Historically, health care systems have been based on complex interactions between power and knowledge (1).
In the not too distant past, the physician-patient relationship was dominated by the physician as the holder of
knowledge and thus the holder of power \u2013\u2013 the doctor spoke, the patient listened. It was not obvious that the patient
had a right to know, a right to be heard, and a right to have an opinion about their own disease. Today, the balance
of power has changed. Once simply a passive end-user, the healthcare consumer has now become a central part of
a decision-making process that is revolutionizing global health.

Providers on the front lines of health care deliver y experience this
phenomenon ever y day: "I think I\u2019ve got this condition. Can you refer
me to this specialist so that I can have this treatment." "Look what
I\u2019ve found on the Internet, that treatment you gave me is wrong."
"I understand this new medication has fewer side effects," etc.

This shift has occurred for a variety of social, economic, demographic,
technological and political reasons, but also because the health care
needs of the American population have changed \u2013\u2013 from predominately
acute, episodic care to care for chronic conditions. Unlike acute episodic
care, effective care of the chronically ill is characterized by informed,
shared decision making and development of patient knowledge, skills
needed for self-management of illness and preventive behaviors.

Increasingly, patients are seeking out \u2014 not simply receiving health information. From basic science to diagnosis
to health promotion, there is now a growing "market" for health information. With a focus on the end-consumer,
the Internet is accelerating this trend. Web sites, such as Web MD (more than 15 million visitors ever y month),
are ser ving as new "third party" information intermediaries that consumers seek out by the millions. In fact, according
to healthcare consultant Lyn Siegel, more than 50% of adults who go on the web use it for healthcare information.

As a result, patients and their families are now better educated and informed about their health care than ever before. While a more informed patient redresses the longstanding power imbalance, it also contributes to complexity. Mov\u00e9o believes the challenge facing health care brand owners, whether they be health care providers or health and wellness manufacturers, is the same \u2013\u2013 to harness the growing knowledge of patients and their desire to manage their own condition. This new

paradigm, which we callInformed Patient Marketing (IPM), offers real opportunities to use health information and its deliver y as an important strategic tool.

Once simply a passive
end-user, the healthcare
consumer has now become
a central part of a
decision-making process
that is revolutionizing
global health.

Consumers now
actively seek
information from
third party
information
intermediaries

As patients increasingly turn to the growing volume of accessible health care information, direct-to-consumer advertising has widely been employed throughout our healthcare system \u2013\u2013 managed care organizations, doctors, pharmaceutical companies and health and wellness manufacturers have joined hospitals as direct advertisers to consumers.

Some critics of direct-to-consumer advertising have suggested that health care is not like toothpaste or cereal \u2013\u2013 If a
patient isn\u2019t bothered by a problem, why create demand by driving them to the physician? Yet studies have found that
consumerslike direct-to-consumer advertising and benefit from it. Research indicates that it helps educate patients
about medical conditions and treatment options, encourages dialogue between patients and physicians, prompts
people to discuss illnesses with their physicians for the first time and others to do so earlier than they other wise
would have, and promotes improved compliance with physician-prescribed treatments.

A recent study released by the National Health Council, whose constituency includes nearly 50 of the countr y\u2019s leading patient organizations representing nearly 100 million Americans with chronic diseases and/or disabilities, notes the positive impact of this type of advertising, "The more information patients have, the more effective they can be in working with their doctor to make decisions about their health care\u2026The Council recognizes that Direct to Consumer advertising provides important information to consumers and patients, which is beneficial to their health."(2).

Since direct-to-consumer advertising is consistent with the whole trend toward consumer empowerment, it is likely that aggressive campaigns to reach consumers will continue to grow. This will not only be true of pharmaceutical companies, the established leaders in this categor y of advertising, but increasingly with others up and down the healthcare value chain.

In short, they are increasingly affluent, insured and interested in the best (and more expensive) options (3).
IPM practitioners must recognize that health care consumers are better informed, more demanding and (thanks
to direct to consumer advertising) increasingly brand-sensitive. While brand recognition will remain the "Holy Grail"
of direct to consumer advertising, brand managers must also recognize that other key factors, such as faith in the
product, proof of results and believability of advertising claims will stem from a greater understanding IPM as an
evolving paradigm.

IPM practitioners must
recognize that health care
consumers are better
informed, more demanding
and (thanks to direct to
consumer advertising)