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Direct-to-consumer advertising: Jury is still out on the benefit to orthopedics
Manufacturers are turning to athletes and celebrities to spread the word on products.
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Orthopedic device manufacturers recently embraced the direct-to-consumer advertising trend full force with some using athletes and celebrities to convey their messages.
Even the American Academy of Orthopaedic Surgeons (AAOS) has used comedian Joan Rivers to get the word out about osteoporosis prevention.
While some current direct-to-consumer (DTC) advertising targets physicians, it is aimed mainly at patients. Opinions are mixed about whether this tact is appropriate for orthopedic devices and clinical therapies.
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Image: Biomet |
“I think DTC advertising can serve either a valuable function or it can actually have a very negative impact on a variety of things,” Brian S. Parsley, MD, told Orthopedics Today.
Parsley said one positive aspect to DTC advertising: Patients who never sought professional care for a treatable condition, such as joint reconstruction for severe osteoarthritis (OA), may connect with a message or spokesperson and seek medical care that may positively change their quality of life.
This may have wider implications as well. Aside from the immediate costs associated with some of these procedures, it could lead to long-term health care savings, said Parsley, who chairs the American Association of Hip and Knee Surgeons’ health policy committee. “That patient may be more independent for a longer period of time and be able to be a functioning member of the society.”
DTC advertising concerns
But many orthopedists, including Parsley, have concerns about DTC advertising, particularly whether consumer-oriented campaigns will escalate patient demand for procedures they do not need or that surgeons are not properly trained to perform. They also wonder if the advertising costs will be passed on to patients and the health care system through higher implant costs.
According to John M. Cherf, MD, these ads actually drive up costs. “They often overstate benefits. They also understate side effects, create unrealistic expectations, and typically promote expensive branded products,” he told Orthopedics Today in a telephone interview.
Cherf said orthopedic manufacturers are beginning to follow the successful lead of the pharmaceutical industry, which spent more than $4.2 billion on DTC advertising in 2005. However, he does expect orthopedic firms to use this vehicle to market their more high-margin products and surgical techniques, such as pricey hip and knee implants. Even though, he noted these ads can be informative. “They could increase compliance. They could better educate patients.”
Parsley said that he favored the original goals of orthopedic DTC advertising, which was to move patients from one company to another and therefore increase sales of implants by promoting established procedures and implants supported by solid outcomes data.
But, when an ad’s intent is to encourage patients to seek a particular procedure, Parsley has some reservations. And for newer, unproven procedures, like hip resurfacing arthroplasty, that approach can backfire.
“Unfortunately, the problem with DTC advertising is it doesn’t always give you a balanced approach,” Parsley said.
According to C. Skip Whitman, MD, DTC marketing amounts to no more than a way for orthopedic companies to maintain or increase market share. “This form of advertising has had no effect upon my professional opinion regarding a particular orthopedic device or product. Having said that, I have seen an increase in patient awareness and questions regarding products that have been celebrity-endorsed,” he told Orthopedics Today.
Consumer oriented
Cherf said if he was in the device industry, he would fear the effects of marketing that bypasses providers and goes directly to the consumer — the patient. “It has the potential to really open up a class-action Pandora’s Box,” he said. If a firm overemphasizes the positives of a procedure or a particular implant and does not sufficiently discuss possible complications or contraindications, “the masses may retaliate with class action [lawsuits],” he said. “I think society will be more punitive if that happens in the future.”
With such possible downsides, physicians wonder about the logic of bypassing them to target patients with DTC advertising.
Bottom line
Some firms have decided to use celebrities in their DTC promotional efforts. Industry representatives who spoke with Orthopedics Today said results of those campaigns are not in yet, but from early assessments, using a celebrity — the right celebrity — may be most effective for building brand awareness and alerting the public to key issues like delaying surgery.
DePuy, a Johnson & Johnson company, twice used celebrities who have DePuy implants in a promotional capacity — actress Angela Lansbury and Chicago Cubs Hall of Fame short stop Ernie Banks, and had success. “We were not looking at it in terms of return on investment,” said Mindy Tinsley, Group Manager, Communications, DePuy Orthopaedics Inc. Citing the success of their brief 2006 campaign with Lansbury, she said, “Literally this reached millions of people and it was a very educational message — ‘Don’t wait. Go see an orthopedic surgeon.’”
Public relations outreach communicates this message very effectively, particularly to women who tend to put off surgery more than men do, Tinsley told Orthopedics Today.
Now, DePuy uses regular patients exclusively in their marketing. “We’ve found everyday people to be extremely effective and believable in talking to other patients,” Tinsley said. “We know that when patients, whether they are high profile or not, encourage people with severe knee pain to talk to an orthopedic surgeon, they are more likely to move past their concerns and explore treatment options.”
Raises awareness
Stacey Jones, who heads Biomet’s DTC campaign, said Biomet started using gymnast Mary Lou Retton as a spokesperson in April 2006 for print, TV and radio advertising. The campaign, geared toward patients, focuses on the M2a-Magnum and Taperloc hip system she received, Jones said.
Biomet’s DTC program is geared toward public awareness of arthritis. “The main campaign is definitely targeted to consumers, trying to raise awareness of joint replacement and treatment options,” she said.
Jones said the campaign has been extremely successful. “We’ve seen huge spikes in call center numbers. We’ve had close to six million Web site hits on Biomet.com since January 2007.”
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Image: Smith & Nephew |
Image: DePuy |
Change with time
Wright Medical Technologies told Orthopedics Today that they did not plan to use celebrity endorsements, but then seized the opportunity when tennis player Jimmy Connors approach the company about how thrilled he was with his Wright hip prosthesis and how it changed his life. Wright signed him on as a spokesperson to tell his surgical success story of pain relief and return to function in July 2006.
Cary P. Hagan, Wright Medical vice president of reconstruction, said other patient-athletes approached the company previously, but Connors was right for their current message.
“Driving patients to the product is still pretty much an unproven strategy. Our program with Mr. Connors is a little different in that we’re looking for ways to provide the message to young or active patients to understand what options are available for them,” Hagan said. That differs distinctly from direct advertising, he noted.
“It still remains a question whether the dialogue should remain between the surgeon and patient and if that is true, then our approach to utilizing these individuals should change over time, as well.”
Do not expect Zimmer to use celebrity endorsements. “That’s not something we will likely go to,” J. Raymond Elliott, Zimmer chairman, said at the firm’s 2007 analyst meeting in February. “We’re probably going to stay with cartoons and comedy, which is more of our specialty anyway.”
Some firms hear about celebrities successfully treated with their products and approach them to appear in advertisements, as was the case with Smith & Nephew and pitcher Randy Johnson. They now work with the pitcher and highlighted him in their booth at the AAOS meeting as a spokesperson for Supartz hyaluronic acid (HA) therapy. “I can’t disclose any details, but I can tell you he has not chosen to work with us for the money. … This is truly something he believes in,” said Ken Long, Smith & Nephew group marketing director for injectable therapies.
Long said the arrangement with Johnson was so last minute they were unable to alert their physician customers of the event in advance of the AAOS meeting. Afterwards the connection with Johnson turned out to be a door opener for those who sell Supartz.
“Suddenly physicians who we had a hard time seeing, will open the door to have a conversation about Randy Johnson,” Long said.
In January Smith & Nephew promoted its Journey knee arthroplasty system through television ads in three markets. They did not feature celebrities, but instead educated would-be patients and encouraged them to talk to their doctors about knee pain and joint replacement. A company spokesperson told Orthopedics Today the firm is still evaluating results from that short campaign but saw increased hits at its Web site, calls to its toll-free number and physicians in the cities where the ads ran reported more office visits.
In 2005, Olympic gold medalist Bruce Jenner entered into a multiyear contract with Ferring Pharmaceuticals as a spokesperson for its HA injectable, Euflexxa, according to William Garbarini, Ferring executive director of orthopedic sales and marketing.
Jenner has appeared at a few orthopedic meetings and conveys the message an active lifestyle is possible despite having OA.
Since most orthopedists perform surgery more often than inject HA, “A lot of his message is to physicians,” Garbarini said, noting Jenner has helped his company build awareness of OA treatments.
Nutramax Laboratories Inc., maker of the Cosamin DS glucosamine/chondroitin supplement for OA, used retired hall of fame pitcher Jim Palmer in its promotions for several years and continues to do so in an effort to get the consumer to raise questions with his or her physician, David Moore, vice president consumer products at Nutramax, told Orthopedics Today. Because of the supplement’s premium position in the market, Nutramax uses Palmer mainly for DTC to start a dialogue with their physicians about the product. “It has to be more about the physician than the consumer,” Moore said.
Stryker, the first orthopedic firm to enter the DTC arena, started using golfer Jack Nicklaus to promote one of its ceramic-on-ceramic hips in 2003. Now, baseball’s hall of fame Johnny Bench occasionally speaks on their behalf.
Un-selling patients
Despite the increasing success of celebrity use in DTC advertising, physicians say it sometimes means they must spend a significant amount of extra nonreimbursed time “un-selling” patients on what they saw advertised either because the surgeon does not use the promoted product, or the device or drug is not indicated for their conditions.
The result: Negative productivity. To combat that, doctors could always switch to another firm’s implants to meet growing patient demand, but Cherf said that has a disadvantage. “If you’re comfortable with Stryker and you switch to Zimmer, there is a learning curve with every change.”
He and Parsley both know of surgeons who acquiesced under advertising pressure and switched implants or learned newer techniques, a strategy Parsley theorized stems from decreased reimbursements: “If you lose 5%, 6% of your practice to a new procedure, you economically may not be able to make ends meet.”
Doctors in competitive markets might gain an advantage and help differentiate their practice by switching to high-tech products promoted in DTC advertising. “One of the great differentiators is technology,” said Cherf, who does not see DTC advertising going away and in fact predicts it could soon expand to Canada and Europe.
“I think you are going to see similar marketing principles you see elsewhere in society in the medical segment. … The sky could be the limit of how successful it is. This strategy was certainly successful for the pharmaceutical industry.”
Nutramax’s Moore said, “I think you’re going to see DTC with a celebrity on a downturn.”
DePuy’s Tinsley disagrees: “I don’t really see it going away. I think it’s probably more opportunistic, for the right celebrity at the right time with the right message. We would definitely consider doing that again because I think it is definitely a very effective way to draw attention to important health issues.”
Stryker Orthopedics was contacted for this piece but did not participate.
For more information:
- John M. Cherf, MD, can be reached at The Neurological and Orthopedic Institute of Chicago, 4501 N. Winchester Avenue, 2nd Floor, Chicago, IL 60640; 773-250-1000; e-mail: Jcherf2002@kellogg.northwestern.edu. He indicated he has no financial or consulting disclosures related to products mentioned.
- J. Raymond Elliott, Chairman, President & CEO, can be reached at Zimmer Inc., PO Box 708, Warsaw, IN 46581; 800-613-6131; Raymond.elliott@zimmer.com.
- William Garbarini, Executive Director of Orthopedic Sales and Marketing, can be reached at Ferring Pharmaceuticals Inc. 400 Rella Blvd., Suite 300, Suffern, NY 10901; 845-770 2600.
- Cary P. Hagan, Vice President, OrthoRecon marketing, can be reached at Wright Medical Technology Inc., 5677 Airline Road, Arlington, TN 38002; 901-867-4628.
- Stacey Jones, Manager, Consumer Marketing, can be reached at Biomet Orthopedics Inc., 56 E. Bell Drive, Warsaw, IN 46582; 574-372-1760; e-mail: Stacey.jones@biometmail.com.
- Ken Long, Group director of marketing—injectable therapies, can be reached at Smith & Nephew Inc, 1450 Brooks Road, Memphis, TN 38116; 901-399-5964; e-mail: Ken.Long@smithnephew.com.
- David Moore, Vice President, Consumer Products Division, can be reached at Nutramax, 2208 Lakeside Blvd., Edgewood, MD 21040; 410-776-4000; e-mail: dmoore@nutramaxlabs.com.
- Brian S. Parsley, MD, can be reached at Baylor College of Medicine, 6620 Main St., 13th Floor, Houston, TX 77030, 713-986-6016; e-mail: bparsley@bcm.edu. He indicated he receives clinical research support from DePuy.
- Mindy Tinsley, Group Manager, Communications, can be reached at DePuy Orthopaedics Inc., 700 Orthopaedic Drive, Warsaw, IN 46581-0988; 574-372-7136; e-mail: mtinsley@dpyus.jnj.com.
- C. Skip Whitman, MD, can be reached at Tri-County Orthopedic & Sports Medicine, 400 Johnson Ridge Memorial Park, Elkin, NC 28621; 336-526-4500; e-mail: skipwhitman@TCOSM.com. He is a paid consultant to Smith & Nephew.