The marketing of a multitude of products as diverse and complex as medical devices presents a range of challenges not seen in other areas of medicine. There are often minimal funds allocated for marketing purposes and a device-savvy sales pitch is required to win over well-informed hospital administrators and surgeons.
Overall, the marketing equation boils down to getting return on investment for the marketing budget, so any campaign has to be very well planned and focused toward the people who make the purchase decision from customised material to education that might be associated with the product.
According to a product manager for one well-known orthopaedics firm, the basic position relies on a direct face-to-face approach with the orthopaedic surgeon and hospital procurement services (pharmaceuticals have a much wider target audience). The main goal is to inform a specific audience using "mailers or flyers" to the surgeon, advertisements taken out in the main journals such as the Journal of Bone and Joint Surgery, internal briefings, exhibitions and displays, learned papers and also training courses and demonstrations. For the marketing process, continuing education and training for the health professional is central, but there has to be a strict division between the two in case of allegations of impropriety.
The internet is playing an increasing role with online institutes allowing surgeons to register for lectures, seminars and demonstrations of procedures by specialist/experts (best practice) without leaving their department. Surgeons are asked to virtually "scrub in" to watch live webcasts of procedures or to attend comprehensive training and education programmes via the net.
A product has to "support itself" to a greater or lesser degree with numbers of successes and by painstakingly building a reputation for quality and trustworthiness. This can ultimately lead to additional investment because technology in the field moves so quickly product life cycles can be short and a star product can easily be overtaken.
Surgeon education is still key in getting the product into the market and widely used and surgeons appreciate this approach although residential courses and conferences to publicise products are now becoming less popular because of the Federal anti-trust implications. Medical device companies also require exceptional public relations support which could often see four or five press releases released each day relating to training courses, product enhancements and new products.
As far as medical device marketing is concerned, over the last year – particularly in the US –there have been a great many changes due to investigations into infringements of the Federal anti-trust laws. These have involved surgeons being paid large retainers or being supplied with gifts. The upshot of this is five major orthopaedics companies – Biomet, DePuy, Smith & Nephew, Stryker and Zimmer – have had varying multi-million dollar fines and have been required to clean up their act.
Their marketing activities are now being closely scrutinised by legal observers assigned to each company and a strict compliance programme has been introduced. The extent of the wrongdoing has not so far penetrated the UK and European markets, although the constraint on marketing activities will be similar.
The patient's role
How much influence does the patient have on the process? Marketing campaigns for pharmaceuticals commonly include patient-targeted television, internet and magazine advertising. This is also true to some extent in the medical device sector but how much influence a patient would have will probably depend on whether their treatment is privately funded or state/NHS funded (if in the UK).
An NHS patient would have to abide by their health trust's choice but a private patient armed with sufficient research and the fact they would be paying might have a significant influence on the choice of device or implant.
An excellent example of patient choice having influence is the Birmingham Hip Resurfacing (BHR) arthroplasty marketed by Midlands Medical Technologies (MMT) Ltd, Birmingham, UK (now owned by Smith and Nephew), which was introduced in 1999. The metal-on-metal design was intended to overcome the past problems of aseptic loosening due to polyethylene wear particles.
The BHR implant was marketed initially by MMT as a reliable and desirable hip replacement for younger patients. The designers had a great deal of confidence in the device that it did not restrict the activity of the patient after the operation allowing them to continue fairly strenuous exercise and activity if they wished. When this implant became available for the first time its younger patient application meant that surgeons actually received requests from patients for it to be used in their cases.
Sally Sykes, a regional marketing manager of De Puy in the UK, says communication to the patient is developing all the time, as a marketing tool in the medical device field. What companies are trying to do is help patients understand their options in conjunction with their surgeon.
In order to get to the patient directly, advertising outside the normal scope has been tried and this has included advertising in gardening magazines and also radio adverts of Classic FM. These two outlets are of course to reach patients who are in the market for joint replacement implants such as knees and hips and were designed to tell the patient how their lifestyle could be restored. This type of approach is also supported by comprehensive information articles and websites including "success stories" to give patients the confidence to choose.
There are now a lot more products to choose from and obviously the pros and cons have to be explained to the patient. For instance, there are now gender-specific knees and new keyhole surgical techniques, allowing shorter recovery times: all these have to be considered. DePuy launched four websites in 2008 for patients seeking information about joint replacement. These web resources provide joint replacement patients with mobility assessment tools, surgical options, recovery information and also link to online discussion groups for peer-to-peer support.
Clearly the internet's use in marketing and education for medical devices has not yet reached its full potential. However, the medical device industry is putting its house in order with relation to the anti-trust laws and now has to expand on its strengths, which include communicating with both surgeon and patient, improving education and using new media opportunities to get the message across.