Offline Disconnect

In 2009, for the first time, TNS Healthcare asked physicians to specify their preferred non-rep information sources, requesting that they rate eight channels on usage and value. (See "Pharma's Service Channels," page 106.)

Not surprisingly, continuing medical education leads the list, both in terms of awareness and value. Webcasts, e-detailing, and PDAs fill out the bottom of the list, with only 42 percent of those surveyed using PDAs. (Interestingly, however, all 42 percent find them valuable.)

Top Service Companies

The TNS Healthcare survey asked doctors to rate how well each of the 17 companies covered delivered across the full range of service experiences.

Merck leads in the US Last year, Merck and Novartis were tied for first place in the United States, with both earning top marks across all service categories. But in 2009, Merck pulled ahead—based on its continuing strength in Web-based services—and was the only company to have a "clean sweep" of first place scores in all eight service categories.

GlaxoSmithKline and Pfizer tied for second place in the US, with top scores in seven out of eight service categories. Web services for physicians were the weak spot for both GSK and Pfizer—the one area where they missed getting a top mark. Novartis fell from first to third place, tying with Lilly, with lead scores on six out of eight service elements. Novartis' two weak areas were Web services—both for physicians and for patients. Lilly's were Web services for physicians and rep conduct.

Novartis tops on service in Europe In Europe, Novartis led on service delivery, with four out of the five major European countries giving the company top marks for effectively delivering key services. Pfizer, Sanofi-Aventis, and GSK also earned high scores across Europe.

Despite this, when it comes to Europe, scores for the new service areas were below average in most countries. Clearly there are major opportunities for European companies to enhance their brand support services.

One country where you can see the need for improvement is the United Kingdom. Ten of the 17 companies measured there tied for first place, with top ratings across all service areas. Unfortunately, that does not indicate high across-the-board performance. Rather, it shows that companies are undifferentiated in the UK market.

Deteriorating Relationships

It used to be that US physicians were considered allies of the industry. It wasn't that they always prescribed a company's brand, but pharma could count on them to understand and support the value of the industry at large.

Not anymore. In fact, in 2009, the number of US physicians who were actively speaking negatively about the industry crossed a tipping point, reaching 19 percent—that's up from 12 percent in 2008. That number is significant because when more than 15 percent of doctors are categorized as "rebels" (those deeply dissatisfied and actively generating negative word-of-mouth), it's difficult for companies to overcome the bad buzz and promote successfully. The US—traditionally the most pharma-friendly market—has never before shown such a negative pattern.

Globally, the picture is worse. Almost a quarter of docs (22 percent) are rebels, according to TNS's TRI*M typology, which measures the strength of a company's relationship with its customers. TRI*M findings show it takes three active advocates, or "apostles," to overcome each "rebel" detractor. In 2008, there were enough apostles generating positive buzz to neutralize negative word-of-mouth. But in 2009, the picture has changed: There are now just two positive "apostles" for every negative "rebel." (See "Market Resistance Index," page 109.)

European countries have traditionally had a high proportion of rebels. This pattern continues in 2009. All five major European markets—UK, France, Germany, Italy, and Spain—have a high percentage of doctors actively creating negative word-of-mouth. The situation is particularly bad in the UK and France, where there is one rebel for every apostle. Further evidence of this lies in the low British TRI*M relationship-building scores.

Spanish doctors go against the trend, however. In that country, the percent of rebels decreased from 28 percent in 2008 to 21 percent in 2009. Still, this rebel population is above the 15 percent that is considered desirable.

Which Company Has the Strongest Relationships?

Taken together, these markets show that pharma's relationships with physicians are weakening around the world. Still, there are some bright spots.

When it comes to having strong and valuable relationships with doctors, Novartis holds the top position globally, according to TNS's TRI*M scores. Physicians in four of the six countries surveyed rank Novartis at the top. AstraZeneca, Pfizer, and Sanofi-Aventis also rate highly, with first or second place finishes in three countries. In addition, Merck, Boehringer Ingelheim, and Takeda—new to the survey this year—show strong performances, with lead scores in two countries each.

In the US, four companies—GlaxoSmithKline, Merck, Novartis, and Pfizer—share the lead based on their reps' ability to build strong physician relationships. There is no statistically significant difference in their TRI*M scores, showing that these reps are forging strong bonds with physicians.

But look closer and you can see cause for concern in the United States. Eleven of the 17 companies measured have seen scores fall between 2008 and 2009. Overall, the ratings have declined from 78 to 75, a significant drop (though still a solid score when compared with other industries). Even Novartis, while it ties for first place, dropped sharply in its TRI*M score, falling from 89 to 81. Pfizer and Merck scores also fell in spite of their first place standings.

Relationship scores fell in other countries as well. For instance, nine of the 17 companies measured saw their scores drop in Germany. Meanwhile, even though TRI*M scores are fairly low in the UK, individual companies are seeing mixed results. GSK and Novartis, in first and second place, respectively, in 2008, have dropped out of the lead. In contrast, Boehringer Ingelheim, BMS, Merck, and Pfizer are witnessing substantial improvements in their physician relationship scores. For BI, this improvement put it among the lead UK companies this year. In 2009, Spain's TRI*M score improved by eight points. Meanwhile, the significant TRI*M score improvement across companies in Spain reflects a strong relationship between the industry and physicians in that country. Novartis' scores, for example, have soared to 94 in Spain—the highest TRI*M score achieved by any company in any country. Pfizer places a close second in the Spanish market.