Selling drugs in the UAE is a pretty daunting prospect. Yes it’s a land of often stifling superlatives, and if a product is not the biggest, it is almost certainly being called the best – an advertiser’s dream you might think. But government regulations dictate that this kind of hyperbole must stop where our hypochondria begins, and all adverts relating to medicines are reviewed by a Ministry of Health committee. Fortunately for the consumer, exaggerations and even encouragements are forbidden by its code.
This is not such good news for the marketer of course. In “Bridging the Gulf,” their 2002 examination of media law in the Emirates, Zayed University professors Tim Walters and Stephen Quinn confirm words such as “unique,” “no match,” and “best product,” are off limits when it comes to describing the contents of an ad agency’s medicine cabinet. And that’s just the tip of the iceberg. The same text also reveals that according to law, medicinal advertisements “must not cause any embarrassment.” Such ambiguity still leaves most advertisers scratching their heads.
But the most fundamental restriction facing medicine marketers is their audience. Direct-to-consumer advertising is only allowed for over-the-counter medication that doesn’t require a doctor’s prescription. This limits the audience for most professional pill pushers to physicians alone.
No wonder advertising spend makes up only around 10 percent of pharmaceutical companies’ marketing budgets, explains Ghandi Gharaibeh, marketing director for the Gulf and Near East at drug giant GlaxoSmithKline (GSK). Print executions designed to reach health professionals are often limited to inserts in medical journals and brochures, which is why 90 percent of the marketing budget goes into what Gharaibeh calls “personal selling.”
“Doctors are sort of marketing intermediaries. They are the decision makers of this process,” he says, pointing out that sponsored events and sales representation, with promotional gimmicks, are the major channels for marketing products to doctors, often dwarfing direct advertising and PR budgets.
There are obvious ethical implications. “We have to draw the line where we give the doctor the information … and when we induce him to use the medication,” he says. Which means that the only benefits the likes of GSK can pitch to physicians are more satisfied patients.
Anything more crosses a fine ethical line, since the legitimacy of a diagnosis is thrown into question if there’s any hint of an incentive behind it. “I’m tempted to think you have a migraine even if you just have a headache … if I have an interest in prescribing a medication,” says Gharaibeh.
Most doctors are understandably uncomfortable at the thought of becoming tools in a marketing machine. “I don’t think they want to think of us as commercially driven companies,” says Gharaibeh, since physicians often “think of themselves as providing a humanitarian service.”
NEEDS MUST. This has curious, mutual feel-good implications. “There’s nothing we work on that we feel is unethical,” says Mohamed Abdel Monem, creative director at True Vision, a seven-year-old marketing outfit in the UAE that does 90 percent of its work with pharmaceutical companies. “At the end of the day we’re marketing a medicine. We’re not marketing a consumer product that may face ethical concerns.”
One manifestation of this is the insistence that medical advertising (apart from weight loss programs) doesn’t create needs in recipients of the ads, but instead uncovers them – and marketers perceive this as a crucial difference from expedient consumer advertising. “In pharmaceuticals, we go one step back. We assume that you’re not even aware of the need,” says Gharaibeh.
This allows pharmaceutical companies to ask out loud of you, the potential sick person, “Do you know that 5mmHg of blood pressure is dangerous for you?” Existing restrictions mean that drug firms are then able to advertise a consumer need, such as vaccination, although they may not point out or compare products.
Assumed altruism isn’t an automatic Advil for PR headaches, however. The most common messaging migraine, says Gharaibeh, is related to post-release safety surveillance, where tested products released into the market cause more problems for end-users than anticipated. In general, a pharmaceutical company’s PR issues are related to the fact that they have safety and efficacy risks, he explains, in addition to the money trade-offs that all consumer products entail. Another disadvanage next to consumer products is that, “At best, pharmaceuticals don’t distort your self-image – whereas consumer products improve your self-image.”
POSITIVE DIAGNOSIS. Crafting the marketing material can involve treading a fine line as well, since simple histrionics don’t often work. “The trend for companies and medicines now is to emphasize better quality of life,” says Abdel Monem. “When you sell real estate to people you don’t tell them it’s to prevent them from living in the cold without shelter.”
Gharaibeh agrees. “We don’t really scare the pants off people,” he says, and criticizes the fatalism of anti-smoking ads. “I personally don’t believe they pay off. If you scare people too much, then they will deny it.” Instead, he says, marketers should emphasize personal improvement and emotional appeals. “Do you want your kid to have diarrhea?” Trust build-up is also necessary in order to foster brand loyalty in the face of competition from generic drugs as patents on brand-name pharmaceuticals expire.
And all of this comes before medicine advertisers even start looking at that old chestnut, cultural sensitivity in a conservative Middle East.
One immediately obvious idiosyncrasy of the region, says Gharaibeh, is the need for clarity in identifying the name and purpose of a medicine in a Middle Eastern ad, compared to a more indirect Western approach. To illustrate his point, he quotes an old British advertiser he worked with, who said that in the Middle East, if you want to advertise a banana, you show a photo of a banana and write “banana” underneath it, whereas in a US campaign you might start out with a monkey chattering in the background.
And apparently getting people to ask for help – as opposed to luring them towards buying shiny things – is hard. “You can’t really motivate people to seek advice,” says Gharaibeh, citing the example of a hotline that GSK set up for people experiencing wheezy chests. It received phone calls only from severe asthmatics, as opposed to borderline cases. Gharaibeh is confident the results would have been different elsewhere.
Sadly, a further problem is the stigma associated with sexually transmitted disease medication, some of which can also be used as preventative vaccines. One example is GSK’s Cervarix, a vaccine that protects against a sexually transmitted virus that could cause cervical cancer.
“People say, ‘And where do I get this virus?’ So we say it’s sexually transmitted. And they say, ‘What makes you think I’m sexually active?’” says Gharaibeh, adding with more than a hint of sarcasm, “This is the Middle East. We only have sex after we get married.”
The implications can be a bitter pill to swallow. “We all know it’s a kind of hogwash,” he says. “We all know that this is a liberal society. People are having sex, and getting
herpes, and getting AIDS. So what’s wrong with talking about preventing a virus which can cause cancer for some?”
The result is often that pharmaceutical marketers are forced to focus on the symptoms of the disease, rather than its actual source. So Cervarix’s marketing focuses on its prevention of cancer rather than the STD-derived cause, and the marketing of herpes medication illustrates how the disease is detrimental to a patient’s appearance, explains Gharaibeh.
HARD SELL. There might be lead in the creative pencil yet, though. A slew of Viagra ads on Arab satellite television show a man attempting to hammer nails into the wall. They all bend, before he settles on one that penetrates the wall without breaking.
The debauchery extends to an ad for Snafi, a generic drug equivalent to Viagra, whose name means “stud” in local Saudi dialect. The ad features a man asking his wife if she has finished helping the kids with their homework, before she asks him if he is ready to do his homework. Wink, wink.
The challenges aren’t limited to social customs, though. Medical marketing is inherently wasteful since, by definition, it is niche. “In consumer, you can potentially talk to everyone,” says Gharaibeh, whereas in pharmaceuticals, you need a bottom-up approach. “You always start with [a premise such as], ‘I assume 15 percent of them have shoulder pain.’”
Since they can’t talk to the average person, who in all likelihood doesn’t have the disease their product promises to cure, marketers need to use more targeted means. These include advertising around TV health programs and in professional publications, and seeking out older audiences who are more likely to be using medication. Gharaibeh also predicts a rise in online advertising, as anxiety-fueled prospective patients look up their symptoms on the Internet.
Regardless of the medium, medicinal marketing is certainly a very different professional environment to the rest of the industry. Abdel Monem concedes that factual demands mean there is little creativity in the medical print work which his agency specializes in. “It has studies, graphs – it’s a lot more solid,” he says. Moreover, the nature of professional-targeted advertising gives rise to miscommunication issues, forcing the marketer to interact with physicians in their own medical jargon.
These constraints have forced Abdel Monem to scrap creative ideas because they weren’t appropriate for the sober, professional audience that doctors present. He consoles himself with the opportunities to be creative when he gets to talk to that elusive but familiar Joe Public. “When you talk to the consumer, you’re talking to someone like yourself,” he says. “It’s a lot easier. You yourself are a client.”
A certain level of professional satisfaction may be lacking, but there’s an enviable level of clarity in Abdel Monem’s business. The pharmaceutical companies have an overall vision, he says, which makes them “very focused clients.”
Not to mention financially secure. While the ongoing global credit crisis is likely to promote downsizing and joint ventures that will limit most marketing opportunities across the industry, Abdel Monem believes his particular niche won’t be so adversely affected. At least, “not to the extent that it might cause a catastrophe.”
The evidence suggests he is right. In spite of the credit crunch, drug giant Pfizer has secured enough capital to purchase rival company Wyeth for $68 billion. GSK increased its marketing budget this year and, despite persistent layoff rumors, is introducing a program to slash medicine costs in developing countries.
As Abdel Monem observes, even in a credit crunch people keep taking their medicine.