Building strong condition brands Received (in revised form): 14th May, 2007 Reinhard Angelmar is the Salmon and Rameau Fellow in Healthcare Management and Professor of Marketing at INSEAD, Fontainebleau. An author of many studies on the pharmaceutical industry, he has worked with pharmaceutical companies such as Johnson & Johnson, Lilly, Novartis and Pfi zer. He teaches a course on Pharmaceutical Marketing Strategy at INSEAD, and is also a court expert in pharmaceutical litigation. Sarah Angelmar is an INSEAD MBA Participant, class of July 2007. She previously worked as a Strategic Account Planner at OgilvyOne, New York, 2000 – 2006 where she developed consumer communications strategies for Boehringer-Ingelheim, Eli Lilly, GlaxoSmithKline, Pfi zer, Schering-Plough and Wyeth Pharmaceuticals brands. She also co-authored and presented DTC Trends Reports for her OgilvyOne Clients. Liz Kane is Planning Director for Pfi zer ’ s Lipitor and Caduet, The Kaplan Thaler Group, New York. She was previously with Ogilvy & Mather, and Deutsch, New York, where she gained expertise in the DTC arena. She has worked on a range of pharmaceutical brands from Novartis ’ Zelnorm to Pfi zer ’ s Lipitor. She was awarded a gold Effi e for the Zelnorm ‘ Tummies ’ work. Keywords branding , positioning , condition branding , disease branding Abstract With blockbuster brands such as Pfi zer ’ s Lipitor, GlaxoSmithKline ’ s Advair, AstraZeneca ’ s Nexium and many others, the pharmaceutical industry has demonstrated its expertise in building strong product brands. Product branding-focused marketing, however, leaves many patients untreated. Patients who do not recognise particular symptoms and medical conditions are less likely to seek medical attention and treatment, especially when their family doctor often lacks the time to probe for each and every possible medical condition. Product branding tells consumers about a solution but not about the problem which the solution addresses. Condition branding educates consumers, physicians and other stakeholders about the problem. We propose that the pharmaceutical marketing paradigm be broadened. Pharmaceutical marketers should build strong condition brands, in much the same way as they build strong product brands. Condition branding facilitates customers ’ decision-making, contributes to better health and may improve the standing of the pharmaceutical industry, which stands accused of overly aggressive product branding efforts, among other criticisms. When condition and product branding are well coordinated, each enhances the effectiveness of the other, raising patient health and brand sales. Journal of Medical Marketing (2007) 7, 341 – 351. doi: 10.1057/palgrave.jmm.5050101 INTRODUCTION
That pharmaceuticals can be branded like
sustain high brand awareness and strong,
Reinhard Angelmar
favourable and unique brand associations.
They invest signifi cant time and effort to
choose appropriate brand elements (name,
Tel: + 33 (0)1 60 71 2641 Fax: + 33 (0)1 60 72 9240
identify their product and differentiate it
2007 Palgrave Macmillan Ltd 1745-7904 $30.00 Vol. 7,4341–351Journal of Medical Marketing
GlaxoSmithKline ’ s Advair. Their success is
high cholesterol, acid refl ux and asthma
condition is treated. 5 Other terms that are
address. For example, virtually everyone
has heard of high cholesterol, 73 per cent
to specifi c aspects of it, include ‘ medical
condition branding ’ , ‘ disease branding ’ ,
during the past fi ve years, 1 and two-thirds
‘ disease-state branding ’ , ‘ market
of cholesterol-tested persons accurately
conditioning ’ and ‘ disease mongering ’ . 6
recall their cholesterol score six months
We prefer the term ‘ condition branding ’
because it is value neutral (unlike ‘ disease
Not all conditions enjoy cholesterol ’ s
For example, to talk about a ‘ medical
condition ’ or a ‘ disease ’ implies that the
condition already is categorised as ‘ medical ’
or as a ‘ disease ’ . Yet condition branding
GlaxoSmithKline ’ s Requip, the fi rst
a condition is categorised, for example,
components of a condition brand, and the
cases, cervical cancer. Research in 2005
characteristics and benefi ts of a strong
followed by a discussion of incentives for
investing in condition branding and fi nally
the coordination of condition and product
or treatment and management practices. 4
These were less than ideal conditions for Merck & Co ’ s Gardasil, the fi rst
THE CONDITION BRAND
benefi ts of Requip and Gardasil, RLS and
brand associations, namely all thoughts,
RLS and HPV — just as Pfi zer and other
organisations have already been doing for
cholesterol. Cholesterol ’ s strong presence
in the minds of consumers is the result of
many years of condition branding efforts
campaigns, annual ‘ National Cholesterol
Education Month ’ activities and ‘ Know
beliefs about the prevalence and outcome
of the condition, feelings (eg fear, anger)
Journal of Medical MarketingVol. 7,4341–351 2007 Palgrave Macmillan Ltd 1745-7904 $30.00 Building strong condition brands
private and public support for R & D and
allergy is an example of a weak condition
associations among patients, physicians,
payers and other stakeholders. Associations
previously diagnosed by a physician. 13 Skin
tend to be favourable when a condition is
prick tests, a simple means of establishing
perceived as having serious consequences,
stigmatised, and which is caused by factors
practices, and there is only one allergist
for which individuals are not responsible
and over which they have no control. 8 – 10
respiratory physicians. 14 One allergist
commented: ‘ allergic diseases are not political “ hot potatoes ” like cancer and
• patients recognise the symptoms or the
health priorities and public education are
physician with the condition, and adhere
certainly not in the slightest bit attuned
to the prevalence and impact of allergic
• other consumers recognise the symptoms or
the presence of the condition, and encourage
presentation to physicians and adherence to
necessity in the increasingly fi erce ‘ war
of conditions ’ . The list of conditions
physicians screen for, diagnose and treat the
• third-party payers pay for the prevention,
diagnosis and treatment of the condition;
as is the list of conditions which doctors
• public and private sponsors sponsor R & D,
sponsors support. Resources available for healthcare are, however, limited, and
Breast cancer is an example of a strong
a growing number of critics question the
cancer among women, physicians, insurers,
of marginal social value. Only conditions
very high. Breast cancer is associated with
(22.1 per cent) fear most, far more than heart disease (9.7 per cent), the second
BUILDING A STRONG
most-feared condition. 11 This motivates
CONDITION BRAND
self-examination), screening (70 per cent
tasks: defi ning the condition brand and
mammogram within the past two years 12 ), early diagnosis, systematic treatment by
Defi ning the condition brand
Patient advocacy is strong and generates
defi ning (1) the condition identity and
2007 Palgrave Macmillan Ltd 1745-7904 $30.00 Vol. 7,4341–351Journal of Medical Marketing
(2) the condition profi le, namely the main
specifi c to the condition, easy to memorise, easy to recognise and
Condition identity
The condition identity serves to identify
and differentiate the condition from other
status of a condition. It enables consumers
conditions. It includes the condition name,
and physicians to recognise the condition,
one another and other stakeholders. Lack of consensus is typically resolved via
‘ consensus development conferences ’ . 18
should be memorable, distinctive, likeable
or at least affectively neutral (no stigma),
of the condition. In particular, the name
serious and requires the attention of a health professional.
Condition profi le
well-defi ned, the key characteristics of
of patients diagnosed with and treated for
atrial fi brillation, a cardiac condition, could
including its (1) causes, (2) time course,
may also be associated with negative affect
profi le and (4) consequences. The scientifi c
(stigma) and lack medical connotations, in
should be considered. Because ‘ impotence ’ had pejorative implications and was not
suffi ciently precise, it was replaced by
Potential causes can be ordered by their
‘ erectile dysfunction ’ . 17 Other conditions
refl ux disease or acid refl ux disease),
condition. Distant causes include genetic,
example, the cause of erectile dysfunction
crawly legs (renamed as RLS — Restless
may be defi ned as a lack of blood fl ow to
the penis resulting from insuffi cient levels of cyclic guanosine monophosphate
(cGMP) or, more distantly, as old age or
cause of a condition is defi ned infl uences
is managed. For example, if old age causes
erectile dysfunction, little can be done
Journal of Medical MarketingVol. 7,4341–351 2007 Palgrave Macmillan Ltd 1745-7904 $30.00 Building strong condition brands
about it. If childhood experiences explain
Managing condition awareness
manage conditions of which they are aware. Condition awareness requires that
people learn a condition ’ s identity. They
be defi ned as acute, intermittent / cyclic
condition name, when confronted with its
For example, depression can be defi ned as
medical progress triggers a redefi nition of
a condition ’ s identity, people must learn
treatment. Alternatively, it can be seen as
typical challenges in managing condition
and patient profile How many patients are suffering from the
condition (prevalence and incidence), and
what are their characteristics in terms of
profi le)? Epidemiological studies must be
name the condition. Creating condition awareness requires teaching the connection
a reduced life span (mortality)? What is
its impact on the quality of life of the
sufferer? And what fi nancial burden does
society? ‘ Burden of disease ’ studies provide
created the ‘ ABCs ’ of IBS, each letter referring to one of the symptoms:
Communicating the condition
Defi ning the condition identity and profi le is the fi rst step in building a
Sometimes, consumers associate symptoms
cancer patients treated with chemotherapy
attributed their fatigue to cancer. Johnson
& Johnson, marketer of the anti-anaemia
condition positioning and repositioning.
brand Procrit (US) / Erypo / Eprex (Europe),
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The following examples illustrate typical
anaemia, they were so focused on fi ghting
challenges in positioning and repositioning
cancer that they paid little attention to
anaemia. Johnson & Johnson, therefore, also raised awareness of chemotherapy-
Women were aware of cervical cancer but
consequences of this condition for their
not of the HPV and the fact that it causes
cervical cancer. To close this knowledge gap, Merck & Co launched its ‘ Tell
someone ’ campaign prior to introducing
Gardasil, the fi rst cervical cancer vaccine.
Osteoporosis was traditionally defi ned as
cervical cancer to their friends, by using
Organization (WHO) defi ned osteoporosis
the spine, wrist or hip of more than 2.5
standard deviations below the young adult
mean for the population. Merck & Co,
asymptomatic nature of HPV ( ‘ you could
osteoporosis and subsidised the installation
cause cervical cancer ’ ). Positioning HPV as a serious, asymptomatic high-prevalence
Positioning and repositioning a condition
Condition awareness is necessary but not
suffi cient for achieving effective condition
By following Merck ’ s advice — ‘ tell
good understanding of the condition profi le (causes, time course, prevalence /
incidence / patient profi le, consequences)
Believing that the cause of onychomycosis,
a condition with symptoms such as yellow,
fl aky nails, was on the surface of the nail,
many patients used topical therapies and
such as debridement. In fact, the condition
is caused by an infection of the nail bed
nail. By personifying the infectuous agent
has rendered existing knowledge obsolete.
as ‘ Digger the Dermatophyte, ’ an animated
Journal of Medical MarketingVol. 7,4341–351 2007 Palgrave Macmillan Ltd 1745-7904 $30.00 Building strong condition brands
miscreant, Novartis changed consumers ’
consumers that ‘ over time that acid can
causal beliefs — and increased the sales
of its Digger-fi ghting Lamisil tablets.
Associating celebrities with the condition
that asthma is an acute or intermittent /
and Pope Jean-Paul II in Parkinson ’ s; and
been educating consumers that asthma is a chronic condition that requires
Until recently the term ‘ depression ’ was
seldom heard outside psychiatric circles in
Japan, where the condition was treated almost exclusively in institutions. 21
Mistaken beliefs about condition
Heart disease is generally seen as a men ’ s
recognise the symptoms of depression. The
disease. In fact, heart disease kills more US
cause of the condition was explained via a
metaphor — ‘ your soul is catching a cold ’
— that suggested that the condition had a
organisations together with the American
The stigma associated with depression was
raise women ’ s awareness of the threat of
lowered when celebrities publicly talked
heart disease, increasing the percentage
Radical repositioning of a condition
condition from heartburn to acid refl ux
disease or GERD (gastro oesophageal refl ux disease) was one repositioning tactic.
• Name : changed from ‘ impotence ’ to ‘ erectile
• Signs and symptoms : originally poorly defi ned
and thought of as a dichotomous (impotent /
communicating these results to physicians
not impotent) condition, a questionnaire tool
classifi ed ED into four categories, ranging
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• Causes : medical instead of psychological
the condition from a children ’ s condition
• Time course : chronic instead of acute or
• Prevalence and patient profi le : originally
strongly motivated to play an active role
30 million (US); contrary to the traditional
idea that impotence is an old man ’ s disease, current estimates suggest that more than
Their motivation derives in part from the
50 per cent of all men over 40 years of age
possibility to position a condition in a
way that leads consumers to consult them
• Consequences : efforts have been made to
demonstrate that ED has serious quality of
life and other consequences, and to lower the
social stigma associated with the condition
psychological to a medical condition. 23
(eg by using celebrities such as Bob Dole).
Why should pharmaceutical companies invest in condition INCENTIVES FOR CONDITION branding? BRANDING
Unlike a product brand, whose owner can
engage in condition branding for ethical
that is most aligned with the owner ’ s
benefi ts. The pharmaceutical industry is
objectives, a condition brand is not owned
by any specifi c individual or organisation.
Because of this, several stakeholders may
standing of the industry and of individual
stakeholders with suffi cient incentives
the health of their population may invest
condition branding will increase the sales
come about through a growth in the total
number of prescriptions for the condition
& Co ’ s ‘ Tell someone ’ HPV campaign, the
increase in the prescription share for their
raise HPV awareness and education among key general public, healthcare provider and
Condition branding can raise the
routes. First, it may increase the total
respective conditions, as with very active
prescription brands by building condition
and payers unfamiliar with the condition.
Journal of Medical MarketingVol. 7,4341–351 2007 Palgrave Macmillan Ltd 1745-7904 $30.00 Building strong condition brands
reposition the condition so that previously
sceptical patients, physicians and insurers
occur when the condition is repositioned
respectively. These two routes assume the
Lilly ’ s efforts on behalf of Cymbalta
provide an example. A recent entrant into
branding may increase patient adherence,
differs from other antidepressants in that it
thus raising the number of prescriptions
is also approved for the treatment of pain
An individual company ’ s incentive to
Lilly ’ s ‘ Depression hurts! ’ campaign
plus pain, and to shape the understanding
the two symptoms. Because Cymbalta ’ s
mechanism of action fi ts with the altered
the largest incentive. This was the case
for Merck & Co in HPV / cervical cancer
(Zelnorm), Johnson & Johnson in chemotherapy-induced anaemia (Procrit /
Condition branding can raise the total number of prescriptions and
Incentives for an individual company to
anticholesterol market (Lipitor) may also
engage in condition branding are greatest
fi nd it worthwhile, as per their cholesterol
when condition branding raises the total
awareness campaigns. GlaxoSmithKline ’ s
number of prescriptions and, at the same
efforts to reposition asthma as a chronic
competitor (Advair) attempting to increase
osteoporosis, namely low bone density or
In conditions with a fragmented supply,
there is little incentive for any individual
installation of bone density measurement
branding that increases the total number
of prescriptions. Condition branding may,
however, still be worthwhile if competitors
jointly funding a third-party organisation
that engages in condition branding for the
fracture, Merck educated the market that bone thinning was a cause of
fracture: ‘ after menopause, women ’ s
more likely to fracture ’ . This raised
shares without necessarily increasing the
2007 Palgrave Macmillan Ltd 1745-7904 $30.00 Vol. 7,4341–351Journal of Medical Marketing COORDINATING CONDITION AND PRODUCT BRANDING
Condition branding and product branding
condition awareness and understanding or
condition misperceptions, it may, however,
the condition is positioned should match
the product ’ s positioning, as illustrated
patients in parallel to product branding
by the examples in the previous section.
campaigns targeted to other segments. This
is the reason why Pfi zer, for example, runs
cholesterol and erectile dysfunction many
launched (1997 and 1998 respectively), in
parallel with product branding campaigns.
CONCLUSION
Product branding tells customers about a
or has little awareness, condition branding
solution but not about the problem which
should precede product branding. Merck ’ s
‘ Tell someone ’ campaign is one example.
stakeholders about the problem is the task
of condition branding. Condition branding
product, especially if the company is the
condition. For example, the ‘ Tell someone ’
effectiveness of the other, raising patient
website carried Merck ’ s name and logo.
Ads about erectile dysfunction without the
Acknowledgments
Viagra name also typically show Pfi zer ’ s
fi nd out more about available treatments,
by calling an 800 telephone number or clicking on a website link. These
References and Notes
telephone numbers and websites generally
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3 Restless Legs Syndrome Foundation ( 2005 ) .
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is largely under-recognized and poorly understood by
Journal of Medical MarketingVol. 7,4341–351 2007 Palgrave Macmillan Ltd 1745-7904 $30.00 Building strong condition brands
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7 For example, homosexuality, at one time categorised
developed the ‘ Rome I ’ criteria for irritable bowel
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estimating the prevalence (number of persons with
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2007 Palgrave Macmillan Ltd 1745-7904 $30.00 Vol. 7,4341–351Journal of Medical Marketing
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