While restrictions on the direct advertising of drugs to consumers have been relaxed in the United States,¹ Japan’s regulators still prohibit the practice. Pharmaceutical companies can, however, advertise indirectly in Japan—the world’s second largest market for pharmaceuticals, behind only the United States; that is, they can alert patients to the dangers of failing to seek treatment for certain ailments but, unlike companies there, can’t mention products by name in the advertisements.

Not surprisingly, there has been some reluctance to spend marketing dollars on publicity campaigns that seem to target consumers with little more than a generic medical education—and risk opposition from doctors wary of pitches aimed at their patients. But two recent pilot experiments conducted throughout 2001 suggest that indirect marketing may be more effective in Japan than companies realize if marketers target distinct groups of sufferers and coordinate this approach with enhanced sales efforts aimed at physicians.

In the first of the pilots, a multinational company doubled the sales of its treatment for a certain type of athlete’s foot, increasing its share of the pilot market by 20 percent. This result was no aberration—during the two months after rolling out a national campaign, the company boosted sales of its treatment by 47 percent and its overall market share by 10 percent. And a local company I will call EyeCo similarly increased orders for its dry-eye medication by 10 percent in its pilot. Translated to the national level, the same approach to marketing might generate an additional $50 million in sales at a cost of $2.75 million, without significantly promoting sales of competing products.

Typically, indirect drug advertising in Japan has mainly involved generic newspaper ads, the distribution of leaflets about treatable conditions to all potential patients, and the sponsorship of meetings. In the pilots, both companies went much further, increasing awareness of their treatments by identifying the groups most likely to be prospective patients and crafting ads aimed directly at these people (exhibit). EyeCo, for instance, targeted contact lens wearers with the refreshingly direct line, "Ignore dry eye and you can kiss your contacts good-bye," together with broader messages aimed at all potential groups of patients. Likewise, the message that "Athlete’s foot of the nail cannot be effectively cured without oral medicine" countered the public’s perception that ointments were the only effective treatment. EyeCo used opinion leaders and organizations to ensure wide media coverage and a continual flow of information in the pilot region. As a result, a survey showed, 90 percent of all potential patients there intended to seek diagnosis and treatment.

Meanwhile, the two drug companies also pursued the corporate health programs prevalent in Japan: corporate doctors and health administrators and company-owned health insurers were encouraged to test and treat their staff members, particularly those in high-risk categories, in their own health care programs. In another new initiative, providers of health check-up services were asked to add diagnostics for dry eye to their menus.

Since in Japan, advertising for prescription drugs cannot direct patients to specific products, the pharma companies faced the challenge of mobilizing their sales forces to persuade doctors to prescribe their treatments over competing products. The goal was to make sure that as patients were learning more about these common ailments—and were prompted to seek treatment—sales reps and doctors were learning how the campaign could help them too.

Traditionally, sales forces don’t see the relevance of marketing directly to consumers. Training sessions addressed this resistance and helped managers and sales reps to understand when and how the pilot campaigns—and direct marketing in general—could draw patients to their doctors. To synchronize promotions and sales activities, the companies made sure that their reps’ sales kits included copies of newspaper articles on the pilots, posters for clinics and hospitals, and leaflets for patients. In addition, doctors were invited to attend seminars where company representatives and opinion leaders (such as highly reputable local doctors and health leaders) noted the growth in the number of patients suffering from these conditions and discussed ways of treating them. Doctors acknowledged the campaigns’ contribution to the growth of their own practices.

Such efforts increased sales in the pilot markets and made it possible for more patients to receive relief from two treatable conditions. True, the competitors of the companies that launched the campaigns also benefited—but much less so. The issue is no longer whether to launch direct-to-consumer marketing campaigns but rather how to do so in a way that maximizes the sales of a company without hurting its reputation.