Recently, Ironwood Pharmaceuticals and Allergan launched an updated DTC campaign for Linzess (linaclotide), an FDA-approved treatment for both irritable bowel syndrome with constipation (IBS-C) and chronic idiopathic constipation (CIC) in adults. It is not because the past two campaigns weren’t working. Since the launch of the first DTC campaign in 2014, weekly TRxs above the baseline trend for Linzess have increased close to 27%. And yet the companies still felt it was time for a change.
Tom McCourt, Chief Commercial Officer at Ironwood Pharmaceuticals, spoke with PM360 about the new campaign, called “Tell Me Something I Don’t Know,” and provides an inside look at their DTC strategy for Linzess. He also explains how a marketer can tell when it is time to change up a campaign and why all of this noise about DTC advertising among politicians is nonsense.
PM360: You recently launched a new DTC campaign for Linzess. However, it appears the old campaign had been working quite well as it helped contribute to a close to 27% increase in weekly TRxs from the pre-DTC trend line. Why did you decide to do this new campaign now?
Tom McCourt: You’re constantly refreshing your ad with regard to the creative as well as the messaging to hopefully connect with different customer segments, which gets more sophisticated and targeted over time. Our first campaign was solely focused on functional symptoms and the potential benefit Linzess could offer. The second generation focused on the nature of the recurrence of those symptoms through a proactive approach to treat those symptoms. In this last campaign, we started hearing a lot from the patients about their frustration with OTC options. The message we kept hearing: “I’ve tried it all. I’ve heard it all. I need something different.”
So, this new campaign is focusing on leveraging that insight around, “Tell me something new,” combined with the overall frustration of constantly using the same thing over and over again—whether it’s diet, fiber, exercise, or OTC laxatives. We also used a very different kind of creative development with stop motion technology, which has great stopping power. It looks like no other ad on TV—at least in the pharma space—which is a big part of what enables a campaign to be successful. It’s got to get your attention. Additionally, the ad has to communicate an impactful, convincing message, which is really grounded on the patient insights. And it’s got to be motivational.
A lot of this campaign is built on patient insights. How did you collect those insights? Was it through focus groups, interviews, social listening, etc.?
All of those things. It started with one-on-one interviews with patients who may or may not have seen our ad and still have not connected with a doc or taken action. Then we did some focus groups, and out of that came a number of different concepts from: “Do we stay with the functional message? Do we migrate to this more frustrated message for the patient that’s really self-identified?” When we tested that in quantitative market research, the message that consistently rose above everything else was: “I’ve tried it all and I’m frustrated. I want something that works.”
Did you ask patients to evaluate your past campaigns or just what they felt was generally lacking from the overall message they have heard about this particular disease?
It was definitely both. We leveraged the messages that laxatives have traditionally used and we also compared the new concept to the old concept. Obviously, this new concept beat it, otherwise we wouldn’t have moved forward. The new idea beat our older campaigns in terms of relevance to the patient and overall motivation to take action.
You mentioned the creative concept and the stop motion technology. What was the thought process behind using that? Was it just to do something different or was that inspired by something that came from the patient feedback?
The woman that has the capability to do this is Sharon DeBacco, who is one of the real legends in the industry. I worked on the first Prilosec ads with her. She did Nexium, she did Crestor, she has created some of the most innovative and effective ads in the history of drug advertising. She stumbled across this technology and saw it as a chance to be creative and stand out among all the other current drug ads, which tend to look the same.
With most ads, they show someone walking through the park, walking down the street, or shooting hoops in the back yard. They all look and feel the same way. That wasn’t the case with the first Linzess ad. It was very different—but still very relevant.
When you look at the three shots in this new spot, it’s really hard to make some of that work in normal video. For instance, how that man in the ad is holding fiber in his hands and then watching that woman exercise and run upstairs in a very novel way. And then the last guy standing in a laxative aisle saying, “I’ve tried all this stuff. I’m frustrated.” All three of those images were very powerful as far as the ability for patients to quickly identify with the disorder and the problem they’re trying to solve.
Did you test the images with patients to see what would resonate with them?
No, we tested about 12 different concepts in the first round. Then we picked the top three, as well as our former campaign, and tested them in a large scale, quantitative study. And this concept emerged as the clear leader.
Do you remember anything that patients were saying about this concept that made you go in this direction?
Yes, I think the real insight: It was effectively communicating two major ideas. The symptoms are very clear, and so is the frustration. And for whatever reason, the technology did that very effectively, rather than the other ideas we had at the time. And I think we’re going to learn a lot from it, because one of the things with any campaign is it needs to be “own-able.” This is one that’s clearly distinct and own-able, because a patient can describe it and the doctors will get it.
More generally speaking, how do you determine when it is time to make a change with a campaign? You spoke about how the Linzess campaign evolved over three iterations. Was that always the plan or do you have any advice you can offer to other pharma marketers in regards to when a campaign might need a new coat of paint?
You should focus on three different things. One lies in understanding the core insights that really drives patient behavior. Part of the first campaign was identifying the functional need and benefit that the drug can deliver on. We wanted to keep that quite simple and very direct.
But it was very broad and spoke to everybody. We wanted to see if it would have an impact—and it clearly did. Then, you always want to migrate from a functional benefit to an emotional benefit. And obviously, an emotional benefit is a far stronger motivator for patients. So our intention was to make sure we establish Linzess for what it is, which is a drug that can effectively treat abdominal pain and constipation symptoms for IBS-C and chronic constipation, and make sure that link is established and the symptoms are those that the patient self identifies with.
Then, as we moved forward, we wanted to migrate to an emotional insight that could be leveraged or communicated to the patient. It was clear that insight was frustration with OTC medications and self-treatment. It was frustration with their symptoms. It was frustration with their doctor. So we wanted to convey the fact that, “It’s okay to feel frustrated, but there’s another option,” which ends up as a pretty powerful message.
I know this isn’t the case with the current Linzess campaign as it has shown to be very effective, but is there anything you can do along that evolution of a campaign to make a switch if something isn’t working as well as you would like? And how early in a campaign can you make that call?
That’s a judgement call. Generally, the one thing we know about ads over time is they fatigue in regard to the impact they have. At some point, people just don’t pay attention to it. It ends up just being there—you don’t have the stopping power of something different and fresh.
But another way to look at it—going back to the earlier point I made—is that a new campaign is sometimes a way to communicate to another segment of patients. You have to ask yourself: “How do we continue to expand or focus to distinct segments of patients that we can motivate to help them help themselves?” That’s how I think about it. Now, the challenging piece for us was the ad was still performing quite well, but you don’t want to get to a point where the ad really does start fatiguing.
At what point do you make the call to say, “You know what? This ad has been airing for a year. Maybe it’s time to refresh it and focus on a distinct, different segment of patients.” Some of it is science and data. Some of it is instinct.
With all of the heat that DTC advertising is taking this election season, do you still see it as an effective way to reach patients?
DTC is getting kicked around in the press and on the Hill, but I think the one thing that’s important for people to understand: This is about the patients. Particularly, when you look at these kinds of diseases—functional GI diseases—they aren’t often thought of as serious medical conditions. Physicians are not always looking for these patients, so the voice of the patient becomes very important.
We need patients to know that it is okay for them to raise their hand and have the courage to admit they have these symptoms—because it’s not their fault. They are suffering from a real medical condition and just want to feel better. We’ve clearly demonstrated that a lot of patients are out there suffering. In three years, we just treated our one-millionth patient and there are tens of millions to go.