PR Marketing: Mystery Wrapped in a Riddle

Yesterday's post, "Marketing Disguised as PR", generated some interesting counterpoints and comments from friends in the blogosphere and on the PHARMA-MKTING discussion forum. Seems that I have hit upon something worthy of further discussion; hence this followup.

Fard Johnmar over at Healthcare Vox was the first to respond (see "Pharmaceutical Marketing = Pharmaceutical Public Relations").

The first issue that Fard raised was the primary role of PR and whether or not PR "plays second fiddle" to marketing. Fard says I asserted that the primary function of PR is to protect a company's image and damage control. Actually, what I said was "Public Relations (PR) is not just for managing a company's image and for damage control." This is a far cry from making a "primary function" claim.

PR Is No Second Fiddle
So, Fard and I are in agreement that PR does NOT play second fiddle to marketing. In fact, that was the main premise of my blog: PR is an important component of pharmaceutical marketing, albeit one that is cloaked in a mystery wrapped in a riddle -- in the sense that not nearly as much attention is paid to the "good, bad, and the ugly" aspects of PR marketing as there is to regular pharma marketing.

Not All PR Is Regulated
This leads to another point raised by Fard, who says "So, while one may argue that regulation is inadequate, the public relations profession isn'’t completely free from scrutiny." Fards points out:

"Public relations materials are assessed by internal pharmaceutical legal and regulatory teams, just like all other promotional items

"Fair balance must be included in all press releases mentioning a study, drug or device"

Yes, of course, if a pharma-sponsored PR piece mentions a drug brand name, fair balance is required. However, in my blog, I was talking ONLY about disease-awareness, unbranded PR, which does not mention a drug brand name.

I am not sure that fair balance is required in a PR piece that mentions a study, if only the scientific name of the drug is mentioned. Could be. I'll have to research that one.

Celebrity Endorsements
Are PR programs reviewed internally by legal/regulatory? Perhaps some of them are.

But there is undoubtedly a lot of PR activity -- such as arranging press interviews with key opinion leaders, celebrities and patients -- that is NOT reviewed internally. These spokespeople do NOT have to provide fair balance. They can say whatever pops into their heads and make the most outlandish endorsements with impunity. In addition, when celebrity endorsers in the pay of pharma companies appear on TV interview shows, there often is no disclosure that they are being paid by the sponsor!

Fard says:

"In addition, responsible public relations practitioners inform media about who is sponsoring a promotional effort and put them into contact with company spokespersons, upon request."

I will limit myself to saying that in a perfect world media would be informed about paid endorsements. That, however, is not the problem. Media also have to disclose the endorsement. So, we have two parties that need to voluntary do the right thing! If the probability of either party doing the right thing is 50%, what's the combined probability of both doing the right thing? [I don't know. I flunked probability class.]

No Guiding Principles = Possibility of Stricter Regulation
The problem is that we do not live in a perfect world where business people always do the right thing -- hence industry guidelines, ethical standards, and -- God forbid! -- government regulation. Where is the PR industry's "Guiding Principles of DTC PR Marketing?" Are they under the desk? Nope. Not there!

What Does "Buy" Mean?
The last issue Fard raises that I would to address is whether or not public relations "buy" media coverage. Let's take an analogy quiz:

PR "buying" media coverage is most like which of the following:

(1) Buying search words on Google
(2) Buying lunch for physicians in exchange for sitting in at a detail
(3) Buying an ice cream cone

The answer: 2

In the same way that sales reps "buy" -- or used to "buy" -- physician prescribing, PR people may "buy" media coverage. Of course, no physician worth a nickel would ever admit that they changed their prescribing habits just because they got a free lunch or a free pen -- but it happens! Similarly, no reporter will write a favorable story just because he/she was wined and dined at a press conference. What about taken out to a fancy dinner? Golf outing? Significant other included? How much of this goes on? We don't know -- that's why I say it's a mystery wrapped inside a riddle.

Traditional pharma marketing is much more transparent and pharma marketers are restrained from using such practices by laws, regulations, and industry guidelines. I don't know of any such regulation of PR marketing.

More Comments
Comments from Gopalkrishna Iyer, a member of the PHARMA-MKTING online discussion group:

Yes! Spin doctors are having a greater role in marketing of products.

This, primarily, is happening because of the higher levels of clutter that exists in the mindspace of doctors. Marketers are having to resort to more creative (???) ways of getting their message across and making it stick.

As put rightly in your post, "enhancing brand value is actually what marketing is all about" and one does put every idea to use in order to achieve that brand value.

So, whether one calls it "Patient Education" "Disease Awareness" "Disease Mongering" "Patient scaring" or PR, one must not forget that such media stories have always been part of the pharma marketers' arsenal. The hype created on so many vaccines, cholesterol, HRT etc. are classic examples.

However, in today's poverty stricken times (in terms hugely distinct advantages of new molecules and in terms of price pressures) marketers are increasingly covering up gaps in communication, creating pressure groups, winding up patients towards their brands and magnifying less significant aspects of disease and therapy through PR.

It is the sign of our times, very much similar to the "gamesmanship" we witness in the sports arena. It is only such drama that has the power to add much needed value to a brand. It is as ethical or unethical as sponsoring a clinical study and then publishing it, or sponsoring a CME on a topic of your advantage over cocktails and dinner.

The greatest influencer of prescriptions still remains the good old scientific data from pre and post marketing clinical trials. The fundamental four of Efficacy, Safety, Convenience & Cost are what finally matters to the physician and patient.

To think that physicians would change their prescribing habits because of newspaper articles or television programs would be simplistic, both, from the marketers' point of view and the observers'. Yes! it will have some favourable impact on the brands it seeks to indirectly promote, and that can only be achieved by a long and sustained campaign. I also agree that PR can accelerate the marketing process and help maximise sales. Well executed communications do have the power to inspire, to motivate and trigger action. PR can also bring issues out of the closet (Erectile dysfunction) and result in brands such as Viagra become dictionary words.

Whether such PR should be brought within the purview of the ethics committees is another issue altogether. Finally, marketing communications is all about creating meaningful reasons to use your product(s).

Marketing Disguised as PR

Public Relations (PR) is not just for managing a company's image and for damage control. It's also used as an adjunct to marketing products and sometimes the distinction is blurred.

PR is used by the pharmaceutical industry to:

• Improve the industry's reputation
• Improve a pharma company's reputation
• "Clearly Displaying" -- ie, promoting -- a Product's Purpose, Benefits and Value
• "Earning" -- ie, buying -- Media Coverage For Your Health Story
• "Development of a Public Education Campaign to Increase Awareness," most often of a "medical condition" for which a drug is indicated
• Buttress the "Value of [a company's] Pipeline" -- ie, generate investor interest in the company's stock
• Aid lobbying efforts ("An Integral And Necessary Part Of The Lobbying Mix") -- ie, debunk or promote social programs and legislative actions that will affect the drug industry (eg. Medicare, Consumer Directed Healthcare)
• Boost employee morale
• Last but not least, Manage a crisis -- eg, Merck spent about $52 million in 2005 on non-product, image advertising in its "Putting Patients First" PR campaign (see "Patients Come First?")
  

I compiled this list based on presentations planned for an upcoming industry conference ("2nd Annual Pharmaceutical PR & Communications Summit"), the tagline of which summarizes the three main functions of PR in the pharmaceutical industry: "Enhancing Corporate, Brand and Industry Value." Enhancing brand value is actually what marketing is all about.

This is quite a long list of roles that is guaranteed to keep Pharma PR professionals and agencies flush. One of these professionals, Ilyssa Levins, president of HCIL Consulting, wrote a "PR View" column in this month's Medical Marketing & Media magazine. In her column, Levins asks and answers the question: "Why should marketers allocate more help-seeking DTC spending to PR?"

According to the Pharma Marketing Glossary, "Help-seeking ads are communications disseminated to consumers or health care practitioners that discuss a particular disease or health condition, but do not mention any specific drug or device or make any representation or suggestion concerning a particular drug or device." These ads are also known as unbranded or disease awareness ads.

Ratchet Up the BS
Because help-seeking ads do not mention a drug by name, they are not nearly as closely regulated by the FDA as are branded ads. Hence, it is possible to ratchet up the bullshit level...and that's where the PR folks come in.


I use the term "bullshit" in a technical, not in a derogatory, sense (see "Is Pharmaceutical Marketing BS?" for what I mean).

PR is one form of communication used to reach consumers and physicians. It generates a lot of messages. Unfortunately, it also adds to the BS level. As I have said before, pharma customers -- patients and physicians -- can only take so much bullshit. If the level rises too high (see diagram), our bullshit tolerance is exceeded and could result in negative feedback.

One example of this is disease awareness ads and news stories that promote a new medical condition almost no one has heard of before. Restless leg syndrome is a case in point. I've written on this topic before (see "Restless Pharma Marketing"). Is this a "medical condition" or is it a normal symptom of aging that can be handled by lifestyle changes? Clearly, the role of PR is to plant the former idea in our minds, not the latter.

The erectile dysfunction (ED) drug marketing arena has had its share of bullshit. Recently, Viagra and other ED drug ads have returned to TV in the guise of disease awareness ads that link ED to hypertension, diabetes, and high cholesterol. The TV ads have only 60 seconds to do this. Who believes pharmaceutical company ads anyway? It would be much better to have a trusted "independent" third party source talk about the connection. Especially impressive would be an article devoted to the subject in a major media publication like the Wall Street Journal.

Just today, I came across the article "Doctors can use the 'Viagra visit' to screen men for heart disease" [subscription required] in the Health Matters column of a special section of the WSJ. Quite a nice placement for Viagra, I thought. It has all the signs of a successful PR campaign that fits hand in glove with the disease awareness advertising campaign, the purpose of which is to broaden the use of ED drugs to a much larger segment of the male population thereby boosting limp ED drug sales (for more on that, see "Blockbuster or Ballbuster?").

The premise of the "viagra Visit" article is that "erectile function" is an early-warning signal for heart attacks and stroke! Like a little, limp bird in a coal mine. This is based on some evidence, which I can only assume is credible -- it is, after all, cited in the WSJ, a publication I always take at face value and one whose every word I believe ;-).

The idea is that doctors should screen men for high blood pressure, high blood sugar, and high cholesterol when they come in asking for Viagra (or Levitra or Cialis). The connection between high BP and ED seems the most direct and logical. Perhaps the thinking is that these guys have never visited a doctor's office before and never had their BPs measured. Unlikely.

The interesting part of the story is the suggestion that men who respond to Viagra -- not all do -- may have undetected clogged arteries not only in the penis, but also in the heart. Or at least, the penile clogs may presage the cardiac clogs.

Anyway, Levins -- the PR professional I mentioned above -- says that a mere $4 million to $6 million PR campaign ("a drop in the proverbial bucket for a DTC advertising budget") delivers a "significant level of disease-state media relations..."

I wonder how much $ went into the WSJ "Viagra Visit" article? [Although the article mentions other drugs, Viagra, as the market leader, benefits the most.]

The problem is that we will never know. There is very little transparency let alone regulation of pharmaceutical marketing that disguises itself as PR. Marketers may push the envelope, but PR people are way out of the envelope! Marketers take the heat, but PR people coolly ply their trade away from public scrutiny, IMHO.

AMA vs DTC: Spinmeisters at Work

The American Medical Association recently called for an FDA-mandated moratorium on direct-to-consumer (DTC) drug ads and left it up to the industry and FDA to work out the details; ie, how long the moratorium should be for each drug. Seems reasonable enough considering that some pharmaceutical companies (eg, Pfizer and Bristol Myers Squibb) already have voluntarily placed moratoriums on DTC ads for new drugs. BMS, for example, set the period at 1 year (see "Pfizer DTC Pledge: ED is Litmus Test").

It's interesting to see how the press and industry publications are reporting on this. Looking at the headlines, one finds a whole gamut of viewpoints ranging from "glass three quarters empty" to "glass three quarters full." Here are a few examples (you can determine how full or empty the glass is in each case):

• AMA Wants Halt on Drug Ads Aimed at Consumers
  
• AMA Calls for Temporary Ban on DTC Drug Ads
• AMA Declines To Support Ban on DTC Prescription Drug Ads, Pending Study
• AMA backs off call for end to DTC pharmaceutical ads
• AMA Adopts Moratorium Policy

All are reporting on the same event. Here are excerpts from the AMA press release:

The American Medical Association (AMA) today announced new policy on direct-to-consumer (DTC) advertising of prescription drugs and implantable medical devices. The new policy includes imposing a temporary moratorium on the advertising of newly approved drugs and guidelines for pharmaceutical companies to follow when preparing DTC advertising.

In addition to the moratorium on newly approved drugs (the time interval for this moratorium will be determined by the Food and Drug Administration (FDA)), the AMA adopted additional guidelines for DTC ads, they:

• should provide objective information about drug benefits that reflect the true efficacy of the drug, as determined by clinical trials;
• should show fair balance between the benefits and risks of the advertised drugs by providing comparable time or space and cognitive accessibility, and by presenting warnings, precautions and potential adverse reactions in a clear and understandable way without distraction of content;
• should clearly indicate that the ad is for a prescription drug and refer patients to their physician for more information and appropriate treatment; and
• should be targeted for age-appropriate audiences; and
• should receive pre-approval from the FDA

The AMA also calls for additional research into the effects of DTC advertising on the patient-physician relationship, overall health outcomes and health care costs.

John Kamp, staunch drug industry supporter and fighter for "truth, justice, and the American way," quickly asserted that "Dr. Kildare is dead":

"AMA's vision of a DTC moratorium looks like government censorship, not patient empowerment, free speech or enlightened public policy," said John Kamp, executive director of the Washington-based Coalition for Healthcare Communication (CHC). "Dr. Kildare is dead. Patients now expect the information that respects their partnership in vital medical decision-making."

"Respecting [patient] partnership in vital medical decision-making" is a funny concept coming from a guy who also defends his organization's opinion that "the patient is the decision-maker only with respect to whether a practitioner should be approached." (See "DTC without the Risk".)

On the one hand John Kamp champions the "vital medical decision-making" patient role and on the other hand CHC sharply limits patient decision making to "should I visit the doctor or not?" Which is it? I guess it all depends on what the definition of "is" or "it" is.

The latter view of the patient is the Dr. Kildarian perspective -- ie, an old-fashioned American way of looking at the patient. That "American way" is about as relevant to America today as Ford or GM cars are to teenagers! duh!

Benefit vs. Risk -- It's About the Money
I am sure the CHC also doesn't like a few other AMA proposals such as DTC ads "should show fair balance between the benefits and risks of the advertised drugs by providing comparable time or space and cognitive accessibility." CHC petitioned the FDA to require even less risk information in DTC ads than there is currently (see "Communicating Risk: Let the Dialog Begin").

The main problem with the AMA proposal on fair balance is "time" and "space," both of which cost money for drug advertisers. And that's what CHC is -- a coalition of drug advertising agencies who have to include all the cost of ad "time" and "space" in their campaign budgets that their pharmaceutical clients pay for. With pharma taking a more critical look at their advertising budgets and where best to spend their money, I am sure the ad agencies are feeling the pinch and are looking for ways to reduce their ad campaign budgets -- but without cutting back on their slice of the pie. So, rather than going to "economic war" with journals and TV networks, it is much easier for them to address the "time and space" problem by cutting back on communicating risk information.

At least that's my take on it.

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More blog posts about DTC advertising...click here.

CME: Promotion vs Education

Pharmaceutical companies provide over half the financial support and funding for continuing medical education (CME) programs. In 2004, the industry spent over $1 Billion to support CME. This does not include the $200 Million or so in advertising and exhibit income that CME providers receive primarily from drug and device manufacturers.

Recently, this largesse has come under scrutiny from numerous sources, including the Senate Finance Committee, which sent a letter to many pharmaceutical companies requesting

"additional information about certain practices. Most notably, as Chairman and Ranking member of the Committee we seek to better understand the role(s) of sales and marketing personnel [emphasis added] in initiating and/or evaluating grants, and the use of grants to provide funding to professional societies or associations and patient advocacy organizations. With respect to the role of sales and marketing personnel in the grant approval process, we are concerned that sales and marketing personnel may influence the awarding of grants in a way that favors those individuals or organizations that are known to advocate use of specific product(s). [emphasis added] With respect to the use of educational grants to fund professional and patient advocacy organizations, we are concerned that such organizations, many of which develop treatment or practice guidelines, may come to rely on such funding to an extent that may compromise their independence. The Committee is also interested in funding provided to academic institutions or state agencies to support the development of practice guidelines or treatment algorithms." (see letters)

In the June issue of Pharma Marketing News, John Kamp, Executive Director, Coalition for Healthcare Communication calls this "regulation by raised eyebrows." Kamp claims that "Virtually everything he's been asking about is clearly illegal and not done by companies -- at least not anymore..."

In other words, the ploy by Grassley reminds some industry supporters of the trick question often asked to entrap unwitting suspects: "So, when did you stop beating your dog?"

"We stopped last year. I mean, yes, we did it [used marketing dollars to fund favorable CME programs] before, but we don't do it any more. [awkward pause] Can I call my lawyers?"

Now, we are supposed to believe that all the CME funding from pharma is handled by research or medical affairs people inside pharmaceutical companies and hence pharma has a purely educational motive for supporting CME.

Although $1 Billion is only a small fraction of the total promotional spend of the industry, it is still a sizeable chunk of dough to shell out with no expectation of return on investment (ie, new scripts for product) and with no involvement by sales and marketing.

Kamp claims that, like pornography, if you look for sales and marketing control of CME funding in enough places, you are likely to find it. Personally, I'm OK with pornography, but what about pedophilia? Where's the line? Anyway, I digress...

You Say ROE, I Say ROI
The industry now talks of "return on education" or ROE rather than return on investment or ROI whenever the measurement of the effectiveness of CME funding comes up. I don't believe they are serious, but let's suppose that they are.

CME is supposed to help physicians provide better medical care. Obviously, part of that is knowing more about new treatments. Another part of providing good medical care is communicating well with patients.

"The ability of physicians to communicate well with patients is one of best skills they could have for treating patients. They are taught much science, but very little communicative skills. A lot of times physicians donÂ’t treat as well as they could because they are not listening or communicating as well as they could be." -- Neil Gray, Managing Director, Healthcare Trends & Strategies, LLC and member of the Pharma Marketing Roundtable.

If pharmaceutical companies were really interested in educating physicians to provide better healthcare, then they should support CME that is designed to improve the bedside manner of physicians.

According to Harry Sweeney, member of the Pharma Marketing Roundtable and CEO/Chief Creative Officer, Dorland Global Health Communications, "there's an awareness in the academic medical community that their graduates'’ bedside manner is terrible! Several of them have inaugurated bedside manner courses."

So, will pharma companies pay attention to this "unmet medical need?" Sounds like Kamp doesn't think so: "It's important, but I don'’t know if pharmaceutical companies will be paying a lot of attention to it."

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You can read more about this topic in the article "Trends in Commercial Support of CME", which appears in this month's Pharma Marketing News. Also see more blog posts related to Physician Sales and Marketing.

Fat Acomplia?

Occasionally, I predict the next frontier in pharmaceutical marketing. Back in September, 2005, for example, I predicted that "sleep aid" DTC (direct-to-consumer) advertising would be the next BIG thing (see "Insomnia - the Next DTC Frontier"). These days, you cannot escape the ads for these drugs, some of which -- namely Lunesta -- have ignored the industry's guiding principles for DTC advertising (see "Lunesta/Ambien/Sleep Aid Drug Blog Topics" for more information about that).

What's next? The next BIG focus for DTC advertising will be obesity treatments.

Leading the pack in this category is Acomplia marketed by Sanofi-Aventis. This drug, which supposedly suppresses your craving for fatty foods, is set to be approved in the EU this summer and in the US by the end of the year (see the Sanofi-Aventis press release).

Fait accompli! Or should we say "fat acomplia"? Read on to see if Acomplia will be successful in the US market.

[By the looks of the following image, the emergence of obesity drugs may just be one small step for the EU, but a giant leap for the US market. Thanks to PharmaGossip for this image.]




However, let's look at the data a bit before we get all worked up about this.

"In trials of Acomplia, those taking the drug shed between 5% and 10% of their body weight if they stayed on the drug for two years..." (see "All Eyes on the Obesity Prize"). OK. That's something, even if not spectacular.

But Acomplia is not indicated as a stand-alone treatment for obesity. According to Sanofi-Aventis, the indication statement for Acomplia will be: "As an adjunct [emphasis added] to diet and exercise for the treatment of obese patients...or overweight patients... with associated risk factors, such as type 2 diabetes or dislipidemia..."

Interestingly, diet and exercise alone can do the job, and much quicker! (I know. I lost 13% of my body weight by diet and exercise alone and it took me only 6 months, not 2 years!)

So, why do we need an "adjunct" treatment that does no better than diet and exercise? Simple. The drug can do it alone and that is how it is going to be marketed (with a nod to diet and exercise as in Eric Idle's "wink wink, nudge nudge, say no more" sense). Since PhRMA guidelines recommend that virtually all DTC ads mention diet and exercise, Acomplia ads will not stand out in this regard.

Will Acomplia be a success in the US? Obviously the market here is HUGE (see photo above). According to the 2005 National Health and Wellness Survey, 77.2 million Americans are obese and 65.9 million more are overweight. That alone spells B-L-O-C-K-B-U-S-T-E-R! Unless, of course, it is associated with heart-valve or other life-threatening side effects (as was the case years ago with another weight treatment drug combination).

A simple pill -- instead of diet and exercise -- appeals to Americans who are primed to medicate themselves at the tip of the hat. However, Americans also like quick results in order to celebrate victory, which as we all know is an elusive prize. In this regard Acomplia's 2-year waiting period (before victory is achieved) may not suit the American psyche.

[Another treatment, Alli by GSK, will also be available soon. It is "essentially the over-the-counter version of Xenical, ... a prescription medicine already available. Xenical works by blocking the amount of fat absorbed through the digestive system." Unhappily for this drug, anal leakage is a common side effect, which has stymied the success of Xenical -- you hardly see ads for it anymore.]

Linking Obesity with Insomnia
It turns out that obesity and insomnia are linked, according to the study mention above. Of the one-third of Americans who say they are obese, almost half report problems sleeping. This link was played up in the recent issue of Pharmaceutical Marketing Executive Magazine ("Meet the Patients: Insomnia and Obesity").

The industry, in other words, is priming itself for a "difecta" -- two drugs in one (Vytorin is the model -- see "Two Sources of Zocor"). This, of course, would be the life-cycle endgame plan for these drugs. Perhaps Sanofi-Aventis will buy Sepracor!

BTW, it amazes me how industry pundits can cite the same study -- ie, 2005 National Health and Wellness Study -- to make their case for marketing new products while at the same time disparaging the study for showing that US citizens are much less healthy than UK citizens despite spending more per capita on healthcare and despite having supposedly better access to drugs and healthcare. All that data, which doesn't support the utility of DTC for improving health, has been suppressed in industry publications like Pharmaceutical Executive Magazine.

More blog posts about DTC advertising...click here.

Two Sources of Zocor

As reported in the Philadelphia Inquirer:

"This week, Merck & Co. Inc.'s patent on the No. 2 cholesterol drug Zocor will expire, clearing the way for generic versions and guaranteeing huge savings for patients and insurers." (See "A shake-up beyond Merck").

The good news is that Merck can sidestep the whole problem with a product that keeps Zocor, the brand, alive -- it's called Vytorin!



What Are You Doing About
The 2 Sources of Zocor?

You’ve heard it, maybe even said it: Zocor comes from Merck. What you may not have heard is that soon there will be a cheaper generic version of Zocor available.

If your still are taking the brand drug after that, it may explain why your drug bill could still be high, even though you’re trying hard to lower prices.

Generic drugs are important parts of lowering drug prices. Get helpful tips from your pharmacist.

You see, in addition to the Zocor that comes from Merck, simvastatin (the active ingredient in Zocor) will soon also be produced by companies your never heard of (Dr. Reddy, Teva, and Ranbaxy)--which means your mom, your dad, even your grandparents can save money.

So, if you’re having a hard time lowering your drug costs in spite of spliting your brand pills, don’t blame yourself. Almost everyone’s cholesterol drugs will come from 2 sources sooner or later. And taking the right one is an effective way to lower your monthly drug bills. "Lower is Better!"

Important information:

The two forms of Zocor aren’t right for everyone, including women who are nursing or pregnant or who may become pregnant, and anyone with liver problems. Unexplained muscle pain or weakness could be a sign of a rare but serious side effect and should be reported to your doctor right away.

Pfizer -- maker of competitor Lipitor -- says that Zocor/simvastatin doesn't have data to prove it prevents heart attacks and strokes like Lipitor. Ask your doctor!

P.S. Cholesterol Drug Sales in US Through 2005

Behavioral Targeting: RJ vs JP

Just when you thought it was safe to go back in the water...bam! In this case, the water is tracking consumer website visits for targeted marketing. It's a tactic being advocated by my friend R.J. Lewis, President and CEO e-Healthcare Solutions, Inc., in his "Eye on E-Marketing" column in the May, 2006 issue of Product Management Today. Unfortunately, the last time it was employed by pharmaceutical marketers, it blew up in their faces. I'll get to that in a moment.

First, however, what is "behavioral targeting" and why is RJ promoting it? Here's what he says:

"In the wake of the attention that Google and other contextual advertising solutions are mustering, a new type of on-line advertising is building steam as well: behavioral targeting. Behavioral targeting is not based on the content of the Web page, but on the on-line behaviors of an individual surfing the Web. It focuses on the user's recent past behavior and delivers advertising that may appear to be superficially out of context, such as an advertisement for a brokerage service appearing on a page about diabetes. It is, however, targeted toward the recent behaviors of the individual who was recently at the website of the brokerage service, or perhaps visiting other financial services sites."

Let's forget that RJ characterizes this as a "new type of on-line advertising," since I will give you a little history lesson below disputing that claim. Also, it is important to keep in mind that we are talking about selling drugs, not "brokerage services." The distinction is important.

Say, for example, that Viagra marketers wished to use behavioral targeting to deliver pop-up ads to men likely to be suffering from hypertension or high cholesterol, two medical conditions that are risk factors for what I call "LDS," which is better known as ED (erectile dysfunction).

The idea is to put cookies -- little pieces of computer code -- "on an individual's Web browser, then matching those behavioral cookies to an index of targeted advertisers when the user later visits another page or website." [Actually the cookie resides on the individual's computer -- it's what's called a "persistent cookie" because it doesn't get erased when the individual leaves the website that originally placed the cookie. The whole idea is for the cookie to collect the list of websites you visit and then use that information to target pop-up or other types of Internet ads to you wherever you surf.]

Back to the Viagra example. With behavioral targeting, the Viagra cookie would awaken the ad server -- presumably RJ's very own eHeathcare Solutions' server -- to deliver you Viagra ads after you have visited sites to learn about hypertension. It may even be smart enough to know you are a male because it waits to see if you visited ESPN or a porno side (porno + hypertension = IDEAL candidate for Viagra!). More likely than not, the algorithm would not be that sophisticated -- it may just as likely send Viagra ads to women as well as men! [This may not be a total negative. ED drug marketers actively target women to help them sell product to their sexual partners. Also, ED drugs manufacturers may have women sexual dysfunction in their sites as a new indication to extend the patent of their products.]

Anyway, that's one problem with behavioral targeting -- it can never be precise enough for some products like ED drugs. It's OK if the product is neutral with regard to gender and indication (eg, treatment of allergies). The "target" would then not be offended by the ad.

But the bigger problem -- and the reason why pharmaceutical companies should be very afraid of this technique -- is the privacy issue. RJ recognizes this:

"Ethical issues exist for technologies such as behavioral targeting. No one wants to be 'followed' around the Web with a human immunodeficiency virus (HIV) ad, simply because they have previously visited a website with HIV-related content. However, health food or gym equipment can be promoted to those who have viewed fitness content or such benign disease categories as allergies or gastroesophageal reflux disease. Behavioral targeting creates a problem with regard to acceptable practices and defining what health care categories may be appropriate for employing behavioral-targeting technologies."

It's not so much that people don't want to be "followed," they want to know WHEN they are being followed and by WHOM and WHY. Note that WHEN, WHO, WHAT, and WHY are also the questions the press asks when interviewing pharma CEOs (actually communications officers) before they write their damaging news stories. The currently accepted standard in good privacy practices also requires that consumers be notified about how they can opt-out from programs that use there data for marketing purposes. While behavioral tracking may not use "personally-identifiable data," this may be too fine a distinction for patient advocates and the press.

Pharma already got a load of bad press related to consumer tracking on the Net back in 2000 or thereabouts, when an Internet marketing company called PharmaTrak enticed pharmaceutical companies to allow them to place tracking cookies on consumers' computers without them being aware of it -- or allowing them to opt-out. The company tracked which product sites these consumers visited and reported the information back to their pharma clients. [Do a Google search on "PharmaTrak" and you can read all about it.]

Although the pharmaceutical companies did not gather any personally-identifiable information about consumers, they were raked over the coals in the press and even sued in court. The incident was the chief motivating force that finally induced companies to create the Chief Privacy Officer (CPO) function.

The first pharmaceutical CPO ever named -- as far as I am aware -- is Jean Paul Hepp, currently CPO at Pfizer, and known as "JP" to his friends. I am pretty sure he would have a stroke if ever the Viagra marketers attempted to use behavioral targeting serriptitiously (or maybe any other way as well).

RJ does not give JP a fair shake in his column. RJ says:

"He [JP] discussed [at an industry trade conference] the slow pace of change and technological adoption at a large global pharmaceutical company. However, the successful pharmaceutical companies of tomorrow will empower and intent their product managers to embrace change."

RJ implies (1) that JP and Pfizer are "glacial" when it comes to technology, and (2) Pfizer -- that "large global pharmaceutical company" -- is just not hip and won't be among the ranks of "successful pharmaceutical companies" because it is not getting on the behavioral targeting bandwagon.

What RJ failed to mention is that JP's career was put on the line by the PharmaTrak scandal (his company, Pharmacia -- since purchased by Pfizer -- was a PharmaTrak client). But JP survived and became, as I said, the first pharma CPO. He's in the catbird seat now and when JP talks, we should listen. What JP said at that conference (I was there and heard it firsthand):

"I've been in marketing for 20 years, so I know the techniques used by marketing and sales. I love them, but you [marketing] guys are really collecting too much data. You're making my life difficult. I would urge you to do it smartly. Data is becoming such a high risk within our companies. Whenever you collect data, think twice. You should collect less data and data of higher quality." [Of course, JP prefaced his remarks with a disclaimer that he was speaking on his own and not for Pfizer.]

JP also went on to say that data must also be classified according to risk. As RJ said, HIV-related data is more risky to pharma companies than health food related data.

RJ goes on to say: "Through experimentation and trial and error, they [ie, "successful pharmaceutical companies of tomorrow"] will seek competitive advantage and higher return on investment by leveraging new technologies to their fullest extent." RJ sells marketing technology services to pharmaceutical clients, so he is not a disinterested party.

RJ believes that behavioral targeting is "fully operational" (Darth Vader music please) and "ignoring [it and other] new technologies may help competitors by allowing them to gain a competitive edge through behaviorally targeting their marketing messages and trial offers to others' customers."

I find that some service providers -- aka vendors -- push their services upon the pharmaceutical industry without regard to the lessons that history teaches us. Oldsters like myself and JP (sorry JP!) need to remind these guys about that history. JP has been around long enough, however, to know all about this.

[Find more eMarketing Blog Topics here.]

Blockbuster or BallBuster?

Erectile dysfuntion (ED) drugs -- Viagra, Cialis, Levitra -- are in the news again. It seems that ED drug marketers have retooled their campaigns after another disappointing year for sales in this category overall.

Some Numbers
Here's a tidbit from the NY Daily News (see "Taking clinical tact in new ED drug ads"; What? Did you think I only read the WSJ and the NYT?):

"Revenues have fallen short of expectations and growth was flat last year as two of the drugs makers cut back on ad spending while revising their messages. Last year, the U.S. market for the drugs was flat at $1.4 billion, according to IMS Health. Viagra's total sales slumped 2% last year to $1.6 billion after falling 11% in 2004. Last year, total spending on advertising for erectile dysfunction ads fell 41% to $241 million, according to TNS Media Intelligence. Much of the drop can be attributed to a lack of Viagra TV ads and only half a year of commercials for Levitra."

Cialis, marketed by Lilly/ICOS, on the other hand, has taken up the slack: Worldwide sales of Cialis reached $747 million in global sales last year, a 35% jump from 2004. (The Total WORLDWIDE sales of ED drugs is said to be about $3 billion.)

Conventional wisdom regarding the pullback in ED drug advertising says it was a result of PhRMA's new DTC guidelines. However, it appears that the marketers have merely regrouped around two core, inter-related messages:

• ED is a medical condition that is caused by high blood pressure, high cholesterol, and diabetes.
  
• Since it's a medical condition, it is chronic and should be treated on a daily basis

Levitra may be taking the lead on the first core message. Some time ago it launched it's "Mens Facts" campaign and Web site. Now, it has launched the Check Men's Facts educational campaign and a new national survey. [The Levitra folks seem to have reserved all the generic "Men's Facts" domain names, really pushing the Immutable Laws of DTC Domain Naming to the limit!]

The Check Men's Facts Web site begins by congering up some big market numbers as in:

• 29 million men have high blood pressure (hypertension)
• 50 million men have high cholesterol
• 8 million men have diabetes

I think these are US numbers.

These medical conditions, the site warns, "could affect your erections." They don't say which way, but you get the point. Some fact.

Videos of physicians on the site ram the scary case home. Randall B. Meacham, MD, for example, has this to say about hypertension and ED:

"Over 29 million in the US have high blood pressure... Two out of three men with this condition, even when controlled by medication, experience changes in erections." [Emphasis added]

Note the careful language -- no "facts" about the degree of ED, what exactly the changes are, what exactly the risks are, etc. Randall also mentions that "80%" of men with ED suffer from one of the three medical conditions mentioned as if that applied the other way around as well; ie, that 80% of men with CV issues are at risk for ED. Those numbers are enough to give any ED marketer a hard one!

Here I am, a man over 40 doing all I can to control my HT with medication, and STILL I am at risk for ED! What am I to do? Get ready for the once-a-day ED pill, silly!

The Once-a-Day Shoe
The first shoe has been dropped: ED is a medical condition associated with three major cardiosvascular medical conditions. Now, we really are seeing the "other shoe" being dropped.

According to ICOS CEO Paul Clark, Lilly/ICOS is targeting men in their forties and fifties who use erectile dysfunction drugs on a 'more frequently than average' basis with a once-a-day version of its Cialis (tadalfil) treatment. It plans later this year to ask the Food and Drug Administration for approval of a once-daily version of the medicine. In May, Icos applied to European drug regulators for approval of the once-daily pill (see "A Daily Pill to Combat Impotence?," New York Times; OK. I do read the NYT also!).

Blockbuster BallBuster
This could raise worldwide sales of Cialis by as much as 32% (an increase of $200 to $250 million over and above the current $776 million in sales), making Cialis an official "blockbuster" drug -- not to mention "ballbuster" if men actually took daily advantage of the benefits!

On the Lighter Side
In Pharmacology, all drugs have two names, a trade name and generic name. For example, the trade name of Tylenol also has a generic name of Acetaminophen. Aleve is also called Naproxen. Amoxil is also call Amoxicillin and Advil is also called Ibuprofen.

;-) I heard that when Lilly/ICOS and the FDA were first looking for a generic name for Cialis, they considered, but rejected the following generic names: Mycoxafloppin, Mycoxafailin, Mydixadrupin, Mydixarizin, Dixafix, and Ibepokin. ;-)

Will Once-a-Day Cialis require a new generic name? If so, what names could FDA and Lilly/ICOS be considering? Ballbustamakin? You guys out there with a better grasp of Latin may be able to come up better candidates.

---

To access more posts about ED drug marketing, see Viagra/Levitra/Cialis/ED Drug Blog Topics.

Sales Force Effectiveness

I attended Pharmaceutical Executive's 1st Annual Marketing and Sales Summit today and sat in on a few interesting presentations related to sales force effectiveness. I review a few here. I hope to cover these in more detail in future Pharma Marketing News articles. If you are interested in this topic, you might like to order the Special Supplement: Increase Physician Access and Detailing Effectiveness (see cover image at left).

What Physicians Want from Reps
Noven Pharmaceuticals presented results from a survey of OB/GYN physicians they conducted to determine the effectiveness of their sales force in comparison to competitors' sales forces.

The study confirms several tenets of conventional pharmaceutical marketing & sales wisdom. For example, the surveyed physicians ranked sampling needs as the MOST IMPORTANT discussion they have with sales reps. Way down on the list of importance to physicians was reps' knowledge of competitors' products.

It turns out that physicians are getting precisely what they want from reps who don't seem to know much about competitors' products and spend little time comparing products. Of course, there is very little clinical data collected that would support direct product comparisons (most clinical trials focus only on comparing a drug to a sugar pill, aka placebo). Hence, it would be inappropriate for reps to make any comparative claims. But that's the topic for another day.

Clinical Educators as Adjuncts to Sales Reps
Innovex -- a division of Quintiles, the contract research people -- talked about the role of "Clinical Educators" (CEs) as adjuncts to pharmaceutical sales reps. CEs are essentially specially trained nurses that either work directly with physicians, their staffs, or with patients to do disease management, educate patients and enhance patient compliance with treatment -- all things that physicians should be doing themselves but are either too lazy to do or just not willing to do.

The use of nurses by Big Pharma in the US may be a new phenom and has attracted media attention. See, for example, today's article in Business Week ("Big Pharma's Nurse Will See You Now"), which claims "For a host of reasons, not least their own self-interest, Big Pharma is staffing up on nurses."

[Use of nurses by pharmaceutical companies was a topic of a Pharma Marketing News (PMN) aricle in 2004 (see "European Compliance Not Only Possible, But Leading Edge"). In the recent issue of PMN, Berlex's Betaseron Education, Training and Assistance program, which also depends upon nurses, was highlighted.]

CEs benefit physicians by improving their practices and can help increase sales rep access to physicians. So it's a win-win, right? Not so fast! Although Innovex claims it can see no drawbacks to CE programs, there are some important issues to consider.

CEs provide value-added services that are offered free to physicians. Anti-kickback statutes might come into play if the program is construed as a gift to high-prescribing physicians. So pharmaceutical companies need to be careful how they deploy CEs among their physician clients. The best candidates may be "no-see" physicians -- the ones with signs on their office doors that say "Sales Reps Not Welcome Here."

Also, unscrupulous physicians might be tempted to charge Medicaid for CE services provided free of charge by pharmaceutical companies. That would be a no-no.

Another potential problem is the conflict between non-promotional and promotional aspects of CE programs. Innovex admits that CEs are "dedicated" to the sponsor's product (Business Week says "Admittedly, the nurses talk up their employers' products, both to the patients and to medical personnel in doctors' offices."). Where is the line drawn? If CEs talk about product benefits, are they also required to provide fair balance? Who monitors this? Will it become the next PR issue for the pharma industry?

Some critics also contend that by hiring nurses as CEs, pharmaceutical companies are competing with hospitals to hire nurses from a shrinking pool of qualified candidates.

Technology Makes Better Sales Rep Caterers
Free lunch for physicians -- delivered by sales reps -- is still an important door opener for reps. I've witnessed reps delivering lunch to my GP several times. Usually, the rep has a big guy helping carry in and set up the hot trays or whatever. It doesn't look that tough to do, although many experts claim sales reps are stressed over it. But there's a technology to ease the pain.

Attendees of the PE conference were treated to a "free" lunch thanks to a company called Total Take Out. But before we could go eat, Total Take Out subjected us to a presentation about their service, which is a Web site where sales reps can order lunches to be delivered to doctors' offices. It's actually a pretty cool application, which also offers discounts to drug companies from particfipating restaurants. But rather than going on an on about that here, I will just reproduce a cartoon that the company handed out. Enjoy!

Medical Device DTC: What's Up With That?

Medical Device DTC stats was the topic of an interesting discussion thread last week on the Pharma Marketing Forum -- a good place to get answers on all kinds of issues relating to the pharmaceutical industry.

As often happens, the discussion was opened up by a simple question:

"Is anyone aware of any research that has been done around what sources were used by and how much a medical device companies spend for advertising / promotions / DTC / brand marketing, etc.? This information is easy to find for the pharma side, but it's more difficult on the device side." -- Melody

My friend, Bill Trombetta, is always a knowledgeable source of information and had this suggestion as a direct answer to the question:

"I am starting to do work with med device companies. They do very little DTC and "traditional" marketing. For ex., Stryker, orthopedic devices, is using Jack Nicklaus in DTC, a first for a very conservative industry sector.

"I don't know of any source that beaks out the promo mix as detailed as you have set it out. But you might try pulling up a company's 10 - K and going to its Income statement and there might be a category for marketing spend overall." -- bill trombetta, professor of pharmaceutical marketing, st joseph's university

David Jastrow, Senior Research Analyst at Thomson Scientific & Healthcare, donated some specific information:

"The 10-Ks have bits and pieces of info that may be useful. Medical device companies are still sorting out best practices for DTC, it will be interesting to see how they apply lessons learned from the pharmas to hopefully improve upon the model. The following rough slides may be of some interest to you." -- David

The following is excerpted from David's slides with my notes interspersed:

Medical Device Companies Face Greater Scrutiny
Recognizing the lack of attention that has traditionally been paid to regulating direct-to-consumer (DTC) marketing of medical devices, FDA in November 2005 held a public hearing to seek input on whether the agency needs to revise its approach to the promotion of medical products, including restricted devices.

For more on this meeting see:

• DTC Pros and Cons Presented at FDA Hearing
• FDA DTC Hearings: Snippets from Day 1
• FDA DTC Hearings Day 2

[For all blog topics relating to the FDA and regulation of pharmaceutical marketing, see Food and Drug Administration (FDA).]

Testimony at that meeting included the following statement:

"The device industry is relatively new to the game," says Carolyn Jones, associate vice president of technology and regulatory affairs with AdvaMed [trade association representing medical device manufacturers]. "Drug companies have had a lot more experience with DTC advertising. Our suggestion to FDA is that devices need to be viewed in a little different light. The medical device industry has a good track record, although limited, with respect to DTC advertising. Because the medical device industry is a late-comer to the game, it's been able to learn from the mistakes of others. If it isn't broke, hopefully they won'’t try to fix it."

Factors Influencing Med Device Product Development



[According to the above survey data, medical device companies may be more concerned with price issues. Obviously, devices are much more expensive than drugs and it is amazing to me that medical device companies are actually beginning to run DTC ads for hip and knee replacements. I don't recall much fair balance in these ads -- what, if any, problems may be associated with these devices? -- JM]

Device Manufacturers Spend Less on R&D, Gain More Patents



[R&D spending by device manufacturers is probably a little less than that of drug companies as a percent of sales. However, as the next chart shows, the number of device patents continues to increase year over year. The drug industry, on the other hand, shows a reverse trend. -- JM]



Understanding the Patient Point of View
Continuing with the discussion thread:

"Many device companies don't seem to feel a need to understand the patient POV, at least not yet. I met with some MR folks recently at one of the largest device companies, and some of them were very categorical about not feeling the need to investigate patient perspectives when conducting developmental research. 'it isn't done that way here' was the attitude. But one of them pulled me aside and said 'it'll probably take a few years, but we'll eventually get to a model where the patient's perspective counts for us... It's going to be a long process though.' It's not about changing the product to meet the 'consumer's' needs, but it's about anticipating positive and negative responses, in particular, that initial conversation when the possibility of a device is brought up in the office or at bedside. That isn't done yet on a broad scale it seems." -- John Mitchel

"Our company has spent many years trying to gather the patient's point of view with our device which shows in its design and treatment schedule. The constant need for our medical device and traditional drug therapy is compliance. We ask for only 20 minutes/day for five days a week and they still balk. People want instant results and lack patience in medical treatments." -- Leo

Compliance, compliance, compliance. How many times have I heard that tiresome phrase spoken by pharmaceutical marketers, who typically blame the laziness of patients? The word "compliance" itself reveals this top-down mentality. To truly understand the patient's POV, marketers must admit that perhaps some of the fault lies with the product rather than with the patient.

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• PhRMA
  
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• Unbranded/Disease Awareness Advertising
  
• Viagra/Levitra/Cialis/ED Drugs
  
• Vioxx/Celebrex/COX-2
  

FDA Paralyzed: Who Will Protect Us?

A few weeks ago, I wrote about how the FDA approved Ketek based on foreign trial data. I raised the suspicion that the FDA was eager -- perhaps too eager it turns out -- to get the antibiotic approved in order to have an effective drug to add to America's anti-bioterrorism stockpile (see "Celsius 3014: Ketek, Drug Safety, & Bioterrorism").

Now we have to learn from an FDA memorandum leaked to the New York Times that a Food and Drug Administration official called in May for a Sanofi-Aventis to halt clinical trials of Ketek in children because the drug could be deadly.

"How does one justify balancing the risk of fatal liver failure against one day less of ear pain?" Dr. Rosemary Johann-Liang, an official in the Office of Drug Safety at the agency, wrote in one of the memorandums.

"The report also said that by April, the agency had reports of 110 cases of liver problems associated with Ketek, and that the rate of acute liver failure connected to the drug was about four times the rate of such events seen in other antibiotics."

Not until the story was published in the New York Times yesterday (see "Halt Is Urged for Trials of Antibiotic in Children") did the company call a halt to the trial -- and even then Sanofi-Aventis said the FDA did not request the action!

Despite the company's insistence that its action was not linked to the story in the NYT the day before the trial was stopped, it's just too much of a coincidence.

In other words, it takes a story leaked to the press and for that story to actually appear in the press to stop a potentially deadly trial.

If that is the only way that FDA officials can do their jobs, then God help us, because the FDA sure can't.

Welcome Back Vioxx, Welcome Back

An editorial in today's Wall Street Journal calls for the return of Vioxx ("Now Bring Back Vioxx") citing a "meta" analysis (wooooo... meta!) published in BMJ claiming to show that "high doses" of Advil "raised the risk of adverse cardiovascular events by roughly as much as such COX-2 drugs as Vioxx and Celebrex." WSJ argued that if Tysabri, which treats MS, can be brought back to the market then Vioxx should also be brought back.

Forget for the moment what they mean by "high dose" and forget that meta analyses are not the gold standard in scientific research. I'm more interested in the ad that Merck will run if and when Vioxx comes back on the market.

Considering that pop music is often co-opted in advertising to put the viewer in the right mood, I envision Merck using the "Welcome Back, Kotter" TV series theme song. Here are the modern lyrics:

Welcome Back, Vioxx

Welcome back,
Your AEs were your ticket out.

Welcome back,
To that same old market you bashed about.

Well the names have all changed since you hung around,
But the pain has remained and the data all turned around.

Who'd have thought meta data'd lead ya (Who'd have thought meta data'd lead ya)
Here where we need ya (Here where we need ya)

Yeah we tease Vioxx a lot cause we've had it on the spot, welcome back,
Welcome back, welcome back, welcome back.

Licensing Sales Reps: Is It a Bad Idea?

An amendment to the proposed Massachusetts State Budget -- recently approved by the State Senate -- could make the state the first in the nation to license pharmaceutical sales reps (see SECTION 100NN) and prohibit them from providing entertainment, gifts, payments or travel to doctors, healthcare facilities or public officials (see SECTION 44L), The Boston Globe reports (see "Senate OK's licensing of drug reps").

SECTION 44L, which was tacked on to the budget by Senator Mark Montigny, Democrat of New Bedford -- the same senator who introduced Senate Bill #402, which also attempted to limit gifts to physicians -- states: "No pharmaceutical manufacturer agent shall knowingly and willfully offer or give to a physician or a member of a physician'’s immediate family, and no physician shall knowingly and willfully solicit or accept from any pharmaceutical manufacturer, gifts of any value at any time."

This is actually more onerous than SB #402, which would require physicians (and other healthcare officials) in the state to file a "gratuity disclosure statement" listing "any gifts aggregating more than $100 in the two preceding calendar years." That bill did not "ban" gifts and did not even set limits on gifts as far as I can see. The state, however, could engage in the "prosecution of illegal conduct involving gifts, educational or research grants, or other economic benefits provided by a pharmaceutical company or an agent of a pharmaceutical company to a public charity [ie, hospital] the circumstances of which reasonably call into question whether such funds are being put to a charitable purpose or indicate a breach of the public trust in the administration of a public charity." This did not include doctors (they are not charities).

Anyway, my main interest is SECTION 100NN regarding licensing pharmaceutical reps.

[If you want to learn more about pharma gifts to physicians, please see a previous Pharma Marketing Blog post on the topic: "Gifts That Keep on Giving" or consider ordering the following Pharma Marketing News reprint: "Free Gifts to Physicians: What's the Big Deal?"]

Is it a bad idea to require pharma sales reps to be licensed?


Why pharma sales reps and not GE light bulb sales people? I don't know. Maybe states require other types of sales people to be licensed. I haven't heard of it, though.

You could say that pharma reps are different -- they sell a product that affects the health of the citizens of a state. Senator Montigny obviously concurs:

"Hairdressers and manicurists must be licensed to work in the Commonwealth," Montigny said. "Pharmaceutical representatives who market prescription drugs and attempt to influence doctors to prescribe name-brand drugs should also be licensed."

But if licensing meant better trained sales reps, then I would favor it. SECTION 100NN does have provision for training as part of the licensing process:

"As a prerequisite to licensing, pharmaceutical representatives shall complete such training as may be deemed appropriate by the department departmentt of public health, in consultation with the board of registration of pharmacy]. As a prerequisite to the renewal of a pharmaceutical representative license, the licensee shall complete continuing education as may be deemed appropriate by the department."

Not only would this open up a new business for training companies, but it could actually make drug reps more effective, depending on the training provided. I assume, for example, that one goal of the training would be to raise the rep's knowledge of the therapy category and competing treatments -- especially generics.

From the experience of people familiar with the preparedness of reps, there are some gaps. Here's an assessment by Michael Kessler, MD, VP of Metamorph Doctors, LLC, a sales rep assessment company:

"Representatives, in general, are scoring lower in their ability to communicate clinical information in a way that is palatable and understandable to the doctor." (As reported in Pharma Marketing News: "Sales Rep Assessment: Shoot the Messenger, the Message, or Both?")

Perhaps doctors are more demanding these days and despite efforts to standardize assessments, they are less forgiving in judging this skill. Nevertheless, this decline in an important indicator is a worrisome trend in light of recent commitments by the pharmaceutical industry to ensure that doctors become more knowledgeable about new drugs, especially before DTC campaigns are launched.

"We also see an across-the-board lack of knowledge of competitors' products or the lack of ability to speak about competitors'’ products in a comparative way," says Kessler. [op cit]

Even sales reps themselves agree that their training levels are inappropriate. According to a G & S survey of pharma sales reps -- see more on this survey in the post "Industry PR & Rep Morale" -- three quarters of respondents agreed that they need more training. 36% felt a need for more disease state training in particular.

Reps also are not very knowledgeable about DTC campaigns relating to their products and their competitors' products: only 40% were very or extremely informed about their products' DTC campaigns and only 10% were that knowledgeable about the competitors' DTC campaigns.

I don't really believe state-mandated training and licensing is the answer to this problem. The effort in Massachusetts, however, represents another exploitation of a chink in pharma's armor that critics are exploiting to pass laws that limit pharmaceutical marketing.

Perhaps the industry has been too busy building their army of reps to properly train them in battlefield conduct and arm them with the knowledge they need to be true "trusted colleagues" of their physician clients.

Industry PR & Rep Morale

In February, I wrote about GSK's use of sales representatives to deliver to physicians and the community at large a PR campaign that is designed to promote the value of the pharmaceutical industry. I criticized this effort on the basis that sales reps are among the least credible of pharma employees (see "Sales Reps Make Poor Spokespeople"). This strategy is the brainchild of Mike Pucci, GSK's VP-external advocacy.

What I failed to realize, however, was that the primary goal may not be to spread the good word but rather to boost the morale of the sales force! What leads me to this conclusion? The recent release of RepReview -- a market research study that examines pharmaceutical marketing from the perspective of sales representatives. The biannual study was performed by G & S Research (see the 2005 RepReview Synopsis).

According to this study, eighty-five percent (85%) of rep respondents think that public opinion of healthcare manufacturers declined in the previous year (2004) and only 5% think it improved (huh?). Of this majority, 51% blamed media exposure as the culprit (duh!). Only 37% cited high medication costs along with manufacturer's greed and a paltry 13% felt the loss of reputation had something to do with unsafe/failed drugs and related lawsuits.

As the G & S report states:

The number of reps in the US alone has grown 85% during the last five years, with practically no physician growth. Today, the number stands around 90,000, and this sales force commands four out of every ten dollars [my emphasis] of the industry's sales and marketing budget. So it's no surprise that improving the return on the sales force investment is a top priority for pharmaceutical companies, both domestically and worldwide.

Add to this the fact that there is an average annual rep turnover rate of 14% to 15% and you realize how important it is to keep reps motivated. Usually, high incomes and big bonuses would be motivation enough (see, for example, "Generation X Pharma Reps"). These days, however, pharma companies need to trim some of the fat and some are even downsizing their sales force -- but other methods of increasing or at least maintaining sales rep performance are also needed. I think Pucci's strategy fits the bill perfectly!

The Hay Group, a human resources consulting firm, also predicts there will be greater demand for experienced sales staff in the biotech and specialty pharma sectors and declining opportunities for recent college graduates pursuing jobs as sales representatives at the major pharmaceutical companies (see "Downsizing Looming and Decline in Pharmaceutical Sales Rep Jobs for Class of 2005").

Big Pharma is now competing for sales reps with biotech, an industry that enjoys -- for now -- a much higher positive public perception. [I say "for now" because biotech is being lured to follow the same path as Big Pharma as far as risky marketing practices are concerned. For more on this, see "Biotech DTC: Business Not As Usual."]

Pucci's program begins with sales training -- steeping reps in facts and figures that support a positive image of the industry (see "The Empire Strikes Back"). The result: instant morale booster!

Will the reps be successful in getting the word out? Who knows? Who cares? Maintaining employee morale -- especially sales rep morale -- is more important. Pucci is a genius!

Other Results from the RepReview Study
The RepReview Study revealed a contradiction between the view reps have of themselves and how physicians probably see them. Forty-one percent (41%) of respondents chose "trusted colleagueue" as the best descriptor of how they believe the physician viewed them during their last sales call (40% chose "new information provider).

A mere 13% chose "sample supplier"!

That's funny, because almost half the reps conceded that physicians would not see them if they did not have samples on hand. How can half of reps be perceived as sample providers by physicians yet only 13% of reps see themselves that way? It's a riddle wrapped in a mystery.

If you are interested in how important samples are in the rep-physician relationship, please consider ordering this Pharma Marketing News reprint: "Intelligent Online Sampling Strategies."