1. What is your grassroots marketing philosophy?
Grassroots activities are powerful because they are personal. At TGI Healthworks, which is responsible for branded grassroots activities, and at the Global Healthy Living Foundation, which is the driving force behind unbranded programs, we are able to create strong bond affinity groups of patients through emotional as well as logical appeals to improve quality of life. Through personal patient initiatives such as a commitment to diet and exercise, and through the support network of our web sites such as CreakyJoints.org for arthritis, as well as our educating and entertaining community-based events, we are able to show patients how to say "yes" to a healthy life in the face of chronic disease that says "no."

We bring the best people to the communities of those most in need, showing Latinos at San Antonio's Nutrition Centers, African Americans at Memphis' community centers, GLBT citizens in New York and San Francisco, and many other cultural and ethnic groups in the U.S. and Europe, how to become more aware of their disease, how to control it, how to communicate with their physician, and how to gain the knowledge that results in taking the right drugs in the right doses.

Grassroots marketing to us is continuous two-way communication through our mentoring program and, using the structure recognized by Nobel prize winner, Dr. Muhammad Yunus, a micro-grant program for patients who have attended an event.

Our mentoring program, initiated through a Genentech grant to our Global Helathy Living Foundation, provides a growth path to positions such as Master Mentor, and a curriculum for patient peer mentors. Micro-grants are small amounts of money given to small patient groups -- usually less than $50 -- so they can defer the costs of follow-up meetings that are used to encourage, inform and entertain, and improve compliance, adherence and consistency. We typically cover transportation, food and venue costs.

The physicians, psychologists, exercise experts, nutritionists and other professionals who work with us understand the importance of short- and long-term goals. They appreciate the need to state goals, support the people trying to achieve them, and recognize success.

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2. What is your position considering the greater state of DTC advertising in the market today?
DTC advertising is in its infancy. We're only now beginning to move beyond one-way awareness efforts. Unlike other consumer goods advertising which creates a user identity (I am identified, and identify myself by the water I drink or the car I drive, for example), DTC advertising hasn't yet been able to penetrate into a personal and voluntary commitment to affiliate with a particular drug. We think this difficulty comes from the presence of authority figures in the prescribing and use cycles. Usually there is a single authority figure in awareness advertising -- the advertiser. However, with DTC advertising, we have physicians, caregivers, and the FDA. Advertisers know the power of word-of-mouth recommendation for consumer goods: if your neighbor uses a certain cleaning product and says it's great, you are very likely to try it too. In the DTC world, it's not just your neighbor, it's a pharmaceutical company recommending that you talk to your doctor. With no disrespect intended, and understanding the limits of the analogy, that's like Proctor and Gamble asking you to talk to your grocer. The fact that there are several powerful and valid influencers in any DTC advertising message means, to us, that mass market advertising serves a useful purpose in awareness while direct personal communication with patients provides adherence, compliance and persistency. Direct, personal communication is what we do.

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3. How will grassroots affect the DTC market and the pharma industry as a whole? and
4. How does grassroots differ from other forms of marketing?
From a time standpoint it is much easier and sexier, but much more expensive, to create and implement a television ad than a grass root campaign. There's a line item in the budget for advertising. The ROI case for it has been accepted. It has become a revenue staple for media companies and is not likely to go away either through choice or legislation, regardless of the provisions in the proposed Kennedy Enzi bill. However, its weakness -- improving compliance, adherence and persistency -- is becoming more and more apparent. Its ROI has a half-life, and brand managers realize it is only the first step. Grassroots activities need to be employed in order to justify the ROI of continuing a mass media campaign that primarily achieves awareness.

Grassroots activities bring sales and marketing together. The traditional Harvard Business School definition of marketing as the discipline that divines what people want, and sales as the activity that moves what is available, is morphed when the flexibility and influencers around prescription drugs are considered. Dosage, duration, and patient initiatives such as losing weight, exercising and changing psychological outlook, can merge what's available and what people want in a variety of markets. Grassroots activities provide this venue for customization through education, motivation to take personal initiatives, and conscientious follow-up.

Grassroots activities bring physician and patient marketing together. While physician education will remain a separate discipline, grassroots marketing cannot be successful without a common patient and physician message - or more broadly, a healthcare provider and patient/caregiver message. Physicians want to know about great programs and they endorse them enthusiastically. The community asks for a unified physician/patient voice. Asking a patient to "talk to their doctor" about a certain drug is only a first small step often results in a request for a drug, not a discussion about it. Dr. Howard Schertzinger, a sports medicine practitioner in Cincinnati who has traveled with us throughout the U.S. speaking at grassroots events, relates a story of a patient who visited him with a painful shoulder and asked for Levitra so he could throw a football through a tire swing (as he had seen a man do on the commercial). Dr. Mark Young, a physiatrist from Baltimore, often mentions the most important vitamin, Vitamin H, which he says is "Vitamin Hope," as he discusses the importance of a positive mental outlook to people with a chronic disease. Our psychologist Dr. Laurie Ferguson, speaks to physicians in every city about how they can help their patients take responsibility for their disease, and then to patients and caregivers about how they can take responsibility. This unified voice, provided by well-planned and implemented grassroots activities, uniquely provides the harmony necessary for wellness and the promise of improved quality of life that all DTC efforts invoke.

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5. What direction do you think pharmaceutical marketing should take in the future?
When pharma marketing flirts with consumer marketing tactics it risks losing its priority credibility position in society. Chronic conditions are not breakfast cereal and to advertise them in the same way ignores a public trust as well as an educational path, reserved, in the public mind, for the most important issues. This educational path is one-on-one communication, not a one-to-many declaration. If we consider the cost to our community of not respecting this high-credibility, very persuasive, personal communication -- whether it is from a family physician, or a professional grassroots activity -- we risk losing patient trust which is the most profitable patient trait, and the most expensive to re-establish. Pharma marketing can step back and appreciate each communication tactic for its contribution to the overall success of a drug. Mass media is the beginning and its job in awareness and initial call-to-action is unquestioned. Even with shorter patent life and drug exclusivity periods, a longer-term perspective that focuses on successful compliance, adherence and persistency techniques through grassroots activities is important in order to decrease initial prescription drop-off.

The internet will continue to play an important role, but it's important to recognize that if a web site is used as a brochure, its potential is ignored. The real benefit of the internet in healthcare is assumed to be patient education and information, but that isn't an ROI-defensible argument. The actual benefit, which is also ROI-supported, is stickiness -- the desire to revisit often. Our arthritis website, CreakyJoints.org -- with more than 20,000 members -- has been able to achieve stickiness by combining in-person local grassroots activities on a national scale with discussion boards, news, information, and entertainment for the arthritis community. Other chronic disease sites which are in earlier stages of development using the CreakyJoints model are BloodSugarSquad.org for diabetes, RedPatch.org for psoriasis, ExahleFoundation.org for COPD/asthma and FitBrain.org for depression. Pharmaceutical marketing in the future, we think, will find ways to economically and powerfully reach patients, caregivers and healthcare providers, as well as understanding that, in some cases, new ROI models that incorporate longer-term returns are necessary.

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6. What are the bigger problems with the pharm ad industry and how to address them?
Loss of credibility. We ask people to bet their lives on our products. We need to be right and when we're not we need to be quick. Quick to admit mistakes early, quick to fix them early, and quick to accept the financial liability necessary to protect credibility. Merck's Gardasil is an interesting example. When Dr. Jonas Salk announced his polio vaccine in 1955, entire communities lined up to unquestionably participate. Government, religious, civic and social institutions endorsed it. Today the moderately high static level from religion, consumer groups, healthcare advocates, government and others reflects cynicism. Whether it is warranted is not the point. It is there, it upsets public and personal health, and every ad pharma produces, and every action pharma takes, needs to be reassessed to ensure that above all other objectives, it builds and reinforces pharmaceutical industry credibility.

Addressing the credibility issue also requires the ability to understand that the next generation of healthcare consumers finds credibility in the truth of Ugly Betty, not the fantasy of Lawrence Welk, and that the Boolean graphics defining these groups does not overlap.

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7. What is the pharmaceutical advertising industry's greatest weakness?
Allowing itself to become the diminished pawn of investors. Pharmaceutical companies occupy a special position in world society. They are a global resource for good. They are arguably the only industry that can, in the words of author Jim Collins take society from "good to great." They combine the best of altruism, idealism, capitalism, and pragmatism. They do not have the aptitude to thrive among amoral businesses that sell vastly less important products for vastly higher profits. Pharmaceutical companies can stake out much higher ground by embracing social entrepreneurship and creating a new investment climate which makes it morally mandatory to invest in them in order to secure the future of society. There are many instances of investors demonstrating the patience to wait for returns from a socially responsible company. The world wants to do what's right and pharmaceutical companies can claim their leadership position.

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8. What are you personally doing to improve the state of the industry?
At TGI Healthworks, as well as at the Global Healthy Living Foundation, we are changing the world, one patient at a time. We believe that information, education and personal initiative are the best insurance for adherence, compliance and persistency. Because our co-founder, Seth Ginsberg, has a chronic disease (diagnosed with arthritis at 13) we are able to create and implement unique programs that, in the seven years since we began, successfully allow patients to change how they view themselves and their disease. We strongly believe our actions, and the actions of social entrepreneurs with similar objectives, is in accordance with Margaret Mead's philosophy that, "A small group of thoughtful people could change the world. Indeed, it's the only thing that ever has."

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1. What do you think makes CRM marketing unique from all other types of marketing?
If we assume CRM is fundamentally a computer-based discipline, CRM is unique among marketing tools in its ability to produce detail, and its infallible memory. This is its strength as well as its weakness. An unlimited number of physicians, patients, vendors can be tracked and served, but sometimes knowing too much causes the human interface to be subordinated. What can result is a creepy relationship with a computer in human clothes.

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2. What important roles does CRM play in the pharmaceutical industry?
Everything we do is subject to discovery. CRM is invaluable for two reasons. First it keeps people from improvising on the fly, and second, it creates an audit/legal trail. Unfortunately this is becoming CRM's most important function. The secondary role, then, for pure automated CRM, is communicating with patients who already are loyal. If they're not yet loyal, CRM needs to be weighted toward human interaction.

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3. What does CRM do for the patient? For the Physician? For the overall health awareness of the public?
CRM is the efficiency tool. It is, or soon will be, depending on where you live, what brings patients, hospitals, doctors, insurance companies, pharmacies and others together, although not necessarily interactively at this point. There have always been two components to the health care relationship, the factual and the emotional. CRM ties together the facts, leaving human energy to be applied to the emotional needs of each party.

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4. What do you believe is key in creating a good CRM campaign?
The key to creating a good CRM campaign is understanding its limits. It's like a navigation system -- it works until it doesn't and if you haven't made other provisions, you're lost. CRM is not click it and forget it, and it doesn't take the place of in-depth human interaction. If it's used as a sophisticated brochure mailing system, it's being wasted. When it's sensibly integrated into everything from grassroots to national advertising, it can easily scale to meet patient, physician and pharmacy demands. It can reach out and touch one person or 100 million.

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5. What should be avoided in creating a CRM campaign?
CRM isn't the next marketing flavor of the month. It is an evolving marketing support mechanism that organizes, codifies and satisfies specific audiences. The technology used to manage the relationship cannot supplant the human interaction that is the relationship.

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6. What changes do you think should be made to the market, to allow for better CRM marketing?
If we define the market as recipients of CRM, then positive changes would include greater unconscious acceptance of the technology behind CRM. For example, ATMs have been around for 40 years. The ATM is an invisible part of conveniently, consistently and economically dispensing money anywhere in the world, in local currency. The customer doesn't question whether the ATM will work, it is assumed it will, and if it doesn't there is another one close by. The customer doesn't expect or want any human interaction in this transaction, although humans are an integral part. Of course banking industry CRM falls apart when they're too cheap to hire enough humans, and you have to wait on hold, pushing an endless sequence of numbers that lead you through voice-lady hell. Health care has the opportunity take the successes and learn from the mistakes of the financial services industry, as well as the people who really get it wrong -- the airlines.

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7. Is CRM marketing needed?
Health care cannot survive today without CRM. Wait till us demanding, technology savvy baby boomers get old enough to start really tapping into the system, and without CRM the entire system will fall down. However, CRM is only the genie, not the master.

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8. Where do you see CRM marketing going in the future?
As the "totally integrated generation" or "TIGS" (our term for 18 and younger industrialized economy citizens who expect technology and human diversity to be an integral part of their life) become independent health care consumers, CRM will drive technology, not the other way around. Computing power will allow people to quickly and portably sustain a relationship that meets their specific needs, and the human interface will be redefined.

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9. Is CRM effective and why?
CRM is effective because it resides in the sweet spot between meeting cost objectives and consumer's needs.

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10. And of course, finally, how do CRM and Grassroots marketing interrelate?
CRM is the enabler of cost-effective national grassroots marketing. Before CRM, grassroots was a local activity that was sometimes difficult to rationalize with respect to ROI in large markets such as the U.S. CRM, however, allows the intimate human interaction -- the essential component in ICAP (improving compliance adherence and persistency) -- to occur at local venues throughout the country. CRM does for grassroots programming what the assembly line did for automobile production -- allow economies of scale, quality control, and low cost per unit.

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