Introduction Sandglasses - an hour of time slipping by in music In a moment you will be viewing and listening to Sandglasses , an ‘installation concert’ created by the Lithuanian composer Juste Janulyte and the Italian video artist Luca Scarzella, performed by four cellists of the Gaida Ensemble with live electronics by Michele Tadini. In this piece several aspects of Janulyte’s mus
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Jungkirbalik.files.wordpress.comBuilding strong condition brands
Received (in revised form): 14th May, 2007
is the Salmon and Rameau Fellow in Healthcare Management and Professor of Marketing at INSEAD, Fontainebleau. An author
of many studies on the pharmaceutical industry, he has worked with pharmaceutical companies such as Johnson & Johnson,
Lilly, Novartis and Pﬁ zer. He teaches a course on Pharmaceutical Marketing Strategy at INSEAD, and is also a court expert in
is an INSEAD MBA Participant, class of July 2007. She previously worked as a Strategic Account Planner at OgilvyOne, New
York, 2000 – 2006 where she developed consumer communications strategies for Boehringer-Ingelheim, Eli Lilly, GlaxoSmithKline,
Pﬁ zer, Schering-Plough and Wyeth Pharmaceuticals brands. She also co-authored and presented DTC Trends Reports for her
is Planning Director for Pﬁ zer ’ s Lipitor and Caduet, The Kaplan Thaler Group, New York. She was previously with Ogilvy & Mather,
and Deutsch, New York, where she gained expertise in the DTC arena. She has worked on a range of pharmaceutical brands from
Novartis ’ Zelnorm to Pﬁ zer ’ s Lipitor. She was awarded a gold Efﬁ e for the Zelnorm ‘ Tummies ’ work.
Keywords branding , positioning , condition branding , disease branding
Abstract With blockbuster brands such as Pﬁ zer ’ s Lipitor, GlaxoSmithKline ’ s Advair,
AstraZeneca ’ s Nexium and many others, the pharmaceutical industry has demonstrated
its expertise in building strong product brands. Product branding-focused marketing,
however, leaves many patients untreated. Patients who do not recognise particular
symptoms and medical conditions are less likely to seek medical attention and
treatment, especially when their family doctor often lacks the time to probe for each
and every possible medical condition. Product branding tells consumers about a solution
but not about the problem which the solution addresses. Condition branding educates
consumers, physicians and other stakeholders about the problem. We propose that the
pharmaceutical marketing paradigm be broadened. Pharmaceutical marketers should
build strong condition brands, in much the same way as they build strong product
brands. Condition branding facilitates customers ’ decision-making, contributes to better
health and may improve the standing of the pharmaceutical industry, which stands
accused of overly aggressive product branding efforts, among other criticisms. When
condition and product branding are well coordinated, each enhances the effectiveness
of the other, raising patient health and brand sales.
Journal of Medical Marketing (2007) 7, 341 – 351. doi: 10.1057/palgrave.jmm.5050101
That pharmaceuticals can be branded like sustain high brand awareness and strong, Reinhard Angelmar
favourable and unique brand associations. They invest signifi cant time and effort to choose appropriate brand elements (name, Tel: + 33 (0)1 60 71 2641 Fax: + 33 (0)1 60 72 9240 identify their product and differentiate it 2007 Palgrave Macmillan Ltd 1745-7904 $30.00 Vol. 7, 4 341–351 Journal of Medical Marketing
GlaxoSmithKline ’ s Advair. Their success is high cholesterol, acid refl ux and asthma condition is treated. 5 Other terms that are address. For example, virtually everyone has heard of high cholesterol, 73 per cent to specifi c aspects of it, include ‘ medical condition branding ’ , ‘ disease branding ’ , during the past fi ve years, 1 and two-thirds ‘ disease-state branding ’ , ‘ market of cholesterol-tested persons accurately conditioning ’ and ‘ disease mongering ’ . 6 recall their cholesterol score six months We prefer the term ‘ condition branding ’ because it is value neutral (unlike ‘ disease Not all conditions enjoy cholesterol ’ s For example, to talk about a ‘ medical condition ’ or a ‘ disease ’ implies that the condition already is categorised as ‘ medical ’ or as a ‘ disease ’ . Yet condition branding GlaxoSmithKline ’ s Requip, the fi rst a condition is categorised, for example, components of a condition brand, and the cases, cervical cancer. Research in 2005 characteristics and benefi ts of a strong followed by a discussion of incentives for investing in condition branding and fi nally the coordination of condition and product or treatment and management practices. 4 These were less than ideal conditions for Merck & Co ’ s Gardasil, the fi rst THE CONDITION BRAND
benefi ts of Requip and Gardasil, RLS and brand associations, namely all thoughts, RLS and HPV — just as Pfi zer and other organisations have already been doing for cholesterol. Cholesterol ’ s strong presence in the minds of consumers is the result of many years of condition branding efforts campaigns, annual ‘ National Cholesterol Education Month ’ activities and ‘ Know beliefs about the prevalence and outcome of the condition, feelings (eg fear, anger) Journal of Medical Marketing Vol. 7, 4 341–351 2007 Palgrave Macmillan Ltd 1745-7904 $30.00
Building strong condition brands private and public support for R & D and allergy is an example of a weak condition associations among patients, physicians, payers and other stakeholders. Associations previously diagnosed by a physician. 13 Skin tend to be favourable when a condition is prick tests, a simple means of establishing perceived as having serious consequences, stigmatised, and which is caused by factors practices, and there is only one allergist for which individuals are not responsible and over which they have no control. 8 – 10 respiratory physicians. 14 One allergist commented: ‘ allergic diseases are not political “ hot potatoes ” like cancer and • patients recognise the symptoms or the health priorities and public education are physician with the condition, and adhere certainly not in the slightest bit attuned to the prevalence and impact of allergic • other consumers recognise the symptoms or the presence of the condition, and encourage presentation to physicians and adherence to necessity in the increasingly fi erce ‘ war of conditions ’ . The list of conditions physicians screen for, diagnose and treat the • third-party payers pay for the prevention, diagnosis and treatment of the condition; as is the list of conditions which doctors • public and private sponsors sponsor R & D, sponsors support. Resources available for healthcare are, however, limited, and Breast cancer is an example of a strong a growing number of critics question the cancer among women, physicians, insurers, of marginal social value. Only conditions very high. Breast cancer is associated with (22.1 per cent) fear most, far more than heart disease (9.7 per cent), the second BUILDING A STRONG
most-feared condition. 11 This motivates CONDITION BRAND
self-examination), screening (70 per cent tasks: defi ning the condition brand and mammogram within the past two years 12 ), early diagnosis, systematic treatment by Deﬁ ning the condition brand
Patient advocacy is strong and generates defi ning (1) the condition identity and 2007 Palgrave Macmillan Ltd 1745-7904 $30.00 Vol. 7, 4 341–351 Journal of Medical Marketing
(2) the condition profi le, namely the main specifi c to the condition, easy to memorise, easy to recognise and Condition identity
The condition identity serves to identify and differentiate the condition from other status of a condition. It enables consumers conditions. It includes the condition name, and physicians to recognise the condition, one another and other stakeholders. Lack of consensus is typically resolved via ‘ consensus development conferences ’ . 18 should be memorable, distinctive, likeable or at least affectively neutral (no stigma), of the condition. In particular, the name serious and requires the attention of a health professional. Condition proﬁ le
well-defi ned, the key characteristics of of patients diagnosed with and treated for atrial fi brillation, a cardiac condition, could including its (1) causes, (2) time course, may also be associated with negative affect profi le and (4) consequences. The scientifi c (stigma) and lack medical connotations, in should be considered. Because ‘ impotence ’ had pejorative implications and was not suffi ciently precise, it was replaced by Potential causes can be ordered by their ‘ erectile dysfunction ’ . 17 Other conditions refl ux disease or acid refl ux disease), condition. Distant causes include genetic, example, the cause of erectile dysfunction crawly legs (renamed as RLS — Restless may be defi ned as a lack of blood fl ow to the penis resulting from insuffi cient levels of cyclic guanosine monophosphate (cGMP) or, more distantly, as old age or cause of a condition is defi ned infl uences is managed. For example, if old age causes erectile dysfunction, little can be done Journal of Medical Marketing Vol. 7, 4 341–351 2007 Palgrave Macmillan Ltd 1745-7904 $30.00
Building strong condition brands about it. If childhood experiences explain Managing condition awareness
manage conditions of which they are aware. Condition awareness requires that people learn a condition ’ s identity. They be defi ned as acute, intermittent / cyclic condition name, when confronted with its For example, depression can be defi ned as medical progress triggers a redefi nition of a condition ’ s identity, people must learn treatment. Alternatively, it can be seen as typical challenges in managing condition and patient profile How many patients are suffering from the condition (prevalence and incidence), and what are their characteristics in terms of profi le)? Epidemiological studies must be name the condition. Creating condition awareness requires teaching the connection a reduced life span (mortality)? What is its impact on the quality of life of the sufferer? And what fi nancial burden does society? ‘ Burden of disease ’ studies provide created the ‘ ABCs ’ of IBS, each letter referring to one of the symptoms: Communicating the condition
Defi ning the condition identity and profi le is the fi rst step in building a Sometimes, consumers associate symptoms cancer patients treated with chemotherapy attributed their fatigue to cancer. Johnson & Johnson, marketer of the anti-anaemia condition positioning and repositioning. brand Procrit (US) / Erypo / Eprex (Europe), 2007 Palgrave Macmillan Ltd 1745-7904 $30.00 Vol. 7, 4 341–351 Journal of Medical Marketing
The following examples illustrate typical anaemia, they were so focused on fi ghting challenges in positioning and repositioning cancer that they paid little attention to anaemia. Johnson & Johnson, therefore, also raised awareness of chemotherapy- Women were aware of cervical cancer but consequences of this condition for their not of the HPV and the fact that it causes cervical cancer. To close this knowledge gap, Merck & Co launched its ‘ Tell someone ’ campaign prior to introducing Gardasil, the fi rst cervical cancer vaccine. Osteoporosis was traditionally defi ned as cervical cancer to their friends, by using Organization (WHO) defi ned osteoporosis the spine, wrist or hip of more than 2.5 standard deviations below the young adult mean for the population. Merck & Co, asymptomatic nature of HPV ( ‘ you could osteoporosis and subsidised the installation cause cervical cancer ’ ). Positioning HPV as a serious, asymptomatic high-prevalence Positioning and repositioning
Condition awareness is necessary but not suffi cient for achieving effective condition By following Merck ’ s advice — ‘ tell good understanding of the condition profi le (causes, time course, prevalence / incidence / patient profi le, consequences) Believing that the cause of onychomycosis, a condition with symptoms such as yellow, fl aky nails, was on the surface of the nail, many patients used topical therapies and such as debridement. In fact, the condition is caused by an infection of the nail bed nail. By personifying the infectuous agent has rendered existing knowledge obsolete. as ‘ Digger the Dermatophyte, ’ an animated Journal of Medical Marketing Vol. 7, 4 341–351 2007 Palgrave Macmillan Ltd 1745-7904 $30.00
Building strong condition brands miscreant, Novartis changed consumers ’ consumers that ‘ over time that acid can causal beliefs — and increased the sales of its Digger-fi ghting Lamisil tablets. Associating celebrities with the condition that asthma is an acute or intermittent / and Pope Jean-Paul II in Parkinson ’ s; and been educating consumers that asthma is a chronic condition that requires Until recently the term ‘ depression ’ was seldom heard outside psychiatric circles in Japan, where the condition was treated almost exclusively in institutions. 21 Mistaken beliefs about condition Heart disease is generally seen as a men ’ s recognise the symptoms of depression. The disease. In fact, heart disease kills more US cause of the condition was explained via a metaphor — ‘ your soul is catching a cold ’ — that suggested that the condition had a organisations together with the American The stigma associated with depression was raise women ’ s awareness of the threat of lowered when celebrities publicly talked heart disease, increasing the percentage Radical repositioning of a condition condition from heartburn to acid refl ux disease or GERD (gastro oesophageal refl ux disease) was one repositioning tactic. • Name : changed from ‘ impotence ’ to ‘ erectile • Signs and symptoms : originally poorly defi ned and thought of as a dichotomous (impotent / communicating these results to physicians not impotent) condition, a questionnaire tool classifi ed ED into four categories, ranging 2007 Palgrave Macmillan Ltd 1745-7904 $30.00 Vol. 7, 4 341–351 Journal of Medical Marketing
• Causes : medical instead of psychological the condition from a children ’ s condition • Time course : chronic instead of acute or • Prevalence and patient profi le : originally strongly motivated to play an active role 30 million (US); contrary to the traditional idea that impotence is an old man ’ s disease, current estimates suggest that more than Their motivation derives in part from the 50 per cent of all men over 40 years of age possibility to position a condition in a way that leads consumers to consult them • Consequences : efforts have been made to demonstrate that ED has serious quality of life and other consequences, and to lower the social stigma associated with the condition psychological to a medical condition. 23 (eg by using celebrities such as Bob Dole). Why should pharmaceutical
companies invest in condition
INCENTIVES FOR CONDITION
Unlike a product brand, whose owner can engage in condition branding for ethical that is most aligned with the owner ’ s benefi ts. The pharmaceutical industry is objectives, a condition brand is not owned by any specifi c individual or organisation. Because of this, several stakeholders may standing of the industry and of individual stakeholders with suffi cient incentives the health of their population may invest condition branding will increase the sales come about through a growth in the total number of prescriptions for the condition & Co ’ s ‘ Tell someone ’ HPV campaign, the increase in the prescription share for their raise HPV awareness and education among key general public, healthcare provider and Condition branding can raise the routes. First, it may increase the total respective conditions, as with very active prescription brands by building condition and payers unfamiliar with the condition. Journal of Medical Marketing Vol. 7, 4 341–351 2007 Palgrave Macmillan Ltd 1745-7904 $30.00
Building strong condition brands reposition the condition so that previously sceptical patients, physicians and insurers occur when the condition is repositioned respectively. These two routes assume the Lilly ’ s efforts on behalf of Cymbalta provide an example. A recent entrant into branding may increase patient adherence, differs from other antidepressants in that it thus raising the number of prescriptions is also approved for the treatment of pain An individual company ’ s incentive to Lilly ’ s ‘ Depression hurts! ’ campaign plus pain, and to shape the understanding the two symptoms. Because Cymbalta ’ s mechanism of action fi ts with the altered the largest incentive. This was the case for Merck & Co in HPV / cervical cancer (Zelnorm), Johnson & Johnson in chemotherapy-induced anaemia (Procrit / Condition branding can raise the total number of prescriptions and Incentives for an individual company to anticholesterol market (Lipitor) may also engage in condition branding are greatest fi nd it worthwhile, as per their cholesterol when condition branding raises the total awareness campaigns. GlaxoSmithKline ’ s number of prescriptions and, at the same efforts to reposition asthma as a chronic competitor (Advair) attempting to increase osteoporosis, namely low bone density or In conditions with a fragmented supply, there is little incentive for any individual installation of bone density measurement branding that increases the total number of prescriptions. Condition branding may, however, still be worthwhile if competitors jointly funding a third-party organisation that engages in condition branding for the fracture, Merck educated the market that bone thinning was a cause of fracture: ‘ after menopause, women ’ s more likely to fracture ’ . This raised shares without necessarily increasing the 2007 Palgrave Macmillan Ltd 1745-7904 $30.00 Vol. 7, 4 341–351 Journal of Medical Marketing
AND PRODUCT BRANDING
Condition branding and product branding condition awareness and understanding or condition misperceptions, it may, however, the condition is positioned should match the product ’ s positioning, as illustrated patients in parallel to product branding by the examples in the previous section. campaigns targeted to other segments. This is the reason why Pfi zer, for example, runs cholesterol and erectile dysfunction many launched (1997 and 1998 respectively), in parallel with product branding campaigns. CONCLUSION
Product branding tells customers about a or has little awareness, condition branding solution but not about the problem which should precede product branding. Merck ’ s ‘ Tell someone ’ campaign is one example. stakeholders about the problem is the task of condition branding. Condition branding product, especially if the company is the condition. For example, the ‘ Tell someone ’ effectiveness of the other, raising patient website carried Merck ’ s name and logo. Ads about erectile dysfunction without the Acknowledgments
Viagra name also typically show Pfi zer ’ s fi nd out more about available treatments, by calling an 800 telephone number or clicking on a website link. These References and Notes
telephone numbers and websites generally 1 Centers for Disease Control and Prevention ( 2005 ) .
Trends in cholesterol screening and awareness of high blood cholesterol — United States, 1991 – 2003 .
Morbidity and Mortality Weekly Report (MMWR) 54 ,
recall risk factor test results? Accuracy and bias among 425 – 432 . Accuracy was defi ned as responses 3 Restless Legs Syndrome Foundation ( 2005 ) . national survey shows Restless Legs Syndrome (RLS) is largely under-recognized and poorly understood by Journal of Medical Marketing Vol. 7, 4 341–351 2007 Palgrave Macmillan Ltd 1745-7904 $30.00
Building strong condition brands U.S. adults . Available from http://www.
womenshealthresearch.org/site/News2?page= rate of diagnosis of allergic rhinitis in Europe . NewsArticle & id=5445 & news_iv_ctrl=O & abbr=press_ Respir. J. 24 (5) ,
4 Ogilvy Public Relations Worldwide and the Centers 14 Royal College of Physicians ( 2003 ) . for Disease Control and Prevention ( 2005 ) . Royal College of Physicians, London .
Papillomavirus Creative Materials Testing. Target C . Professor of Asthma, Allergy & Respiratory Science and Consultant Physician, King’s College, 5 For a pioneering discussion of condition branding, University of London, to the House of Lords Science see Parry , V . ( 2003 ) . The art of branding a condition .
and Technology Select Committee, 6th October, (May) , 38(5), 42 – 49 .
Disease-Mongers: How Doctors, Drug Companies, and Insurers Are Making You Feel Sick , of atrial fi brillation and anticoagulant therapy: effects & Henry, D. (2006). The fi ght against disease of an educational programme. The West Birmingham mongering: generating knowledge for action. PloS Int. J. Cardiol. 110 ,
Med. 3(4), e191, and the other articles in the April 2006 issue of PloS . See also Moynihan, R. & Cassels, 17 National Institutes of Health ( 1992 ) . A. (2005). Selling Sickness: How the World’s Statement: Impotence , Vol. 10. U.S. Department of Pharmaceutical Companies Are Turning Us All Into Health and Human Services, Bethesda, MD .
Patients , Nation Books, New York, NY .
18 For example, a multinational committee of specialists 7 For example, homosexuality, at one time categorised developed the ‘ Rome I ’ criteria for irritable bowel as a disease, was subsequently demedicalised. See syndrome (IBS), which provided the basis for estimating the prevalence (number of persons with Medicalization: From Badness to Sickness (Expanded ed.) , IBS), outcomes and other important condition Temple University Press, Philadelphia .
( 2003 ) . Attributions for serious illness: are Br. Med. J. 332 ,
controllability, responsibility, and blame different 20 Society for Women’s Health Research ( 2005 ) . constructs? Canadian J. Behav. Sci. 35 (2) ,
Women’s Fear of Heart Disease Has Almost Doubled in Three Years, But Breast Cancer Remains Most Feared review of coping with illness: do causal attributions matter? J. Psychosomat. Res. 50 ,
An Attributional Theory of Motivation 11 Society for Women’s Health Research ( 2005 ) . Fear of Heart Disease Has Almost Doubled in Three Years, children to ADHD adults: observations on the But Breast Cancer Remains Most Feared Disease , Soc. Prob. 47 (4) ,
for Women’s Health Research, Washington, DC .
2007 Palgrave Macmillan Ltd 1745-7904 $30.00 Vol. 7, 4 341–351 Journal of Medical Marketing
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Poster Presentations 405 Novel compound heterozygote mutation in two siblings with SCID JAK3 mutations Hans H. Shuhaiber, M.D. 1, Edwin Guzman, M.S. 1, Kwame Anyane-Yeboa, M.D. 1, Jennifer M. Puck, M.D. 2 1Pediatrics, Columbia University Medical Centre, New York, N.Y., United States, 2Pediatrics, UCSF School of Medicine, San Francisco, C.A., United States During the last 15 years, an incr