eDetailing: Surveys Say...

At the recent Technology Supported Physician Detailing conference in Philadelphia, Liz Boehm presented data from a recent (2005) Forrester Research survey of eDetailed docs. I took away a few interesting bits of information that I'd like to summarize here -- a more detailed summary will appear in this month's Pharma Marketing News (subscribe here).

You might compare these survey responses from physicians with a Jupiter Research survey of pharmaceutical company marketing executives (see "eDetailing ROI Better Than DTC?"). If you want more information about eDetailing, start with this definition. Forrester defines eDetailing as follows: "A pharmaceutical- or medical device firm-sponsored, Internet-based program that informs prescribers about products or diseases."

There are many advocates of eDetailing -- including myself -- that would like to see more of it. Proponents, both inside pharma companies and outside, use survey data to buttress their arguments for greater spending on eDetails. In some cases, however, the numbers seem to show confusing trends and even may suggest that eDetailing may not be all that it's cracked up to be.

Large Majority of Physicians Have Never Been eDetailed
According to a Forrester 2005 study, eDetailing "dwells at the fringe of MD marketing." Sixty-nine percent of physicians surveyed say they have NEVER participated in an eDetail and an additional 10% have participated in one or less eDetail per year.

High prescribers are eDetailed more frequently than low prescribers. Forty-eight percent (48%) of physicians writing more than 100 scripts per week have been eDetailed whereas only 26-28% of physicians writing 50 or less scripts per week have been eDetailed. According to Boehm, "there's a lot of room to grow" as many physicians would like to be eDetailed but have not been asked to do so.

Whether or not Pharma companies will expand their eDetailing programs depends on several factors. Return on investment (ROI), of course, is an important one. Another is continued physician acceptance. To date, a lot of that acceptance has been due to the cash-equivalent honoraria offered to physicians for participating in an eDetail.

Cash Honoraria
Perhaps it's no surprise that cash honoraria is cited by 93% of eDetailed physicians as influencing their decision to accept an eDetail. In fact, 35% of eDetailed physicians cite honoraria of some sort (could be textbooks) as the primary reason for accepting eDetails, according to the Forrester survey.

Compare these results to a 2003 Forrester survey of eDetailed docs: 77% of eDetailed docs say honoraria as a reason for participating in eDetails. 40% of the docs agreed with the statement "I love them [honoraria]! That's the reason I do eDetails!" and 95% of doctors surveyed said honoraria "are the reason" or "would sway my decision" to participate in an eDetail (see "Pharma Marketing News eDetailing Supplement").

It seems that between 2003 and 2005 doctors have become even more conditioned to receive incentives, not less so (93% in 2005 vs. 77% in 2003 cited honoraria as an influencer). Or maybe we should look at the 95% number in 2003 vs. the 93% number in 2005?

The question marketers need an answer to is this: Are physicians moving away from cash and cash-equivalent incentives as eDetailing motivators or not? The answer to this question will determine if eDetailing becomes mainstream or not. Unfortunately, physician surveys do not seem to give us a definitive answer to this question.

Do eDetailed Physicians Prescribe More of Less of the Detailed Product?
If eDetails don't result in more scripts being written, then why bother? If a large segment of eDetailed physicians write less scripts for the featured drug, that would diminish the ROI.

Forrester asked eDetailed physicians "Which of the following have you ever done following an eDetail?" A number of calls to action were listed including prescribing more of the featured drug as well as prescribing less of the featured drug. Happily, 49% of eDetailed physicians reported that they prescribed more of the featured drug. This is a good thing. However, in the 2003 survey, a larger percentage (58%) indicated they prescribed more of the featured drug. It seems, therefore, that eDetailing is becoming less effective, not more.

What about the other side of the coin -- prescribing less of the featured drug? It appears that the same percentage (6%) of eDetailed docs in 2003 and 2005 said they prescribed less of the drug.

However, I attended another conference where a marketer from a major pharmaceutical company compared 2004 Forrester data with the 2003 Forrester data. Data from the 2004 study showed that 50% of eDetailed physicians said they prescribed less of the featured drug compared to 6% in the 2003 study!

Surely, this could not be right. Several people in the audience tried to explain it as anomaly: it may be a Vioxx effect or it may be due to a larger sample size (more eDetailed docs) and reflect a movement towards a more accurate mean.

No one was willing to accept it the at face value -- that, as time goes on and more physicians are exposed to eDetailing, a larger percentage of eDetailed docs were prescribing less of the featured product!

It turns out that we may not be comparing apples to apples in the 2003 vs. 2004 data. The first study (2003) was done online through eDetailing Vendors, the second study (2004) was a mail survey through the AMA, and the third study (2005) was also done online via the vendors.

The online studies (2003 and 2005) asked "Which of the following have you ever done following an eDetail?" Respondents had to answer "Yes" or "No". In both of these studies, 6% answered "Yes" to the question regarding prescribing less of the featured drug.

The AMA (2004) study, on the other hand, asked the question in a slightly different way, according to Boehm. It asked "How often have you prescribed less of the featured drug: Never, Rarely, Occasionally, Frequently."

According to Boehm, "when you ask a question that way, you get more granularity." In other words, more respondents are likely to check off "rarely" because maybe they did it once. With the "Yes/No" choice, however, people tend to say "Yes" only if they've done the thing asked more often than they've not done it. Boehm believes that the majority of the 50% docs in the AMA study have only prescribed less of the featured drug rarely or occasionally.

Cautionary Tale
Advocates of eDetailing -- especially eMarketers within pharmaceutical companies -- should be careful when presenting data from these surveys and comparing results from one year to the next in an attempt to illustrate trends. You just might kill the goose before the golden egg is laid!