You have my word on it

Editor’s note: Stephen J. Hellebusch is president of Hellebusch Research and Consulting Inc., Cincinnati.

Many makers of nonprescription (over-the-counter, OTC) medicines devote some fraction of their marketing resources to professional promotion - trying to convince doctors and dentists to recommend their brand above all others. The effect of a health care provider’s recommendation (reco) for a specific brand has long been a measurement challenge. A series of studies over the last eight or nine years has shown that health care provider (HCP) recos can have a dramatic impact on some brands (even in categories where they have no effect). Alternatively, they may have little impact on a brand. The latter occurs especially in categories that are not strongly medical, as one would expect, e.g., hand lotion.

One issue has repeatedly been raised and rarely, if ever, addressed: What do the professionals themselves think about recommending and what do they think are the hot buttons that cause them to recommend a given brand or brands? Since this question is academic (most medical marketers want to know the impact of a given promotional technique on recommending, not what the professionals think it might do), the question has rarely been researched.

The author had an opportunity to do so, using his firm’s e-mail panel of doctors. The panel also includes a small number of dentists (who, of course, are also doctors, but work in a different area than primary care physicians). In conjunction with a presentation given in January 2005, we used our panel and asked 25 primary care physicians (PCPs) and 26 primary care dentists their opinions on a number of topics surrounding recos.

The objective was to determine what a group of doctors and dentists think of recommending as compared to prescribing, what they think drives recos and what they think consumers (patients) do when they receive a reco.

The sample consisted of 26 dentists and 25 PCPs who have been in practice for at least two years and are 65 or younger. Each received a $40 honorarium for their time and participation. Potential respondents were screened and, if qualified, taken through an online interview lasting six to seven minutes.

Findings

Patient recommendations

Respondents were asked what percent of their patients fit into the following categories: receive an Rx and no OTC; receive a reco and no Rx; receive both an Rx and reco; and receive neither. Nearly half of dentists’ patients receive no Rx or reco (Table 1). Most patients of PCPs receive an Rx and no OTC. Only 7 percent of patients of PCPs receive no Rx or reco.

Then, respondents were asked to rank the previous four categories in order by preferred course of action (Table 2). Of the four possibilities both professionals prefer a reco and no Rx. Perhaps this lets the HCP believe they have contributed while generating the least hassle for the patient. Dentists prefer “both Rx and reco” the least; speculation is that they dislike seeing patients in that much trouble. On the other hand, PCPs prefer “neither Rx nor reco” the least. Perhaps they feel they have not done enough if no product is provided.

Dentists decide whether to treat their patients with an Rx or reco by severity or degree of pain, cost and convenience of recos for patients versus an Rx, which product does the job most efficiently and which has the best chance of compliance (Table 3).

PCPs decide their course of action by which is least expensive, taking insurance into account, the need for effectiveness, patient preference and patient history (Table 4).

A significantly higher percentage of PCPs than dentists had given their patients a choice between an Rx and reco within the past week, 84 percent to 42 percent, respectively (Table 5).

Brand recommendations

When they decide what brand to recommend, dentists consider brands that they are familiar with, based on efficacy, the patient’s economic situation, the cost and how well the product has worked before (Table 6).

When they decide what brand to recommend, PCPs consider brand familiarity, their experience with the brand, cost, efficacy and the existence of generics (Table 7).

Respondents were shown eight factors and asked if each influenced them at all in determining which brand to recommend. Among dentists, the highest percent selected samples, peers and self online. Among PCPs, the top three choices are samples, peers and pharmaceutical sales reps (Table 8).

After selecting which influenced them at all, these professionals were asked to look at the list and rank the top three. The rankings are shown in Figure 1 and Figure 2. For dentists, peers, samples and self online came out highest. Somewhat surprisingly, self online received the highest number of 1st rankings. PCPs ranked peers, samples and sales reps highest, with peers receiving the highest number of first-rank votes.

Respondents were asked what percent of patients they believe buy and use the brand that is recommended to them. Dentists’ responses ranged from 15 percent to 95 percent, averaging at 71 percent. PCPs’ responses ranged from 20 percent to 90 percent, averaging at 70 percent (Table 9).

Patients follow through

These PCPs and dentists believe that marketing attempts to increase recommendations for certain brands make sense; they believe patients follow through. They also prefer to recommend over a number of other options, which gives OTC products a competitive edge. These professionals also clearly indicate that persistence in marketing pays, since familiarity with a brand is the primary reason for recommending it, among both groups of professionals.

Many of the differences noted between dentists and PCPs were to be expected, such as the lack of prescribing or recommending among dentists. Of greatest interest was the differential role of pharmaceutical sales reps. The dentists see few, and, as a result, the sales representatives’ influence is not all that important in the scheme of things. The PCPs see pharmaceutical sales reps much more often and think the reps are much more important to them.

The lack of interest among PCPs in manufacturers’ online information is also interesting given the resources devoted to this method. While the dentists appear to take full advantage, PCPs prefer to rely on other sources - including especially their peers. This squares well with anecdotal stories of PCPs using in-office equipment purchased in the late 1980s and early 1990s - antiques. More surprising is that these particular professionals were interviewed online, and this pro-computer-biased sample apparently has little experience with surfing the Net.