Do you believe it’s worthwhile to do direct-to-consumer marketing for a medical device used in surgery?
To be clear, I’m not talking about durable medical equipment (wheelchairs, diabetic supplies). I’m talking about devices that “improve patient outcomes in surgery.”
Here’s the three-pronged logic I gave an industry executive:
1. IF YOU ADVERTISE TO THE PATIENT, the doctor easily can talk him/her out of the superiority claim saying, “I’ve done many surgeries the old way successfully” and “you have nothing to worry about.”
2. IF YOU HOPE THE HOSPITAL WILL ADVERTISE TO THE PATIENT, they likely won’t use your name in their ads. For example, I can’t think of an oncology claim by a hospital that mentions a medical device manufacturer by name.
3. IF YOU SUCCEED IN GENERATING PATIENT PULL, it likely will come at a cost much greater than alternate ways to convince your points of distribution to use your product.
So I asked the Medical Devices Group I lead, “Do you agree with my logic? Do you have a counter argument about direct-to-consumer marketing?
Are you aware of any medical device manufacturer that has successfully used direct-to-consumer marketing for a device used in the hospital or clinic?”
Jeremi Leasure very very interesting topic, so glad i recently joined this group. i agree with comment but want to offer a count-point of sorts for consideration. one headwind that i believe drives the industry relates to patient’s familiarity with healthcare, in general. i remember days when working in healthcare was considered a vocation or calling and i think the US population is moving away from that view. in part, because folks have a better grasp on what healthcare is and a better understanding of the entire service process. that could be good or bad; regardless, its happening and embracing may be best path for some companies. so i agree, direct-to-consumer marketing does not make much sense but improving patient education could lead to more adoption of needed care. driving revenue and making sense for a company’s bottom line. thanks again for the post!
Holger Plettenberg In my experience it really does happen that patients ask: ” do you use the XXX-technology I saw in this TV show/ read an article about in…”. And if the answer is no they change the surgeon. This is especially true for treatments with high personal costs, e.g. special transplants.
Emily Gahr I have to Agree. It would take quite the training as well to try to sell to the end user whom has had little to no experience with the device you’re trying to pitch. As you mentioned a doctors professional opinion holds much more weight than a sales managers and I highly doubt a consumer is going to over look the opinions expressed by their doctors.
The only objection I do have as far as “surgery” goes is that a product that compliments the product in use, such as an inner cannula that would then be placed into the surgically placed tracheostomy tube, could possibly be selected by the end user and therefore sold directly to the end user. For example a unique inner cannula which allows the patient to speak while their cuff is inflated. This would be a unique feature which would promote patient care and increase quality of life within or outside of the hospital, and therefore it could be considered an easy sell to the end user. This makes your sale to the surgeon or doctor for that surgically placed tracheostomy tube, smoother.
So you see a product with features that are made specifically to enhance patient care could be sold directly to them, it just takes a special and unique product to do so. Thank you.
Brad Nelson This isn’t surgical, but what about GE’s TV marketing of 3D/4D ultrasound? They weren’t first to market with it, but I think they could have been largely responsible for creating the demand for “baby face” scans in the US, resulting in most hospitals and clinics needing to buy a 3D machine so patients wouldn’t go down the street to a “competitor” that had it. This is despite the questionable clinical value in most cases.
You may be right about the cost/benefit analysis however, GE must have spent a fortune on the ads.
Carlos Ramirez It is very logical to think that the sale will be successful, while being made to direct-to-consumer, in this case would be the interventional physician or nurse.
We should never go to the patient, just in case it has to go to his medical expenses insurance and let them see for the price of this medical device use.
While we see the medical surgeon and the end user and who can give us the best feedback device usage, our sales will be more successful and frequent. Thank you for your attention. Carlos Ramírez H.
Odd Viking Höglund Hello. As an inventor and entrepreneur, the thought of pull from the public is tempting: “Here is a device that enables an easier and quicker surgery.” Here is the link. “Doc, please use it.”
As a clinician and surgeon, I’m put off by it. In short, the layperson often misunderstands these things, and the used arguments are taken out of context. I instead end up explaining this and that, which is a waste of time; all a bit annoying.
Furthermore – this is an international list – marketing of this kind of equipment towards the public is not necessarily legal in all countries.
All in all, I agree, I would not advice to walk down this path – instead target and convince the end users, the clinicians/surgeons.
Tony Grieder Joe, I seem to remember seeing advertisements for artificial knees a few years ago, and I have seen ads for MRI machines, but I don’t recall ever seeing an ad intended for patients for an oximeter, for example. I do think that hospitals could make a good case for advertising that they have certain state-of-the-art equipment available in their OR.
Fred Zinos Can you make a claim that utilization of your new device will reduce costs associated with malpractice? The argument “this is a better way” rarely prevails over the argument “this is the way we’ve always done it.” However, when you add an economic incentive things may begin to change.
Michael Todd Depends upon the products BENEFITS to patients. Side Effects, Smaller Scars etc?
Jacob Rowe Good logic, but human nature can have a very large lever. Human nature for patients wanting the latest & greatest. Human nature of the surgeon wanting to be known as a thought leader and early adopter/evaluator of new technologies. I was on the wrong end of the Zimmer Gender Knee campaign. It worked really well. Surgeons that used my competitive total knee devices had patient after patient arguing against their reasons to not use the gender knee. The surgeons one by one used the gender knee because of this campaign. Surgeons that already used the gender knee saw patient volumes grow as patients were funneled to them. Surgeons that didn’t use the gender knee had patients walking away to the surgeons that used it. It was not until outcomes data showed no improvement in did surgeons start to win the argument. My experience is the right marketing and the right product can have a successful direct-to-consumer marketing campaign. Unfortunately I was on the losing end. Was it sustained? No.
Jason Kitayama Joe, nice post. Generally, I agree with you as I think that most patients are not (yet) prepared to adequately assess the risk/benefits of most medical/surgical interventions. It seems that the typical person thinks that a 0.1% chance of AE is less threatening than a 1 in 1,000 chance. That being said, I do think there are some areas where DTC can be effective and enhance the patient experience.
The first is the where market development is the goal and growing awareness of the available therapies is important. DTC lets patients approach their MDs to discuss new options. Here, I think of novel therapies that compete with more traditional therapies… maybe minimally invasive ortho procedures like knees and hips.
A second is an area where the therapy includes a lifestyle impacting element. Here I think about ICDs / pacers. Remote monitoring changed the way patients interact with the therapy and made for an improved experience.
Alja Lambers In many countries it is prohibited to (commercially) approach patients to inform them about products which are only available by intervention of a medical doctor.
Peter Angelopoulos, MD. FACC, FSCAI, FSVM I agree with you Joe. I personally think that DTC (direct-to-consumer) advertising is not worth the money. I never had a patient come to the office and ask me for a drug that they saw on TV. However, negative advertisements DO work. Patients have come in and asked me to take them OFF of drugs they are seeing lawyers suing drug companies.
And to your point, even if a patient came in and asked for a particular stent, I would tell them that it would be a game time decision on whether I use it or not and that they cannot tie my hands behind my back when it comes to my work.
So I agree with your recommendations to your industry friend. Peter
Jon Gardner The patient isn’t the customer.
Curt Vinyard I can think of three just off the top of my head: da Vinci, CyberKnife, and Gamma Knife. In the case of the former, it is used in surgery. In the case of the latter two, they are used in lieu of surgery, or in conjunction with surgery.
Rob Kinslow Joe, I agree with your logic, both as a marketer and also from experiencing this reasoning firsthand as a patient. I’ve had spinal fusion that used my client’s allograft, but not because I requested it; the neurosurgeon used my client’s and another provider’s and it was simply a matter of which hospital he would operate at. I’ve also had both hips replaced, which may be more pertinent to this discussion. I helped S&N launch hip arthroscopy back in 2006 at AAOS. When I asked my surgeon (in 2013) about minimally invasive, he scowled and said, “There’s nothing minimally invasive about hip surgery.” I had to discreetly inquire just to learn whose implants he was using (Stryker).
In either case, despite my years in med devices, I wasn’t going to question either my neurosurgeon’s choice of implant or an orthopedist who has done thousands of hip replacements, with consistently excellent outcomes. Imagine the average patient trying to do this. It would most likely backfire.
Jim Garver The LAP-BAND, I don’t have the figures because I wasn’t on the marketing side but before it was bought by Allergen and they did their normal screw up with this device (think AMO) the DTC campaign was very successful in generating referrals and hospitals did advertise that they were offering the Band.
Susan Hartman Hi Joe. Here in the UK, marketing direct to patients is not permitted (with some very specific exceptions usually associated with long-term conditions), it is also against the industry code of conduct and as such all patient information documentation needs to be mindful of this and carefully edited. Personally I do not have a problem with this and think it is an ethical approach. Patients may not fully understand their condition and are quite likely to request an inappropriate product or treatment, motivated patents can generally find out about most options with a simple Google search and be armed with information with which to question their doctor.
Justin Quick Susan, How are you? I agree with your comments & would go so far as to say that the industry should be more proactive in educating patients through the various social media outlets. The problem is that we are all inclined to believe our solution is the best! It will be interesting to see if the ABHI has a view on this when the industry meets on the 12th October to discuss the revised Code of Business Practise.
Joe Hage Thanks for all these thoughtful replies! Jacob Rowe’s example resonates with me. Yes, if there is a campaign educating patients about adverse events with a competitive product, that could be effective in driving patient requests.
I would, however, ask you, Jacob: Do you believe these patient requests INCREASED DISTRIBUTION of competitive gender knees? If yes, would it have been less expensive to bring clinical studies to value analysis committees to achieve the same outcome?
Having said that, a well-written and placed editorial can do wonders.
Joe Hage To Jim Garver, the LAP-BAND is a good example but it was introducing a new category. And the term “lap band” is synonymous with that surgery.
In my discussion with the industry executive, he is looking to introduce a way to perform a common surgery with better visibility, better processes, etc.
I can’t see a direct-to-consumer campaign having any impact for him.
Dan Marshall In my experience doctors may buy a cheaper device or the Honda model compared to a Mercedes model. Both will do the job but the better model might be less invasive but more expensive. Patients should be shown different device options since cost may be a factor. This is really more of a disclosure on why they use this particular device over others so the patient can take measures to protect themselves. Marketing directly to patients is a bad idea though. Patients will never have the capacity to understand every detail to determine the best device. My biggest concern is some patients are so focused on making the wrong decision that more information hurts them.
Les Hill Yes very true of lap band. I was a key marketer & tech consult in the late 90s in Australia & still today with a european band & ring. The name lap-band stuck like glue as the popularity of the technique & product grew. When more competition advanced the name of the original is still referref to today. New techniques & devices have born emerging markets. Now we consult more actively with the surgeons involved but do not direct market with patients. It is unethical to do so in our opinion. But at times we are asked opinions by surgeons to discuss options based on patient’s criteria. This is becoming a highlight with our minimizer ring due variables with revision bariatric surgery and the inevitable changes to patient intake & lifestyles. Earlier years asthma pumps were a high profile device marketed directly to patients sold from GPs pharmacists & direct from distributor the most common was the flatus pump from Italy. Da Vinci is an interesting multi-level marketing exercise too.
Phil Dolliver Hello all, when Cytyc Corporation (now Hologic) introduced the ThinPrep Pap Test, it was marketed directly to women through magazine ads very successfully. That approach drove incredible sales and adoption of the technology.
Matt Valego Hey Joe, my experience has been that DTC can be effective if the device is largely private pay and used more in elective procedures. Also, in areas like wound care if there is even some retail/pharmacy availability to the device. People with difficult wounds have typically been through a number of different treatments or devices and are looking for and researching different solutions. Just my thoughts.
j. paul nolan Sorry Joe, I think your view is “Balderdash”. The whole laparoscopic surgery movement, driven by US Surgical, was aimed at the patient. Surgeons were dragged kicking and screaming into the modern world by marketing aimed at patients.
Kevin Rodgers aaahhhh…….no! Pt will buy things out of desperation. Let the lawsuits begin.
Joseph A. Steele intuitive surgical is an example worth talking about.
claudia cobianchi A local hospital here in Austin runs DiVinci ads all of the time. 3 D mammography stalks me on Facebook. Also in my opinion the patient is the customer as well as the physician, hospital and payer.
Susan Smith I think it isn’t the device but the procedure that should be marketed. Too many patients are not aware of better options they should consider because too many physicians have not kept up with current and sometimes breakthrough valuable technologies and treatments.
Joe Hage Kevin Rodgers, what do you mean, “Let the lawsuits begin?”
Ron Woering Do you believe it’s worthwhile to market a medical device used in surgery directly to patients?
Well I strongly do.
The doctor will have 15-20 minutes per patient in which he has to do his examination, draw a conclussion, suggest a treatment, explain the benefits and the risks. And then the patient goes home loaded with worries, questions and doubts.
It is of great help if the patient can go on the internet and find a good homepage that gives objective information , explains in details , drawing, movies the function of the device, the risks & benefits.
If the patient needs, he/ she can do this again and again, tile he/she has understood all implications of the treatment or can make up a list of questions for the doctor at the next appointment.
Jen Gander I believe parts of this are debatable and depends on the speciality…eg I would love patients to know the abilities of an interventional radiologist rather than the equipment they use. But I would also like to note that marketing materials used in device land needs to be regulated. I see many materials with crazy statements and claims with no evidence behind it.
Robert Poyser I sort of agree with you Ron, the only problem is there is so much conflicting information on the internet, and the patient does not have the 6 years at medical college to sort the wheat from the chaff. To be honest I think the patient really wants reassurance not a doctors degree.
Back to the original post, I think for e.g. Contact lenses customer brand awareness can affect Dr prescriptions, but branding is different for each medical device (pharmaceuticals as well) , but on the whole the patient does not care who makes what, as long as it has CE mark/FDA approval (for those aware) and that’s the point of approval it’s by a body of experts and not a layman or an add campaign.
Our pursuit for our rights to information has made us all knowledgeable to the extent we are dangerously ignorant of the full facts!
Lauri Campbell I agree with you, Joe. Unless the procedure is cosmetic in nature, the cost of DTC for most device companies (especially start ups — who are the ones with innovative new technology) does not typically translate into meaningful increases in adoption. In the beginning Intuitive didn’t really advertise directly to consumers or patients — their customers did and still do — very effectively. The company may do it now at some level — but they are no longer the new kid on the block. Similarly, laparoscopic surgery was most effectively advertised by the providers doing it, not by the companies themselves. it’s not a bad strategy to educate patients via an online campaign, but to really “promote” and expect that promotion to result in doctors choosing your procedure over whatever their current, preferred practice is, has not been demonstrated to work effectively.
Colin Cook Joe: Thanks for bringing up such an interesting topic. At Dancecard we have had the privilege to track and optimize the outcomes of over 45 DTC campaigns, and I’d love to share some of the dynamics we have observed.
First, I think there are some products for which your observations are 100% true.
It is very hard to make generalizations about which procedures can effectively be marketed through DTC tactics, but if I had to boil it down to 3 critical questions I would propose these: 1) Is the device used in a setting that allows for patient influence, 2) Is it in the PCP’s interest to refer, 3) Has at least 20% of your HCP channel bought into your device and put tools and processes in place to effectively receive and convert inbound leads.
Let’s look at each of these in turn
1) Is the device used in a setting that allows for patient influence?–This is simple…..if the patient comes in on a stretcher straight into the ER there is no opportunity for them to influence the type of defibrillator or pace maker or coronary stent gets implanted. I would also be shy away from DTC for an auxiliary device that is used electively by a specialist based on what they observe in the course of procedure.
2) Is it in the PCP’s interest to refer? PCP’s need to be aware of your device and feel that it is not going to cannibalize a procedure that they themselves can perform and make some money on. Marketing hernia related technology is a hard task for this reason…..many PCP’s consider hernias a bread and butter procedure and will dissuade their patients from perusing a robotic solution, a superior mesh, etc. Intuitive Surgical has identified hernias as a big growth area…it will be interesting to see how they fare.
3) Has at least 20% of your HCP channel bought into your device and put tools and processes in place to effectively receive and convert inbound leads? Before you launch a DTC campaign make sure that your channel is ready to receive the traffic. When a prospect calls an office will the front desk know how to talk about the clinical and lifestyle benefits of your product, or are they going to throw a wet towel on the prospect by putting them on hold or answering questions in a rushed or frantic matter? Will calls go into a voice menu? Will practices pick up in 10 seconds or less? Practice preparedness is critical; ignore it at your own risk!
Let’s dig into your suppositions in more detail.
A) The doctor can easily talk him/her out of the superiority of the claim. I think you are basing your argument on a PCP setting in which the generalist can do the procedure themselves and are thus motivated to flip. The most effective device DTC campaigns drive prospects to a specialist and, if you have done your specialist recruiting and training correctly, they will have already bought into the superiority of your offering. Said another way, the foundation for DTC begins with the sales team singing up specialists with the right kind of motivation. When a product is first launched there is obvious motivation to build out as big a specialist footprint as possible, but this motivation needs to be tempered with the discipline to select practices that have bought into the product.
B) If you hope the hospital will advertise to the prospective patient, etc., you are putting manufacturer-driven DTC and hospital marketing into the same bucket and they are different animals. The only device manufacturers who can count on hospital help are those that have a product that the hospital can use as a tent-pole offering – one that distinguishes them from their local competition and positions them as leading edge. Intuitive Surgical has had great success working with hospitals initiating branded advertising that mentions DaVinci by name. Most of these programs will be structured as co-op plays in which both parties contribute media dollars. Check out www.srmcroboticknee.com for an example of a co-branded site we recently produced for Smith and Nephew.
C) If you succeed in generating patient pull it will come at a much greater cost, etc. Your argument here is based on the premise that hospitals and physicians will purchase a device on its clinical merits alone, without first knowing how large patient demand is and what the manufacturer is going to provide in terms of lead generation. Some specialists may do this, but the vast majority are going to ask really hard questions about the manufacturer’s marketing plan. A sophisticated manufacturer will be able to sit down with a buyer and demonstrate a proven conversion model that accurately predicts the exact cost to acquire a new patient based on catchment area, media costs, and level of incidence.
Hope this is helpful to folks!
Steve Anderson We recently kicked off a social media campaign to make parents aware that Preceptis has developed a surgical instrument (the Hummingbird) that enables ear tube surgery to be performed under conscious sedation, without the requirement for general anesthesia. In this instance, we strongly believe that parents and their pediatricians will influence the ENT community to provide this options. FYI, in 16 days, we have already had more than 30,000 hits (predominantly Facebook).
Robert Poyser Sometimes a DR has to sell the procedure to the patient, before they give consent… If the patient has heard of the process equipment/products used it can help!
Stephen Pincus I don’t think that a blanket statement can be made on this subject. It really depends on the device and it’s impact on the patient that is perceivable by the patient. For example, may devices that enable in-office procedures, such as varicose vein treatments can be effectively advertised to patients, with the device utilized being the differentiator, and this can drive patient traffic. On the other hand, if the patient is unable to personally perceive a difference, and equivalent outcomes are delivered, advertising to the patient is likely to be a “fools errand”, as you imply in your introduction to this subject.
Wessam Sonbol When we started Delve Health (www.delvehealth.com), our pitch was to engage patients through data that already exists via social media avenues. We talked to quite a few people in the Device world and we get very negative response. Our approach was to use the data we already collect on clinical trials, publications, etc and build social media campaigns showing people that clinical trials is an option and using data that exists – we can prove it. So – as the company matured, we moved away from that a bit. Steve Anderson – would love to connect and learn more about your social media campaigns.
Ralph Polk, CBET Joe, this a very interesting thread. There are many different backgrounds and experiences contributing their input. I have had the opportunity to work at several medical facilities and served on capital review committees. In my experience, purchase request packets are submitted by the department leader based on either their personal preference, facility standardization or clinician request. I have yet to see one submitted based on patient demand. The closest I have seen are donation requests where a contributor is buying a specific quantity and model of equipment for the facility. As a Clinical Engineer, we review the packet for standardization, safety recalls, long term maintenance costs, etc. The two biggest factors in how quickly a packet is approved and funded are 1) patient safety issues and 2) significant, immediate ROI. Improved protection of Patient Health Information is another factor quickly on the rise.
Joe Hage Contributors, you made my week. I’ve been leading this group for five years now and it’s still highly rewarding to generate this type of discussion. Add to it Wessam making a new connection in Steve Anderson and you see the power of our community in action.
Weighing in, it was good to read some counter arguments. I agree, direct-to-consumer makes sense for patient education and, for brands synonymous with the surgery (LAP BAND, LASIK), it can make a world of sense.
I still believe DTC is – to borrow a phrase from Stephen Pincus on this thread – a “fool’s errand” for most medical device manufacturers IF THE GOAL is to increase distribution and adoption.
There are many more economical ways to accomplish this.
P.S. I’ve copied this conversation on my Medical Marcom blog for posterity’s sake. You can see your contributions at https://medicalmarcom.wpengine.com/medical-device-marketing/ask-your-doctor/
Paul R. Garrett, MD Hospitals advertising new devices is so much better than the endless and deceiving anecdotal stories I hear about cancer treatment successes. I truly believe they should be banned by FTC or FCC or both.
Joe Coughlin I do not support this because the general public is too easily swayed from advertising. They hear what they want to and whatever theu did hear becomes a panacea to relieve them of their burden; physical, psychological or otherwise. Medical devices are best routed to medical PROFESSIONALS.
Lynn Thompson I agree that most patients do not have the knowledge base to evaluate medical devices used in surgery. However, I think that the usefulness in marketing to patients depends on the type of device and the layers of separation between the patient and the device. For example, if a particular device is to be used during open heart surgery, it is likely too far removed for the patient to get involved in the choice (other than possibly a general type of implant). If it is something like laser eye surgery, the patient could potentially choose a doctor based on the equipment that they use.
Philip Wolf Interesting question. When laparoscopic surgery was getting started, patients actively sought surgeons who could offer this type of surgery. The massive increase in the number of laparoscopic surgeries performed was patient driven.
Chander Bhushan Vashisht It depends on whether Medical device is user’s friendly. If it involves surgical procedures or diagnostic procedure, target audience can not be a Patients but Technical influencers.
Lorraine Kowalczyk I do not support this. I have to agree with Joe Coughlin. I did a lot of research when it came to replacing my hips. Afterwards I spoke to the doctor about my thoughts . In turn we were able to have an informed discussion . I say leave the direct marketing to the experts in the field for that specific device.
Neil Kosterman I remember when it became possible to advertise prescription drugs to consumers. According to many the sky was going to fall, if allowed. It hasn’t yet fallen, as near as I can tell. As long as the government allows Docs to continue practicing ethical medicine, I believe it to be quite healthy to inform consumers to a higher level. Is there a chance that some ads will be misleading, sadly that will happen, but as long as we can rely on the Docs to provide ethical guidance to their patients, and I believe we can, then it should be allowed. P.S. The good Docs I’ve known and worked with through the years enjoy the opportunity to work with knowledgeable patients.
Debra Little I often joke that if I ever have to be hospitalized, I will show up with the products that my company manufactures. Seriously though, medical devices should be marketed to the professionals using them. That’s not to say that patients don’t have the right to know about these devices. I am sure patients would have liked to have known about the issues with certain IVC filters before they had them implanted.
Michael Ram No. Don’t market to patients. However, as someone long active in the medical device industry I always question my doctor and surgeon regarding what procedures they will perform and the particular devices they intend to use.
It is not uncommon for the physicians I know to ask me what is new or coming soon in regard to devices and medical procedures they are used in. But be aware there are those physicians that don’t like patients that know to much.
Amin Kassab Bachi Usually doctors adopt the new device or procedure first. My opinion is that most of the public don’t have the necessary scientific or clinical background. So, even when a hospital promotes a new device it seems attractive until their doctor says otherwise because in the end patients generally believe that (the doctor is the competent professional with the required expertise to decide what’s best).