iting prescribers) and face-to-face contacts gener-
ated 6%, print generated 3% and online activities
1%. Online activities accounted for 3% of total
media expenses but generated 7% of marketing-
driven prescriptions and was more responsive than
TVor print; online costs are estimated at $11.33 per
incremental prescription, compared with $17.12
for television adverts and $13.33 for print
(DoubleClick Media Mix, http://www.doubleclick.net)..)
The range of marketing strategies is large, and
includes
advertisements to prescribers in medical jour-
nals and other publications;
detailing to prescribers (face-to-face visits);
free samples and gifts to prescribers;
medical education activities for prescribers;
DTC advertising to patientsviageneral publica-
tions, radio and television;
disease awareness campaigns, targeted at
patients;
Internet sites, targeting patients and pre-
scribers;
contributions to patient support groups;
other activities.
51.9 Advertisements in medical
journalsAdvertising can be considered to be any represen-
tation by any means whatever for the purpose of
promoting directly or indirectly the sale or disposal
of any food, drug, cosmetic or device. Promotion of
a drug prior to market authorization is not per-
mitted as the proposed indications have not yet
been verified (Health Canada, 2000).
Advertising should be undertaken when it
provides the kind of reach and presence among
existing and potential customers that other pro-
motional options cannot do. Advertising can be
used to project a brand in the market, to reward
and encourage customers, to establish a presence
and to give a personality or attitude to a brand. The
campaign should be designed around the availa-
ble marketing budget and needs a good, simple
idea if it is to stand out from other messages and
information (Pharmaceutical Marketing Live,
http://www.pmlive.com).
Many medical journals rely on advertising to
survive and sometimes this gives pharmaceutical
companies a degree of influence over editorial
content. US studies have shown that more frequent
exposure of prescribers to advertisements heigh-
tened product and message awareness and
increased prescriptions, as well as increased con-
fidence in the claims made by the advertisements
(Vitry, 1996).However, aUK study failed to show a
clear association between extent of advertising and
subsequent prescribing by GPs (Joneset al., 1999).
This may in part be due to a perception that claims
made in drug advertisements may be misleading
(Villanuevaet al., 2003).
GPs are increasingly using computers for
accounting, prescribing and medical records, and
screen advertising is an alternative to print. How-
ever, care must be taken that patients do not have
access to the advertisements in countries where
DTC advertising is prohibited (Nolan, 2000).51.10 Detailing to prescribers
Face-to-face contact between pharmaceutical
representatives and prescribers has long been the658 CH51 ADVERTISING AND MARKETING