Ask your neighbor, or perhaps your doctor, about choosing a knee implant, but a new advertising campaign by an implant maker does not dare suggest that your hospital may have an opinion.
DePuy, a Johnson & Johnson company based in Warsaw, Ind., has since early March been test-marketing a commercial that hawks its arthritic knee solutions to a target audience of aging baby boomers. The campaign adds knee implants to the growing list of pricey, for-professional-use-only medical products, including prescription drugs, which are being touted on television directly to consumers.
The TV ads for Imagin Knee Solutions are running in the greater Miami and Phoenix areas, two test markets with healthy proportions of senior citizens. The ads will continue until the end of May when, based on feedback and outcomes, the mass-market campaign could be expanded to a national audience, said David Swearingen, a spokesman for New Brunswick, N.J.-based Johnson & Johnson. The campaign also may be widened at some point to include DePuy's line of hip implants, he added.
The DePuy campaign potentially adds a new, complicating dynamic to one of the most notoriously difficult relationships for hospitals. As hospitals increasingly struggle to contain mounting supply costs by standardizing products and whittling down the number of vendors they buy from, orthopedic surgery represents one of the last bastions where physicians often still dictate purchasing decisions.
"Physicians are unwilling in 90% of our hospitals to standardize to reduce their implant costs for the hospitals," said Scott Crandall, senior product manager of orthopedics at Novation, the joint group purchasing organization for VHA and University HealthSystem Consortium. "You have to have someone internally at the institution willing to fight these battles, pull data together and say, `It is costing the hospital too much money and this is why.' "
It probably won't help the cause that the hospital's key role in knee-replacement surgery is not mentioned anywhere in DePuy's 60-second commercial, which features an energetic middle-aged woman hiking the steep hills of San Francisco. She explains that she and her husband adopted the city as their home in 1967 "and never looked back" until her picture-perfect life was threatened by arthritis in her knee. The commercial offers viewers an opportunity to take a "Joy of Motion" quiz by visiting a Web site or calling a toll-free number to speak with a registered nurse.
The Web site, 33imagin.com, also offers a surgeon locator of a limited number of physicians who are trained to use DePuy's orthopedic products. Physicians did not pay a fee to be included nor does the locator constitute a referral or recommendation, according to the Web site.
Johnson & Johnson would not disclose the cost of the campaign. Swearingen said he believes DePuy is the first orthopedic-implant company to move into mainstream TV advertising, but Johnson & Johnson companies spend hundreds of millions of dollars annually on commercials for a wide array of consumer products and prescription drugs, pitching everything from Tylenol to shampoo. Last summer, suture giant Ethicon launched a direct-to-consumer TV and print campaign for Dermabond, a product available only to professionals and in wide use in hospital emergency rooms (July 8, 2002, p. 10).
Swearingen describes the commercial as a "consumer educational campaign" that merely aims to apprise patients of treatment options, working in tandem with physicians. The campaign "is totally intended to engage physicians in the process," he said. Coupled with the historically strong relationship between orthopedic surgeons and orthopedic implant sales representatives, the marketing campaign promises to create more problems for hospitals, said Novation's Crandall. "(Sales representatives) see the physician as their customer, not the hospital. They look at the hospital just as a place to conduct business," Crandall said. "The rep has a better relationship with the surgeon than the hospital does."
Novation hospitals represent 40% of the implant market, a market potential of approximately $2 billion, but member hospitals actually purchase $1.1 billion worth of implants under Novation contracts, Crandall said. Novation has three agreements for hips and knees, including one with DePuy. Implants can cost anywhere from $900 to $6,000 each, he said, but lately because of new or improved technologies, there hasn't been much opportunity for discounts.
Crandall said he suspects that direct-to-consumer advertising will be a boon for suppliers, "but it's going to make my job more difficult because it will create more confusion than there already is." Implant costs have been climbing as much as 10% a year for the last five years and probably will jump even more if patients request specific products, making an end run around hospital purchasing decisions, he predicted. "I think DePuy is trying to make an effort to funnel people to their doctors," Crandall said.
That's an effort that Richard Laskin, associate chief of knee service at 138-bed Hospital for Special Surgery, New York, could live without. Choosing an implant should be a physician's decision, driven by quality, not cost, Laskin said. "Surgeons and physicians in this country have abrogated care to nonsurgeons, to bean counters and CEOs who went to Wharton. Their only consideration as to what is bought is the cost, and I think that really is a disservice to patients," Laskin said
Laskin said he does not have much patience for direct-to-consumer campaigns that attempt to circumvent doctors, either. That sort of marketing doesn't educate consumers; it just blindly sells products, "putting you down to the level of hair-growth products," he said.
"Do you have any idea what Nexium does? I don't," Laskin said. "I've been listening to the ad for more than a year now, and they never tell you, but I know Nexium is a purple pill. Their ad campaign works beautifully on me."