"In five years, I expect detailing and sampling to come down a bit in share-change effectiveness as people learn to better leverage DTC. peter mehr, vice-president, promotion analytics, health products research

Within DTC, spending on branded and non-branded campaigns is headed in opposite directions, the former up, the latter down. Companies, Devereaux says, "are turning to cause marketing—providing programs to the needy, for example—to generate press, instead of doing aggressive corporate advertising. The few who are doing image advertising are ending up spending their money to speak for the industry instead of building their brands." Ramspacher, however, believes "we'll see much more growth in unbranded DTC, focusing more on disease management and education, in addition to, not in place of, branded DTC." She says pharma has two motives to go this route. One is to tap into the broader untreated "sufferer" population and move them into the healthcare system. Novartis, for example, has a "know your blood pressure" campaign that makes no mention of Diavan (valsartan). The other is to address the industry's reputation problem with PR-type advertisements on pricing and value. (Indeed, David Gascoigne, leader of the promotion management practice at IMS Consulting, says public relations is a "rapidly growing component of the promotional mix.") Some of this will be image advertising. GSK is running an ad highlighting the company's research on Alzheimer's. Ramspacher says it tugs at the heartstrings but is clearly intended to promote the company.

DTC appears to be nowhere near its potential. "Compared with more 'sophisticated' consumer product advertising," Ramspacher says, "DTC is somewhat 'immature' in the complexity of its message and creative." A common criticism, she says, is "every ad looks the same: smiling people walking along a beach." There's not a lot of differentiation. "You can almost attach any brand name and it would work the same way." Her conclusion: "There is still room for pharmaceutical advertisements to grow." But, she warns, "it's a tricky proposition. You have serious diseases being treated. How do you make ads less 'happy' but not depressing or disconcerting?" As much as pharma is mulling how to scale back its sales forces, Ramspacher says, similarly tough questions are being asked about how to differentiate products and speak to the seriousness of disorders while staying within FDA guidances. Gascoigne believes "we'll start to see pharma experiment with very focused programs targeting key patient segments, such as Hispanics, to reap the benefits of DTC."