R E P O R Ts
MA RKE TIN G SCIENCE INST ITUTE R e p
o Reports r t s
How Corporate Social Performance Influences Financial Performance: Cash Flow and Cost of Capital Manoj K. Agarwal and Guido Berens (09-100)
Spending on the Fly: Mental Budgets, Promotions, and 2 0
0 Spending Behavior 9
I Karen M. Stilley, J. Jeffrey Inman, and Kirk L. Wakefield (09-101) W O R
K How Important Are Brands? A Cross-category, Cross-country Study I N
G Marc Fischer, Franziska Voelckner, and Henrik Sattler (09-102) P A P E
R The Effect of Brand Acquisition and Disposal on Stock Returns S
E Michael A. Wiles, Neil A. Morgan, and Lopo L. Rego (09-103) R I E S
I Boundaries of Self-Expression: Identity Saturation and I S Brand Preferences in Consumer Choice S U
E Alexander Chernev and David Gal (09-104)
Reports O N 2 0 0 9 E
I Marketing of the Life Sciences: A New Framework and M ARKETING SCIENCE INSTITU TE W OR K IN G N P A P ER O Research Agenda for a Nascent Field 1000 Massachusetts Avenue . S ER I E S 0 Stefan Stremersch and Walter Van Dyck (09-105) Cambridge, MA 02138 USA 9 -
0 I SS UE O NE 0
617.491.2060 1 www.msi.org NO. 0 9 - 0 0 1 MA R KE TING SCIE NCE INS TITUTE Reports
Executive Director The Marketing Science Working Paper Series Classroom use Russell S. Winer Institute supports academic The articles that appear in Upon written request, MSI research for the development MSI Reports have not under- working papers may be Research Director —and practical translation— gone a formal academic copied for one-time classroom Ross Rizley of leading-edge marketing review. They are released as use free of charge. Please knowledge on issues of impor- part of the MSI Working contact MSI to obtain permis- Editorial Director tance to business perform- Paper Series, and are distrib- sion. Susan Keane ance. Topics are identified uted for the benefit of MSI by the Board of Trustees, corporate and academic Search for publications which represents MSI mem- members and the general See the searchable publica- ber corporations and the public. tions database at academic community. MSI www.msi.org. supports academic studies on Subscriptions these issues and disseminates Annual subscriptions to MSI Submissions findings through conferences Reports can be placed online MSI will consider a paper for and workshops, as well as at www.msi.org. Questions inclusion in MSI Reports, through its publications regarding subscriptions may even if the research was not series. be directed to [email protected]. originally supported by MSI, if the paper deals with a pri- Marketing Science Institute Single reports ority subject, represents a sig- 1000 Massachusetts Avenue Articles in MSI Reports are nificant advance over exist- Cambridge, MA available in downloadable ing literature, and has not 02138–5396 (PDF) format at www.msi.org. been widely disseminated elsewhere. Only submissions Phone: 617.491.2060 Past reports from faculty members or doc- Fax: 617.491.2065 MSI working papers published toral students working with www.msi.org before 2003 are available faculty advisors will be con- as individual hard-copy sidered. “MSI Working MSI Reports (ISSN 1545– reports; many are also avail- Paper Guidelines” and “MSI 5041) is published quarterly able in downloadable (PDF) 2008–2010 Research by the Marketing Science format. To order, go to Priorities” are available in Institute. It is not to be repro- www.msi.org. the Research section of duced or published, in any www.msi.org. form or by any means, elec- Corporate members tronic or mechanical, without MSI member company per- Publication announcements written permission. sonnel receive all MSI reports To sign up to receive MSI’s 2 0 0 9 (PDF and print versions) free electronic newsletter, go to The views expressed here of charge. www.msi.org. are those of the authors. WORKIN G Academic members Change of address MSI Reports © 2009 Academics may qualify for Send old and new address PA PER Marketing Science Institute free access to PDF (down- to [email protected]. SE RIES All rights reserved. loadable) versions of MSI reports and for special rates on other MSI print publica- ISSU E ON E tions. For more information and to apply, go to “Apply NO. 0 9 - 0 0 1 for academic membership” on www.msi.org. W o r k i n g P a p e r
Marketing of the Life Sciences: A New Framework and Research Agenda for a Nascent Field
Stefan Stremersch and Walter Van Dyck
With the growth of the life sciences industry, unique and challenging marketing problems emerge. This report proposes a new research program—bridging medicine, business, and economics—which would have a broad influence on public policy and business issues.
Report Summary pliance. The authors qualify these decision What unique challenges do marketers in the areas according to their practical importance life sciences face that require industry-specific and academic potential. knowledge development? Although marketing scholars often seek to contribute new knowl- Based on prior research and practice, the edge that is applicable across industries, the authors formulate preliminary generalizations authors argue that specific knowledge develop- for key decision areas, to evaluate early streams Stefan Stremersch is ment is necessary for the life sciences industry, of research and develop propositions to direct Chaired Professor which is defined as companies in pharmaceuti- future research. Offering a clear definition of of Marketing and cals, biotechnology, and therapeutic medical life sciences and discerning the boundaries of Desiderius Erasmus devices. the domain, the authors suggest that the field Distinguished Chair of life sciences marketing needs to establish of Economics at the Through a study of prior literature and itself not only practically but also theoretically Erasmus School of through surveys of marketing experts, and methodologically. Economics, Erasmus Stremersch and Van Dyck identify industry- University Rotterdam, specific decision areas that life sciences mar- A fertile area of future research, life sciences and Visiting Professor keters must deal with, including therapy marketing presents unique and often challeng- of Marketing at IESE, creation, therapy review, and therapy promo- ing marketing problems, for which high- Universidad de tion. In therapy creation, marketers face deci- quality data are available. The authors note Navarra, Spain. sions concerning therapy pipeline that investment in research on life sciences Walter Van Dyck is optimization, innovation alliance formation, marketing as a research program would also Associate Professor and product positioning. Therapy review address concerns across disciplines such as of Technology involves marketing decisions concerning global business, medicine, and economics. Research and Innovation market entry timing and key opinion leader on life sciences marketing will have a broad Management, selection. Therapy promotion centers mostly social influence, on public policy, companies, TiasNimbas Business on salesforce management, communication the press, and people’s quality of life. I School, Tilburg management, and stimulation of patient com- University.
WO RKI N G P AP ER S ER IES 121 Introduction makes it to market—leads to life sciences development portfolios being uniquely shaped While marketing scholars often seek to con- as funnels (Ding and Eliashberg 2002). Life tribute new knowledge that is applicable across sciences marketers decide on product position- industries (Stewart 2002), some industries ing (the match between indication and new have unique characteristics that require therapy) many years before market entry. industry-specific knowledge development Market entry for new therapies is strictly regu- (Eliashberg, Elberse, and Leenders 2006). lated, differentially so across countries. If mar- Examples are the services industry ket access is granted, manufacturers get a (Parasuraman, Zeithaml, and Berry 1985; limited time of market exclusivity—in most Rust and Chung 2006; Vargo and Lusch cases, 20 years as of initial application filing, 2004), the entertainment industry (Eliashberg, of which 10 to 12 years are typically spent in Elberse, and Leenders 2006; Eliashberg and clinical development—after which generic Shugan 1997), and the high-tech industry therapies may enter the market. Life science (Bourgeois and Eisenhardt 1988; Glazer and firms’ marketing efforts are typically capped Weiss 1993; Heide and Weiss 1995; John, (e.g., in many European countries) and/or reg- Weiss, and Dutta 1999; Stremersch et al. ulated (e.g., some states in the U.S. require 2007; Weiss and Heide 1993). medical sales reps to undergo a certification process). It is also one of the only industries In this paper, we argue that this requirement in which manufacturers are legally prohibited also applies to the life sciences industry. In our from communicating directly with their end definition, this industry spans companies in customer (with the exception of New Zealand pharmaceuticals, biotechnology and therapeu- and the U.S.). tic medical devices, and forms the innovative producer side of the health-care industry. Two The life sciences industry constitutes an impor- fundamental dimensions underlie the life sci- tant and growing part of our economy: e.g., the ences industry: science-based knowledge U.S. life sciences industry represents $271 billion (know-why) and quality of life. of global sales in 2007 (PhRMA 2008). In the U.S., prescription drug spending, the life sci- Life science companies are significantly more ences industry’s largest component, is expected linked to science than is any other industry, to accelerate through 2017 (CMS 2008). and convert the know-why they develop into new therapies (therapy creation). The resulting Because of the industry’s vast importance and therapy is scientifically reviewed by society in its unique challenges, marketing literature has terms of its impact on people’s quality of life, recently turned to the life sciences industry to by examination of the therapy’s safety, efficacy, study salesforce effectiveness (Manchanda and incremental cost-effectiveness (therapy and Chintagunta 2004; Manchanda and review). Life science firms promote their life Honka 2005; Manchanda, Rossi, and sciences therapies, to health-care provider Chintagunta 2004; Mizik and Jacobson 2004; and patient, within the regulatory framework Venkataraman and Stremersch 2007), therapy designed by society (therapy promotion). compliance (Bowman, Heilman, and Marketers face unique challenges in decisions Seetharaman 2004; Wosinska 2005), commu- on therapy creation, therapy review, and ther- nication effectiveness (Cleanthous 2004; apy promotion (see Figure 1). Iizuka and Jin 2005; Macias and Lewis 2003; Mukherji, Dutta, and Rajiv 2004; Wosinska The scant survival probability of newly 2006), and innovation (Chandy et al. 2006; created therapeutic inventions—only 1 in Ding and Eliashberg 2002; Prabhu, Chandy, 5,000–10,000 new inventions eventually and Ellis 2005; Sorescu, Chandy, and Prabhu
MARKE TING S C I EN C E I N STITUTE 122 Figure 1 Key Marketing Decision Areas in Life Science Firms
Therapy Creation Therapy Review Therapy Promotion Therapy Pipeline Market Entry Timing Sales Force Optimization Globally Management Innovation Alliance Key Opinion Leader Communication Formation Selection Management Therapy Positioning Stimulating Patient Compliance
2003 and 2007; Wuyts, Dutta, and Stremersch A second constitutive characteristic of the life 2004), among others. sciences industry is that the preventive or cur- ative therapies it creates are scientifically The objectives of the present paper are to reviewed as to their effect on people’s quality evaluate past research, suggest new directions of life, after which these therapies are pro- for future research, and ignite life sciences moted to patients and providers to convince marketing as an important area for scholarly them of the acclaimed effects. Improvement in research. We achieve these objectives by defin- quality of life is expressed as an increase in ing the life sciences industry and discerning its “quality-adjusted life years,” (QALYs), and can boundaries, deriving the key marketing- lie in enhanced effectiveness, reduced side decision areas in this industry, formulating effects and improved convenience (Garber and generalizations and propositions derived from Phelps 1997). Improvement is based on both prior research and state-of-the-art practice, quantity and quality of life years generated by and suggesting specific directions to steer medical interventions. future research. The components of the life sciences industry Defining the Life Sciences Industry and We discern three components of the life sci- its Boundaries ences industry: pharmaceutical, biotechnologi- cal, and therapeutic medical devices. These Underlying dimensions of the life sciences three industries are science based, as their industry patents typically refer to more scientific papers A first constitutive characteristic of the life than do any other industries. For instance, a sciences industry is that this industry creates study by Narin (2001) has shown that phar- scientific knowledge as to why a certain ther- maceutical and biotechnology firms cited apy affects the human body in a certain way. respectively 7.3 and 14.4 scientific references Science represents “know-why” (Kogut and per patent, which were the two highest science Zander 1992), in contrast to technology, linkages of all technology areas. While not which represents “know-how” (Quinn, Baruch, separately identified in the study by Narin and Zien 1997). The average number of scien- (2001), therapeutic medical devices are also tific papers a firm cites (science linkage) when very much science based. First, the average applying for a patent on its inventions, rather science linkage of all medical devices and than the number of other, prior patents equipment companies, which includes thera- (know-how development), can be used as a peutic medical devices, is more than twice the measure of the extent to which a firm is sci- average of the high-tech industry, such as ence based (Narin 2001).
WO RKI N G P AP ER S ER IES 123 Figure 2 The Life Sciences Industry and Its Boundaries
Life Sciences
Cosmetics-based Food-based Therapies Therapies Device-based Cosmeceuticals Therapies Nutraceuticals
Medical Devices & Equipment
aerospace or ICT (Narin 2001). Second, ther- quality of life. apeutic medical devices companies, such as Nektar Therapeutics or Arthrocare,1 belong to Typical cosmeceuticals are antiwrinkle agents the most science-based companies in the or balms to treat eczema or burn wounds. economy. These products prevent, treat, or cure diseases, mostly of the skin. Therefore, these products These three industries also market products are distinct from mere cosmetics, which aim that aim to improve the quality of life. These to alter the appearance of the skin, eyes, hair, include inorganic compounds (pharmaceuti- nails, etc. Some cosmeceuticals (i.e., cosmetics- cals), organic compounds (biotechnology), and based therapies) are science based, e.g., acne- therapeutic devices that affect the (diseased) care products with therapeutic antiseptics. human body. Take breast cancer as an exam- ple. Pharmaceutical firms aim to improve Medical devices and equipment range from breast cancer patients’ conditions through wheelchairs to imaging devices (such as MRIs) chemotherapy, while biotechnology firms may to stents. Equipment such as a wheelchair offer targeted therapies (e.g., Herceptin by improves the patient’s quality of life (e.g., Genentech) for well-identified patient types. through mobility) but is not science based. Device-based therapies also are often used Medical imaging devices do not therapeuti- with the same objective of increasing quality- cally improve humans’ quality of life and do adjusted life years, for instance, through represent know-how (technology) rather radiotherapy. than know-why (science). Some devices (i.e., device-based therapies) enhance the quality Discerning the boundaries of the life of life and are science based, such as stents, sciences industry implants, and pacemakers. The above definition allows us to discern life sciences boundary industries (see Figure 2): Nutraceuticals refer to products such as nutri- cosmeceuticals, medical devices and equip- tional supplements, vitamin- or calcium- ment, and nutraceuticals. These industries con- enriched foods, and polysaturated fatty acids. tain a small segment that belongs to the life Nutraceuticals may improve quality of life sciences industry because they produce thera- beyond merely feeding the body as food. pies that are science based and that improve However, only a subset of these products (i.e.,
MARKE TING S C I EN C E I N STITUTE 124 Figure 3 The Life Sciences Industry in the Health-care Market
Payers Financial Providers Product Producers Intermediaries Intermediaries
Hospitals Pharmacies The Life Science Government Insurers Physicians Wholesalers Industry and its Patients HMOs Integrated Delivery Group Purchasing Boundary Employers Networks Organizations Industries
Source: Adapted from Burns (2005).
food-based therapies) is science based and Methodology thus part of the life sciences industry. An Figure 4 graphically depicts our methodology. example is sterol-derived, cholesterol-lowering We first identified marketing decision areas in Benecol. life sciences from a literature study (step 1).2 Table 1 provides an overview of the major Therapies exist that include both a devices publications in life sciences marketing, accord- component and a cosmeceutical or nutraceuti- ing to the three areas we defined—therapy cal component. Examples include breast creation, therapy review, and therapy promo- implants (cosmeceuticals and devices) and tion—in International Journal of Research in nutrigenomics, personalized diet recommenda- Marketing, Journal of Consumer Research, tions based on diagnostics of bodily fluids Journal of Marketing, Journal of Marketing (nutraceuticals and devices). Figure 3 (adapted Research, and Marketing Science, which have from Burns 2005) positions the life sciences been claimed to be a good representation of industry in the health-care market. Payment major journals in marketing (Stremersch and flows from left to right, from payers to Verhoef 2005; Stremersch, Verniers, and providers over financial intermediaries. Verhoef 2007). Products flow from right to left, from produc- ers to providers, over product intermediaries. Given its relatedness in the health-care value The life sciences industry is the producer side chain, Table 2 provides an overview of the of the health-care market. health psychology literature, in the same major marketing journals. The table discerns three frameworks in this literature: health-related Key Marketing Decision Areas in the behavior, health-risk perception, and health Life Sciences Industry communication. Two early schools of thought underlie these frameworks: protection motiva- Next, we derive the key decision areas for tion theory and the health belief model. marketers in the life sciences industry. We first Protection motivation theory predicts protec- discuss our methodology, after which we iden- tion intentions as a function of severity, vul- tify and qualify the key marketing decision nerability, response efficacy, and self-efficacy areas on managerial relevance and scholarly and is used to test the effectiveness of health potential. communication (Maddux and Rogers 1983;
WO RKI N G P AP ER S ER IES 125 Figure 4 Methodology
Practitioner Literature Review Academic Literature Review Step 1
Pre-identified Life Sciences Marketing Decision Areas Identifying Marketing Decision Areas & Domains LS Marketing Practitioners Personal Interviews Step 2
Identified Life Sciences Marketing Decision Areas
LS Marketing Practitioner Healthcare Payer & Provider Marketing Academics Telephone Survey Telephone Survey Online Survey
Step 3a Step 3b Step 3c
Life Sciences Marketing Decision Areas Importance Rating Life Sciences Marketing Decision Areas Future Low High Research Need
Health- Critical High enhancing Decision Decision Areas Low High Areas Step 4 Practice- High Impact Ancillary Performance- enhancing Research High Low Decision enhancing Research Areas Decision Areas Step 5 Incremental Knowledge- Qualifying Future Research Low Research enhancing Research
Rogers 1975; for a review: Keller and health economics literature. The following Lehmann 2008). The health belief model articles provide good reviews on the health (Becker 1974; Rosenstock 1974) proposes that economics literature for interested readers: on increasing risk perceptions should lead to pre- the cost of innovation (DiMasi, Hansen, and cautionary behavior (for a review, see Menon, Grabowski 2003); on price competition among Raghubir, and Agrawal 2008). pharmaceutical firms (Bhattacharya and Vogt 2003; Scherer 1993); on the effect of generic Although it is more distant to the life sci- entry on branded drug prices (Frank and ences–marketing field, we also reviewed the Salkever 1997; Grabowski and Vernon 1992);
MARKE TING S C I EN C E I N STITUTE 126
e ) ) s w
g t
5 r e 2 s a e i 4
9 a ) 0 p v g m
7
6 9 e r r 5 t
s e 0 i t y 3 8 x 1 f a R d 8 2
,
t
n
e
r 1 l
n t – n 9 y 9 9 e , n d i e 5 a
e a 7 2
1 b n 0 2 2
m p c n k
s 6
-
5 – i 9
a r 1 s e t o ) n
2
1 0 m 9 m m a , u e a
n
o ) ) r n d r 8 i o o i 1 e e n 3 t m a d f e r ( 7 8 o r g i c r 9 f f
d o
c 9 u e s l
i 9 9
a
s e a s r i 1 d n
s
s 9 i e i (
9 e 9 d u p o t e l
i e g m e u v f 1 D i n i n r u 1 1 r q s d
a u t e r q n r , l o – – r c a I & S c a - o n c m o i ( ( o
1 d a R C 8 5 h ) r
c r
d u a - g i
i g s s
9 f p a 8 8 e n o e t e t p
2 8 1
C t s t 9 c m a 9 m 9 a a P 8
2 3 9 5 r r r a a a m 1 i i 1 1 h ( f c D f c ( 3 7 ( b t 3 2 U 9 3 B E l l a a l t i e
n
m s
d e e n t o g c o o c i m i n
a i e i l s l m o r f -
s f b a h e d
n e e
n c p r
i e e n
o S t
i x v g d e o L m u i s d t e
t e l l l u - t s o t b e o r i i O a e i e e i r
e s
d h r d b r a g d d d g c t t S t a d n e s s o g L e e n o o o i i s a u r n a e o d q l r m m p a m D O R N D U M
d d
e e s s d g m m m m
r r r r a a e n f i i i i i s f f f f b b o v - -
l a
l n k e e e e e e s o b r a - o g g h h h h s c i t t t t - o u i e t d d
t f f f f c a m w e e m p r l l o o o o e e o e
u
m l w w c r n o b m w w w w n o o o s o o a f e e e e n n o e c r i i i i r n v v i v v P R E K K F C
t s t a s
e
r f
r
e i e f t e
t e h n t t t o
s v a
i
i
e r a e t a t s ) a s
i i
e
b v w u e t
s
m s i A
a
w
h r i e t b
o t e n
n s i o E e e y
s h g h l t a t e h r r . b L t o
i p t A T c r e g
g r
m
a a a
r f t a E m N a n r
d
. e
e a a r L i ( u i n c o
l s ) i f n
n p
g n v
) t i c y f i e t o e
s
s 2 N f
t o n
e a n 2 c o m ( f i h i
t m a l s a ( e s . i t e t g
i h o k e i
c
e
s
A y c h
s p a t n g
t d s c
n
e y
h i d y s i r a n e
e e l i f t e l n r s a n
f g i n
b a i t e l a e h v o d d p i t a
h t o i e i n
b u a e u g v
a i t
i
i
n t t i t f m N f r s d n t r a q d q i d y t s
t i i i e e u a o o i e c i n o . e a
p n s s b
v o f c
c b s i s x t n w i
a a e r t g a a o
t
o r p u
n e t n r
n o r n l c r
m e n o p l
i r e d d i u e t l o r e l o
– a a p
a b i
i s i e t h E i c f p m o
t y p i t t r p m e
t v
f t e c
r i s
m
r i x i
a r n y u v m e d u m l e f u s u a o s i e d a r u r e
t o t c r o n u i o d
t
l n q h
e c
f r e a m n e a
t s
a e g
o s c o
p l r r n
v h r p e a n e i v a e l i a d a p d e e t
a f s o r p
r -
z
r o e a e i
n d
m d i n a h i
t
f e e n
t d a r
h r p e s b s l a i o e - n a
r
h o n g o l
e e o
d s a t w l a t i v
g f r y o i a o t L
a R e n d i r r c i e u f a e o t e
u
a
l h i a r l o a e a s . p m o s n h n n
a l q
o
v g - m t i t y l l
u p
f r t t n . c m o
o s t n
e u o
o i i u
i e a i
h
y l l o r t f t i h
a c t t o e n i f o g e i l g g i i i
n a i o o c c .
r o r l a t i f r h n
b i e t a i
d g i n
e n n p v n w a c r T o n h
c u a u l
e h b e
h e
t i g a o o o e t l t
t f . o h i s l i i s e s c a l w t f t t n n d
N d y g a o i a
e
c i w e a e
s r a m u
o f n e a a t b n s r t i n n n l i r o r e
e s r u
w
t
v i b i s m
t e r
e
o i a f l n
l c i h p
e n o e w i o t i m t r o c s f
i
k d l t i l t a c d e s o r l
e h l o n c
n e i f e t f t r s n n t L c k e i n t e a r o i
s
n n i n n t A
e o f o o ) u i - a c a g a a t k
p d n g
i
e d o v
n r r p
i . r t
o
l
g t 1 l g i n n ’
( t m
n b a y a e c e a i o u n n i a n t a
s n
r t . y
o i n i t n t i t o t c s e i t d e
d
i ) p l
o n i f i d t - t d n i o l c n o e n a c f n n o r i g e e i 1
u a c n e e i t e e t e b t ( h g a e s s a o n o t c n t u c v F
q r s m
a i i a
a i a
k t
a r a m t r m
t
t r c n
d m o e v a v s s i r c t f s c e e e t n c o e e r a e f l t a a h i o
o r r r
o r s
e e i e a m m r s p a o p e l e l r r c c c a f g t n c e d n r r l b r i r i f s h o i i u e n n n t o n n m n e h n m o i i i i p l h e s f i i t d s i c i p M P F I F A – s e n c o i s n s i a e c e O i F F F r e P P c A A A A I T P I I D S
) e f
7 i , )
, L y n 0 ) 5
y
o
d 0 f h 5 i 0 , d
t n c 2 . , u o 0 n 0 l ( s a a
a r 0 a 2 D a e t h ( u
t
e r h 2 t
, w h ( u C C e n m
a C
e
b l
, D
s i e a
, i
y s e y a u r l ) ) , v 1 t r l r u p c m d s
4 r 6 t P M S E o r h s a n e
y e 0 0 l r h o e b a t d d d d r u e v b 0 0 o a h u n n n n o r h a 2 2 ( ( a a a a A T O T S C P M W
WO RKI N G P AP ER S ER IES 127
s , d
h e e ) ; A i c u 1 3 E n
e ) n t L i 0 9 d a t 2 6
o
n e i 0 s 9 p N 2 s 9 4 -
c o
n b 2 1 t s e m 9 2 s
m u C o – r
–
c s r h i o 1 1 d d i t c p u 7 6 1
o f c g – i e
c o , r
t
d 9 6 9 u t r s v 7 u c t u
d r A o n o ) 9 ) 9 o 8 d n y r a e ) e r e E r i e
0 1 2 1 L o b 9 p p
r h d ( 6 ( p s t r m
0 s
0
t e l a 1 a 9 p d k N u f s s ( d r n - r
0 0 n f a s t t
l n a i a 9 e i e e e o -
s i c i s 2
2 n i a e a t i t c d r 1 h r t y – – o r r t A c
l o c c u – d i o o
a p b c b c 1 2 r u u 2 D d i a v 4
g
i g 7 l r F 9 8 e d d 3 o e o e p 9 2 5
4
9 2 b s
t t r 9 o 9 o
t n 9 1 5 2 2 3 6 u r y r a a a m 1 1 n n n c ( i p 1 ( p b i c i p 2 2 5 1 9 2 B E
l l a a t t s
n n
s n
l e e l t d e n n o e c n m m i
i i o o d e d l l s a f r r
s f o
o a a
e e n n e e n n n m d r p p m
o o m i i
o i i
x x o i g u d d s s t m d n d e e e o s s u u r - - m o a t r t o o i i h e e i i i
a s i s s d r r h d l x m a a s g g t z S t t i a n a i e g g e t L a e n n a s a a u u s a e e o k o i o d d O q e q P l l l H R M R R U M - e c
r s
d u m f
c r e
n o i f i t t o s f s o
o c c
i m a e
l t n k u u e w r s o b r a a
- o d d h e c n i t o i u i e t d o o
m t o v f r r c r n a w
m p c m r h h o p p o t t a r e - - e o d e u
f m i
c - f r e n w w n o m w w
w i k s n d o s o o o
e e a f s e e n f r r a o . i e c i r n h o n t a b g v g i N N R R E F C o
i , t y
l a
n e v
t
g i s
s
o s
o
t r o i d t n t
. e t d i t n
s c n
e c y n a
h e a e n u v e d t c u g
m a i h
c v
t g
k t . m r w
n
h n d n a d
r
e u n n o n i s
d e o o o o a i A i s o r d w f m a h r d e m n e r
d n i n r t f
t i E l a o n C o
v t n m o
r n p h s L a m p y
i r i e
r g r i a s
D e
. g
f a t o
i a
s b
e g l b s
f y
c N r n d l e n h . n
- w
o s w n g r e i t
a a d e n s b c o l b o b y s t e
y i s L e i l
d n o l c
a n e n g t l r s i
i r r a a n r b n c t o r i m e a u i c a
o
a n
w p u
d l o h r a
i e r r l p a t r f i
e u s A
t y i n l e o n i
a
k o i
b s i a
r w r n u n h n c i d r r e . t s s e t i n
o l
s v
i e e e i l q o s
r o i a o h a t
t h o r o o r i o f i
t m
h r o t t t c i e t a f
t x t
c r t a p
t e i s m o c m g r u i c
a
i
p r m e n
v
c o h t
o n i n m e s F r
f e n m t c i t o y i o i
o N
n i
s u t t e o y
f m o a o .
m f g i a w i p e n r i
a l
g r n e t c
c a s l f
o e e f l h i o i o ’ s l h n t n l e
g l t r a l o p l
a t
i h s i t i
m t
g c a
t
f e n l u p e e y p r l e
i
a c
b m r t e m e u i
o r i s v f a q i i t r r t f m t c s a h u l t t o o a e
d i o
e e i o n e a l c o u c s l o r r c d s c a t
e r p i i o r r
m i g
m u t d h t r f e t u t o d e n h a
r a b t d
s s
e t t r c c o h . c
p l m q e
n c o a
p s n a t a x , r
i s i
r n u p
i
u t r e o t e i r e s g o
p e l m l e . n
t e y a i r g d n a f n d c
r u r
e f n s i
a b f e h e o i i g g
o i o u o g o i m
o c t y i n o
h r
h t r u h o r f
y C o g d x c d e t n t e d s i l
c s
e y p
a p f e q
t .
t t n a e - v h . o a r a r i t u o
l t s r v v m c i n g r n n s o f a e i l
t o u i n t r o w n e e t l
e m r o o e n a m t i
a n h s i n n i v e n f
r s h
a g n s t
r a n p m h i i t c h h
i i s
r e y t c e
t t n p a
e t u o n i m s i a r i
i h d
w g h t i a e p e d y d P l
t n m d m s
m c d h e a e e e e f
t u l
h
i t r e t b a l w s e n a o . t t i n v h s
h
c
p
t o
l a a r
d
o e b v l r ) s s s o r
i a r e f
a c g r c i o e i t n o g i o
e o r m l a i e t v e h t y r h o r A t o m
b r n t s r n a h
t n o b
n b d h r a
i
b E g a o
s i p r u r
s t i c d
y v s e L t f a a g d o o t n e p g
y t e e
i d o
t a r h n e b
f t o m n
n d s e
n d v i h N r h n r g h e p
o i i i e t n n e r o o ( s
s k
e a r t t l t i i u r c i e i n
a
p v r v
t n p i e
d t i y c
r u e s a a i e
e l g s
u d o s
h h a n l c h e
c t k c e g t t r b g e h h r h s l h i e y o i e r t t e v t s
t a
e n a m r A c p n h a w
p i a
v h s l o b i a
n y
a t
y
x
w t h i a e s l e
e c
t t s t s l h
r d h n m i h o n e g o s t h i
n r m f t y d a s t
a
l f l o w l a e n
o o d s
p a
c o i
o l e i t o i t o i t y e l r h r e t e d
s i a s t e
a t f e h c h F s m c a b c k s d o r e t e r
e
n e e
a e s
a s i t d e t u a
n b
r n l s
k
n u n
a e v r h n c r r r
t e
u a r i n u i d r n w i h a e h o e a n r u g e m t a i t e n s e e e p a r s
t a o a e o l i e a c r
l r l e l e o d x h h e r i h p e n n h s h h e a t r m w i i n g c T v a t s d t e t a i d E M F T P N M n o d i s G G e s i a T T u c e O E E n r e i P P P t A T M P M P D n o ) c
3 , ,
y n 0 . l o d 0
i w
t a n 2 d , e
( i a t y a n
v e e h d d a u u
r
e
f n r h h e C C R n n s
a a
b b u , a a a
h a y y s a a u ) ) ) ) n r 1 n r r r p p i c m m l C
9 8 8 8 g t P P o r r
s a a u e
, e 9 0 0 9 l r r h o o e n t o t d d r o e e b 9 0 0 9 o o o o b u n n l o a h h a 1 2 2 1 ( ( a ( a S ( A T C T S M M T A R
MARKE TING S C I EN C E I N STITUTE 128
e ,
s g
d a 0 f
)
n
e p s 7 i o
t s 2 6 t 5 b
C
s 9 i l e s x i T i r 9 l n n e 1 e r i i g c (
9 a
n n O s o
u i
s s n
r 1 s a
c e i f g n d d
r ) –
d a p d e a e o o t s
n n t e
p
3 e t e p p n s
) r 0 s n a a a d s
n h 9
i s e r r r a
c e a 3
k 8 s c a 9 e d
b b h u 8 c m n s 9 e n 9
l c c n i 1 n c l l s i i m i a i o 5 u (
r 9 r 1 t t t i a l t e
a a u a
t b a u r 2 u n u r 1 - s ,
l s n a c c
a ) r i i
o e p b s e – p c c d u n s
i g i v e y h h p p e 0 C 7 n l r t t o r o n n v 0 9 7 i a a d c c e e 7 8 a e e
e o i o w - r r p 8
1
s t s i r 9 9 p l e e e g 9 5 9 5 3 9 m n b a h m o e 1 1 h h e ( ( t 1 1 r l 6 c a t a o 3 1 T 2 N B E
f g
n o n
d o
i l
i d n n n e e s l n r r
a o d u
r i e r l f a u a l t
o t f r e d b i e a t e a c l h
l b t m c o
d i r d u z
i i
f
i r n n c
o l
o t h m s n i f w
a a s s n c a d
l o i i
m l l r r i m t a a s s o
a e s e e a i s s n a e e B h t d r m u d d n t
e e l e n y y f e l a l e t f e e o e o i y s a i a a a p a a h s m d K t s s B m B L G D H U M
r o i v
t t t g a
c c c n l h n k u u u i r e a o n d d d i o r u b t g o o o t
r r r a t n a w p e i h h h e p p p e t t t e l - - - e c m p k i
c r w w w r m p w w w h o n o t o o o a e e e a f a i h r r r o r n m g i g g w M C N N N F C
e
r e r t c e s
y d t i
e t
t t g o a t n r i e a n l e s c u n l a
a o
p t
e
h t a a
e t i
s h d f
o
o r h e
- t o t t u
t t l p t m
e
l e
v
d e e e u d q e m e g r i t a g r r p
t w
h e a n i r k p b v u n t e e a s u r v i
t o e o a l g e a t e e c l s i , i e r s m
m
c v a . h
h s i h s i a u d e , t h
t e u o a g r
o e d s n
v x e
t f
d m
v
r n l c d
M e n e
i e . o e h n a
g y l a o t t r
r o d o a e n
e e r c f . u y p d n e e
r i s h a e a e m s i
s n s t s
p
p a v o r h b
t v i e ’ ,
y g y
s a
d e e
c e e d l T t n s t s d
o n l r r r o
r o r e a
s d r r n t
t j .
a n r a n d n o u a t e g n a s e u r t i s s n a n n l c e s n n o a t i i v g r n
v o e i i h e
p i e u
n i a l i p o n a t
d t s e i
t n g
s o n t c r e v i p e a
e n i a l u e y e o a m a d o r c t
o s f b r d m i o o
e L r
n p f r r h v
b
l
t e
n s i t
r a s r
e
N e p e c o
a o . e
e e e
l u
t r i
i e d t e e s f x s t v e p . n h p
e p o e f P a a t r
( h a . s e g e r i l e a o w s i n
e t l i
o t b r
s
i
. o a t
s a s a r h d o d
t r
o
t t s d l
w o p r n a
n
f
e c t
t a t n
e y t s n n e i r e y i a a v , o e d o ’ n t m e r v a i
i d e u e r
s r y a u e s p r t h e t y s s a u e c t e h v u e n o p a h n i c p r s
a a
r e u - l h p a t T s c T t e d f B o e o g v c
y n a k
e a f
i
n l
t
.
r n m t i a a r d n . o p g . o n r r p e d n s
i s s o e a o i p d w t n
a t a d e o i e e s e
n o c e i m L e p l n o c i o e n i t e a P r m
r l p e
p i s l
h c o e
b a
d
. g a s e g t y i l . n n u r u o n r r c
s d f
l e f a t a s
a p a b
e a f o w p t e o e
t r n e
d h i e h i
n n i s d f v s t r t n i h o o k n e - i e c v e s s d l e
d d
e t t o . n o
c a
g
e h p e r a u e
e a
e t s c e g i e f r
e t t s e e v a n t g s o f e d n m p e e n h r p i u i n c
r
v e f b i s g t d o b u
o e s g f
- s
s o
h e
d a c n s a
l v f a a a t r s a f p r
i i
w e a y
i d t f t f
t
a h r s n t e r
c c e e d s i o i r
n a e a s m n i - y a v c l h o p e e g h
s t n s
i e e d f s
a a e e e o l t
m - f n n
e s e l
r n g g l y d j r f r a h t i t
s i t , f
t o e
t g l o u h e n u h n n s o r s a l
s t i
f a t h n i i e n e e e ; f h t t
e e o n p a
l a e
e i e p e a m k
v l
i y
e e g r – o a
e
o l t v s r g e s d s t t i m l i e d i k a r c
v m n n e l t r
o
t n C s n g a r s
t t
i
a n
i i r H e a a o T e e o g l e
t
r n s c
a i n c t
n e r m i g a c h e . c i e a a o d s
e o i m ) p a
o t O h r i o n . d a a
m , t k n s t i
i e
e s f s s
c p p
’ y c o r s t p l g - n r n
o o e
r s e r r s i r r e i n p e
t e i t a s a i h i t a i s a o e F e h e a t h e p o o r r r
r i r m s p n t p p
e l t r t
t
p e e m
e s
e s e g e
w k a e n
e r e n e n e m m r
n n u n v i n n r i v r e m h s v v o v f n t u c t u y t y e a o o f o o e s i a r a a a o i o e i s i s i i e n a a o a o r h h e h h h l m t p a c e p h a t t h m d c c m p s w p M T P D G C n o i s G G G G G s d i a T T T T T e c e E E E E E u r e n A M M M M M D i t n o c
, a
t
,
, l w d d . n
r l i i e ü i n n u i a
h h n a a a t t
g v t a d
r r ö e a , , v N e t u u r r e
R
G o , n , , e e
u r i m m t t o r r
, t
u y s ) ) ) ) j ) h n n n a a b a a 1 r e a p i r
e e a k k 8 9 n n 4 4 r 1 t P C o a r a e
n n p p u h h i 9 9 0 0 0 l r h n r r s s t s S ç d d a a e i i 9 9 b 0 0 0 a o a k u e e r r n n h h h a 1 1 2 2 2 ( ( K K ( ( C ( a C a A T C T A D D S S
WO RKI N G P AP ER S ER IES 129
d
, s
e
s t
, t w g u
n o ) n g o u n
l i e n g r e t . u 1
i e r n
d n t s S n i 0
s i . d o l a w k
a
0 e t l U s a C p e a h e e
2 t
c e a
i n – b m m
s s 0 t ) 1 f
h o s a 9 a n t t 0 s s 1
o t ) ) ) n r 0 e h e n
9 p
0 t 0
n , c 9 2 o 9 y s , 8 a 9 a x f e r e e r s n 1 9 0 i
9 6 r 9 e 1 g u h t s
o s ( t
o f
9 0 9 1 a 1 i p
e
r l a g n
t
6 r c o 1 2 1 f e h - , d a p e
a t p t p 5 3 – – s
– i c c c o i e e i i i l a
r e a c 4 7 6 1 0 8 8 l r i h n e , c a i c m d e s 3 9 0 7 3 8 r e i s
o e p , u 3 t l w s y n l r l g e 9 0 9 2 9 v
n 4 2 ,
r h f a a h u m o e 1 2 1 1 a ( p ( ( 4 1 ( c r 6 o F P A v p B E
o
t l
e s a l r i d
l
e a e s n e l m d i h e
o d o l s f y i o a
t o r n s a t o i s s m e
o e m
b
e n t e d
k
r y l i e
n r h o
r e t v i g a b e a a t i i v d
o r i t e l i l o t a e s o r g T m a m e a e
e a h d e m m o d g d t t s S i y d d e g t L n e e a o o n a s n i n a e s
a m a b a m O n G N C B e U M i n c i o i s t y p i h r
p c
x
t i s
e c e e e e s l m r k u - c c m v n r a i p d g n n u t r r r
o o u l i o i n t t a a y t o o o i r o i i l w t i i i l l e p h c v p t h v v v e e - e
p p p t a k c a a a r h w n m r w m m m n h h h e g o o e a t a o o o i r e e o e r n i b g b m M C N C b C F C H
t
.
e
s
e s e s
c a . t n r
o r
c i
e , s n - . g a s . s s n o h
a s
t o m a r t w f e t n s
s i i l
s s d i a
c r l e l o e i e r o
o e i l n b o d e t w v k p n r n r r e t
t r a p
a a t n t a c i t o m i a p r s m f a e
a
c r a
e m a
p
b d s o w
s e
e b a t t
t m o d
h n c n o
r h
v
c d p n
c c n t d h
o t a a i s e
e n o d t e e r
s n t f n p i h e h e
f n s d a
a t t b r l a m i e u
s g e t
e a i
- h w
a
o e l t t t s
s
i a h a n y P
n n , t s s e e e i r a
i
i o c a e s n . n . k e t t o n t e h r d i p g s t r
a t i r
c
e w a v e r i e e r r
) s c
c a l c n n v k h i a d
a e e e i w e f r a
n a t c e o l f h v m
s
r
t m
m f a e e c
a a t o e i o n
i ) r i i d s e u r
g o
l l c f m o d d
s
g a n w a s h n
e ) p a e l
s
t i e n n p t n l r r s e a t r i s i i s i s n r
s e m a o i e c p m n t s r p
c w e o D c w
o
t o e ( r d i
r s
a
y f r e t
c n
l e o i
t a . f e a n i t c i
r c
d e k c e v o t e e
t e r c o
i c t r a l
a g i i n c y n d
s (
f ( a y t e e t t a e t
f
n n i s e y s a d c f g f d a r i i h c
r e t e t m a h a i n a e a e r o T l
t i f m u a n
h
a a p
l l s e t
s e i s .
a f w m c e t e g i p s
t
h t
y
e a n c m o h e t g s o n t f i m l n t g a r g
l e u r c
i
o e m
f o o a s , e S w r r t c a f o e
d t u
c d
f s
h r n r l u e o e a . t
i
e t a c e
n
o o o o r m i d x d d a e t c t a n y e i r
c e v r h
i
- - c s n n h r t n h c e s
e i i
i a
t m t l t h o d ) a a
a l n t
d e o
i - e b p g v w w l t l n s t u c a i e a
s
r g i i o a c r b e
p a , l s o h i e h n a s s s d e
r t h p a i m n h p t c m t f r e
r n a s c a i a
o w r o u i a o t a
e c m i a a v c r d n t
o
i
b c y n
o o d
o l
n c s p s r n o h i f c n l n x i i a h c i
i s s i e ( c i a g o
p
o r a o s l
i r f v a
n s r e w t n p t i t m y n o p g e
i s e - o f o r e
s t a c r h a s
.
n r n e d g r c e n t m
n r i i n e a l p a
e i n o n
u n c s e e o l
o o l f i s e
s i i p e
a t l t i t t k
d c g u e r F p n n
n c r r n
f
e a k e m . s i i c o i e o e s m e a e o k s
y k d n i e e
r i d i m M i r r r r v p u r e r n d t p l s e e m m t e d i g s a
o a a d
n
F
r n
t n h h o o l a e e s m A a r e p m s a a r a m i r M M T A S T v U a c i h n c o r i s
G a s d , , i a r T M e c C C e e E i M M u r F e P P
n S S H A C C M D S , i t i
s n
s , a o
n t n c o
) n o
a i n , d ) 5 a ) t R u n
m w o 7 0 5 , l m g i a e 9 0 0 a i a
m a e
r v 9 2 0 d t o a d ( n t H a e r 1
2 n n
e n o ( ( h R P , i i t a
a
u t u r n k e h u y y s h ) g p j ) s n a a 1 e i r p p i c a
4 r n a k C 4 t S t o i m r a a
c e n
n 0 i 0 s l n r r h n s i t s a d w d a 0 e e o b 0 e o h e u n o h n r h h 2 a 2 ( a D P A T C T S T C W B M a (
MARKE TING S C I EN C E I N STITUTE 130
e g ) g
n
. a n 4
i
o o , p
S
t 9
.
s g t
o e m e d 9 t e n x
7 U . s n 1 i
h l 5 i a n
i t e 1 r r
s n S
a 8
a f t n e n – . e o i n i r m
a c c n o 9 h
i s i i i 1 e g U o t n b
i a t s
c
t
1 n
n e o 9 v i e u s
r s t m g l
e n
o s i o e t 9 i n ) e i r u a d h p y m
h m c t r n a 1 i e c h g 2 p s
h i t o ( o
m e a
d u c n r
n i 0 c n
n p c c
f t n a i i l a y e i
i m o
0
l l
t a s s t . a i l a r l a r n r t
d y n u y 2 S a c p a r a e r y y o o p e . i o e h
– l l c i f i h h o i t o d h h
r f h h p p l U i C 5 3 r t c t t p s 4
c
g i c
e a
d r . e 8 9 e n n s n
e r p 8 7
9 d e s t n S a 7 9 e o o u e e . 9 5 1 , 3 n n r a o a e m 1 h h a 1 t c c l U o t ( 1 a 2 1 3 M y p M B E
l s e e a l l i v l e i r
a
l t t l
e s a d s n
s t s e e a t n
d s o i o a k e n y d o
o a r r i
r l d m m e s o s i
a
g m d c s - o o t s - l s
r m y t m e o g n m e a y e
r e o e i g n l
t r h d t e t r e i d o t v l t e e a d t e c g t a r p s e g u o a s - n u n e e u h a e o l s r a s m m 4 L R V a a C U M
y g e t
a t r t
c s l n n y - k u r a o o g g d i i r r o u t t e n o o t l i o o s r p p t w i
i p i i h o l n p e t r r v v e - e h a o k c c c a a i w c r m s w s p n c h h y o a s e e e a r s e o e o r r r e g p b N S P r b M P F C
s ,
t
y e
t h l h s
c
, o i
t h
t s l t c
p e e a s . e
i
g t s f i t u u a f h z
y b A n m e c i a
l o s e
i
m s e a n a a h
r n C s l
e
A t h i m s e e
, s t i T e s s p a e
a k a v C f e e v e r
o v c i a a i D l i d w i m l i s T t
s
h t o u
t i
B m h t r
t i n t l
c n
s
, h s a D
o e c s e . c p r u f a
r y d a o e s r c t n h d
k t
. o r r e o
i f u r u a s t o p a f o e j a l M e t g p o t
f i
s i s g e o
p a n d
a v
s s n . c
t
a a s
i e A t n b , i w i l t i t i
y r
e l m s h n
s m n l n t s i a .
e
f a i a i a
. h g e c
c r a l s y e a r i a n i s e d o i i a
e g n a t t o i n
c i e t h t h
i h r
s i
n p t s b l e e s i s f d o n g P e i a i
s e a i i i
e
a
s t n a r i w a t l n D
d t r p v . a
n i s e g i
n t e
s
e
l m a s s a s t f . a y i i e r g i i n e n e n n f c d c n i y c r i r
o h i i c i a O t d l e t d s t t r o n a t
i a e i m
a
g n n i
) v t
t i t s t r n v i e l p a i i a M s c n s u i t c e c d a
t
c r e i i t a i a
D , y l e i c c e n . H s i u e p e s i m
d h i s s f m s i t
v r h y t e i . y f a t y d d r t c r a f
e a
n c h n y
m c i t
f
, h e r l h i e t o ) t s o r l ; h e o l
t a e o
a E r
t - p
c a s p r s e n r a a
A e
a c
n d s
i p e u . g e h k
r a l o u
p c l h r
s d r o i n i e s C i t h n
d s e t h d t
t
d e n a
a e c T s a o u t o o s c i m h e s a s n n
n c l d o s i t
r l
r w t
i D u r
v
m a o s e n ( a s e i o g e f c p y p
o u d b
n d . s v r
r t
p a n
r r a e
e i s f d
i e
e n r o g t , f e n a e c d o d o g i s s l f s n n c r o r c r t n e
a b n a n i e s
c e M g t i u e
t a a - e t r c a y p a r
t h
s t i i a e s e e
n b t f r
. i s c . t n c p i
p e c t e t s c
c
k n
y i t ,
e
o i m e t r i e h r a a A e v h f u e i n r f g
s i t n s d i f s a n l c l f e c r t a f r s g n o d
n o a C u y m n
u e i v e i
i a a e
e a r o e a y T n t l o h
m n s a e h b l v s d
m u r l v b n l
o (
r o o p e p i m D w o f e i
a q t e m
t p w e s A o r
d m r a r h – m t
s
t r s m v c a v
e t v g r n o n T u e o i f n u e C c h o e u s f e o e t c
e
s d n t e i c l a a i T f r p n r o . b e i i
n p r t t a
f u
f l a
i s h s f
w k r s p m f D t d e h e
a r y d s w n e e n
a
t o
e e o u s d e a
n t y i e p n l e o t
o y c g
l o l s d h h n d g m g i r t
c t i d r a s e s p n a t t b
s n m n a s s
r n n s g n a n e s p e c s
a i
e , u i i c i f t e
l u o o
a e s o t
e a e s f a v ,
d e n h
l c
d a c c
a s i q o d e p n - c n e
t i r e y t
c e m c
n o i g n a y i l s
o k e , t i
e s
i f i t c o t a o e c i s r a r t e i i t i n t t i e e v c v h r t t F -
d g i a e l o n i
i e t t c l a a
n c v r n s
t u t m s i e l a i e e s i i i i p e a e c t t t t r n e g s c e
w s d a s s h m n i a a d c i s u e t t a a r v a l
a
e m p a y e r o e s r o c e l l
a f f r a a
i r r e
e r f n h n x t a f l o s h e h c e e n s e g g r e d c i s l a i o r p T p o e o h M E D p P P S e d n
e , , o i s u s i a n M M M M i c e t M M M r F F F F e n A C D S C S S S C o c
, n )
) o , 9 i t 9 n 9 o e 9
9 u
9 d
m d
r 1 ,
. n ( a o n 1 l d . n t
( l G r a a a
s e
n a
P
a i
, s ,
t u
n u v e t e n
u y e s r g a j ) ) ) n p e n
e 1 r p l i a
y r a
s a 4 4 1 t t J o m ü r a s n e a a
i i 0 9 0 l n r h r n n n h i e t s k d e b 0 9 0 a ö o h a a h e u e n h a 2 1 2 ( ( ( C a H D A T C T N G A D H
WO RKI N G P AP ER S ER IES 131
r ; t o
n on health-care policy (Drummond, Jönsson, f
e s n m i e
e and Rutten 1997; Scherer 2004); and on refer- h
n t g a n f i i
a
c a o n n i w
i
m ence pricing (López-Casasnovas and Puig- a
r
d p
u m g o i e e
u y f l u e g
n o r ) l m p Junoy 2000). c s r
r a e d o 4 e o c g
l f p B i e
7 s t
d a p e d
c 9 m s l n e l i
i
a o a s 1 h
a o l s y c s
r – e l c n
y Step 2 was to conduct two-hour personal : i l
i l e h 3 e r h t e t a M i l b s s 7 e F p n m
p
g a s S interviews with nine marketing experts in t o 9 o
e o n 2 r ; a s m i 1 h g ( w p t e M 1 s B E n
i life science companies, such as Amgen, n o i t
i GlaxoSmithKline, Novartis, Novo Nordisk,
s n o n o p o
i l t a and Philips Medical Systems. To have suffi- t s c e s u a d d e d r
o cient confidence in our findings and to qualify o
r
t g p m d n
e l
i : o r the marketing decision areas we identified in P e y o
t h d j P i d t
S l e ; n i L e o t y s l o terms of importance, we conducted quantita- l m
O U c U M a . b
d o e
y tive telephone surveys with marketing man- l i g g d
u e t g t
s agers at life science firms (step 3a) and with n y
i a r e r m t o i w t s l
- e
k health-care payers and providers (step 3b) and s y r l a h g r t t a o u e n
t n n i s
r conducted an online survey of marketing y t e w p
u n c t e e e o e o j k n c k
r m r e
p academics (step 3c). n g a s a a g n o i r e t m r M A F
C e : k
r G s
a T t u E
m We sampled marketing managers (step 3a) n
n r M e
o
o ; j l m e b
a through snowballing, first contacting respon- a c
e r m n a
g e t a t e i l a dents we knew personally, after which we con- o v a i p n l f u l
m a q e o - o
h tacted executives the first respondents c c s t m
t e t n l e n i s
e i a identified as useful respondents, and so on. h i n t t s s
o
s a i f t t p a c c o In total, we contacted 110 executives.
f
e u l o n n
e d s a n o
o
i Representing a response rate of 87%, 96 exec- o c r t i r
t e c p a d h l i n t a c u utives agreed to participate in a telephone l u e l a f m u
i
t o n s m r a
o interview: 40 managers of pharmaceutical
: i
p s n g C i p P a n p i
S a firms (such as Astellas Pharma, AstraZeneca, o
r
e ; t u y d t . n e m ) e e c i
k Bristol-Myers Squibb, GlaxoSmithKline, s t s
t u m
n r a r e u t o g
e b s o Johnson & Johnson, Merck AG, Novartis, -
a d v l d n e y e o l n h a l
d s Novo Nordisk, Organon BioSciences, Pfizer, s i a m a l o
e h b i n
m u r m i o t i d
p Roche, Sanofi-Aventis, Schering, and Wyeth), t a
c p n a v n i c t
o e a i
e e y n 28 managers of biotech firms (such as Amgen, t r s b u d i
e o c n m l d i e t a a m p Biogen Idec, Galapagos, Genzyme, Novo s s
h h o t
g m c a g
s l
r : n a y n i e Nordisk, and Organon BioSciences), and e i s c t
M ( p d l l n
a a C l n
e i a p u ; 28 managers of medical devices companies a
l F c i n g . - o
r a o s s a n i n v t e
i t n t e (such as 3M, Medical Division; Agfa Medical a l e e a a a
a m l a h h t r n
m p M T i S o e f Products; B. Braun Medical; Coloplast; t
o e c d N n n
Johnson & Johnson Medical Products; Philips e . o a i i n s l u l s o i a n i a M M t - i Medical Systems, and Siemens Medical c e t n a r F F e z n o i i t A S D S o
m Solutions). We overweighed the pharmaceuti- a c i t v
, p o n o n
cal industry, given its larger size. From these n
i o e .
i l
n : t i F l a e o l
e managers, we inventoried key decision areas
A I t p e
m i : e e p s d o d
r b
a (via open question) and the importance of n y a e e P l p r a A
u
a a A y r s s )
r )
n each previously identified (in steps 1 and 2) n 1 r e n p i t n
4 e 1 h t o o t a o i e n
d 9 8 l s r h : s n i t
a decision area for the firm, on a 1–7 scale. n r 9 e b 9 c O o u a e a h 1 P a 1 T ( V A T C T M ( P D
MARKE TING S C I EN C E I N STITUTE 132 e s g 5 t a s n 4 s t s t p
e t –
n s s t n t t n d d e 8 x e s n n e e u t d e 1 t d s e e
d n n u s
u t
o
d d u f t d a s t n n s e u u
o e s t t p s
s s o
i
g g e s s
g e e e s e k s
c e t t e t t a t d g s r i a l s i t e t e e l i g
n e a a a a t e t t e r r l d n s o u e e u u l u u c
t a
a a l l a e t n c l s o d d d n d d n u i u u o
t p t d a o c r u a a a
a a a d d d
n n t d
u c r r r r e c s t y s p a
t a a o n a t t d
i t s
g g g g r r r i s t
r r n r a r p C n c s n e s g i e g g
i
r e e e e l e t r f r r a l e A g c i a f r
e t i d d o d d e e e a B d f e t e v a l i a f a n n h r r n c n d l t i d d i s c p a s u u M u u p a b n n r n n o t e
i
s u c r u p u u e h 0 3 h 9 p 8
2
6
7
5 s t g i 0 1 5 2 1 0 8 5 7 7 4 2 0 5 8 8 i a m 5 2 3 2 8 9 1 7 8 1 w h 6 1 5 3 4 1 B E
l a c i g o l s s s s t t t t o n n n n s n e e e e e w m m m m e m i i i i i r r r r o
v e e e e r n a e t e p p p p e p t a x x x x h y n i E E E E P T D r o i n
v o d d d i a t e e e
t - t t l
h k a h a a a n r k a e t c l l l l i s o r r r o u b e e e i i t n a
t r r r r o o o -
- - - w i i i p u e d p h h h h h v v v e e h t t t t t e e m l l l l l
t c a a a c m a a a a a d n a h h h r m l a e e e e e n e e e e o o r e r a b b b p c H H H H H F C
h h
, t
h t i
t l
n o e
i s
i t s y n
a
f c w
s e
t r
e
w e r o s e u
o
y . e e i d
e k a t l k
d t e o h e i d n o s
g n
l
h
g a t t r n c a e u
t i . e
i o r t t t
d m a e y a y
f i i r o n o s
t d
s m b n
t u t
i e a
i k h g
d t t l e i a t s r o s e n a y s s o a m i a i t n r
t
k r i i n c
p
h e e i
e o v t u g r s b e u l y l e i e i u s o e i n t d
i s R d t
t
n u l m l v r a i s b r
o e r e b i w n g b . e
n o o
.
u f s u s a t
i
u t
v .
d v e s n n , h e c a
d n i c u s d a t i t
m ) o e p s f r
e t l n
l t c o ) i n
n u e l e n
o d n l i e d
l
a n i r . i e t a o a t c p c l c
1 o d a t o b r i
r e l s v i r d a (
c e s n a n w o t i a e s p a e c
i s e g a e a e i
o t t n v h t n e s e
n t f a d
e a o i i e v n s n
i i p g t p o u s o P i e i v s m n s r n g
i l s l h b
e e a i
r i i i r e t , s o t c f f i t u n g
r .
t
n l e A d s i
t e c l ) o e a n a o u o
n
a
y n m W e e i n d r o
c . h
r y n v a t m
i c
t t
o t o r , n h e i – .
b m a t y r i i
t a t
d s n n u e g l t
l
n o d
f i a i e o
s a i e t n g i m l o l o s
)
g n b n y
a d n o h o t e i r v s b u d e n
e y
i t i t g
h c e 2 l t t t e o n m r
a
c s e c t ( a n a a u
n a s e v )
g a r h a a e y p
a
t u c , r r n u l h
r h e e b
c t t u u r l c A w
t p t n d g f , i n i d , r i
e a a m
i c
n f r f s o o a y t l n n o o f e t g f a c e p f h u d
r b r n c i i e
o r
b i o
t c s s a b e n n c o e n h
n o - y ’ o r
m
t e
h e n f t m n u a n t r
o e , y e t
l t s h n s o
k r m o r v s i
c s t m t c u o o s t a
c l i
l b i e e t a o
c o
a t o e e . a c
y e n s h t n n
w s i h f a a u e e e
c
l d g
l f e
r g S n e r r r n f v l o T c a
e s r . m t r e l d t i n
i a e
e n a c o t e e i t
i o i a e . r h . e
i o b a o l
v U d g
o p r n t
s t o c e o
h d c o i
c w w g
s r
f o o n p l t o t o o v a e a
t o
e t f n l u s l i p g i n t m a
o p u o
u a c
s a c e - a s t b
t e o v a d
u i n
r
a a o n i k t e t o
m i s , , n h t h r n n n r h e i a e o g u s
t h . t . o n x e p s t e r l
d t r o e s c e
a g l p
h h e e
r l
u
v e g g t ( e l e t r a d e y t j h i y a . u c . n e y g - s r
m a g t c
i s t t
f e b e e a
n d c e l s e
d e i l n b c r e w u o f l g ( t
( c n d v p s h l
a h i n o u
e e g i r
i
a e t e
r o o x e n a e n t e i e c s c u r
i u d
y e y
d e w y r u m
e
e h b t t v s r a o h , e n o
t c
t m e r i e i i
c t s
k r e f e t t t d
l e r n l d r s v e c o e g e r
t i s a u a m a i
i h i p c n n t e i r
a d
o o - t n
t t c h n c y n l r d r i o
t a e e i a e
n o e r p t g h h e
n t e e o t a p
a o t t e
l i o i d p n f e d d t r s c h u i l o o f t r h t o e a i r i i r m i t r
r a d - - b i o r e c
a c
a e c n f m h f p m e g t
h a l
a a e e l l n d i L r r i
h p o l g h e e n e r T f e -
p
t
k
g n a n e e l s e a t w
c
u o v n
h s c
e x i h
s s d t
a u i . f a o y r
f p t
f p
u o n s t
i g
r
e s l e t a i
t e d i y e s o n n g
n g y m i
e
h o o t d n d m r a r m
l l , l t t a t a n s
r e
t o n e a t
n i r h e n
o o o e
o i e a i t o n l i l g a n o i t l , e x t n t f e i b s o i l t a t c t r d
h m w b s
l i
r t
n a a ´ h e h
l e s n
t o i
e t
i t n t t t e p w y r m y s e n l
k n o
r n e r
a n
a t n n r n r t d e n d e r h i r i e s l a s t o r a e o
e
a w
e n c e e e o o n c o o m a e u s x d c e n
t i e i t r c o c d e t e t i t n r c m a
- i e y e m n m g m F e i h l e a
n
a m e o g l g u e a v
u l
n h l g
s s
u u t e a a t i b e p o p n s r i a l p u n
a r n p a u g s n i m
t - P g g i c i d d h l i
n o k f m t m g o a h t g a m s g n g
k
o l u u i c k n a n s e
o o s s r e n e e o r r e e o n e i o o e h i n u u a h n n m c e h p i a c t f p r f R t c R p e s b d d t d I C R R M I l a e
H d
g n
f
, n a e i n s o i
R
e n K .
L l
w o
d w a d d d
n m e n t o
n i a e a s m o
) ) ) ) ) a
v i
2 r r
8 r n 8 8 8 8 S g G o e g e
o 0 n e 0 0 0 0 l h , g t n t l d r s o v b 0 0 0 0 0 i o u n e o i a 2 2 2 2 2 ( ( ( ( ( a A T O B B H R W
WO RKI N G P AP ER S ER IES 133 d e s t u
n n s
i f t s e e f t n s c n a r o s t
l e u s e C s s l
t t 8 a n d l r
o n n u 9 a a t u i
d t 6 y e e t s t i n s i d
a d d 3 a t r p
n n e u u l s n n t o t t 3 d u
f a o e s s o i a
n l
5 a o , m h d u
e e a a s 1 f h u t t / l 8 d
m t c o s C y a a s a s 8 a t t o d s
t
r i u u u
s c 1 n n n n s e
g
e d d d
e r r e e l a , r l l i i g h
a a e e t t v d d e a p 3 , r r e i r v h l a c u i i t d u d l 0 4 g g i t d i p r r u n r b n s o o 1 6
n i
e e u i m c c u o
e d l p
6
, ,
s d s d d i
2 9 1 7 0 0 7 6 0 n a n n h m n a 7 i c 9 u u 6 3 1 8 9 4 6 B E
l a
l c i a g v i o l h s s s s t t t t o c
r n n n n s s n d a e e e e e n w w
, m m m m e e m a i i i i y i i
r r r r o
, v v e e e e e r r n a v e a t t r e e p p e p p p t t a a u x x x x h y n n i d i S P E E E E T D
n n n
n k s o o o d d o i i i i i t t t e e r t
t - t - l
k a a a p h h n a a n r k a t t c c c l l e l l i i i s o o r r o u e i e c i i t n n n a a t t r r r o r o -
-
- w i i p u u u e e p p e h h h h h h v v e e h h t t t t t t e e p m m m l l l l l l
c a a
c c m a a a a a a d n d r h r h m m m k a e e e e e e s n e n e e e o o o o r i r a p a b p c c c b H H H H H H F C
.
n
, s
s
o i
n h n h
t
, t t t i
o i c e o s d i
i m r u t d t
a e r
w n w
l h u f o
s
p n t
t
p o
i o s l l a d a
y f t i b c e y r d e n a
r t h l
r a a e i
c e ,
t c u c a e r t u l
i
s a e n
y p e r r r t
r a t i m t , e s
e s i e a u i i e h t p e y c a r w r s
t s l . m d t y r
i
u a i
n s p c f f p e n m n r a c u o e f i p
o t i
t p m s b d t u g i e t o d
i c
i
a s k x e k e
t e a x n a n o
s s
n
e s t ) c s e d i i r s r t i
o i h i l i c i n i l o r
s , t
e h r l a f r n
r p g m h t s
f - u y s a
h e
a a e e
p t f n o e
p o s
e n l e i s n
l e h i d p - y r i n p w u t t s r r e d a t f
n e
e n o n r
b
l i e r p n e i e s r a l n h
e e m s
d l p r i o a e d
h
r v e r o v y a r
o s t , s h c m e e u l i n b d - e
e t a . l t
t r i c e e c p n h r m f
t e a e i W c
i n t r c
s e g a a
l s m
s i
r
r o . a . h u r t a e t . e n e d r
o e u r f e h n
a f e r e n p n t r a r f t n s h e n o (
w e s c i
t e e i s a o
e
e u e m t n o u h c y r
r m i t n a r ,
i n h p
t n t w s p u t
c n c t n o e g o e a o s
x d o i
s s a o n f a c e p n e a a c c i e r e t n i c m i e e
h c e n t
e e f
e l c a i
;
r e , n v i r g , m
o r o
o o r ) i i f r t i a y
y n n r m o d y s t f l e l
a c i e s m s n e l t t o e u o n m
s n c k c
e h i f i u u m c - d c o s a . s h a s e g i f e
a a v i r a s t m i c r n s l a
e t w f e
h a
i r v t
c n h e n r d t a t
u t t s
e i e
i t
a m i i t n
, i m o t f t e
s m l p h f s o s t u v l a h f r r i s o ( d
e
n i s t
c u h n e e t )
u l
o a e l e c o p g
y e i n e o c s s
k s o g b
y
n i c a b s n a c
y i i a e
t n
, i e e k t d c w a
i
o e r a o e i t o t e r a b c h y s s o i , o n
a r i
i t
e h r e c m n p s a g m n t , r h
e w i c w n c
g
m a
r s d t f a
f i e b i
c o a
g . f f f l n a
n o g a e e o e s
n n s o f s i f t k t e p n i r
i c m e o r
y n o z n i h -
r s
s o e
n s t
e i g i i h e i p l i i u i
s l g t y s t d t y s t g g l e
r o n d m i c i g r a s . e i
m r s n i d
a a c s u
u
a a t r i t
s i c r s a . s o b a e o e s s s a w n a a s
o a r t l i p o u a s n
n
r o
r b - v e f t n r u n s s i e c c t f ,
a e
c l e e i t e o o d . c l
a v h g a e e a u s r f
t e h t c t n s c o h f r e r u p v
i h - c c o g d r a a
p f e n a g i f m . o
s r s e i
s t i o - p g o o e g h - w c
d e m s i
m f e e s f
e r y a c
d k t i e , e l l m e n y ( n p e y
v r r r i s e - e r o t
z e
y p
r n d a
e i o y b t a
f w a s
k o c c y p r k e r r i i e f e
a e n i r o r
t m S l
r l t
h
e s s o v o a
n
y e c l h e
i o a a a i e e - e p m
. e t t h r
a a l o r t
n k e
u r ) t l a - m o s
v h f h e s e s b a u a
h d t e a h t m s s c e u r i a l t h y u
e l t m l s
o i u x i
e t n r
s g
g
o , l u r
g c , r s a d
a c a f e u d t d ) e . e l a m a g n e e e
a l
g o C s e e g r e
o x t e n o q f r G t e g p o n n
f , a s e s e e
o p s –
h n .
e
.
e a
t c r i a t o m c . h
e d h s a r
g o
n o s n
e
y t n d ’
n r
s c i f l
n d ( y n s n
e t e n i g o h r m e o
l e x n
o o i r a o t i i n o a n a e i i n m t h n p t v h i u o n n a r y s t t i o o t c v z t i c i i f l
i o
d e s l F n n s a p
o
e - o d i a n o d d v e a
e n i r i r t p b e r i e e d e e t y t n o e v e i c o
c h a a n e e c i c n g c m v r d v e i r t e h s
o
m o l f h h d a m t h n m e n p i e e e o o o t s e
a h t e e o
o
i r r r r r e r n f e m e m o e v h o p n h h n p w p p p p C o t e t m o e h i b h c a p c ( R I W M D E A )
) ) , 6 7 n 5
0 0
,
o 0 ) , ) y 0 0 n d l n
0 6 l 4 2 i e n 2 e ( 2 0 ( 0 m (
a
d h G M
0
r a 0
o e m n , n e h , 2 2 l o ( u
( C e k o a a
a s r s r o ) d a n , 2 l r r n i d p
n w 4 n t e G A B o o n e l
a a o m 0 l h n l n l t r a t l l d d d o b 0 e e o h g e u n n n o h a 2 ( a a a M A T C A B K T C D
MARKE TING S C I EN C E I N STITUTE 134 e g a
m p
n o
t e o n x
r e e e
a n
e w g
s t s n t n n i w e
e i c t
s o i t r b
i u e r d e
o t d
a f d b o e l d
e a
v o g a s w l e u r u d n t t
e i i n o t g e p d n i
y t p
v s s a a e g l a h s n r
h n r c t i a a p o o
m e l n
g t u a h e r C e p a 0 0 n n c r
s
d e e p l i i u e e 7 7 m y g t
t
d h v o a r d i - o i o m m l d n c d s h e o i d o o r w s a u n r n m v r
r
i n e a p a w i w d e m u v
p
4 7
2
t s i a a 0 0 2 4 0 1 4 4 5
a a n m 4 2 1 m 9 4 u n 2 6 4 8 3 B E
c i s s s t t t h y n n n p e e e e v a r r m m m i i i u g r r r s
o y
e e e a e n t d d p p p p h u a n x x x t t y s a E E E E T D
n n n
k k s s o o o d i i i i i t t t e r r
- - t l k a a a h h n n a r a t t c c c l l l i i i o o r o u e i i t n n a a n t t r o
- w i p u u u e e p p h h h h v e e h h t t t t e e m m m l l l l
c a c c m a a a a r r d d n h m m m a e e e e e e n n e o o o o r p p a a c b c c H H H H F C
s n
e i
e r
d i
f
d e s d f
o d a
- o
d e y s
t
s e
o t
w e o
n t a
s s n
a e
e a e a g ,
l a d s o a e e
y a k m i m y . t v n l e n
h t h e n
r o
v
i
c t r i
e g e h e l , t y c l i c a r i e y a t D e e e y c o n h l l e
e
u t
b
a i t r v r l e s h w i s h . s i e
s v e
e m v u e s t
i a a
T v a
g i s e e k t b d h i
v m w
t s
i i q s a a d r t s e t
i e b l . t f
s i e
(
t e t s r a
u , e t c e g c A
o e e t o l h
e c e t h n
c e t e e e e a
e t e r c
m u . l p n n
h e
r r e
s u i h f t j n . f g g y n t a t e e
m u
o
o i
l i e s m d
f
t s t b s o s
m t e f a g a e t i , e s
a e n o c e m u o s r e n u e i a s i
- h s d k n f e
t h t c s e t m
i S c g i l
o n q k h f
s l e e e c
c
t
d e t r l f e i , s r
u s e n o r e d . i i l l t n i n e n l i n s s s a e i r u v m e b h
a w p e a a s e
l
b l w s a
a
e
n l c n l i e r
o r u
P n r o e n i d t r g e d l o s r w
e i e a n n e r d
e q o l
. a
h a e c i e w o c c l k t e h a e s e t e
e p c a i
g e e ( t
c t n n r
v
s c l c a m s u g h
s n s g h ) . , e t t
n i k r m e c t a i
n u u d t i a e
k t i e v r e l o t
d h s s a e r c t i l o d a s g f
c s w o r e t u
d o
g n c i o - e
t c t
o i n m v s
e r e c n e : r a
s e n n
i d s i o f i
e t d h s s v
t u s
e e f d n t
t e r e r s j m a r s m s f i n l c d m e s a g o e a
a h e
i l l e u e e t
e b n o e
a e t r
h n
r c w s w h j t
t i p i
d e u
a m w t y o
l
m e s n b n s o s r
v b v n e l o c c g
d b h i
i
o i s h u a
o n e n u t e a h
e t a r n c t o d e l t o e h r x i s d
c i k c r t a e a
p r
c e m
a
o a m e e
e e y t n n
f t - c h a f g o i r e e h i s a t k d s e s t n f h e b m
t m e o r e l r
r
t e i t
o t
o e
a
f a s a l
s a t s e t e l n b g d
n a s v a
h d e r d e e u r h
s t i
c
e s
h f a n t a e r r v c n
- s e r r , o i f i s o n r e a i v e r f
t e t
i f b e n w e
a d e o o c e s o e i t h s f i o
r
f w m l h i t r a c n h d s
a
h t - e
n
e
e a t i a n
g i t l t e s
a n
u o l y c w e a d e n d
l o g g n u r n f l
e s p e e r e e h n i p i
h p , e e r l p
v n l e e r t o
) p k h t e
r e g i t , e p
e
c
t t e i p h . e h , y s l l a e n u u
n t e h t g n a t t m i
t o l
p w
l o
t e l s k t r t
a f e a s
a . e b .
a u a r e n
o e u
a i i e r
f o g n o l i r h s n e n y (
r s l
s i h t e a
v
g p r y s
t n o
i g
o r s o s y b
e e w n o
e t n i r e o t e a
r m f r c l y e i t o o n s s b p m o
n
f d g i
o d k h p i g n m m e e o m x
t y
f l e e h m s
m i
e e s d t m
p e o d e y o p y l c b u e r t e y
a e a d v e m d m a e s
e e a i c t d l r n a
c l l r s a l r e m n n
u e y i P f e a a i l n
m e i e a t e r r
r u s h w t g o
w o u r s t o t o g
e i t . a
s h u m c s - t r r
s ) - o c
o s e e o n h i o
t h d
s l n t s r e s
n i l e e i i v n i l c i g h v i n r T x
m a o o i s m a e a
s o
k
t t l d
k r n n a d m e ’ s n i a . o
h p i
t
e t e n h r t m t a s r u g e s u t
m a o s e e s f t e
r n d e u
o g i n m r
s t a r n y
g t e o r t v
v o i l e a n d c o n r i n d a a d a t i e - l i o a o t p a l c m t t e u m f n c e c
o e v
o e F l m
o c
l i c v e m c a
t m e m r m c n f i e - i n a e u y e e e e
m t
e i r
o r g n j
e w s s i e j e x
n i c m t w i a
h h o h n
o l t s d s t t t v b n t o c b e o r a f l s w e a a a a i i
g l l e e r n r l o o u n o u i o n o h a h o n n i p t a f l d b m t s a f a p n s p k p w s c S M I I G
) ) 3 4
. 0 0 l e
0 a 0 , c
s t 2 2 u ( ( u d L e
k
r e n n d p e i u
o n a
L s s m ) ) n
2 i a r i , m p
3 4 r t R o r e n
e m 0 0 l h o n l t h l d o b 0 0 o o u a e n h a 2 2 ( a ( A T C M T K K
WO RKI N G P AP ER S ER IES 135 d
e u b s n u i l s r t
s
r t c e n n 2
e n o s e m 5 b e s C s s s e u t t t 1 d e m s
n n n w u n e n
t t t d e e e i s
e n o f n m
d d d
c
e
b 9 a f e
u u u
t d e f
t t t 2 2 h , s s s d n t a a w 9
l 1 t 0 e t u a
s e e e a
e t t t g
6 d d d e h y b a a a a 1 t n a n t h l
r i - u u u a a , l 0 0 s n n a
g
d d d
r a , 0 , r l e e e 4 6 s r a a a e
e r a 4 h 1 9 r r r m u v m
d c d t e i d 7 1 4 g g g i o o n
5 n
r r r n a r n b , , , i e e e a w u a n w u 6 e m
p
2 7
2
s d d d 6 e 5 4 3 0 0 , 3 2 5 5 2 a n n n m 2 7 8 4 u u 2 m u 1 1 3 5 1 7 B E
l a c i g o l s s s s t t t t o n n n n s n e e e e e w m m m m e m i i i i i r r r r o
v e e e e r n a e t e p p p p e p t a x x x x h y n i E E E P E T D
n n
n k s o o o d i i i i t t t e r
- t
l
k a a a h n a n r k a t c c c l
l i i i s o o r o u i e i i t n n a n t t r r o
- -
w i p u u u e p p h h h h h v e e h t t t t t e e m m m l l l l l
c a c c m a a a a a r d n r h m m m a e e e e e e n e e o o o o r p a p c c b c H H H H H F C
o
n t t e l
i
e g
s
c
n a o f u y e n i
t e a e l n y l c i
o l r t i b t
n e d l e a
s p s e t i s
r
s a d
l r n v u a s h e o
. g e l
d i s e t
b g e e t f a a t e t s f y
e e a e
t e s i
m r n p n e t r e n
i m e s g p s v i o n a e o a
i c s
t p a e
o e h d t . n t e i c r
t l a b d e p i t c e v n t y p c t
u
s i a
m i m o t o l c h l t t , r c u r m a e
a f t e e m i e ) r f e h
a
a
p e a s c
r o a s n f v s
r s
i v
r i y y a g e h o e u e a t t o e a
n t s
e r p r c u t e i
t
f h g
t a l
a e p e N t d u t i v c s t i n r -
l e a l c
o i
v h n e o c t h ( . e e e c t e o e b p t r e a i l n
e
m s s s n a u i n n h i d s a
v o l e . a b k
t h t a
e
t l , r o
t s t q
n a l
o s s e l s a s i e c y i e i u r s e s e e n l i e c e F a e p p r r e c t t h c r - e e n
h o
w -
o i p
t l t o
t u l a c r .
r t a
i r e k
e
t
i e u r c r y n s a d s a e a o s o m s l
l e d
g n i v e r r h
u t e a d o t t r t o o r
m i a n
b e u c - h a e c v p
i t u a f a t t t . o c t f i p t d , l
l e c l a i . a
e
c
g
. s k n s b l a f ,
a i s e r s u v a i d i e a
f s n n r c e e s e
n y v e , c s d e n i n . r a l n t a
e i e e
i o u ( m a i i i s h t h e
r
o
v k l h (
a a a t e c
w h i r r i b t
o r s
e g t e p y d e e c a c i o i g t s s s a p b d r e
e l n h o i e r a n h b
l a t l u i h r m k l
e t - a
e e a e e i
t
d i a c
s o v d e r u r o k o o
e p s t
s e p e b n r u f b e s ) e i g
a e c h
p a r o d u i t a
t t
l a v - h n o s
w e n h n t t
t o d i o n r k t R y i u l a s f s , e o
t s e
n u s t w i e p e v N e i c a u o e i . v m s a
n i d
s
e
b i o r n
o v r n v
t v a b . t l e l
i e
e o
n i e
y a
l e e t o e r t e h t k m s a c i i u n d s u e u t i r v i v e d
o r m c l p s a g i v v s r f n e n o i h r e t
a e a e d r
r
m t i e a n i o c
a
t a r v g a r b
e a n d r a s u i i i i d b i
n p y r h t l g m o p - a I n a g n e t ,
t o
p e e e f t e d g e
r n ,
p o
k s l l
n a i . c e m h p h s i h e e e t c a b - t
d t e e n r e s a t g - m u l
g i s s
v e
e n s
e e l s a e i f d e r s n l f t m t o
v u i b e t
d e s i s i
g i t e u l p o
n u a c a s e
a t n d a
a l e d s
k
a i s n c i
i v a o r r
c h i t t s o s r s y e e f a
v n b t t e
t i r t i d c f e i u m
s e
e e r h
s r e
e n
t o m a e t r s
n o
s r d a g i h a f l e s
s l
t - r d
h m
n
a t a
p , t n c e n t l f b u e s a
c a o i e e s i u - r s g n e t t t u g
v m h o r o
n s e g o f d k b
e u i s g a j d
n n c t t
n n d l o n n n
o n i g o a d i s
o n
i r
s i n b e i
t s e
i s f
p t r r a o i a l o e v o e o u h
o s t r e n n d d e c c o h t o p r h
u t s g a i t r
f e
d n e
r a o o s s
o a c e
- l
v a s i s ’ h s f c h e y a
t e t e s e c i s o t y g - e
e o e o r e a l g r u t o r y
x s l m t r p c r e l n
r y i u s m e
a b t
m n i a e e e e b t p e i r t
p
a
e c e p e
m y k n s c d a e n p
t
l o h c
v e n d e l e h s h t u
d s e e n o l h
t e t e e - v n v m i p h s T n
o r c a e
l e e i i t i t i e i a e )
t n t t g
t t p c g s n o i
e a r . e u i F a l l h
s r r s y w a a a a a
t t r a o a v s e l t i p t i a
p w e a e
l s p s c c n u e e c s - f r o
p d c m m s t i d e s h i
o u i i f r m i e
m l r t l l n n k p
t e s f e v e a a e e c e
o m s r
f e r e o e s o o a i e i e s h n h n m i c o r m a s a r t b p e r c c b t i n M M C N I S
)
n 2
)
a 0
, n
h d 2 0 , t
k h ) n g s 0 2 c a r a ( a u 3 d 0 n o
e
l K k r 0 e 2 a
b n ( B p e 0 i u
n d o m , L r s s 2 m e n ) ) n
2 i a r ( n e i , p
t g
a 2 9 r t R R o o .
s e n
l e m 0 9 l h n n e l e t a l d d a o b 0 9 e c o
o u e n n p t h r u a 2 1 ( a a T ( e A T C S K M T L
MARKE TING S C I EN C E I N STITUTE 136 e s g t
a n s e t p t e
s s t n t r a d x e n e u u e t d k e d s n s u
t
o d t a n y r n s u t m t
o i e g s s
s e r
d t r d e d e e u e a e t t t n d u v u s a a i n a
n d u i u
n u t e t
a
e d d u n t r s
a 9 a t a o a g r r g u n 0 r C u g g n d
e e i 1 r r l d
a d k d e e a , a r s u t r n o c d d t 6 g i n u s g r n r n m
7
i e e u s u
e 0 p
5
, 0 d s d 9 u 4 1 7 8 2 4 a n m t 1 9 s 1 u 9 2 1 9 B E s s s t t t t n n n n e e e e m m m m i i i i r r r r
e e e e a e t p p p p p a x x x x y E E E E T D
d d e e
t t n n n a a l l o o o e e i i i t t t r r
- - l
k a a a h h n r k a t t c c c
l l i i i s r r o o u i i t n n n a a t r o o
- i i w p u u u e e p h h h h v v e e h h t t t t e m m m l l l l
c a a c m a a a a h h d d n r m m m a e e e e e e n n e o o o o r b b a a p c c c H H H H F C
e
s l
b y n
e
n t
f
n h l i o v
e e e l g e s e i o c
v i a t r t
e r
v n i e
n h l
i u
t c u a s i
t , c a t e
o i y g w l
s
e
i
d t d w e
S n n s f
m f e h h t i i n t w o s s n e h w t n i
r r n
u o t n o o s v e o D e o a o o f i i u c s
I o
a l o
o m a i o t r e
l p i b f l W b l
t i v p - t e y a
m i
o t
g A a e h f a n t
o a o m t
n s . l c a i
r f a
a n
n a p l n f f o a m e i o
n e a
i m i r a i s
i n
n t i m e e f W e r s o s r h t s m e n h o s r b
e s
e t
s o d a a i g h r r i t
o s . p
i e t a a
v o e u
f r e s t e g
n h c , i o f a n d c t h u w v a t s n f n n a c h o n a e n d i a
v i
n s i e t o i i o i t e i r c i r n a
s
o i r o l
w
m t n
v n i s t v i , l
r c
i a i e k r o s , t a g
a e s d , o i o n a a a d c s i p e x e a g o i b e b l e i d e p
n t t w
f d v o h
e i a c r c s
m e e e n r c i t i a e i s
r
o
h n o a v l t n e s r
u i n g t i f v t i ) i e o c a .
e e t d i e
l
o
a b d r r d v n r c m t e o
,
n e
s h i p i a c
e n t r
d n u f t e w t p n a m
d h
i r s e o n s m
r
n t n s o a , r i o a
a u s e v e y e
r v f s t n o
o e
g t i s e s i e p h a , o h i e n c t h i t e t n e
s f r a t c e v o i h i t v n e e i c S
i t t c r l i c c i i a
r p i n v
g n t
n i t
d , n m s i i u
e g t w m u c f D e h t e n f i
c d r
i I p o f e
g r s i t S n i o n o a i f
r t t e i e n v e u o n f s
d n w n c v n e A s e i f i c d n e f i i D
s d i i
t c
f i d
t e r
I o d e e a i -
v
n k e r n n v n s h e e i c r n n i d g s e p i t A d h t u o i h e d s o n
w r a i v
h
n n t e
a n
o t i I i o g e n i
p s r o h d T n h s w y - s i m
t e
g i e t w i p s
l c f m p
. a c n p s
l e o
c l e h . e h n v , i b
s
d t o e i i o
r . c e e n t
e a g n a a r s d t
r h r n r a
v a d s r
s
e a n u i n p A c p e o o t n r p
.
p e
i a e i n i f
i w e a d e i x
l
t r b a n d . o e
e
( h c m t h d
o s
e h r u f n t . t e s
t u a c a t t o n s n
r
g n o
t n n s y o r
q i a a e c n n i c t e r n
n o e n s o
e p e
t r m i f a
u e i l i o i n t i e , o o p r s n o f
h t o d v j e s g s i i t v o f i
m a i h g
o t a t n m c u o t o t a n t
i s n n b
d
a
s
f o a e i
i a d e o a a f h a a a
d u e d o u i e o s d s e n t n s l k h
t l i a g r d c s s i o s h
v n c s s m t n n l r o o e
e t
i
r i m e n
e a b r i r e r t
e s l l a e o e r t
a e p k n b i e d
e
-
s e b v a o s
c i v u c
c m l s y c s f f i
a f e
r , l f p v i l l
e l r f e r n U r v o s e i n n s s l
- o r n i h l o i e r i y e d e u i g o r o
o . m
a a
v w
d d v f p r s s
w
c s r p t a o e
a o e
c u h i
e i s n e n o
m e i a
W r d s a . s
a t s v i
s h f
n e i l
g e v g U i t e e n a s n r , r
c e
o i . - n s n h n v
h i
a s f c a ’ i r n a
e i e t e g e t o a f e d i h
d g o m
o n i f h k
n
e a r v r v i v
h a e u i
a t p s e t n i m s p t v e e o e u o n
n
t t o i e n s n i e s h h g i - o
i t i t i t a r s m s c a f f s s t u e c o
c
v h o e n
b
r b s m s l a e
w , i
u
o e v o o d
s a e q n m n
f
n n e i r r a s f e
v e s o S r
d y d c n l n f e t t s f m s
o l o o m a o p u o c i n r
t s
g e o
e s e s d
o x x
o e
f
i D
l a s t
f l l r i I o r o
a s d
n s l n n d e e a t n n y s
n r u r t a u i n m u n t t l i e
n n e n n o A i f l a n s s a t a s o
d o d a n p e t n n d i l
v r i p
r c i o o o m a s
e
a r f t a t i n i i
a o
i x n
o o e e e e d s e t t d m l i o i r h u s
i o o l r i a h s i a e t a c c m t e c v f t p u r r i l
u r c F p g e
v
q r a f v t a
f
r
a i p i e m a e a e m o h , e d e e e u u e e e e e e c e t v r r n s e a - v c r
w c s s m e r s r i o r b u r h h
o
s p u f r n r
o r u o t t j e d e e e n o r c a s o
e a f - o s a e
r i r e p d e n e o f l n a a h e h e e o h i n n e h n n n m e f p l b a r t p l n c e m s a i i b t h r o a s p T I I M I
r k k e c c ) l
l o o 8 l l d e 9 n B B K d
9 a e
d d d 1 r ( u n n
i n
s a a ) ) ) b n a 2 r n
i
u 6 5 7 r r t o o k e h e e 9 9 9 l h n n l l c t l l g b 9 9 9 e o o u e e l a a 1 1 1 ( M ( ( A T C R K K B
WO RKI N G P AP ER S ER IES 137 s We sampled health-care payers and providers t
n y e b
(in step 3b) from contact lists provided by d d u t e
s
v IMS Health. Out of a sample of 545,
t 9 r
e n ) 6 t e e s a 4 112 respondents participated (response rate O
u m s l d s e d M a r n g a = 21%), among which 81 were physicians H u e r a ( a
d g n i s
n m t
v (health-care providers) and 31 were represen- a e i o n u l i t s
e d m a l
s a n d n tatives of health-care government and health t a i h m z u t
c o n i t l e i f s c 0 e r n a
i management organizations (health-care pay- 0 d e a e p i 6 2 4 s h g 6 s 9 , 3 0
r a m e ers). From this sample, we obtained the o a r 3 1 3 B E 4 impact of the previously identified (in steps 1 to 3a) marketing decision areas on patient t t t t welfare, on a 1–7 scale. n n n n e e e e m m m m i i i i r r r r
e e e e a e t p p p p We sampled academics (step 3c) using two p a x x x x y E E E E T D criteria: (1) they have a position in marketing; d e
t n n
a (2) they have knowledge relevant to the life l o o d d e i i t t e e r
t t - l k a a sciences industry, through their academic h a a r a t c c l l
l i i r r r o u e e t n n a r r o o o
- - research. Of a sample of 78, 29 academics i w i i p u u e h h h h v v v e e h t t t t m m l l l l
c a a a m a a a a eventually participated (response rate = 37%): n d h h h m m a e e e e e n e o e o o r b a b c c H H H H b F C N. Agrawal, M. Ahearne, R. Bezawada,
d
e L. Bolton, D. Bowman, R. Chandy, A. Ching,
r s r i
’ e r t
f
s M. Dekimpe, M. Ding, X. Dong, o r a e d
.
r e h c y n
c t e
i i p t
e a a J. Eliashberg, P. A. Keller, L. Krishnamurthi, v m
d h s i
n h i t u , e t n
m p r s r o ,
a n i a e a s n t a n n M. F. Luce, P. Manchanda, M. K. Mantrala,
t t o r t
m o a c s o o r r r p g i r
c u t a e e o e t
s o e r c i N. Mizik, C. Moorman, H. Nair, J. C. Prabhu, s c p n d s w t p a m
a x n
f n , c o h e , e s e o s e e c i t p c V. Shankar, C. Sismeiro, A. Sorescu, E. R. d f c t h i
f
f p
t n
a y
e o p e y a e t y . f s
i v
r o s l d
b n i s Spangenberg, P. Stern, D. Vakratsas, C. Van o t t i n
a s
n c o t s s n , b r o e o r i p c c m e n i e t a i n i e - den Bulte, S. Venkataraman, and S. Wuyts. e t s t o m o a i m e s i h p a m i t t c v
c o v u l - s i r . i u s t p a c e t s
a From these academics, we obtained (on a 1–7 e
a s
l w u t c o d f
t e n e g
c a o i e o e l h m f v n s o e
e
a f i
i h
r scale), for each of the previously identified t c s r t p c e d h n
e
i a a t
t a f l p m n e h n c i u e e h r t - l v a a a
o marketing decision areas (step 1 to 3a), the c
c h e r g h
a t e t . t
t e r r o t l e
t v h t n e n , n p a a
a n e t s y n s e o i following: (1) the extent to which these areas e c e
i i e r d r
i e f t
f , g
g g h e n e e h i f s a f
d t n n v n h c r f a i
i i i o u are covered by present marketing research in t e n t
f l t t t e
o o r i - i y a n e
n o a e t p s d
v r h i o
e s d g s , t l n progress; (2) the extent to which they deserve
i o a c s g e u c n i m s
r a i
e h b p h i a
s r h t r g o e
d i r e a
t
p s
a
e more scholarly attention in the future; (3) the o
f , h n l o b c , t t s c i c
h o m
- a s a
n a t i r t v
l n f s n h
e a i s o s t e t
i a extent to which the academics sampled con- r i a l l r
e s r
t p t h s e w s e a a e h l o c n t p l e i h o e T d n e p a o a
d
b ceived these areas to be important for life sci-
a h n f p o
d . r c
p - i r
r l
s u t d t o f o a u h r
t a n a n o s o l r I g i c
o ences marketers in practice. m n
e
s i a i e t a f
c e s m . t
o f
i v r h g x i e , o e d
t a e h o n a
p s e h e i s t i c e t , e l
T t
t h
c a r s
r n d a e e r n . e e a n t r e g l a n o b s e g l n
i b a e a c i
Step 4 yields the practical impact of life sci- u c t i t
n F o u o a l
n h
i p n m h
a o t c h i e i t r i p e l i n l t t
c d p p i n h i e u l
a ence marketing decision areas, from both a r
t t l m s a y e a i a f
g e e y s a e e o i r h n e n b m p c l c i p R H M T h I y firm profit and patient welfare perspective. )
r r 7 Step 5 consists of mapping the need for aca- e
e 8 ) v g i 9
3 l r demic research, as perceived by academics, on 1 d e 9 d ( O n
B
9 n .
d a r d a
1 decision area importance, as perceived by
J d (
e n
n l n n l u
a h a i a
s a ) ) practitioners (combining the input of both c t n
2 h r t i i m r
l m 9 9 c t o r e e r e u d 7 7 l h t o n n v u
t marketing managers and health-care providers i r e b 9 9 o a l i h o u u r a 1 1 ( C ( A T C M M F B O and payers).
MARKE TING S C I EN C E I N STITUTE 138 Table 3 Description of Key Decision Areas in Survey
Decision Area Clarification Provided to Respondents Associations Made by Respondents Therapy Creation Therapy Pipeline Includes premarket decisions on portfolio or “Our pipelines of the future will have to contain Optimization pipeline optimization more targeted therapy-diagnostic combination projects” (Johnson & Johnson). Innovation Alliance Includes decisions regarding alliances during “How do we get synergy amongst alliance Formation product development partners?” (Philips Medical Systems). Product Positioning Includes premarket decisions on competitive “Instead of being product-minded we should become positioning (including segmentation, targeting) more solution-minded” (Philips Medical Systems). of the product Therapy Review Market Entry Timing Includes decisions regarding optimal market- “At present, marketing and pricing is too country- Globally entry timing, pioneer versus follower advantages, specific. How do we make a good tradeoff between international launch strategy, and new-product local and global market entry?” (Johnson & market-potential forecasting Johnson). Key Opinion Leader Includes the structuring of the company’s key “We assured fast product uptake in a socially Selection opinion leader network for maximum effectiveness retarded area by convincing the members of a local fertility control council exerting high impact on the local doctors” (Organon). Therapy Promotion Salesforce Management Includes decisions on optimal sizing and targeting “It is absolutely necessary for sales people to have of the sales force, decisions optimizing sales-call the level necessary to build relationships with quality, optimizing the use of product samples, healthcare providers” (B. Braun Medical). including sales-response models Communication Includes the design of optimal communication “How to reach patients with the present regulatory Management strategies, including the use of medical publications, restrictions?” (Roche). DTCA, and Internet-based communication reaching patient and physician disease communities Stimulation of Patient Includes the design of optimal patient-compliance “There’s a gamut of new technologies like smart pill Compliance programs bottles coming available now to support compliance. We should consider them in our product delivery designs” (Johnson & Johnson).
Identification of key marketing decision apy positioning. The key decision areas in ther- areas apy review are market entry timing globally Figure 1 contains the key marketing-decision and key opinion leader selection. The key deci- areas, grouped into three higher-level decision sion areas in therapy promotion are salesforce domains: therapy creation, therapy review, and management, communication management, therapy promotion. In therapy creation, the key and stimulation of patient compliance. Table 3 decision areas are therapy pipeline optimiza- describes each decision area. The second tion, innovation alliance formation, and ther- column presents the clarification we provided
WO RKI N G P AP ER S ER IES 139 median importance to business performance, Figure 5 above-median importance to patient welfare; Importance of Critical Decision Areas on Firm Performance and (4) ancillary decision areas of below-median Patient Welfare importance to both business performance and patient welfare. Importance on Life Sciences Business Performance Communication management and key opinion Below Median Above Median leader selection appear to be critical decision areas. Market entry timing globally and sales- e
r Therapy Pipeline Communication
a force management are performance-enhancing f l Above Optimization Management e decision areas. The low relevance of salesforce
W Median Stimulating Key Opinion Leader
t
n Patient Compliance Selection management to patient welfare may explain e i t
a why many hospitals and physicians have P
n started to deny access to pharmaceutical sales o Innovation Alliance Market Entry Timing e
c reps. Therapy pipeline optimization and stim-
n Below Formation Globally a t ulation of patient compliance are health- r Median Therapy Positioning Sales Force Management o
p enhancing decision areas. Innovation alliance m I formation and therapy-positioning decisions are ancillary, probably to therapy pipeline opti- mization.
to our respondents when asking them to rate In step 5, we confront the practical importance the decision area’s importance. The third col- of decision areas (those taken to be the highest umn contains associations respondents made to of importance in terms of business perform- each decision area during our interviews. ance and importance in terms of patient wel- fare) with the need for academic research, as Qualifying key marketing decision areas in perceived by academics. The average need for terms of research potential future academic research ranges from 5.0 In step 4, we join relevance in terms of busi- (salesforce management) to 5.8 (stimulation of ness performance (averaged over all life science patient compliance), on a scale from 1 to 7. firms we surveyed) and relevance in terms of In Figure 6, we qualify the cells as follows: (1) patient welfare (the average of the averages high-impact research: research that promises over all surveyed payers on the one hand and to be an important contribution to academic all surveyed providers on the other hand3). knowledge and that is of high, immediate Average importance to business performance practical relevance to business performance ranged from 4.8 (innovation alliance forma- and/or patient welfare; (2) knowledge-enhanc- tion) to 5.6 (salesforce management), while ing research: research that promises to be an average importance ratings to patient welfare important contribution to academic knowl- range from 3.6 (product positioning) to 5.2 edge but that is not necessarily of immediate (communication management), all on a scale practical relevance; (3) practice-enhancing from 1 to 7. In Figure 5, we qualify the differ- research: research that is of high, immediate ent cells as follows: (1) critical decision areas practical relevance to business performance of above-median importance to both business and/or patient welfare but that is not neces- performance and patient welfare; (2) perform- sarily of immediate academic importance; (4) ance-enhancing decision areas of above- incremental research: research that neither is median importance to business performance, of high, immediate practical relevance nor below-median importance to patient welfare; necessarily represents an important contribu- (3) health-enhancing decision areas of below- tion to academic knowledge.
MARKE TING S C I EN C E I N STITUTE 140 Generalizations, Propositions, and Figure 6 Directions for Future Research Research Agenda Based on prior research and practice, we for- Future Research Need mulate preliminary generalizations (G) to evaluate early streams of research in this area Below Median Above Median and develop propositions (P) that provide s s
e direction to future research. Preliminary gen- e n i r Communication Therapy Pipeline s
a eralizations are already supported by the exist- u f l
B Management Optimization e
s ing literature but may benefit from additional W e Sales Force Management Market Entry Timing
c t n n Above Globally testing through techniques such as meta- e e i i t c Median a Key Opinion Leader analyses. Propositions are exploratory and at S P
e
f Selection d
i least partly supported by verbal logic, mathe- n L
a Stimulating Patient
o
t matical proof, or empirical evidence e
c
e Compliance n c (Stremersch and Tellis 2002). Following the a n a m t
r Below r qualification of decision areas in Figure 6, we
o Therapy Positioning Innovation Alliance o f r p Median
e Formation emphasize past research (generalizations) or m P I future research opportunities (propositions) and provide an overview in Table 4.
While all four types of research are valuable in Therapy creation their own right, the chance of gaining a break- Therapy Pipeline Optimization. In life science through insight is the highest in the “high firms, therapy pipelines contain all innovation impact” (top-right) quadrant. Such decision projects along the following temporal stages. areas are therapy pipeline optimization, market During discovery, therapy candidates are entry timing globally, key opinion leader selec- screened for maximum activity on the biological tion, and stimulation of patient compliance. target. Preclinical development and clinical Future research on innovation alliance forma- development use, respectively, in vitro or animal tion is qualified as knowledge-enhancing experiments and human experiments. research. The academic knowledge generated can be ancillary to decision areas such as ther- Prior research on therapy pipelines aimed to apy pipeline optimization. Communication determine the optimal number and sequencing and salesforce management are practice- of innovation projects that a firm’s resource enhancing areas. Research on therapy posi- base can support and that serve its goal to tioning will likely be incremental. maximize the number of commercially launched innovations (see Blau et al. 2004; Academics assessed the need for future Chandy et al. 2006; Ding and Eliashberg research on therapy positioning as a low prior- 2002; Loch and Kavadias 2002). This prior ity, because they considered this decision area research finds that there exists an inverted-U of low practical relevance, while they assessed relationship between the number of innovation the need for future research on salesforce and projects undertaken and the number of inno- communication management as a low priority vations commercially launched. However, because it is already largely addressed by past scholars in this literature stream have not dis- and ongoing research, despite its relevance cerned the different temporal stages in the remaining high in the eyes of other academics. therapy pipeline. While companies’ ability to convert innovation projects in commercially launched products may suffer from the firms’
WO RKI N G P AP ER S ER IES 141 Table 4 Overview of Generalizations and Propositions
Decision Areas Generalizations and Propositions Therapy Creation G1: There exists an inverted-U relationship between knowledge similarity between alliance partners and the number of new therapies that the alliance yields. G2: As the level of repeated partnering in a firm’s innovation alliances portfolio increases, its radical innovation output increases. G3: As the number of alliance partners in a firm’s innovation alliances portfolio increases, its incremental innovation output increases. P1a: There exists a positive relationship between the number of innovation-discovery projects initiated and the number of patented inventions of a firm. P1b: There exists an inverted-U relationship between the number of innovation-development projects initiated and the number of commercially launched innovations of a firm. P2: Innovation-development projects on targeted therapies lead to more commercially launched innovations than the same number of innovation-development projects on nontargeted therapies. Therapy Review P3: Pioneering yields market share advantages for generic therapies. P4: Firms that launch a new therapy in a referencing country early relative to the set of referent countries will obtain a higher price than firms that launch a new therapy in a referencing country late relative to the set of referent countries. P5a: The higher the uncertainty on therapy effectiveness, the higher the impact of clinical leaders, as compared with market leaders, on other physicians’ prescription behavior. P5b: The higher the uncertainty on therapy side effects, the higher the impact of market leaders, as compared with clinical leaders, on other physicians’ prescription behavior. P6a: Clinical leaders have a higher impact on hospital-based physicians’ prescription behavior than do market leaders. P6b: Market leaders have a higher impact on general practitioners’ prescription behavior than do clinical leaders. Therapy Promotion G4: The mean effect of detailing on brand prescriptions is (a) positive but (b) small. G5: DTCA has a positive effect on (a) the number of patients seeing a physician for the respective disease for which a therapy is advertised, and (b) total category-level demand in the category of the therapy that is advertised. P7a: Communicating complete (including both favorable and unfavorable) therapy information in sales calls may affect the firm’s long-term ROI on detailing more positively than communicating just favorable therapy information. P7b: The effect postulated in P7a is larger in the case of therapies for life-threatening illnesses than in the case of non–life-threatening illnesses. P7c: The effect postulated in P7a is larger in hospital environments than in outpatient environments. P8: The effect of a direct-to-consumer ad on brand-level demand is higher the more the ad depicts favorable rather than unfavorable therapy information. P9: The effect of a direct-to-consumer ad on brand-level demand is higher among female viewers than among male viewers. P10a: As disease complexity increases, CRM-enabled compliance programs increase in effectiveness to stimulate patient compliance, as compared with technology-enabled compliance programs. P10b: As symptom salience decreases, technology-enabled compliance programs increase in effectiveness to stimulate patient compliance, as compared with CRM-enabled compliance programs.
MARKE TING S C I EN C E I N STITUTE 142 taking on too many projects in development, R&D Focus Database maintained by IMS this may not be the case in discovery, in which Health, and the FDA’s Orange Book, all of more exploration leads to more effective which contain detailed pipeline information. knowledge on biological targets, resulting in As outcome variables, scholars could gather more new therapy opportunities. Therefore, information on the number of approved new we propose the following: patents (recorded by the U.S. Patent and Trademark Office) and therapies (listed in the P1a: There exists a positive relationship FDA Orange Book). between the number of innovation-discovery projects initiated and the number of patented Innovation Alliance Formation. As Figure 5 inventions of a firm. shows, practitioners consider decisions on innovation alliances to be ancillary decisions. P1b: There exists an inverted-U relationship At the same time, this decision area has pro- between the number of innovation- vided an ideal and often-used testing ground development projects initiated and the for theory development on interfirm coopera- number of commercially launched innovations tion. The reason is that the life sciences of a firm. industry provides possibly the richest docu- mentation on such alliances (e.g., Recap’s The optimal number of innovation- database on interfirm agreements) and its out- development projects a firm should undertake comes (e.g., patents, new products). may also be contingent on the type of innova- tion project. Targeted (specific for certain Similarity between parties in an alliance is prob- patient types) therapy innovation projects ably most often studied. Dissimilarity between require fewer resources in development and partners yields greater learning opportunity, as feature higher probabilities of ultimate regula- there is less knowledge redundancy, while simi- tory approval (Vernon and Hughen 2005). larity between partners makes it easier to under- Therefore, we propose the following: stand one another and share information. The tension between both arguments has led many P2: Innovation-development projects on tar- researchers (Cloodt, Hagedoorn, and Van geted therapies lead to more commercially Kranenburg 2006; Prabhu, Chandy, and Ellis launched innovations than the same number 2005; Wuyts et al. 2005) to find a curvilinear of innovation-development projects on non- relationship between knowledge similarity targeted therapies. among alliance partners and the innovative out- come that the alliance yields. This leads us to Scholars may also find it worthwhile to study preliminarily generalize the following: other types of innovation projects as contin- gency factors, beyond targeted or nontargeted G1: There exists an inverted-U relationship projects, such as radical versus incremental between knowledge similarity between alliance projects. Studying the therapy pipeline in the partners and the number of new therapies that context of patent expiry may also be fruitful. the alliance yields. Firms may anticipate expiry in multiple ways, such as the development of combination Scholars have also studied the differential drugs, more convenient administration and effect of alliances on radical versus incremental dosage methods, and re-engineered variants innovation (Wuyts, Dutta, and Stremersch with higher effectiveness or less serious side 2004). For radical innovation, it is instrumen- effects. To develop and test such a contingency tal that alliance partners repeatedly cooperate framework, scholars can analyze databases, to stimulate knowledge transfer through the such as the Pharmaprojects database, the development of relationship-specific heuristics
WO RKI N G P AP ER S ER IES 143 and the sharing of mental models, among oth- Elidel for a mild-to-moderate indication of ers (Madhaven and Grover 1998; Uzzi 1997). eczema, hence for first-line use. Competitor Genentech and Roche provide a successful Fujisawa introduced a variant of this molecule, example of such repeated collaboration. For Prograf (tacrolimus), targeted at moderate-to- incremental innovation, large portfolios may severe indications of eczema, hence for sec- be beneficial because of scale effects in devel- ond-line use. While both firms could show opment (Ahuja 2000; Wuyts, Dutta, and scientific evidence, only tacrolimus got Stremersch 2004). We can preliminarily gen- endorsed by the U.K. government, while eralize the following: Novartis could not show that pimecrolimus represented good value for money (Gregson G2: As the level of repeated partnering in a et al. 2005) for the moderate indication. Later, firm’s innovation alliances portfolio increases, the company did get endorsement for the its radical innovation output increases. moderate to severe indication after resubmit- ting. If positioned for a severe indication, G3: As the number of alliance partners in a a therapy may have a higher likelihood of firm’s innovation alliances portfolio increases, being approved at a high price, but it may its incremental innovation output increases. concern a relatively small market. For instance, Symbicort by AstraZeneca was first approved Future research on interfirm cooperation will for severe asthma, after which AstraZeneca likely continue to use the life sciences as a enlarged the market for Symbicort to COPD testing ground for theory development, (chronic obstructive pulmonary disease). with continued use of databases such as Pharmaprojects and Recap, study of newspa- As there are many possible indications, all pers and magazines, and surveys. Novel break- with different levels of uncertainty for the throughs are likely in the area of social respective therapy to be approved and with networks and the balance between internal varying price expectations, future research may and external innovation. aim to specify decision-support models using Markov chains simulating market size using Therapy Positioning. Therapy positioning patient flow dynamics (first use, reuse, switch- refers to research and development decisions ing from competition) at various price expec- on the envisioned therapy toward specific tations and approval likelihoods. indications. The practitioners we surveyed consider therapy positioning an ancillary deci- Therapy review sion area, while academics did not see a strong Market Entry Timing Globally. Research need for future research. Therefore, we will not outside the life sciences industry has shown derive theoretical generalizations or proposi- that pioneers do not have long-lasting market tions. Decision makers need to balance three advantages (Golder and Tellis 1993; Shankar, key dimensions: (1) the likelihood of the ther- Carpenter, and Krishnamurti 1999). In the life apy being approved for the respective indica- sciences industry, an important moderator on tion, (2) the price firms will obtain from the the market return on pioneering may be therapy, and (3) the market size for the respec- whether it concerns generic or branded thera- tive indication over time. pies. In the case of branded therapies, pioneers are the first entrants in a therapy category, e.g., If positioned for a mild indication, a therapy Mevacor (1987) for statins. In the case of may reach a large market, but at relatively low generic therapies, pioneers are the first generic prices and with possible denial of approval. available for a specific therapy, e.g., the first Consider Elidel (pimecrolimus), a therapy for generic simvastatin, the statin introduced by eczema by Novartis. Novartis introduced Merck as Zocor.
MARKE TING S C I EN C E I N STITUTE 144 There are many cases of late-branded entrants keting support (commonly available from firms that take over pioneers through increased such as IMS Health, Kluwer, or Verispan). effectiveness, higher convenience, or weaker side effects. Examples include Zocor and Firms typically do not launch a new treatment Lipitor in statins (increased effectiveness), simultaneously across the globe. Rather, they Symbicort in asthma- and COPD (higher use specific launch sequences, often driven by convenience), and Xyzal in antihistamines countries’ regulatory systems, economic wealth, (weaker side effects). and size (Danzon, Wang, and Wang 2005; Kyle 2007; Verniers, Stremersch, and Croux 2008). Quite contrary to common wisdom in other Differential launch timing across countries has industries and contrary to branded variants in been shown not to affect unit sales (see life sciences, generics may yield strong pio- Stremersch and Lemmens 2008), while it neering advantages. The first generic variant shows an inverted-U relationship with launch for a specific therapy (“the pioneer”) may price (Verniers, Stremersch, and Croux 2008). attract and maintain a disproportionately large In the life sciences industry, launch price is market share. Reasons are multifold. First, it rarely a market price; rather it is often an takes substantial effort from physicians and agreed-upon price between supplier and gov- pharmacists to explain bioequivalence between ernment or an insurance firm that acts as a different variants (Gupta, Yu, and Guha (co-)payer. In such negotiations, entry timing 2006). At the same time, only the pioneering may be used both by the payer and by the firm generic benefits from the large price differen- as an instrument to affect the agreed-upon price. tial with the alternative (the branded variant). Generics that subsequently enter do not show An important contingency factor that has not that large a price differential, and when they received any attention is the role of cross- do, the generic pioneer may readily match the country influence in launch sequencing. Often, lower price, with market shares remaining sta- this cross-country influence is institutional- ble (Hollis 2002). The first generic entrant ized, as payers will use the price of a therapy typically also made supranormal profits before in a defined set of other countries (the “refer- the entry of a second generic, because the first ent” countries), if available, as a reference price provided the only (cheap) alternative for a very for the negotiations in their own country (the expensive branded variant (Gupta, Yu, and “referencing” country). Such regulation incen- Guha 2006). The arguments above lead us to tivizes companies to avoid spillover effects the following proposition: (Hunter 2005). We propose the following:
P3: Pioneering yields market share advantages P4: Firms that launch a new therapy in a ref- for generic therapies. erencing country early relative to the set of referent countries will obtain a higher price The life sciences industry lends itself well to than firms that launch a new therapy in a the examination of order-of-entry effects, as referencing country late relative to the set of entry is very much documented, e.g., with the referent countries. FDA (drugs@fda) for the U.S. These entry dates can be complemented with dollar sales To test this proposition, one can gather regu- estimates of IMS Health. Moderators that one latory data from Urch Publishing and the may consider in such research efforts are clini- OECD, both of which track international reg- cal profile of the treatment (e.g., profiles main- ulatory health systems (including identifica- tained by the UK National Institute for Health tion of the set of referent countries for each and Clinical Excellence NICE or published referencing country), and integrate it with meta-analyses in scientific journals) and mar- IMS Health data on international prices and
WO RKI N G P AP ER S ER IES 145 introduction dates. One can think of also (GPs) with large practices, who gain recogni- including firm effects (firms may have differ- tion by the satisfaction and loyalty of their ential policies dependent upon their home patients. They deliver key experiential mes- market or size) or therapy effects (payers sages on the therapy to their peers. across countries may have differential price- and market-access policies for different For instance, consider as a contingency factor therapy classes). In addition, international whether uncertainty manifests itself on effec- diffusion studies can deliver valuable and tiveness or side effects of a life science therapy. complementary insights into international Uncertainty on effectiveness can be reduced launch decisions. through quantitative assessments, without much detail on specific physician practices Key Opinion Leader Selection. Life science (based on large scale studies). On the other firms often stimulate reviews of their therapy hand, side effects information is more qualita- by select key opinion leaders, as they may tive and very much dependent upon the spe- serve as product champions to their peers. The cific composition of a practice (based on case effect of such opinion leaders on other physi- studies). As clinical leaders support quantita- cians’ prescriptions can be large when consid- tive assessments of effectiveness, while market erable uncertainty exists (e.g., after a change in leaders share case detail on side effects from the regulation of or the introduction of a ther- practices similar to those of other physicians, apy) or when physicians experience normative we can propose the following: pressures, e.g., when there is strong formulary adherence (Coleman, Katz, and Menzel 1966; P5a: The higher the uncertainty on therapy Iyengar, Valente, and Van den Bulte 2008). effectiveness, the higher the impact of clinical Nair, Manchanda, and Bhatia (2006) show, for leaders, as compared with market leaders, on instance, that the effect of opinion leader pre- other physicians’ prescription behavior. scriptions is 100 times larger than the detail- ing effect on regular physicians, after the P5b: The higher the uncertainty on therapy market underwent a change in NIH (National side effects, the higher the impact of market Institutes of Health) guidelines. leaders, as compared with clinical leaders, on other physicians’ prescription behavior. However, we cannot take the positive role of opinion leaders for granted (see, e.g., Van den Another contingency factor one may consider Bulte and Lilien 2001), and future research is the physician’s institutional setting. As com- should inventory the contingencies that affect pared with general practitioners, hospitals have the role of opinion leaders. In such research, it formal ethical guidelines (Gallego, Taylor, and is worthwhile to consider two types of key Brien 2007) for what an individual practi- opinion leaders with potentially differential tioner may adhere to, which increases the effectiveness: clinical and market leaders. return on legitimacy. Clinical leaders enhance Clinical leaders are experts within the respec- legitimacy to a greater degree than do market tive disease and therapy class with a strong leaders, which fits with clinical leaders’ high reputation, as evidenced by their publication impact on formulary decisions. At the same records in top-ranked medical journals. They time, market leaders achieve their influence are typically involved in premarket product through similarity of practice. The practice of testing and have cooperated with the firm to a market leader generally is more similar to a reduce clinical uncertainty of the therapy. In general practitioner practice rather than a hos- contrast, market leaders are tightly connected pital-based practice. For these reasons, we pro- to the local patient and physician communi- pose the following: ties. They are typically general practitioners
MARKE TING S C I EN C E I N STITUTE 146 P6a: Clinical leaders have a higher impact on tiveness (Venkataraman and Stremersch hospital-based physicians’ prescription behav- 2007)—and physician traits (see, e.g., Gönül ior than do market leaders. et al. 2001). There is room for further study, in the following ways. A first opportunity is to P6b: Market leaders have a higher impact on increase through meta-analysis the reliability general practitioners’ prescription behavior of the preliminary generalization stated above. than do clinical leaders. Kremer et al. (2008) offer a first attempt at such a generalization, but they provide only a Researching the propositions above can limited number of significant moderators and include surveying all physicians in a certain omit drugs’ clinical profiles. area to inventory their opinion leaders, as well as utilizing Likert-type scales on each of the A second opportunity lies in the development identified leaders as to the extent to which of models that allow policy experiments. they are clinical and/or market leaders. While we have a reliable read of the mean effect of detailing, all models are estimated on data showing relatively little policy variance, Therapy promotion which inhibits any extrapolation to policy shifts in detailing, by either the manufacturer Salesforce Management. A first decision area (many firms are presently considering drasti- in therapy promotion is salesforce manage- cally reducing their detailing efforts) or the ment. Visits by the sales force of life science regulator (several European countries are con- firms to physicians are referred to as “detail- sidering curtailing detailing). ing.” Much academic research has emerged on the effectiveness (ROI) of detailing The third opportunity lies in developing (Azoulay 2002; Berndt et al. 1995; Leeflang, physician-targeting models, based on volume, Wieringa, and Wittink 2004; Manchanda and physician responsiveness to detailing, and Chintagunta 2004; Manchanda, Dong, and competitive detailing patterns (for working Chintagunta 2004; Manchanda and Honka papers in this tradition, see Dong, 2005; Manchanda, Rossi, and Chintagunta Manchanda, and Chintagunta 2008; Kappe, 2004; Mantrala, Sinha, and Zolters 1994; Stremersch, and Venkataraman 2008). Mizik and Jacobson 2004; Narayanan, Desiraju, and Chintagunta 2004; Narayanan, By far the most room for novel research seems Manchanda, and Chintagunta 2005; Parsons to be in the content of detailing visits. Past and Vanden Abeele 1981; Venkataraman and and, for most companies, present detailing Stremersch 2007). A generalization of this calls only present favorable information using literature is: positively biased information sets; e.g., only studies favorable to the brand are presented, or G4: The mean effect of detailing on brand side effects are omitted. This sales model prescriptions is (a) positive but (b) small. seems increasingly dysfunctional, with hospi- tals and physicians reacting adversely to detail- “Mean” in G4 refers to the mean across brands ing, even rejecting it altogether—symptomatic and physicians, as prior literature did show of the conflicting logics between life science high physician- and drug-level heterogeneity, firms and the rest of the health-care value including some brands and physicians showing chain (Singh, Jayanti, and Gannon 2008). a negative return on detailing (Leeflang, Wieringa, and Wittink 2004), and investi- We propose that life science firms can gain gated specific contingency factors, such as substantial returns from communicating unfa- drug characteristics—side effects and effec- vorable information in their detailing calls, for
WO RKI N G P AP ER S ER IES 147 two main reasons (Leffler 1981). First, physi- may have a higher return on legitimacy than cians, in view of their ethical, gate-keeping do general practitioners in the outpatient envi- function for patients, prefer more complete ronment. Revealing unfavorable information information, even if unfavorable, over ambigu- together with favorable information enhances ity. Second, communicating unfavorable infor- a sales rep’s legitimacy. mation may enhance the legitimacy of the sales rep and the firm (Singh, Jayanti, and One may conceive of several tests of P7a–P7c. Gannon 2008). This enhanced legitimacy, in IMS Health’s U.S. panel data include data on turn, may deliver sustained physician access which attributes of a drug were discussed in a and increased trust in the firm’s messages. sales call. Adding information on how drugs in Both will strengthen long-term ROI on a category compare on each of these attributes detailing. Therefore, we propose the following: may reveal whether favorable rather than unfa- vorable attributes were discussed. Several indi- P7a: Communication of complete (including vidual firms have records on which studies were both favorable and unfavorable) therapy infor- covered in sales calls, which can reveal whether mation in sales calls may affect the firm’s unfavorable studies were covered. Long-term long-term ROI on detailing more positively detailing ROI can be regressed on both types of than communicating just favorable therapy data to test the propositions above. One can information. also conceive of longitudinal experiments to test the propositions above, experiments in which P7b: The effect postulated in P7a is larger in physicians or medical school students are the case of therapies for life-threatening ill- detailed within a simulation. nesses than in the case of non–life-threatening illnesses. Communication Management. While com- munication efforts of life science firms may P7c: The relationship postulated in P7a is target both consumers and physicians, the larger in hospital environments than in outpa- budgets dedicated to the former group are tient environments. more than 10 times larger than the budgets dedicated to the latter (Kremer et al. 2008), In P7b and P7c, we conjecture that the effect and based on the interviews we held with prac- of disclosure of complete information may be titioners, direct-to-consumer-advertising contingent on whether the disease is life- (DTCA) is also the most challenging. The aca- threatening and on what the physician’s insti- demic literature on DTCA (Berndt et al. 1995; tutional setting is. Agents confronted with a Bowman, Heilman, and Seetharaman 2004; decision of high importance attach a higher Iizuka and Jin 2005; Narayanan, Desiraju, and value to information (Celsi and Olson 1988). Chintagunta 2004; Wosinka 2005) studies Therefore, physicians’ preference for more mostly the overall effectiveness of DTCA and complete information, even if unfavorable, yields the following early generalization: over ambiguity will be higher in the case of life-threatening diseases than in the case of G5: DTCA has a positive effect on (a) the diseases that are not life threatening. For number of patients seeing a physician for the instance, there will be more value in reducing respective disease for which a therapy is adver- ambiguity about the side effects of chemother- tised, and (b) total category-level demand in apy, even if they concern an increased proba- the category of the therapy that is advertised. bility for pneumonia, than when detailing concerns information on the increased proba- Future research on other potential outcomes of bility for insomnia caused by antihistamines. DTCA, such as its effect on brand choice, As argued above, practitioners in hospitals would be fruitful, as it is fraught with debate.
MARKE TING S C I EN C E I N STITUTE 148 Iizuka and Jin (2005) and Wosinska (2005) females and that female requests are more eas- find that DTCA does not affect drug-brand ily accommodated by physicians than are male choice, while Berndt et al. (1995) and requests. We propose the following: Narayanan, Desiraju, and Chintagunta (2004) find a positive effect of DTCA on drug-brand P9: The effect of a direct-to-consumer ad on choice. Such future research could involve brand-level demand is higher among female meta-analysis or the analysis of contingency viewers than among male viewers. frameworks. Many other boundary conditions can be for- An example of a contingency factor is the mulated, on aspects such as the type of disease degree to which DTCA messages include and patient–physician relationship, both of favorable and unfavorable information. While which may inform ad content and target the unfavorable information—e.g., on serious side audience decisions of firms. Data availability effects of therapy—may arouse consumers on DTCA is high. Secondary data sources (Moorman 1990), it may at the same time include ACNielsen and TNS Media yield negative emotions that hinder informa- Intelligence. Both data types can be connected tion processing (Agrawal, Menon, and Aaker with aggregate-level sales data, e.g., from IMS 2007; Keller 1999). Therefore, we propose the Health, or panel-level data, from IMS Health following: or Verispan. Also, experimental studies may have high potential, as they may reveal under- P8: The effect of a direct-to-consumer ad on lying psychological processes. brand-level demand is higher the more the ad depicts favorable rather than unfavorable ther- Stimulation of Patient Compliance. As our apy information. survey results show, life science firms under- value the importance of stimulating patient At the same time, no study develops a process compliance, both from a patient welfare and view on the effects of DTCA on the demand profit perspective. Our interviews with man- for a specific therapy. The process involves agers revealed that they consider their impact DTCA triggering a patients’ request for a on patient compliance minimal, while they therapy at the physician’s office, which the think it is mostly affected by the provider in physician can accommodate or not. The role his or her interaction with the patient. In con- of patient requests and what factors affect the trast, our survey among providers and payers degree to which the physician accommodates shows that they believe that life science firms’ them are not addressed by the academic litera- efforts to stimulate patient compliance may ture at this point (for an exception, see have important effects on patient welfare. Venkataraman and Stremersch 2007). Developing such a process view may yield rel- Despite the high relevance of patient compli- evant insights for managers, e.g., on audience ance, academic research has not studied the targeting. Just as an example, consider audi- role of the life science firm in patient compli- ence gender. Prior research has shown that ance in depth. Prior research has found that women are more concerned about their health provider expertise (Dellande, Gilly, and than men are (Verbrugge 1985), and interact Graham 2004), the attitudinal homophily more assertively in health care settings than between patient and provider (Dellande, Gilly, men do (Kaplan et al. 1995), and that physi- and Graham 2004), the frequency of contact cians are more empathic to female than to between patient and provider (Bowman, male patients (Hooper et al. 1982). Heilman, and Seetharaman 2004), reminder Consequently, one may expect that DTCA messages (Becker and Rosenstock 1984; may more easily trigger requests among Rosenstock 1985), and the burden of therapy
WO RKI N G P AP ER S ER IES 149 (Kahn and Luce 2003 and 2006; Kahn et al. one’s awareness of actions to be taken (Keller 1997) all affect patient compliance. The only 2006). CRM-enabled programs promote a research that exists on how life science firms patient’s belief in self-efficacy, and technology- may affect patient compliance studies warning enabled programs promote mindfulness. The labels. For instance, Ferguson, Discenza, and potential of CRM programs to promote Miller (1987) have found warning labels that mindfulness is limited, because the reminder include information on the consequences of ill frequency within a CRM program is unable to compliance to be effective. match therapy frequency (one or multiple therapy occurrences a day). In contrast, tech- Today, life science firms sporadically institute nology programs cannot offer interpersonal new types of compliance programs, of which coaching (see, e.g., Bandura 1982) of the the effectiveness remains void of academic patient to stay on therapy. scrutiny. We categorize such compliance programs in technology-enabled and CRM- Given their differential behavioral rationale, enabled (customer relationship management- the effectiveness of both programs is likely to enabled) programs. depend upon factors such as disease complex- ity and symptom salience. First, the more CRM-enabled programs typically used in complex a disease, the higher the likelihood practice are direct mail or call campaigns. that ill compliance is driven by disbelief in Pfizer has developed a “Staying on Track” cus- self-efficacy. CRM-enabled programs are able tomer relationship program for its statin drug to effectively reduce such uncertainty, while Lipitor (Arnold 2004). Such programs moni- technology-enabled programs are not. Second, tor patient disease and refill status, motivate the less salient the symptoms of a disease— patients to stay on therapy regimen, and pro- think of the flu as a disease with salient symp- vide patients with therapy risk–related infor- toms and high cholesterol as a disease with mation, tailored to the specific stage of low salience—the more compliance will be therapy with a patient’s specific symptoms and driven by one’s mindfulness. When salience is motivations (Hopfield, Linden, and Tevelow low, technology-enabled programs will be 2006). more effective in stimulating compliance, as compared to CRM-enabled programs. Technology-enabled programs include a tech- Therefore, we propose the following: nological device to remind patients to take their pills. Bang & Olufsen Medicom’s blister P10a: As disease complexity increases, CRM- card–based “The Helping Hand” device gives enabled compliance programs increase in a visual indication of therapy compliance effectiveness to simulate patient compliance, as through red or green LEDs as soon as a blister compared with technology-enabled compli- is inserted in the device. Another example is ance programs. “SIMPill,” a smart pill-bottle reminding patients through SMS that they have forgot- P10b: As symptom salience decreases, technol- ten to take their medicine. ogy-enabled compliance programs increase in effectiveness to stimulate patient compliance, Interestingly, both types of programs connect as compared with CRM-enabled compliance to different behavioral rationales that can ulti- programs. mately lead to ill compliance: a patient’s belief in self-efficacy and mindfulness. A patient’s Future research may consider a broader array belief in self-efficacy refers to one’s belief of of contingency factors than those developed in being capable of carrying through the pre- the propositions above. Such research promises scribed therapy, while mindfulness refers to to be very impactful for academia and practice
MARKE TING S C I EN C E I N STITUTE 150 but at the same time very challenging to exe- importance to practice and academic potential. cute. Relatively few firms have instituted a Underlying this qualification is the under- compliance program, patient-level data are standing that not all scientific breakthroughs hard to obtain, and patients self-select into a need to be of immediate practical relevance to program (which may cause sample selection be worthy of academic interest. It is more issues). One method may be to conduct a con- important for academics in this nascent field joint experiment with physicians as informants to be able to qualify their research in terms of on patient behavior. In such a conjoint experi- academic and practical impact and the route ment, one could manipulate program design through which this impact takes place than factors and estimate their effect on patient necessarily to work on an immediately practi- compliance, as informed by the physician. cal problem. The field of life sciences market- Test–retest reliability and comparison with ing needs to establish itself not only practically actual cases could further support the validity but also theoretically and methodologically to of such an approach. A more demanding alter- have a future. native would require cooperation with a life science firm that is open to a field experiment, To us, at least, it is clear that a fertile future including a longitudinal survey of the compli- for this area is likely, both from the demand ance program participants. side and the supply side, within a wider per- spective on marketing and health (Stremersch 2008). Among the inflow of scholars into this Conclusion area, often-heard motivations are (1) that this context presents unique and often challenging Some industries require industry-specific problems, (2) for which high-quality data are knowledge development, as they have unique available, and (3) of an impact that transcends characteristics that yield specific challenges for any problems typically investigated by market- marketers. With the present paper, we have ing scholars (compare the marketing of new aimed to advocate such knowledge develop- oncology drugs with the marketing of deter- ment for life sciences marketing. Empirical gent). At the supply side, universities are likely evidence that life sciences marketing will to invest considerable research funds in life indeed grow into a fruitful area of (specialized) sciences marketing as a research program that research is eminent, and the body of research transcends different schools (the business that is specific to the life sciences industry is school, medical school, and school of econom- growing. ics), creates vast societal influence (on public policy, firms, the press, and the public at In developing this article, we were often struck large), and does not have a pure for-profit by how little is known about this exciting area. nature (as much of the other business school Defining life sciences—to our surprise, no research has). useful definition exists in the literature— proved to be challenging, but at the same time At the advent of a new domain, there obvi- eye-opening. Discerning clear boundaries of ously are as many cynics, who claim that noth- the domain also allows us to demarcate areas, ing is fundamentally different about life such as nutraceuticals and cosmeceuticals, sciences marketing and that conventional illustrating the spread of life science therapies insights can easily be extended to such mar- throughout other industries, such as the food kets without adaptation, as there are enthusi- and cosmetic industries. asts, who embrace these markets as being as different as the moon is from the earth. The Using both practitioner and academic input, former group often finds a dominant argu- we qualified decision areas according to their ment in the data-driven nature of the original
WO RKI N G P AP ER S ER IES 151 contributions to life sciences marketing. That, Acknowledgments however, in itself is not a reason why an indus- try cannot be guided by different principles, The article was written when the second which lead to unique challenges. Similarly, the author was on the faculty at Erasmus argument that some challenges are also present University, and both authors contributed in other industries does not preclude the equally to this article. They acknowledge the development of a new marketing domain for research assistance of Christiaan Bakker, the life sciences. In the dialectic tradition, the Christian Van Someren, and Jo Sinjorgo. They present paper tries to build the case for the also thank Jacco Keja from Quintiles, and enthusiasts. Early interest at conferences, in Servaas Buijs from IMS Health, which are journals, and in MBA program offices seems business partners of the Institute for Life to favor the enthusiasts. The least we have Sciences Business Economics at Erasmus hopefully achieved with this paper is to define University Rotterdam, for their support. The the playing field on which cynics and enthusi- authors are grateful for the comments made asts will interact, both in research and in on preliminary versions of this article by their teaching. colleagues Nuno Camacho, Eelco Kappe, Vardit Landsman-Schwartz, Isabel Verniers, Sonja Wendel, and Stefan Wuyts. Finally, the authors thank survey respondents in the busi- ness and academic communities.
Notes
1. Nektar Therapeutics offers noninvasive deep-long and the Association for Consumer Research Conference delivery systems. Arthrocare offers minimally invasive (2000–2008), (5) unpublished working papers from our surgical procedures involving tissue removal and files. In our study of the industry literature, we included treatment. Journal of Medical Marketing, Life Sciences, Medical Device Technology, Medical Marketing and Media, Pharmaceutical 2. Our sample of academic literature included (1) mar- Executive, and Pharma Marketing News, among others. keting journals, such as Journal of Marketing, among oth- ers, (2) journals on the boundaries of the marketing 3. The responses of payers were very similar to the discipline, such as Management Science, among others, responses of providers. The correlation between the aver- (3) specialized journals in life sciences and health eco- age ratings across both groups of respondents was .90, nomics, such as the Journal of Health Economics, among yielding a similar ranking on importance of decision others, (4) recent proceedings of conferences, such as the areas. INFORMS Marketing Science Conference (2000–2008)
References
Aboulnasr, Khaled, Om Narasimhan, Edward Blair, and Performance.” International Journal of Research in Rajesh K. Chandy (2008), “Competitive Response to Marketing 16 (4), 269–84. Radical Product Innovations.” Journal of Marketing 72 (3), 94–110. Ahuja, Gautam (2000), “Collaboration Networks, Structural Holes, and Innovation: A Longitudinal Study.” Agrawal, Nidhi, Geeta Menon, and Jennifer L. Aaker Administrative Science Quarterly 45 (3), 425–55. (2007), “Getting Emotional About Health.” Journal of Marketing Research 44 (1), 100–13. Akçura, M. Tolga, Füsun F. Gönül, and Elina Petrova (2004), “Consumer Learning and Brand Valuation: An Ahearne, Michael, Thomas W. Gruen, and Cheryl Burke Application on Over-the-counter Drugs.” Marketing Jarvis (1999), “If Looks Could Sell: Moderation and Science 23 (1), 156–69. Mediation of the Attractiveness Effect on Salesperson
MARKE TING S C I EN C E I N STITUTE 152 Arnold, Matthew (2004), “Directing Compliance.” Bowman, Douglas, Carrie M. Heilman, and P. B. Medical Marketing and Media 39 (6), 36–46. Seetharaman (2004), “Determinants of Product-use Compliance Behavior.” Journal of Marketing Research 41 Azoulay, Pierre (2002), “Do Pharmaceutical Sales (3), 324–38. Respond to Scientific Evidence?” Journal of Economics and Management Strategy 11 (4), 551–94. Burnett, John J., and Richard L. Oliver (1979), “Fear Appeal Effects in the Field: A Segmentation Approach.” Bandura, Albert (1982), “Self-efficacy Mechanism in Journal of Marketing Research 16 (2), 181–90. Human Agency.” American Psychologist 37 (2), 122–47. Burns, Lawton R. (2005), The Business of Healthcare Becker, Marshall H. (1974), “The Health Belief Model Innovation. Cambridge, U.K.: Cambridge University and Personal Health Behavior.” Health Education Press. Monographs 2 (4), 409–19. Celsi, Richard, and Jerry Olson (1988), “The Role of ––––––, and Irvin M. Rosenstock (1984), “Compliance Involvement in Attention and Comprehension Processes.” with Medical Advice.” In Health Care and Human Journal of Consumer Research 15 (2), 210–24. Behavior, eds. A. Steptoe and A. Mathews, 175–208. New York, N.Y.: Academic Press. Chandran, Sucharita, and Geeta Menon (2004), “When a Day Means More than a Year: Effects of Temporal Berger, Jonah A., and Lindsay Rand (2008), “Shifting Framing on Judgments of Health Risk.” Journal of Signals to Help Health: Using Identity-signaling to Consumer Research 31 (September), 375–89. Reduce Risky Health Behaviors.” Journal of Consumer Research 35 (3), 509–18. Chandy, Rajesh K., Brigitte Hopstaken, Om Narasimhan, and Jaideep Prabhu (2006), “From Invention to Berndt, Ernst R., Linda Bui, David R. Reiley, and Glen Innovation: Conversion Ability in Product Development.” L. Urban (1995), “Information, Marketing, and Pricing in Journal of Marketing Research 43 (3), 494–508. the U.S. Antiulcer Drug Market.” American Economic Review 85 (2), 100–5. Chintagunta, Pradeep K., and Ramarao Desiraju (2005), “Strategic Pricing and Detailing Behavior in International Bhattacharya, Jayanta, and William B. Vogt (2003), “A Markets.” Marketing Science 24 (1), 67–80. Simple Model of Pharmaceutical Price Dynamics.” Journal of Law and Economics 46 (2), 599–626. Cleanthous, Paris (2004), “Informative Advertising in U.S. Pharmaceuticals.” Paper presented at INFORMS Blau, Gary E., Joseph F. Pekny, Vishal A. Varma, and Paul Marketing Science Conference, Rotterdam, Netherlands. R. Bunch (2004), “Managing a Portfolio of Interdependent New Product Candidates in the Cloodt, Myriam, John Hagedoorn, and Hans Van Pharmaceutical Industry.” Journal of Product Innovation Kranenburg (2006), “Mergers and Acquisitions: Their Management 21 (4), 227–45. Effect on the Innovative Performance of Companies in High-tech Industries.” Research Policy 35 (5), 642–54. Block, Lauren G., and Punam A. Keller (1995), “When To Accentuate the Negative: The Effects of Perceived CMS (2008), “National Health Expenditure Projections Efficacy and Message Framing on Intentions to Perform a 2007–2017,” Office of the Actuary in the Centers for Health-related Behavior.” Journal of Marketing Research 32 Medicare and Medicaid Services, www.cms.hhs.gov, (2), 192–203. accessed October 20, 2008.
Bolton, Lisa E., Joel B. Cohen, and Paul N. Bloom Coleman, James S., Elihu Katz, and Herbert Menzel (2006), “Does Marketing Products as Remedies Create (1966), Medical Innovation: A Diffusion Study. ‘Get Out of Jail Free Cards’?” Journal of Consumer Research Indianapolis, Ind.: Bobbs-Merill. 33 (June), 71–81. Danzon, Patricia M., Y. Richard Wang, and Liang Wang ––––––, Americus Reed II, Kevin G. Volpp, and Katrina (2005), “The Impact of Price Regulation on the Launch Armstrong (2008), “How Does Drug and Supplement Delay of New Drugs: Evidence from Twenty-five Major Marketing Affect a Healthy Lifestyle?” Journal of Markets in the 1990s.” Health Economics 14 (3), 269–92. Consumer Research 34 (5), 713–26. Dekimpe, Marnik G., and Dominique M. Hanssens Bourgeois, L. J., III, and Kathleen M. Eisenhardt (1988), (1999), “Sustained Spending and Persistent Response: A “Strategic Decision Processes in High Velocity New Look at Long-term Marketing Profitability.” Journal Environment: Four Cases in the Microcomputer of Marketing Research 36 (4), 397–12. Industry.” Management Science 34 (July), 816–35.
WO RKI N G P AP ER S ER IES 153 Dellande, Stephanie, Mary C. Gilly, and John L. Graham Gallego, Gisselle, Susan J. Taylor, and Jo-anne E. Brien (2004), “Gaining Compliance and Losing Weight: The (2007), “Priority Setting for High Cost Medications Role of the Service Provider in Health Care Services.” (HCMs) in Public Hospitals in Australia: A Case Study.” Journal of Marketing 68 (3), 78–91. Health Policy 84 (1), 58–66.
DeSarbo, Wayne S., Alexandru M. Degeratu, Michel Garber, Alan M., and Charles E. Phelps (1997), Wedel, and M. Kim Saxton (2001), “The Spatial “Economic Foundations of Cost-effectiveness Analysis.” Representation of Market Information.” Marketing Science Journal of Health Economics 16, 1–31. 20 (4), 426–41. Glazer, Rashi, and Allen M. Weiss (1993), “Marketing in Desiraju, Ramarao, Harikesh Nair, and Pradeep K. Turbulent Environments: Decision Processes and the Chintagunta (2004), “Diffusion of New Pharmaceutical Time-sensitivity of Information.” Journal of Marketing Drugs in Developing and Developed Nations.” Research 30 (4), 509–21. International Journal of Research in Marketing 21 (4), 341–57. Golder, Peter N., and Gerard J. Tellis (1993), “Pioneer Advantage: Marketing Logic or Marketing Legend?” DiMasi, Joseph A., Ronald W. Hansen, and Henry G. Journal of Marketing Research 30 (May), 158–70. Grabowski (2003), “The Price of Innovation: New Estimates of Drug Development Costs.” Journal of Health Gönül, Füsun F., Franklin Carter, Elina Petrova, and Economics 22 (2), 151–85. Kannan Srinivasan (2001), “Promotion of Prescription Drugs and Its Impact on Physicians’ Choice Behavior.” Ding, Min, and Jehoshua Eliashberg (2002), “Structuring Journal of Marketing 65 (July), 79–90. the New Product Development Pipeline.” Management Science 48 (3), 343–63. Grabowski, Henry G., and John M. Vernon (1992), “Brand Loyalty, Entry, and Price Competition in Dong, Xiaojing, Puneet Manchanda, and Pradeep K. Pharmaceuticals after the 1984 Drug Act.” Journal of Law Chintagunta (2009), “A Multi-category Model of and Economics 35 (2), 331–50. Physician Prescription and Detailing.” Chicago, Ill.: University of Chicago Booth School of Business Research Gregson, Nigel, Keiron Sparrowhawk, Josephine Paper No. 09-10. Mauskopf, and John Paul (2005), “Pricing Medicines: Theory and Practice, Challenges and Opportunities.” Drummond, Michael, Bengt Jönsson, and Frans Rutten Nature Reviews Drug Discovery 4 (February), 121–30. (1997), “The Role of Economic Evaluation in the Pricing and Reimbursement of Medicines.” Health Policy 40 (3), Gupta, Sachin, Yu Yu, and Rahul Guha (2006), 199–215. “Pioneering Advantage in Generic Drug Competition.” Ithaca, N.Y.: Cornell University, Johnson School Research Eliashberg, Jehoshua, Anita Elberse, and Mark A. A. M. Paper Series, #37-06. Leenders (2006), “The Motion Picture Industry: Critical Issues in Practice, Current Research, and New Research Hahn, Minhi, Sehoon Park, Lakshman Krishnamurthi, Directions.” Marketing Science 25 (6), 638–61. and Andris A. Zoltners (1994), “Analysis of New Product Diffusion Using a Four-segment Trial-repeat Model.” ––––––, and Steven M. Shugan (1997), “Film Critics: Marketing Science 13 (3), 224–47. Influencers or Predictors?” Journal of Marketing 61 (2), 68–78. Heide, Jan B., and Allen M. Weiss (1995), “Vendor Consideration and Switching Behavior for Buyers in Ferguson, Jeffery M., Richard Discenza, and John A. High-technology Markets.” Journal of Marketing 59 (July), Miller (1987), “Increasing the Odds of Patient 30–43. Compliance through Prescription Warning Labels.” Journal of Health Care Marketing 7 (1), 37–46. Hollis, Aidan (2002), “The Importance of Being First: Evidence From Canadian Generic Pharmaceuticals.” Frank, Richard G., and David S. Salkever (1997), Health Economics 11 (8), 723–34. “Generic Entry and the Pricing of Pharmaceuticals.” Journal of Economics and Management Strategy 6 (1), Hong, Jiewen, and Angela Y. Lee (2008), “Be Fit and Be 75–90. Strong: Mastering Self-regulation through Regulatory Fit.” Journal of Consumer Research 34 (5), 682–95. Friedman, Margaret L., and Gilbert A. Churchill Jr. (1987), “Using Consumer Perceptions and a Contingency Hooper, Elizabeth M., Loretto M. Comstock, Jean M. Approach to Improve Health Care Delivery.” Journal of Goodwin, and James S. Goodwin (1982), “Patient Consumer Research 13 (4), 492–510. Characteristics That Influence Physician Behavior.” Medical Care 20 (6), 630–8.
MARKE TING S C I EN C E I N STITUTE 154 Hopfield, Jessica, Robert M. Linden, and Bradley J. ––––––, and Lauren G. Block (1996), “Increasing the Tevelow (2006), “Getting Patients to Take Their Persuasiveness of Fear Appeals: The Effect of Arousal and Medicine.” McKinsey Quarterly 2006 (4), 1–15. Elaboration.” Journal of Consumer Research 22 (4), 448–59.
Hunter, Derek (2005), “Guaranteed Future Pain and ––––––, and –––––– (1997), “Vividness Effects: A Suffering: The Recent Research on Drug Price Controls.” Resource-matching Perspective.” Journal of Consumer WebMemo 908, 1–3, Research 24 (3), 295–304. http://www.heritage.org/Research/healthcare/wm680.cfm. ––––––, and Donald R. Lehmann (2008), “Designing Iizuka, Toshiaki, and Ginger Zhe Jin (2005), “The Effect Effective Health Communications: A Meta-analysis.” of Prescription Drug Advertising on Doctor Visits.” Journal of Public Policy and Marketing 27 (2), 117–30. Journal of Economics and Management Strategy 14 (3), 701–27. ––––––, Isaac M. Lipkus, and Barbara K. Rimer (2002), “Depressive Realism and Health Risk Accuracy: The Iyengar, Raghuram, Thomas W. Valente, and Christophe Negative Consequences of Positive Mood.” Journal of van den Bulte (2008), “Opinion Leadership and Social Consumer Research 29 (1), 57–69. Contagion in New Product Diffusion.” Cambridge, Mass.: Marketing Science Institute, Report No. 08-120. ––––––, ––––––, and –––––– (2003), “Affect, Framing, and Persuasion.” Journal of Marketing Research 40 (1), 54–64. John, George, Allen M. Weiss, and Shantanu Dutta (1999), “Marketing in Technology-intensive Markets: Kogut, B., and U. Zander (1992), “Knowledge of the Toward a Conceptual Framework.” Special issue, Journal of Firm, Combinative Capabilities, and the Replication of Marketing 63, 78–91. Technology.” Organization Science 3 (3), 383–97.
Kahn, Barbara E., Eric Greenleaf, Julie R. Irwin, Alice M. Kremer, Sara T. M., Tammo H. A. Bijmolt, Peter S. H. Isen, Irwin P. Levin, Mary Frances Luce, Manuel C. Leeflang, and Jaap E. Wieringa (2008), “Generalizations Pontes, James Shanteau, Marc Vanhuele, and Mark J. on the Effectiveness of Pharmaceutical Promotional Young (1997), “Examining Medical Decision Making Expenditures.” International Journal of Research in from a Marketing Perspective.” Marketing Letters 8 (3), Marketing 25 (4), 234–46. 361–75. Kyle, Margaret K. (2007), “Pharmaceutical Price Controls ––––––, and Mary F. Luce (2003), “Understanding High- and Entry Strategies.” Review of Economics and Statistics stakes Consumer Decisions: Mammography Adherence 89 (1), 88–99. Following False Alarm Test Results.” Marketing Science 22 (3), 393–10. Leeflang, Peter, S. H., Jaap E. Wieringa, and Dick R. Wittink (2004), “The Effects of Pharmaceutical ––––––, and –––––– (2006), “Repeated-adherence Marketing on Sales of Prescription Drugs in the Protection Model: ‘I’m OK, and It’s a Hassle.’” Journal of Netherlands.” Groningen, The Netherlands: University of Public Policy and Marketing 25 (1), 79–89. Groningen, Working Paper.
Kaplan, Sherrie H., Barbara Gandek, Sheldon Greenfield, Leffler, Keith B. (1981), “Persuasion or Information? The William Rogers, and John E. Ware (1995), “Patient and Economics of Prescription Drug Advertising.” Journal of Visit Characteristics Related to Physicians’ Participatory Law and Economics 24 (1), 45–74. Decision-making Style.” Medical Care 33 (12), 1176–87. Loch, Christoph H., and Stylianos Kavadias (2002), Kappe, Eelco, Stefan Stremersch, and Sriram “Dynamic Portfolio Selection of NPD Programs Using Venkataraman (2008), “Bucking the Trend in Marginal Returns.” Management Science 48 (10), 1227–41. Pharmaceutical Detailing: Fusing Data to Gauge a Policy Shift.” Rotterdam, The Netherlands: Erasmus University, López-Casasnovas, Guillem, and Jaume Puig-Junoy Erasmus School of Economics, Working Paper. (2000), “Review of the Literature on Reference Pricing.” Health Policy 54 (2), 87–123. Keller, Punam A. (1999), “Converting the Unconverted: The Effect of Inclination and Opportunity to Discount Luce, Mary F., and Barbara E. Kahn (1999), “Avoidance Health-related Fear Appeals.” Journal of Applied Psychology or Vigilance? The Psychology of False-positive Test 84 (June), 403–15. Results.” Journal of Consumer Research 26 (3), 242–59.
–––––– (2006), “Regulatory Focus and Efficacy of Health Macias, Wendy, and Liza Stavchansky Lewis (2003), Messages.” Journal of Consumer Research 33 (June), “A Content Analysis of Direct-to-consumer (DTC) 109–14. Prescription Drug Web Sites.” Journal of Advertising 32 (4), 43–56.
WO RKI N G P AP ER S ER IES 155 Maddux, James E., and Ronald W. Rogers (1983), ––––––, Kristin Diehl, David Brinberg, and Blair Kidwell “Protection Motivation and Self-efficacy: A Revised (2004), “Subjective Knowledge, Search Locations, and Theory of Fear Appeals and Attitude Change.” Journal of Consumer Choice.” Journal of Consumer Research 31 (3), Experimental Social Psychology 19 (5), 469–79. 673–80.
Madhaven, Ravindranath, and Rajiv Grover (1998), “From ––––––, Rex Du, and Carl F. Mela (2005), “The Effect of Embedded Knowledge to Embodied Knowledge: New Standardized Information on Firm Survival and Product Development as Knowledge Development.” Marketing Strategies.” Marketing Science 24 (2), 263–74. Journal of Marketing 62 (4), 1–12. ––––––, and Erika Matulich (1993), “A Model of Manchanda, Puneet, and Pradeep K. Chintagunta (2004), Consumers’ Preventive Health Behaviors: The Role of “Responsiveness of Physician Prescription Behavior to Health Motivation and Health Ability.” Journal of Salesforce Effort: An Individual Level Analysis.” Consumer Research 20 (September), 208–28. Marketing Letters 15 (2–3), 129–45. ––––––, and Rebecca J. Slotegraaf (1999), “The ––––––, Xiaojing Dong, and Pradeep K. Chintagunta Contingency Value of Complementary Capabilities in (2004), “A Multicategory Model of Physician Prescription Product Development.” Journal of Marketing Research 36 Behavior.” Chicago, Ill.: University of Chicago, Working (May), 239–57. Paper. Mukherji, Prokriti, Shantanu Dutta, and Surendra Rajiv ––––––, and Elisabeth Honka (2005), “The Effects and (2004), “Estimating the Effects of Direct-to-consumer Role of Direct-to-physician Marketing in the Advertising for Prescription Drugs: A Natural Pharmaceutical Industry: An Integrative Review.” Yale Experiment.” Paper presented at INFORMS Marketing Journal of Health Policy, Law and Ethics 5, 785–822. Science Conference, Rotterdam, Netherlands.
––––––, Peter E. Rossi, and Pradeep K. Chintagunta Nair, Harikesh, Puneet Manchanda, and Tulikaa Bhatia (2004), “Response Modeling with Nonrandom (2006), “Asymmetric Peer Effects in Physician Marketing-mix Variables.” Journal of Marketing Research Prescription Behavior: The Role of Opinion Leaders.” 41 (4), 467–78. Palo Alto, Calif.: Stanford Graduate School of Business, Research Paper No. 1970. Mantrala, Murali K., Prabhakant Sinha, and Andris A. Zoltners (1994), “Structuring a Multiproduct Sales Narayanan, Sridhar, Ramarao Desiraju, and Pradeep K. Quota-bonus Plan for a Heterogeneous Sales Force: A Chintagunta (2004), “Return on Investment Implications Practical Model-based Approach.” Marketing Science 13 for Pharmaceutical Promotional Expenditures: The Role (2), 121–44. of Marketing-mix Interactions.” Journal of Marketing 68 (October), 90–105. Menon, Geeta, Lauren G. Block, and Suresh Ramanathan (2002), “We’re At As Much Risk As We Are Led to ––––––, Puneet Manchanda, and Pradeep K. Chintagunta Believe: Effects of Message Cues on Judgments of Health (2005), “Temporal Differences in the Role of Marketing Risk.” Journal of Consumer Research 28 (4), 533–49. Communication in New Product Categories.” Journal of Marketing Research 42 (3), 278–90. ––––––, Priya Raghubir, and Nidhi Agrawal (2008), “Health Risk Perceptions and Consumer Psychology.” In Narin, Francis (2001), “Assessing Technological The Handbook of Consumer Psychology, eds. Curtis Competencies.” In From Knowledge Management to Haugtvedt, Paul Herr, and Frank Kardes, 981–1010. New Strategic Competence: Measuring Technological, Market and York, N.Y.: Lawrence Erlbaum and Associates. Organisational Innovation, ed. Joe Tidd, 155–196. London, U.K.: Imperial College Press. Mizik, Natalie, and Robert Jacobson (2004), “Are Physicians ‘Easy Marks’? Quantifying the Effects of Oliver, Richard L., and Philip K. Berger (1979), “A Path Detailing and Sampling on New Prescriptions.” Analysis of Preventive Health Care Decision Models.” Management Science 50 (12), 1704–15. Journal of Consumer Research 6 (2), 113–22.
Moorman, Christine (1990), “The Effects of Stimulus and Parasuraman, A., Valarie A. Zeithaml, and Leonard L. Consumer Characteristics on the Utilization of Nutrition Berry (1985), “A Conceptual Model of Service Quality Information.” Journal of Consumer Research 17 (December), and Its Implications for Future Research.” Journal of 362–74. Marketing 49 (4), 41–50.
–––––– (1998), “Market-level Effects of Information: Parsons, Leonard Jon, and Piet Vanden Abeele (1981), Competitive Responses and Consumer Dynamics.” “Analysis of Sales Call Effectiveness.” Journal of Marketing Journal of Marketing Research 35 (1), 82–98. Research 18 (February), 107–13.
MARKE TING S C I EN C E I N STITUTE 156 PhRMA (2008), Pharmaceutical Industry Profile 2008. Innovative Late Entrants Outsell Pioneers.” Journal of Washington, D.C.: Pharmaceutical Research and Marketing Research 35 (1), 54–70. Manufacturers of America. ––––––, ––––––, and –––––– (1999), “The Advantages of Prabhu, Jaideep C., Rajesh K. Chandy, and Mark E. Ellis Entry in the Growth Stage of the Product Life Cycle: An (2005), “The Impact of Acquisitions on Innovation: Empirical Analysis.” Journal of Marketing Research 36 (2), Poison Pill, Placebo, or Tonic?” Journal of Marketing 69 269–76. (January), 114–30. Singh, Jagdip, Rama Jayanti, and Elizabeth Gannon Quinn, James B., Jordan J. Baruch, and Karen Anne Zien (2008), “Strong Medicine: Conflict of Interests and (1997), Innovation Explosion. New York, N.Y.: The Free Pharmaceutical Marketing Practices.” Working Paper. Press. Sorescu, Alina B., Rajesh K. Chandy, and Jaideep C. Raghubir, Pryia, and Geeta Menon (1998), “AIDS and Prabhu (2003), “Sources and Financial Consequences of Me, Never the Twain Shall Meet: The Effects of Radical Innovation: Insights from Pharmaceuticals.” Information Accessibility on Judgments of Risk and Journal of Marketing 67 (October), 82–102. Advertising Effectiveness.” Journal of Consumer Research 25 (1), 52–63. ––––––, ––––––, and –––––– (2007), “Why Some Acquisitions Do Better than Others: Product Capital as a Rao, Raghunath Singh, Rajesh K. Chandy, and Jaideep C. Driver of Long-term Stock Returns.” Journal of Marketing Prabhu (2008), “The Fruits of Legitimacy: Why Some Research 44 (1), 57–72. New Ventures Gain More From Innovation than Others.” Journal of Marketing 72 (4), 58–75. Spangenberg, Eric R., David E. Sprott, Bianca Grohmann, and Ronn J. Smith (2003), “Mass- Riis, Jason, Joseph P. Simmons, and Geoffrey P. Goodwin communicated Prediction Requests: Practical Application (2008), “Preferences for Enhancement Pharmaceuticals: and a Cognitive Dissonance Explanation for Self- The Reluctance to Enhance Fundamental Traits.” Journal prophecy.” Journal of Marketing 67 (3), 47–62. of Consumer Research 35 (October), 495–508. Stewart, David W. (2002), “Getting Published: Rogers, Ronald W. (1975), “A Protection Motivation Reflections of an Old Editor.” Journal of Marketing 66 Theory of Fear Appeals and Attitude Change.” Journal of (October), 1–6. Psychology 91 (1), 93–114. Stremersch, Stefan (2008), “Health and Marketing: The Rosenstock, Irvin M. (1974), “Historical Origins of the Emergence of a New Field of Research.” International Health Belief Model.” Health Education Monographs 2, Journal of Research in Marketing 25 (4), 229–33. 328–35. Stremersch, Stefan, and Aurélie Lemmens (2008), “Sales –––––– (1985), “Understanding and Enhancing Patient Growth of New Pharmaceuticals across the Globe: The Compliance with Diabetic Regimens.” Diabetes Care 8, Role of Regulatory Regimes.” Marketing Science, forth- 610–6. coming.
Rust, Roland T., and Tuck Siong Chung (2006), ––––––, and Gerard J. Tellis (2002), “Strategic Bundling “Marketing Models of Service and Relationships.” of Products and Prices: A New Synthesis for Marketing.” Marketing Science 25 (6), 560–80. Journal of Marketing 66 (1), 55–72.
Scherer, Frederic M. (2004), “The Pharmaceutical ––––––, ––––––, Philip Hans Franses, and Jeroen L. G. Industry—Prices and Progress.” New England Journal of Binken (2007), “Indirect Network Effects in New Product Medicine 351 (9), 927–32. Growth.” Journal of Marketing 71 (3), 52–74.
–––––– (1993), “Pricing, Profits, and Technological ––––––, and Peter C. Verhoef (2005), “Globalization of Progress in the Pharmaceutical Industry.” Journal of Authorship in the Marketing Discipline: Does It Help or Economic Perspectives 7 (3), 97–115. Hinder the Field?” Marketing Science 24 (4), 585–94.
Shankar, Venkatesh (1997), “Pioneers’ Marketing Mix ––––––, Isabel Verniers, and Peter C. Verhoef (2007), Reactions to Entry in Different Competitive Game “The Quest for Citations: Drivers of Article Impact.” Structures: Theoretical Analysis and Empirical Journal of Marketing 71 (3), 171–93. Illustration.” Marketing Science 16 (3), 271–93. Thompson, Craig J. (2004), “Marketplace Mythology and ––––––, Gregory S. Carpenter, and Lakshman Discourses of Power.” Journal of Consumer Research 31 (1), Krishnamurthi (1998). “Late Mover Advantage: How 162–80.
WO RKI N G P AP ER S ER IES 157 –––––– (2005), “Consumer Risk Perceptions in a Cognitive Distance.” Journal of Economic Behavior and Community of Reflexive Doubt.” Journal of Consumer Organization 58 (2), 277–302. Research 32 (2), 235–48. ––––––, Shantanu Dutta, and Stefan Stremersch (2004), –––––– and Maura Troester (2002), “Consumer Value “Portfolios of Interfirm Agreements in Technology- Systems in the Age of Postmodern Fragmentation: The intensive Markets: Consequences for Innovation and Case of the Natural Health Microculture.” Journal of Profitability.” Journal of Marketing 68 (2), 88–100. Consumer Research 28 (4), 550–71.
Uzzi, Brian (1997), “Social Structure and Competition in Interfirm Networks: The Paradox of Embeddedness.” Administrative Science Quarterly 42 (1), 35–67.
Van den Bulte, Christophe, and Gary L. Lilien (2001), “Medical Innovation Revisited: Social Contagion Versus Marketing Effort.” American Journal of Sociology 106 (5), 1409–35.
Vargo, Stephen L., and Robert F. Lusch (2004), “Evolving to a New Dominant Logic for Marketing.” Journal of Marketing 68 (1), 1–17.
Venkataraman, Sriram, and Stefan Stremersch (2007), “The Debate on Influencing Doctors’ Decisions: Are Drug Characteristics the Missing Link?” Management Science 53 (11), 1688–1701.
Verbrugge, Lois M. (1985), “Gender and Health: An Update on Hypotheses and Evidence.” Journal of Health and Social Behavior 26 (September), 156–82.
Verniers, Isabel, Stefan Stremersch, and Christophe Croux (2008), “International Launch Timing and Pricing of New Pharmaceuticals.” Rotterdam, The Netherlands: Erasmus University, Erasmus School of Economics, Working Paper.
Vernon, John A., and W. Keener Hughen (2005), “The Future of Drug Development: The Economics of Pharmacogenomics.” Cambridge, Mass.: NBER Working Paper No. 11875.
Weiss, Allen M., and Jan B. Heide (1993), “The Nature of Organizational Search in High Technology Markets.” Journal of Marketing Research 30 (2), 220–33.
Wong, Nancy, and Tracey King (2008), “The Cultural Construction of Risk Understandings through Illness Narratives.” Journal of Consumer Research 34 (5), 579–94.
Wosinska, Marta (2005), “Direct-to-consumer Advertising and Drug Therapy Compliance.” Journal of Marketing Research 42 (August), 323–32.
–––––– (2006), “Direct-to-consumer Advertising, Media Publicity and Demand for Prescription Drugs.” Paper pre- sented at INFORMS Marketing Science Conference, Report No. 09-105 Pittsburgh, Penn. “Marketing of the Life Sciences: A New Framework and Research Agenda for a Nascent Field” © 2009 Stefan Wuyts, Stefan, Massimo G. Colombo, Shantanu Dutta, Stremersch and Walter Van Dyck; Report Summary © and Bart Nooteboom (2005), “Empirical Tests of Optimal 2009 Marketing Science Institute
MARKE TING S C I EN C E I N STITUTE 158