Report Presented by Six Degrees

Optimizing Spiriva’s

Brand Identity

February 24, 2005

2

agenda

1. Overview

2. Key findings

3. Research Details

4. Conclusions

5. Recommendations

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3

Overview

4

design and objectives

• 53 physician IDIs

• 40% Pulmonologists

• 60% Generalists

•Use of projective exercises (visual & verbal) to identify:

• Existing & desired emotions around treating COPD

• Current brand image for Advair, Combivent & Spiriva

• A compelling, differentiated and credible brand image for Spiriva going forward

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5

participants

• Recruited from client list

• 2 – 30 years in practice

• Full time practice

• 5+ Spiriva prescriptions written within the last 30 days

• > 5 COPD patients per week for generalists

• > 10 COPD patients per week for Pulmonologists

AUDIENCE Pittsburg Atlanta St. Louis TOTAL

PUDs 3 9 9 21

Generalists 14 10 8 32

TOTAL 17 19 17 53

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protocol

• Discusson of most rewarding & most challenging aspects of treating COPD

• Metaphor exercise: ‘Treating COPD is like…’

• Image selections for physician emotions around best case COPD treatment scenario

• Image selections for Combivent, Advair, Spiriva

• Discussion of proxy Spiriva window image

• Image selections for impact of improved patient outcomes

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Research Images

8

animals

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concepts

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fonts

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people

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symbols

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Key Findings

COPD a dire, hopeless, thankless condition

Physicians contain negative emotions and desire some

positive emotions

Physician emotions unaddressed by current brands

Opportunity to create an emotional relationship

Spiriva best able to make the emotional connection

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Research Details

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I. feelings re treating COPD

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COPD treatment dynamics (cont’d)

Physicians feel responsibility towards their patients and have need to help

• “I went into medicine because I love being able to help people, to make a difference. It makes me feel good” (GEN)

• “When you can help a patient in distress and help them get on with their daily lives, it makes you feel good; you feel satisfied that you've been able to have an impact” (GEN)

• “A lot of time people do it to themselves - people don't see how it will be in the future with this disease – as a doc I look forward, the patient can't/doesn't” (GEN)

Physicians limit their emotional investment with COPD patients

• “You have to be emotionally detached to be more objective & balanced” (PUD)

• “It's more risky to sympathize with COPD patients, because you can get to know them over 10 years, you're [probably] going to go to a lot of funerals, and you‘d be an emotional basket case” (PUD)

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COPD treatment dynamics (cont’d)

Even when sick with COPD, patients frequently engage in self-sabotage behavior

‘Responsibility’ for patient health remains with the physician

• Patients are dismayed when health continues to fail “There is nothing more you can do?’

• Patients give up, leaving it up to the physician to keep them engaged in ‘the fight’

• “It’s like being a parent trying to get their child to change behavior”

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COPD treatment dynamics (cont’d)

COPD and patient behavior ‘robs’ the physician of their ability to be “successful” and leaving them feelings of:

• Impotence and futility

“You get paid so little - without that hero feeling, there’s nothing in this profession” (PUD)

“It makes me feel a little bit of hopelessness, because you're up against something inexorable” (PUD)

“You're worthless because you can't help them” (GEN)

• Frustration and anger

“In most of cases doctors win – we have powerful drugs- but its harder to change someone's behavior!” (GEN)

“Sometimes I just want to throttle them!” (GEN)

“I feel frustrated and angry at patient and the situation” (PUD)

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most rewarding…

Both generalists and specialists responded similarly to what for them was most rewarding and most challenging

Although physicians generally found little about treating COPD rewarding, when pushed they consistently cited…

• feeling good about their ability to make an impact (when possible)

• their successes in stopping patients from smoking

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most rewarding…

“Getting people off oxygen/keeping people out of

the hospital” (GEN, PUD)

“Nothing is rewarding about treating COPD”(PUD)

“When I can help people do the normal things in life” (GEN, PUD)

“…when I can restore some of my patients’ quality of life”

(GEN, PUD)

“When patients stop smoking – this rarely happens” (GEN)

“When I can make them feel better/deliver some relief” (GEN, PUD)

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most challenging…

However, physicians’ dominant reactions revealed significant frustration, low expectations, and feelings of impotence

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most challenging…

“When the disease is advanced, you're worthless because you

can't help them” (GEN)

“I feel frustrated and angry at the patient and the situation” (PUD)

“[I feel] anger because they do things that make them worse and pity, because some are

hooked... they can’t help it” (PUD)

“It’s a terrible disease. The meds help somewhat, but when they're advanced it is difficult. It's like seeing an animal hit by a car… there’s nothing you can do”

(GEN)

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nature of treating COPD

Physician metaphors provided insights into physician feelings of:

• the inevitability of death,

• treatment futility

• resignation to failure

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nature of treating COPD

“It’s like…

• being in a boat in the ocean with water entering through a hole, and all I’ve got is a cup to bail with. It will work for a little while, but eventually the ocean will overwhelm the boat.” (GEN, PUD)

• [being] Sisyphus – [he’s] doomed to push a rock up the hill forever, and every time he gets to the top of the hill, it falls all the way back down and he has to go back and do it again. And when the rock falls for my patients, I'm there trying to help them hold the rock up and keep it up there, but more likely than not, it's going to fall down anyway.” (GEN, PUD)

• a forest fire you can't put it out. You start putting it out, and another part flares up again. Sometimes you're lucky and you get the fire out for months or years, but it's a frustrating disease. Some smolder for a while, and some flare up all the time.” (GEN)

• trying to slow soil erosion. You can slow it but you'll never stop it." (GEN)

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nature of treating COPD (cont’d)

Others expressed frustration with patients’ self-sabotaging behavior

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nature of treating COPD (cont’d)

“It’s like…

• trying to keep a beautiful building in repair that you know will never be the way that it was when it started… I'm trying to restore or reaffirm the architecture of the building - I retile the floors, they tear it up. I fix the façade, they tear it back down.” (PUD)

• trying to keep somebody from falling off a roof with no walls when they're…roller-skating. It’s something that’s not safe, and [like smoking] you expect them to fall [eventually].” (GEN)

• seeing a person going over a train track and seeing the train coming and not admitting that it's going to hit them, and they're not listening to me tell them ‘don't go, don't go, don't go!’" (PUD)

• being in a constant tug of war; I'm on one side and the cigarette is on the other side; cigarette can [call on and] be strengthened by [allies of] alcohol, life stressors and other things.” (GEN)

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treating COPD: best case, worst case

When asked about treating COPD, physicians sometimes described themselves as being in a tug of war with COPD

In this tug of war, it is the patients’ behavior that generally determines the treatment scenario for the physician

Physician COPD

BEST CASE:

Compliant Patient• No smoking

• Cooperative

• Responsible

WORST CASE:

Non-Compliant Patient• Self-sabotage behavior

• Demanding/resigned

• Absolved of responsibility

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best case scenario

Regarding the best case treatment scenario, physicians expressed positive, but contained emotions

Far less frequently physicians expressed feelings of elation and joy

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best case scenario

“Limited success. No over-joy. Glad it’s working, let’s move on” (PUD)

“Satisfied – a sense of accomplishment; not giddy, but happy; a sense of confidence and accomplishment. (GEN)

“Finally… one more battle I could win! Happy, but suspicious about what's going to happen next” (GEN)

“I'm relieved/happy; I feel more valuable” (GEN)

“Generally [with COPD] I'm tired out, my day's been long, and I just want to go home; it's a fleeting moment when you have a positive impact” (GEN)

“Leaning forward: progressive like me. Methodical, organized, strategic plan” (PUD)

“no frou-frou” (GEN)

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best case scenario (cont’d)

“It's very positive; let the party begin” (GEN)

“Full of joy; happy because patient can come close to carrying on their normal routine” (GEN)

“Simple emotion of joy - pure unleashed joy. No negatives, nothing down. Joy. Elation. Relief after feeling imprisoned by something. Release from burden.” (GEN)

“Exhilarated. Joy. Big element of satisfaction” (GEN)

“I nailed it...I was successful” (GEN)

“Top of the hill happy. A little burst of joy” (PUD)

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II. brand perceptions

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combivent reactions

• Combivent perceptions are somewhat mixed

• Many consider Combivent a reliable, proven therapy – a likeable, ‘trusted partner’.

• Others perceive Combivent as an awkward therapy combination of inferior efficacy, old and outdated, vulnerable to competition.

• Most physicians feel comfortable and/or confident when prescribing Combivent

• Others feel conflicted - they “can do better” for their patients

• Most physicians agreed that Combivent’s strength is in its ability to provide short term relief by rapidly opening airways

• Several spoke to Combivent’s role in bringing control to more desperate patient episodes (can’t breathe)

• Several referred to it as a security blanket for patients

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combivent reactions

Positive/neutral Combivent associations:

• Combination therapy

• Speed (immediate relief, burst of air)

• Reliable, dependable

• Security blanket, trusted companion (especially for patients)

• Powerful, respectable

Negative Combivent associations:

• Older, dated

• Cumbersome (not the elegant pairing of therapies Advair has)

• Sense of anxiety, frenzy (where patients are when taking Combivent)

• Limited application (ST symptom relief)

• Risk of overuse, underuse Confidential

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combivent reactions (cont’d)

GENERALISTS

• More likely to think Combivent has significant short term and long term benefit

• More likely to think of Combivent as an older but still respectable, prominent component of therapy

SPECIALISTS

• More likely to see Combivent as limited to short term benefit (but still useful)

• More likely to see as outdated and less relevant as a strategic solution (although nice to have around)

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advair reactions

Physician associations with Advair were generally very positive

• Though much of this appears to be a halo effect from Advair’s dramatic success in Asthma.

Frequently during interviews physicians afforded Advair benefits in COPD that in fact, when probed specifically, are applicable more to Advair in asthma.

• Even when re-directed to think of Advair in COPD, physicians slipped back into thinking of Advair within its broader asthma indication.

• These physicians described Advair as strong, dependable able to get the job done (well) and a good team player

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advair reactions

Specialists are more likely to be suspicious of Advair's presence in COPD treatment

• … question Advair leveraging asthma success in COPD

• more likely to describe Advair as flashy, aggressive and showy

In general, Advair was perceived as a strong and effective combination therapy

• Its ease of use and additional control for both patients and physicians (delivery, dosing, dose tracking within device, etc.) drives significant positive feelings, and the Advair inhaler is a gold standard for delivery.

Physicians generally expressed a sense of confidence and comfort about prescribing Advair

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advair reactions

Positive/neutral Advair associations:

• Synergistic short and long term therapeutic components – elegant design

• Strength, sustainability

• Convenience (delivery device, 2 in 1 therapeutic design, twice a day dosing)

• Efficacious (relatively consistent mild impact on patients’ condition)

• Impact (moderate) on functionality

• Sense of calm, consistent comfort

Negative Advair associations:

• Symptomatic focus - inability to modify disease course

• Number of patients that don’t respond

• Concern re: Serevent, risk of toxicity

• Something is not quite right – off kilter (in COPD) Confidential

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advair reactions (cont’d)

SPECIALISTS

• More suspicious of Advair's presence in COPD treatment

• More likely to value/see impact of COPD targeted MOA

• Spiriva as [better] alternative to Advair

• More likely to see Advair as a gamble in COPD

GENERALISTS

• More likely to consider Advair COPD ‘standard of care’

• Less likely to tease out patients’ asthma vs. COPD disease components

• It keeps on working – hits the target

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spiriva reactions

• Physician associations with Spiriva were generally quite positive

• Though much of this was related to its position as newest therapy

• Physicians’ understanding of Spiriva’s competitive advantages, etc. depends greatly upon their personal exposure to Spiriva

• Most physicians have limited exposure to Spiriva

• It tends to be used in most difficult COPD patients

• Most use it in combination with other therapies

• Those with the greatest understanding of Spiriva consider its greatest benefit to be its modification of the disease course

• Others see its once a day dosing as the biggest advantage (convenience, compliance, simplicity)

• Interestingly, many physicians seemed to rethink Spiriva's application/role and their use of Spiriva when discussing it's targeted (COPD) nature vs. Advair

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spiriva reactions

Physicians, especially those with the most knowledge of Spiriva, were much more excited about prescribing Spiriva than either of the other two therapies

• Several physicians spoke of feeling technically savvy, cutting edge, enthusiastic when prescribing Spiriva

• One suggested he felt like a pioneer when prescribing it

Spiriva is seen as the smart new kid on the block with a bright future

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spiriva reactions

Positive/neutral Spiriva associations:

• Bold, innovative, powerful

• Able to change course of disease

• Able to impact patient functionality ("the key to opening up a new lifestyle for my patients“)

• Elegant, convenient (single integrated therapy)

• Scientific, special, exciting

• Progress (technical)

• Becomes stronger over time

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spiriva reactions

Negative Spiriva associations:

• Unproven

• Unknown/unclear (application, role)

• Slow (to take effect)

• Add-on to current regimens

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spiriva reactions (cont’d)

GENERALISTS

• Unsure of where Spiriva fits in – assume it is a technological advancement and has a role but…

• Often perceived Spiriva as an 'add on' therapy (add on to Advair) driving incremental improvements

• More likely to use Spiriva with COPD patients not responding (well) to other therapies

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spiriva reactions (cont’d)

SPECIALISTS

• More likely to appreciate Spiriva’s pathophysiologic impact

• More likely to appreciate the benefits of Spiriva’s COPD targeted MOA

• More likely to see the limitations of Advair in treating COPD patients

• More likely to see Spiriva’s promise as a COPD therapy – young but growing into strong, powerful competitor

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spiriva window

The Spiriva window proxy image was well received but was not consistently attributed to a specific COPD brand

Those who saw the airflow as a gust (episode) of air were more likely to attribute the image to Combivent

• Immediate air flow, a sudden burst of air, Combivent relief

Those who saw an abundance of allergens were more likely to attribute the image to Advair

• Advair use for allergic asthma

Those who saw an open window and air moving freely in and out often associated the image with Spiriva

• Spiriva applicable to COPD air trapping

• COPD patients prefer to sit near open windows

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improvements for patients

The most frequently mentioned impact for patients of desired improvements in therapy were as follows:

• Freedom: (progressive scale) - freedom from oxygen, from bed/recliner, from home (being homebound), solitude, exclusion from family/social activities

• Mobility: ability to walk to mailbox, walk around block, go to the Mall, grocery shop

• Stamina/strength: can stand/shop/walk for periods of time

• Hope: for life, activities, QoL

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improvements for patients

The unsolicited impact for physicians mentioned included:

• Sense of power to impact

• Enthusiasm, hope

• Freedom from COPD status quo

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Conclusion

1. A hierarchy of emotional and social/self-expressive needs exists

in the treatment of COPD for both physicians and patients

2. The intensity of desired emotional and social/self-expressive

benefits is restrained by the progressive nature of COPD and

irresponsible patient behavior

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patient benefits hierarchy

functional emotional

social/

self-expressive

QoL HAPPINESS/JOY BELONGING/ACCEPTANCE

MOBILITY FREEDOM INDEPENDENCE

STAMINA/STRENGTH HOPE CONFIDENCE

ESTEEM

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physician benefits hierarchy

emotional

Social/

self-expressive

ENTHUSIASM CONFIDENCE

SATISFACTION/CONTENTMENT EFFECTIVE/SUCCESSFUL

EMPOWERMENT ESTEEM

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physician barriers

Self-expressive: I can’t be a successful/good doctor

Emotional: I can’t make a difference, impotent

Functional: inadequate therapy

The combination of COPD and irresponsible patients stymies

physicians at every level:

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conclusion

1. A hierarchy of emotional and social/self-expressive needs exists for both

physicians and patients in the treatment of COPD

2. The intensity of desired emotional and social/self-expressive benefits is

restrained by the progressive nature of COPD and lack of patient

compliance

3. The pharmaceutical brands in COPD are perceived differently,

but no brand has “staked out” any of the emotional or social/self-

expressive high ground

4. Brands currently only speak to patient benefits

5. No brand currently addresses emotional or social/self-expressive

physician needs

6. Spiriva is best positioned to address these emotional and

social/self-expressive needs

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Advair: physician-directed imagery

Advair is communicating to physicians with patient-based, functional

imagery

COPD ASTHMA

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Spiriva physician-directed imagery

Spiriva is communicating to physicians with abstract + patient based,

functional imagery with a touch of generic emotion (joy/happiness)

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opportunity

Consumer

based

Physician

based

functional e

motio

nal

Take the emotional

high-ground for

Spiriva among both

physicians and

patients

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risk

• Care must be taken to avoid the trap of depicting generic, banal emotional and social/self-expressive imagery

• Imagery alone is unlikely to have the specificity to communicate the particular emotional and self-expressive benefits that are optimal for compelling and differentiated communications

• However, imagery with cogent titles achieves the desired specificity

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core criteria

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physician imagery that connects

• Target physician with physician imagery

• (need not be exclusive of patient imagery)

• Don’t exaggerate emotions

• Leverage key emotional and self-expressive benefits:

confident/bold

contentment/satisfaction

esteem

Illustrative only

Now, you

can feel

better about

treating

COPD.

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abstract imagery

• Consider abstract imagery carefully

• Physicians in general struggle with

abstract imagery

• Abstract imagery must allow physicians

immediately to deduce meaning and

relevance to COPD

• Again, a title or subtitle is advisable to

increase the likelihood of desired

interpretation

• Based on responses and comments

made, consider depicting Spiriva as the

key to a new beginning in COPD

treatment for both doctors and patients

Illustrative only

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other considerations

• Signal (especially to generalists) that

Spiriva is state-of-the-art science

targeted at COPD

• Reinforce that Asthma is different from

COPD

• Advair targets Asthma

• Spiriva designed for COPD

• Spiriva offers substantive, steady

improvement and is worth delayed

impactIllustrative only

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consumer imagery that connects

Drive emotional and self-expressive benefits

• Avoid functional imagery of doing tasks

alone (that’s Advair, leave them with it)

• Avoid trap of depicting freedom or

happiness/joy in traditional, generic

ways

• It’s over the top for COPD/not

credible

• It’s not differentiated

• Define emotions in terms of inclusion

and role-recapture

esteem

belonging/acceptance

happiness/joy

Be the grand

dad she

deserves.

The rewards

are worth it.

She’s worth

it.

Illustrative only

Be the

partner

he

married.

He needs

you.Confidential

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if Spiriva were our brand…

Physician communications hierarchy:

physician benefit

patient benefit

Spiriva reason to believe

You went into medicine to help people

and it gives you satisfaction to do so.

Spiriva enables you…

…to return more of your COPD patients to

their important and rewarding roles as

parents, grandparents, friends and

citizens…

…because it is the most state-of-the-art

therapy specifically designed to target

COPD that we have…

The Conceptual Story

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recommended brand personality

• Understated sophistication

• Strong & confident

• Smart & focused

…contrasts with Advair liabilities of:

• loud & flashy

• unfocused

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final thought

• If DTC campaign is an opportunity, evaluate the cost/benefit of targeting caregivers (e.g., spouses, children) as well as patients

• They may be more motivated to seek change in therapy [benefits Spiriva]

• May help generalists overcome sense of futility/resignation

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contact information

SIX DEGREES LLC

14500 North Northsight Boulevard

Suite 233

Scottsdale, Arizona 85260

Phone: 480.627.9850

Fax: 480.627.9851

www.6dg.com

Contact persons: Frank Schab or Elaine Leonetti

Contact phone: 480.627.9850

Contact emails: fschab@6dgs.com or eleonetti@6dgs.com

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