INTRODUCTION

The value of marketing is sometimes not obvious to physicians. But, without marketing, physicians would have a more difficult time learning about many of the treatments they use. Marketing allows manufacturers to educate consumers and/or physicians about the products they make and their benefits. A poor product will not succeed with marketing alone, but many good products have failed as a result of lack of marketing, or from poor marketing.

So, what constitutes good marketing? Concisely, effective marketing helps the physician provide a better outcome for the patient by persuading her or him to use the promoted product. But, when digging just a little deeper into that statement, one will see the challenges of marketing. Which physicians are targeted for promotion? What outcome is sought? Which patient is the right one for this product, likely to have the targeted condition, and seen by the targeted physician? What product should the manufacturer promote? What makes a product worthy of promotion and likely to succeed, and conversely which ones should not be promoted to physicians? Done well, and for a good product, marketing can be a win for manufacturers, physicians, and, ultimately, for the patient.

The physician’s challenge is to sort out from a number of product marketing efforts those products deserving of support. How can the physician make that determination? First, with an admitted bias, it seems that a larger company has more resources to commit to testing to prove their products worthy of support, and more to risk if they were to market a product that does not meet high standards.

There are three categories of concern for any health product, whether intended for skin health or for any other health condition. These categories are safety, efficacy, and compliance. This framework works well for the physician trying to decide which products to support. The manufacturer must make a product that performs well in each regard and persuade the professional and the patient of that fact.

SAFETY

Safety testing done by a research-driven company begins with a four-step process of selecting the right ingredients. First, screening is done on potential new ingredients for a variety of acute and/or chronic toxic endpoints. Examples of screening include tests for acute toxicity, neurotoxicity, developmental and reproductive toxicity, mutagenicity, carcinogenicity, eye and skin irritation, and skin allergic response.

Once a critical toxic event is identified (generally the toxic effect seen at the lower doses of the ingredient), dose–response studies are used to determine the highest dose at which no toxicity is seen. Next, use of a product is studied to calculate the actual exposure to the ingredient a consumer will encounter. Finally, a mathematical analysis will determine a margin of safety, which would compare the level of an ingredient where no adverse event was detected with the expected level of human exposure usage in the real world. If the margin of safety is high, the ingredient can be used.

This ingredient testing is just an example of the thoroughness with which leading companies test products. In addition to ingredient testing, before formulating a product, testing is done for ecological safety. Specifically, testing is done for ecotoxicity and biodegradability. It is not enough to determine that a product has a high margin of safety in use—the environment also needs to be considered and protected.

Finally, a finished product will be tested for irritancy and sensitization potential. Irritancy is tested for both diluted and undiluted products in repeated exposure. Sensitization is tested using models such as a repeat insult patch test. Because light can exacerbate allergic responses in some instances, testing combining ingredient exposure with light exposure is carried out. The product will be tested for stability (Does it work as labeled even after exposure to extreme temperature?) and to be sure the product and packaging prevent bacterial growth from occurring in real world circumstances.

EFFICACY

Efficacy is evaluated in numerous ways. There are two primary categories of measurement for ‘antiaging’ moisturizers: ‘health’ benefits (how good a moisturizer it is) and ‘beauty’ benefits (its effect on appearance of fine lines and wrinkles, skin tone and texture, etc.). For ‘health’ benefits, transepidermal water loss (TEWL) can be measured objectively, as can capacitance, an indirect measure with a correlation to moisturizer efficacy. Expert grading is carried out to evaluate visual dryness and redness.

In the beauty category, leading edge measurement uses digital photography with carefully controlled lighting and facial positioning which allows either naïve graders or expert graders to view side by side pre- and post-treatment images to evaluate improvement. Computer imaging can also be used to evaluate skin topography and tonality changes. To understand how advanced corporate progress is in this regard, the Canfield Visia® computerized imaging system was developed from Procter & Gamble technology. Other measures include the traditional skin turnover evaluation using dye and tracking number of days until the dye is not visible. This can be evaluated either by a trained grader or by using imaging technology to identify the presence of dye.

The leaders in the field, who have written chapters elsewhere in this volume, should be relied upon to understand how these measurements work. However, from a marketing perspective, how can a provider digest what proof is offered if they are not expert in all the measurement methodologies? The following questions may aid in evaluating the quality of the data:

COMPLIANCE

Compliance in the category of cosmeceuticals is most often achieved when the final product is aesthetically pleasing and can be considered overall as a cosmetically elegant product (Fig. 4.1). Such attributes as having superior packaging, a nice feel and spread during application, absorbing readily into the skin, and improving the appearance of the skin immediately in a cosmetic or superficial way are all important when it comes to product usage compliance.

Fig. 4.1 The aesthetics of a cosmeceutical influences compliance

Patients are more inclined to learn about and experience the long-term benefits of a product when there is an initial attraction to the aesthetics and an instant gratification benefit. Some examples of ingredients that provide acute benefits are light diffusers (e.g. titanium dioxide) and visual opacifiers (e.g. micropigments) which are used to diffuse or reflect light away from the skin’s surface, helping to reduce the appearance of fine lines and wrinkles and reduce shininess.