Use and Perception of Scientific Medical Reprints

TITLE OF PRESENTATION Use and Perception of Scientific Medical Reprints Elsevier Health Panel Research Report Date August 2017

I 2 Report Structure Research Objectives, Methodology & Sample Executive Summary Key Findings Section 1 Current Usage Section 2 Perception of Reprints Section 3 Attitudes and Development Appendices

3 II Research Objectives, Methodology and Sampling Research Objective To understand how global healthcare professionals are acquiring, using, and judging scientific medical reprints and which future developments they would find useful. Methodology A 10-15 minute online survey with healthcare professionals both from the Elsevier Health Panel and Elsevier s internal lists. The questionnaire was developed by Elsevier in partnership with DJS Research. Research participants were invited to take part in the survey by email and participation was either incentivised with 300 panel points for panellists or entry into a prize draw to win one of six Apple watches for non-panellists. A total of 1,611 respondents from 14 countries representing Asia, Europe, Middle East, Latin America, and USA are included. Fieldwork was conducted between the 23 rd May and 19 th June 2017. Sampling Each market within each region has been weighted equally to achieve a level total figure at a regional level. EMEA and Latin America data has also been sub-sampled to ensure weighting efficiency. APAC has not been sub-sampled due to the small base size of SEA. Leaving the base as it is keeps a weighting efficiency close to the recommended threshold, and keeps the bases higher. The US data has not been sub-sampled or weighted. See Appendices for full listing of respondent data.

III 4 Executive Summary Usage Behavior Physicians obtain reprints in electronic format more frequently than paper Obtaining reprints via the internet is the most frequent, and most preferred method In non-english speaking markets, reading reprints in native language is low Around half of physicians read most of the reprints they obtain Highlight: Reprints are obtained less frequently in Germany compared to other markets, and only a small proportion claim they read all of the reprints they obtain. Preferences Almost half of physicians prefer e-reprints vs paper reprints (though German physicians have an equal preference for both) Downloadable PDFs are the preferred format for reprints in all markets except Germany (where print paper reprints are preferred) Interest in reading the whole reprint article increases when the content is highly relevant to their speciality (otherwise, reading the abstract and/or conclusion is more common) Highlight: Physicians in Korea tend to read bits of articles only; they are more likely to read the whole article if it is highly relevant, but the increase vs a general article is modest.

IIII 5 Executive Summary, continued Attitudes & Future Development The majority find reprints useful, reliable and a good way of keeping up to date Having free access to the selected article is considered the most useful additional feature The majority would be interested in services such as Online Article Services accessible reprint repositories supported by sponsors Medical articles and guidelines (EMEA, LA & APAC) and clinical trials (US) are the most useful information sources when making prescription decisions Highlight: Half of US physicians are willing to accept a reprint from a Pharma Sales Representative even if its value required acceptance according to the Sunshine Act. The complete 106 slide research study is available on request, detailing results by country and region. Contact your Elsevier representative for more information. Interested in seeing how Elsevier s digital and web reprint formats work? Try our free Elsevier ereprint Demo: http://demo.elsevierreprint.com Go to the Elsevier Content Services Reprints website for all of our solutions and contact details: http://reprints.elsevier.com http://www.elsmediakits.com/international/display

TITLE OF PRESENTATION Section 1: Current Usage Behavior Frequency, Amount, Formats and Readership Presented By Date

7 1 Globally the majority of healthcare professionals do read scientific reprints The key reason for not reading reprints is because physicians never receive them. Do you read scientific articles in reprint format? 13% 13% 12% 12% 13% Why don t you read article reprints? 7% 21% 7% 7% 20% 87% 87% 88% 88% 87% 38% EMEA LA Asia USA Overall Yes No Not interesting Too commercial I never receive them I don't have time Other Don't know Results of mean averages over the four regions.

2 8 Reprints are usually obtained online, from sponsored sources Reprints are not often obtained from conferences or symposia. Indicate how frequently you obtain article reprints from the following sources % of respondents GLOBAL RESULT On the Internet / online sponsored by 3rd party (i.e. pharmaceutical companies, etc) 5% 20% 24% 31% 20% From colleagues 12% 22% 34% 28% From a Sales Rep visiting hospital/clinic/office 13% 22% 45% 19% From a Sales Rep at a conference 5% 16% 59% 19% Symposia 11% 63% 20% Daily Weekly Monthly Bi-monthly or less Never Results of mean averages from all regions.

3 9 Reprints are more likely to be obtained in electronic formats How many reprints and in which format do you obtain each month? Average Total Paper Electronic Overall 13 4 9 EMEA 11 3 8 LA 13 3 10 Asia 13 3 9 USA 16 6 10 Country Examples 15 4 12 8 2 6

4 10 The format does not alter the probability of readership greatly. How many of the reprints that you obtain do you read? GLOBAL RESULT I read all the reprints that I obtain I read most of the reprints I read half of them I only read a few selected reprints I never read them 43% % respondents 46% Results of mean averages from all regions. % of respondents 22% 20% 20% 15% 16% 17% 0% 0% Paper Electronic

TITLE OF PRESENTATION Section 2: Preferences Presented By Date

5 12 Electronic reprints are preferred in all markets, except Germany. What type of reprints do you prefer? Sample Market Highlights GLOBAL RESULT % of respondents (mean average) No preference 18% Paper Reprints 31% UK CN DE 27% 27% 19% 26% 14% 46% 55% 43% 43% E-Reprints 51% USA 21% 33% 45% AUS 18% 29% 53% Those who prefer paper reprints are more likely to read a few reprints a month whereas those who prefer E-Reprints are likely to read more. LA 21% 21% 57% No preference Electronic Paper

6 13 Downloadable PDFs are the most preferred format, mobile apps the least. Provide your level of preference for the different scientific article reprint formats GLOBAL RESULT % of respondents Downloadable PDF (Saving PDF for offline use and printing) 47% 35% 15% 3% Print - Paper Reprints 31% 18% 11% 40% e-print for ipad & other mobile devices combined with downloadable PDFs for offline use and printing 17% 29% 30% 24% e-print for ipad & other mobile devices 5% 18% 45% 32% Results of mean averages from all regions. 1st 2nd 3rd 4th Stated order of preference

7 14 Desire and use of local language only paper reprints is low globally. Indicate your preference of paper reprints in these languages English only Use in both languages Native language only Overall 18% 78% 5% APAC 21% 75% 4% EMEA LA 13% 21% 82% 76% 6% 4% 2015 Native language only preference is less frequent than in 2015 (especially in France and Latin America) English only Mix of English and Native My native language only

TITLE OF PRESENTATION Section 3: Future Developments Features and functionality healthcare professionals desire. Presented By Date

8 16 The likelihood of reading the whole article is higher if it is relevant If the reprint is relevant to your specialty, which parts of the reprint do you read? 100% 90% 80% 70% 60% 78% 88% 85% 73% 81% Example from USA of difference in reading behavior when reprints are not relevant to their specialty. 48% 48% 19% 21% 40% 50% 40% 30% I read the whole article Abstract Main body Tables and figures Conclusion 20% 10% 15% 17% 13% 9% 10% 8% 11% 10% 6% 8% 5% 5% 5% 7% 7% 15% 17% 13% 9% 10% 0% I read the whole article Abstract Main body Tables and figures Conclusion EMEA LatAm USA Asia Overall

9 17 Guidelines are considered most useful for prescribing treatments Clinical trials have the biggest difference in perceived value across the regions. Which information types do you find most useful when deciding whether to prescribe a drug? 0% 10% 20% 30% 40% 50% 60% 70% 80% USA EMEA Asia Guidelines Clinical trials Medical Journals/articles Recommendation from colleague Medical congresses/meetings Medical books Medical society websites Online clinicians communities Paid online clinical reference portals Info from pharma sales reps Google or other search engines Other 25% 26% 19% 26% 24% 14% 34% 12% 9% 12% 4% 10% 28% 5% 6% 2% 12% 12% 3% 55% 52% 58% 74% 73%

10 18 Over half would find online access to the selected reprint very useful Additional features / functionalities that would be most useful in future electronic reprints % of respondents GLOBAL RESULT Have free access to the selected article on independent publisher website 4% 5% 25% 66% Highlights of main take-aways of the article 3% 7% 30% 59% Comments/discussion forum with peers 2% 5% 11% 42% 41% Slides/Tables for embedding into presentations 7% 17% 45% 27% Sharing of articles with peers/colleagues 2% 8% 14% 41% 34% Video interviews with one of the authors 6% 44% 14% 21% 23% 19% Results of mean averages from all regions. Video interviews with KOLs Translation to other languages Don t know 1 - Not at all useful 6% 10% 8% 9% 2 - Not very useful 15% 13% 21% 22% 3 - Neither useful nor not useful 37% 33% 4 - Somewhat useful 15% 14% 5 - Very useful

11 19 A large portion of respondents are interested in online reprint repositories How interested would you be in a service like Online Article Services where physicians can access reprints from a central source? EMEA & LA Asia USA 60% 53% 50% 45% 40% 35% 38% 30% 20% 10% 0% 1% 7% 3% 2% 1 - Not at all interested 2 - Somewhat uninterested 6% 7% 3 - Neither interested nor uninterested 4 - Somewhat interested 5 - Very interested

TITLE OF PRESENTATION Appendices Presented By Date

Appendix 21 APAC US EMEALA Sample breakdown weighted Market Source of sample Language Number of completes Germany Elsevier Health Panel German 61 UK English 61 France Elsevier Health Panel & Elsevier s internal lists French 61 Spain Spanish 61 Poland Polish 61 Elsevier s internal lists Latin America Spanish 61 US Elsevier s internal lists English 42 Australia / New Zealand English 49 India English 49 Korea Korean 49 Hong Kong (China) English 2 China (China) Elsevier s internal lists Simplified Chinese 34 Taiwan (China) English 13 Malaysia (SEA) English 33 Indonesia (SEA) English 2 Singapore (SEA) English 14 49 (CH / TW / HK) 49 (SEA) 654 overall 366 246

Appendix 22 APAC US EMEALA Sample breakdown unweighted Market Source of sample Language Number of completes Germany Elsevier Health Panel German 42 UK English 37 France Elsevier Health Panel & Elsevier s internal lists French 259 Spain Spanish 462 Poland Polish 183 Elsevier s internal lists Latin America Spanish 340 US Elsevier s internal lists English 42 Australia / New Zealand English 62 India English 30 Korea Korean 31 Hong Kong (China) English 4 China (China) Elsevier s internal lists Simplified Chinese 68 Taiwan (China) English 27 Malaysia (SEA) English 16 Indonesia (SEA) English 1 Singapore (SEA) English 7 99 (CH / TW / HK) 24 (SEA) 1611 overall 1323 246

Appendix 23 The sample is comprised of two-thirds medical specialists and one-fifth general practitioners. Occupation % of respondents Setting of Practice % of respondents General Practioner Medical Specialist 26% 7% 19% 60% 62% 73% A government hospital Your own medical practice / office A privately-owned hospital 5% 20% 12% 17% 31% 33% 28% 41% 48% Other 14% 31% 7% An academic / research facility 14% 21% 20% Top 5 medical specialties* EMEALA US Surgery (13%) Dermatology (16%) APAC Surgery (23%) IM (10%) EMG* (16%) Paediatrics (8%) Neurology (8%) Urology (16%) Cardiology (6%) Dermatology (7%) Oncology (12%) Dermatology (6%) Anaesthetics (6%) Neurology (8%) Radiology (5%) A government clinic I m still in training Other 13% 7% 3% 3% 7% 4% 15% 8% 26% *Endocrine, Metabolic & Genetic Disorders

TITLE OF PRESENTATION Thank you for reading Request the full research report from your Elsevier representative and dig into the full regional and country level opinions and behavior of physicians. Presented By Date