Bruce Lehman’s been in the advertising game since the late 1970s, but the principal at Lehman Millet, a Boston-based marketing and communications agency, has been focused on the medical device and diagnostics industry solely since the 1990s, making it a powerful player in the industry despite its relatively small size.

Today, Lehman Millet‘s client mix includes biotechnology, biomaterials and specialty pharmaceutical firms, along with its core medical device customers. MassDevice: spoke with Lehman, 59, about an ever-present question: “How, exactly, do you market a medical device?”

MassDevice: What’s the biggest challenge you face in marketing medical technologies?

Bruce Lehman: Your number one challenge is always the fact that you’re marketing to the healthcare professional. There are very few professions that are more conservative when it comes to changing behavior than physicians. They are trained to do no harm, to be very dependent on clinical data. They are naturally, and should be, more comfortable with tried-and-true, rather than “try something new,” and with few exceptions most of them are very conservative. The number one challenge of any company that is trying to advance medicine or change the way it’s practiced is to find ways to help health care professionals change their behavior

MassDevice: Can that be accomplished strictly through messaging?

BL: It starts with making sure that you have been able to demonstrate very vigorously that the products will do what you say they will do. You’ve gone through FDA or CE or both, you’ve had very rigorous trials and the data supports the claims that you intend to make with your product. That’s no different than big pharma. What is different with the companies in the medical device and diagnostics arena is that this isn’t just about writing a prescription and monitoring the patient. This is often about the tactile experience, in the case of surgical products. It’s not just about, “This product will do what say what we do.” It’s about the customer’s technique, skill and capability to use the product. In the case of monitoring or diagnostics, it’s about their ability to monitor results. In the case of biomaterials, it’s about their ability to deliver the products as intended.

To do this you have to start with data. Then, generally, you have to include experience in some way, shape or form. The key second step to the adoption of innovation is trial. I don’t mean clinical trials, I mean that you need alpha- and beta-users to experience the products, peer-to-peer influencers and user networks. There will increasingly be an appropriate role for the consumer to play in this as well. I might add that unlike big pharma, with many of these products the adoption process is multi-level and the influencers are varied. So, when you think about the marketing and communication associated with the adoption of these products, it is deep, it is rich and it’s a surround strategy. It includes awareness, education and experience.

No agency can do all of that, so what you see in the market segments that we serve is the company’s core competency is the development of thought leaders, opinion leaders, champions, clinical centers of excellence. They have to have core competencies in the training and education of their medical devices. So one reason medical device companies, as accounts for agencies, are so much smaller than big pharma or mainstream is that so much of the competency required to drive success resides in the companies themselves.

MassDevice: So your role is to use what they have to shape their message more clearly?

BL: Yes. It’s also to be as much of an objective third party as possible in helping them to acquire, assess and understand “voice of customer.” One thing that is exactly the same in medical technology as it is in consumer is that the decision to buy is a combination of the intellectual and the emotional. Even though in medical technology there is a significant dependence on the intellectual side, it is a data-driven process. But at the end of the day decisions are made emotionally as well.

One of the things medical device companies do not do as well as their colleagues in big pharma is believe in, appreciate and take advantage of the insight into what motivates their customers, from that emotional point of view. So we can help them there and ensure that the messaging that’s developed and the tactics that are used are within guidelines, are grounded in the rational side of the equation, are well within their approved labeling and claims, but can also extend the communication into the emotional side of their customers’ decision-making process.

MassDevice: Do you foresee a day when medical devices could go much deeper into direct-to-consumer advertising, like big pharma?

BL: We’ve already seen it, to a certain extent. It will never rival the spending of big pharma, and it’s not even appropriate that it should. The business models are different and the requirements are different. I think there’s up to $200 million spent in the direct-to-consumer space for medical devices, and that excludes areas that are considered more consumer plays, like infant formula, blood glucose meters, contact lenses, photochromic eyeglass lenses. They’re not included as medical devices, but in fact they are, so the numbers are actually a little bit higher than what Nielson reports, but they’re never going to approach the money spent by big pharma.

MassDevice: Are there any subsets of devices that are more marketing-friendly?

BL: Yes, I think there are. Let’s take a step back and look at what makes direct-to-consumer work. In big pharma it was easy. You started with chronic or prevalent conditions, massive patient populations on the order of 10s of millions. You had a product that had a lot of gross margin available to use — once a drug is on the market, it has something like a 90 percent gross margin. You had ease of professional endorsement, since you’re simply asking a physician to write a different word on a script. He’s not significantly changing his behavior. He’s making a different choice, and often there is no real substantial cost to the patient to make a change. Terrific ROI’s in that area.

When we look at products in terms of the medical devices or diagnostics arena, where do these exist? Chronic conditions are tough, because in many instances the surgical procedures are supposed to end the chronic condition. In terms of demographics, where you have millions of customers, you have diabetes, which is a good space, as is aesthetics, and you could argue total knee or hip replacement will be a big demographic for the orthopedic companies. The ease of professional endorsing is challenging, because in these instances you’re really asking the physician to consider changing the tools he uses in his practice, or to change the therapeutic treatment option that he’s been using for many years, not just write a different word on a piece of paper. So it’s much more difficult.

Having said that, we know that the first real area of medical devices that successfully marketed direct-to-consumers was blood glucose meters for diabetes. That diabetes category, over the last 10 years, has transformed into an almost consumer category. And not just with the meters, but with the delivery of insulin, with pumps and systems that combine monitoring and pumps. Also, in vision care, Lasik surgery was very successful in marketing directly to the consumer. When you look at what Stryker (NYSE:SYK) has done with knee implants, by bringing on Jack Nicklaus as a celebrity spokesman of total knee replacement, they followed the lead of the Lasik community with Tiger Woods.

So here are some areas where direct-to-consumer works well. Underlying these examples is that you have the opportunity to reach out to 10s of millions of patients. When the numbers get in the millions or less, it becomes much more difficult. I also see a lot of opportunity in the aesthetic market. Our agency is involved in the re-introduction of silicone breast implants, and direct-to-consumer was a component of that.

What you will see all instances is a surround strategy that begins with ensuring that the healthcare professional is, first, aware, highly educated and there is a substantial base of other healthcare professionals who have adopted the product. If you don’t take care of that first, going direct-to-consumer is a guaranteed formula for failure.