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Make way for the virtual sales call
Pharma companies are examining their on-line strategies closer than ever, but technology issues in the UK still need to be resolved for e-detailing to really take off.

For every net-savvy marketer out there, there is probably an old fashioned sales manager who just wants more face-to-face calls, not virtual ones. The great questions of 2002 seem to revolve around whether traditional selling will increasingly be replaced by rampant new technology. Do existing sales people face a future of confinement in an on-line call centre 'sweat shop' as some pundits propose? Or are those US models of the future being spun just a little too creatively, is the technology being stretched too far, and, last but not least, does the prime customer want it?

E-detailing is a hot topic. The term covers a wide spectrum of activities from live interaction - on-line detailing through pharma company website activity - to more static branding and banner adverts.

After a slow and cautious start, many pharma companies profess to having on-line strategies. Some have e-business heads and directors. As ever, some choose to go their own way while others work closely with existing Internet players. Everyone is keen to explore the new media; everyone is concerned not to get burned by over-investment in immeasurable spend.

Chris Doyle, a senior marketer at Napp, is clear on this: "What you can't measure and what you can't manage you shouldn't pay for. At Napp we've done a lot of good work exploring electronic detailing - working with Doctor Online (NHSnet) and using MediQuiz (from Life Healthcare) to attract GP customers and investigate some non-web-based systems. Gaining extra promotional voice and getting measurable results is important." is a widely used portal by up to 60,000 medical practitioners. Its Commercial Director, Erik Jan Scholten, says: "Doctors feel very comfortable using, which makes us a good partner for suppliers. We work closely to ensure our users receive useful information. These are new services and over the next six to nine months we should start seeing some objective statistics that back up the value."

An example of such a partnership is with Leo Pharmaceuticals, whose launch of their 'interactive on-line representative' sounds exciting and is to a point. It offers a dermatology microsite, laden with medical information and PGEA-approved educational material. Leo prefers to describe it as an "on-line medical support centre," rather than an on-line representation, enabling clinicians to access clinical papers. There is a rep contact option, which offers the opportunity of a rep to call, as well as brand reminders, etc.

These are complementary activities, or, in some cases, additional activities, but such promotional activities cannot be seen as replacements within the marketing mix," says Erik Jan Scholten. "These are new activities so it will be six months before we have some statistics."

Looking to the US Statistics abound from more developed markets like the US. There is a lot of discussion around models for interactive rep detailing, with a lot of credible claims for increased airtime, productivity and return on investment. Given the investment size of fieldforces, with a cost of 70 to 80 to put a rep into a GP surgery, this has to be an area of interest. Dr Doron Junger, CEO of, is enthusiastic: "The US has shown us clearly that significant returns on investment can be made by e-detailing. These can give a real opportunity for increasing revenue on older products; for example, a 480% return on a six-year old product."

With more than $10 billion spent on field sales promotion by 63,000 reps, it is no wonder that ZS Associates has researched the opportunity extensively in the US. Two major players, iPhysicianNet and Pharmadetailing, are keen to supply the technology and the expertise. There is an opportunity for cost cutting and enhancing the marketing mix but these are early days. Clearly, this is more than using a visual aid on a web cam - the skills, communication objectives, products and customer types all need redefining.

UK in the slow lane Is it the technology or a lack of creativity that is holding back the UK? A quick survey of the scene shows a translation of established practices to electronic media but no real innovation.

"It's a bit of both really," comments Ben Blackmore, Senior Art Director at Life Healthcare. "Some companies appear to think that electronic/Internet promotion is more rigorously restricted than it actually is, but the same rules apply. For example, prizes in competitions have identical cash values put on them. But until we have free access to broadband/ADSL, then downloadable/on-line services can't really be compared with the US. Realistically, that's three to four years away.

"Not all of this happens in the surgery; GPs will go on-line from home, just as they take journals home to read. In terms of cost, the lack of free access continues to be an issue - every minute they're on-line clicking around MediQuiz or a company website, it's costing them money."

For the uninitiated, broadband offers hyperfast and constant Internet access, delivered either by cable operators or by telecomms providers via DSL (digital subscriber lines). There are also wireless and fibre optic options: this is a techie battleground in the US. What does it all mean? Quite simply, a cable broadband modem connection can deliver 3mb per second - that is 50 times faster than a standard 56kb modem attached to the NHSnet. Speed is the key. Real on-line detailing is a teleconferencing function, a true broadband activity because it needs perfectly synchronised high quality audio and video feeds. Is it available in the UK? BT will connect you via ADSL for around 500 a year, which speeds up your connection by a factor of 10.

It will clearly be a while before the industry can go full on, presently limited by NHSnet and slow access. Not only is NHSnet behind schedule (1999), but with 92% GPs connected, it is notoriously unreliable - a recent system crash in September meant e-mails took three days to get through. Even more bizarre, like something from a 'Yes, Minister' script, NHSnet is a privately run intranet and is costly to use - there are documented cases of large files costing as much as 300 to send, forcing cash-strapped hospital administrators to use fax or courier! Such issues don't help your customer to become more receptive to electronic initiatives.

Companies have a choice - go it alone, work in partnership or work with an agency like Life Healthcare. "We've developed MediQuiz to work as a 24-hour detail aid. It's interactive and gets the GP at least typing in the product name, with a prize to win, that allows local rep contact," says Ben Blackmore.

'Stickiness' is a key word here - getting the GP attracted and kept interested is clearly the challenge. Companies that choose to go it alone often attempt to build product promotion into their corporate site but unless the GP has a good knowledge of manufacturers and brands, these are difficult to use. There is also a wariness of own-company sites. A US study has shown that nearly 80% of GP respondents rate accurate and credible information as a main requirement with 60% suggesting that the removal of all advertising would achieve this.

Doctors in love? There is an assumption that doctors love the Internet. Like all assumptions, it is flawed. From the US comes the recently published Forrester report, which looks at resistance to Internet use by physicians. Compared to healthcare managers and industry, a sample of doctors view the Internet as relatively low importance in buying services (10%). Most respondents do not believe the hyped up claims for productivity and time saving - the area most popular are medical literature sites, usually non-commercial ones like Medline.

Medical education and CME (continuing medical education) using interactive sites are a big opportunity for the industry., the most popular GP site, is one month in to its on-line eCME programme. So far, more than 4,000 GPs have used it. "It's great to be able to answer a real need - this has been the most requested service over the last couple of years so it's no surprise it has really taken off so quickly," says Dr Neil Bacon, Chief Executive of The ability to earn PG accreditation 'points' from the Royal College of General Practitioners (RCGP) on-line, out of hours, even at home, is real benefit to time pressured GPs. Modules or series of modules can be sponsored.

"There are three separate benefits to manufacturers here," says Dr Bacon. "Firstly, obviously brand advertising associated with a disease/therapy area. Secondly, a chance to build a different type of extended relationship with prescribers - out of hours and linked to learning. Finally, it is measurable. Part of the accreditation means attitudes are surveyed pre and post-module, allowing anonymised data showing changes for client companies."

So, will CME be replaced by eCME? "Not 100%," says Dr Bacon. "The attraction of meeting colleagues at a PG centre will never disappear, but we expect a rapid uptake over the next six months for 17,500 users, particularly as the service will be promoted by the RCGP themselves in January."

Other enthusiasts predict that GPs will work with a stethoscope in one hand and a Palm Pilot in the other, although a recent Harris survey (again US) shows 18% of all physicians using a handheld device - some years before it is standard equipment. Harris predicts 50% by 2005, with the rest adopting slowly. Interestingly, this could put the US behind Europe/UK, due to the lack of central government policy drive on electronic prescribing and electronic patient records. In fact, the UK leads the world in this instance, with 87% of GPs using electronic prescribing, compared to only 9% of their US counterparts.

Now, if the technology isn't ready yet for full swing e-detailing action, what should be going on? Is there a way of communicating electronically with NHS customers, yet without over reliance on an Internet linked to 56k modems?

There is another way "The Internet is fantastic, but it's not the only route into the surgery," says Dr Steven Bauer, Marketing Director of healthcare technology company DXS. "In South Africa, doctors generally only use the Internet in their private time, meaning that product messages are seldom seen during the patient encounter," "We provide a platform for pharma companies to promote products and to communicate to clinicians that is not Internet-based. There is clearly a reluctance to spend time searching the Internet for credible/reliable data here in the UK as in other countries. Every GP has a practice system with a desktop screen - that system is the way in to talk to them. We can provide add-on software that will sit alongside some of the major practice software providers."

By integrating the DXS platform with Microtest, Seetec and Healthy Software so far, a window opens on the GP's computer, allowing a client company to advertise a brand at the point of diagnosis, make PILs and medical information available, not to mention the medicine monograph database, supplied by Haymarket Medical Publishing. Like other sources, usage data has to be anonymised, but clients will be able to see monthly reports for each product and measure the 'noise volume'.

"We are running Adizem XL within DXS - it solves all of the Internet problems: it sits in front of a user GP when they're writing scripts," says Chris Doyle. "Having this sort of promotional tool is very valuable when you are managing a portfolio of varied products. And it's measurable - it's like 'pay per view' for GP advertising."

In South Africa, DXS has enjoyed rapid uptake by GPs and pharma clients alike. Peter Leid, Marketing Manager of AstraZeneca South Africa, says: "I like the fact that my product brand and supporting literature appears every time the diagnosis is made in the clinical system." Doctors appreciate the time saving offered by the comprehensive medicine reference, CME, patient education and electronic pathology requests. In fact, the majority of CME in South Africa is now completed electronically, a future that is more than possible for the UK.

Why are independent GP system providers rushing into partnership with DXS? Two main reasons - they share in the revenue stream and the platform allows them to do faster updates across their user databases. Not everyone is rushing, however. The major provider is EMIS (Egton Medical Systems), with a 50% market share in England and Wales. Within the current EMIS system is 'Mentor', an advanced decision support program co-developed with Oxford University Press. Covering more than 2,000 diseases, it uses photographic and video material, with many of the pages containing external links to connected websites like Medline.

All new activities have a learning curve and the e-detailing/e-marketing curve looks to be a steep one. The companies that will succeed in this strategic area will be the ones that act now and learn quickly. Having a company website is not enough - working with GP friendly sites like is attractive; fitting your brand ads into current GP practice software is equally so. The other challenge remains finding the creative solution before your competitor does - transferring marketing activity from one medium to another isn't enough. The opportunity of building a different and new relationship with prescribers remains the Holy Grail.

Jonathan Akehurst, MD, Masterclass International. E: