Blogs Critical of Drug Industry Are Most Credible, Says Survey

I will be in Las Vegas this Monday and Tuesday where I am speaking at the Healthcare Blogging Summit. I will be participating on the panel, "Blog Search, Distribution, Measurement & Reputation Management", along with Fard Johnmar (HealthcareVOX blog), Tom Eng, Healia (medical blog search), and Constantin Basturea, Converseon (a Web 2.0 communications agency).

At this meeting, I will present the details of the Pharma Blogosphere Reader Survey. Below is the press release, which highlights some of the findings from that survey, which I hope stimulates some discussion at the meeting.

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First Ever Pharma Blogosphere™ Reader Survey Reveals That Blogs Critical of the Pharmaceutical Industry are Viewed More Credible than Blogs Supportive of the Industry

Results of the First Ever Reader Survey of the Pharma Blogosphere™ Presented at the Healthcare Blogging Summit in Las Vegas

Survey sheds light on the credibility and bias of over 20 blogs devoted to various aspects of the pharmaceutical industry

Las Vegas, NV – April 30, 2007 – A new survey of pharma blog readers presented today at the Healthcare Blogging Summit by VirSci Corporation, publisher of Pharma Marketing News newsletter, reveals that four of the TOP FIVE credible pharmaceutical-related blogs are "industry critics," as rated by industry and non-industry readers alike.

According to industry readers, the TOP FIVE credible blogs, in rank order, are In the Pipeline, Pharmalot, Pharma Marketing Blog, BrandweekNRX, and PharmaGossip. In the Pipeline blog is the only "industry supporter" in the group (see TABLE, below).

Non-industry readers also considered critical blogs more credible, although the list of blogs in this group is somewhat different (see TABLE, below).

Pharma Rag, PharmaGossip, Question Authority, and Pharma Giles were considered the most critical of the industry by all 143 survey respondents, whereas On Pharma, In the Pipeline, Drug Wonks, and Eye On FDA were considered most supportive.

Aside from bias for or against the industry and credibility, respondents rated blogs according to readability (layout, ease of reading and finding information) and usefulness (for keeping readers aware of the issues).

"Top Honors" overall went to In the Pipeline, Pharmalot, BrandweekNRX, PharmaGossip, and Pharma Marketing Blog.

Thirty percent (30%) of respondents read 2 to 9 pharmaceutical-related blogs more than once a week. Eighty-six percent (86%) read pharma blogs to keep up to date with industry news and gossip; 69% to learn more about industry business practices, regulations, etc.; and 22% to "snoop" in order to see what bloggers may be saying about their companies or blogs.

The most frequently read blogs are Pharma Marketing Blog, PharmaGossip, Pharmalot, Question Authority (Dr. Peter Rost), In the Pipeline, and Eye On FDA.

"Both the drug industry and its supporters seem to have fallen into the same credibility gap," said John Mack, publisher of Pharma Marketing News and author of Pharma Marketing Blog and Pharma Blogosphere™ blog. "The results of this survey are a wake-up call to blogs that support the industry. They must do a better job convincing readers—most of whom are likely skeptical of the industry to begin with—that the information in their blogs is credible."

VirSci Corporation's survey was featured in the April issue of Pharma Marketing News. A reprint of the article "How Readable, Credible & Useful are Pharma Blogs? can be found on the Pharma Marketing Network website and purchased for $9.95. It’s free to subscribers of the newsletter (subscribe here).

TABLE: TOP FIVE credible blogs according to industry respondents (left 2 columns) vs. non-industry respondents (right 2 columns), based on the percentage of responses in the "Top 2 boxes" (Superior/Excellent). N (industry)=43 (excluding respondents who “never” or “rarely” read the blog); n>5 (includes only blogs having more than 5 responses); N (non-industry)=100 (not Never/Rarely); n>10. Excludes Pharma Watch blog because it is now closed to the public. *In the Pipeline is the only “industry supportive” blog in this group, as judged by respondents.

About the Survey
One hundred forty three (143) respondents to the survey ranked 22 pharmaceutical-related blogs according to readability (layout, ease of reading and finding information), usefulness (for keeping readers aware of the issues), and credibility (accuracy of information). The survey was hosted online between February 3, 2007 and February 28, 2007. VirSci Corporation acknowledges with appreciation Chris Pounds at Myriad Pharmaceuticals for help with survey design and analysis.

About VirSci Corporation
VirSci Corporation (www.virsci.com) publishes Pharma Marketing News and owns Pharma Marketing Network, which brings together pharmaceutical marketing professionals from manufacturers, communications companies, and marketing service providers for wide ranging discussions and education on a multitude of current topics. Pharma Marketing Network & Pharma Marketing News provide executive-level content coupled with permission-based e-marketing opportunities.

Media Contact
John Mack, VirSci Corporation
Phone: 215-504-4164
Cell: 215-431-0859
E-mail: johnmack@virsci.com

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Dispensing Under the Influence

A recent study of pharmaceutical industry gift givinig caught my attention. Here's the background.

A new study released by the New England Journal of Meddling (NEJM) revealed some interesting statistics:

"Eighty-three percent of all pharma bloggers who responded to the NEJM survey said they received free food and beverages from pharmaceutical companies."

"About one-quarter of all pharma bloggers said they received full or partial reimbursement from the industry for attending blogging conferences, and 18% of pharma bloggers said they were paid consultants to drug companies."

"Seven percent of pharma bloggers said they received tickets to cultural or sporting events."

One pharma blogger, who is also a physician, defended his choice to accept dinner this way: "It takes a lot more than a steak and fries with strangers on a precious night off of work to corrupt me and buy my influence..."

Nevertheless, these are staggering statistics!

More and more pharmaceutical companies are reaching out to bloggers in the Pharma Blogosphere. As reported in the April 2007 issue of Pharma Marketing News, Johnson & Johnson recently invited several prominent pharma bloggers to a lavish dinner at a New York City Restaurant (see "Should Bloggers Dine at Pharma's Table?").

Not until now, however, have we had any data to suggest how prevalent this influence peddling is.

Of course, there is no such study of the extent to which pharma bloggers are wined and dined and influenced by the pharmaceutical industry. But if the numbers quoted above really represented what was going on in the Pharma Blogosphere^TM, I am sure readers of these blogs would be a lot more skeptical of pharma blogging credibility than they are (for more on that, see "How Readable, Credible & Useful are Pharma Blogs?"; You can get a FREE copy of this report by filling out this Reprint Request Form. This offer ends Saturday, April 28, 2007 at midnight Eastern US).

Actually, as many of you undoubtedly know by now, the REAL NEJM (ie, New England Journal of Medicine) did publish a report of a PHYSICIAN survey. Just substitute "physician" every place you see "pharma blogger" in the above quotation and that would be the reality.

Dispensing Under the Influence
Of course this is nothing new about physicians accepting freebies from drug companies as many industry people will gladly point out. "It is one of those 'duh' studies," says Bob Erhlich, Chairman of DTC in Perspective and author of a recent e-mail OpEd piece entitled "The Physician Factor."

My point is this: What's "duh" for physicians would be "wha?" for any other group under similar influence of drug companies.

According to Ehrlich, many physicians are guilty of "DUI" - dispensing under the influence:

"Most of the time doctors reward their favorite rep with some extra market share points since many drug choices are me-toos anyway." (DTC Perspectives #258, April 27. 2007).

I find that an incredible statement for someone who is generally considered an ally of the industry to make. It's akin to the infamous Zubillaga "buckets of money" statement (see "The Zubillaga Affair: Effect on the Prospects for Pharma Blogging"). Don't expect Mr. Erhlich to be fired any time soon. He's the Chairman of his company!

What's the harm of a little influence peddling?

Let me give you a personal example to make my point.

The real NEJM study found that "Cardiologists were more likely to receive direct payments from drug companies in the form of consulting fees or lectureships. Researchers surmised cardiologists were targeted by industry because their opinions influence the prescribing patterns of nonspecialists" (see "Doctor freebies common, study says").

Could it be that my cardiologist may have prescribed 80 mg/day of Pravachol for me because of a favor or "reward" to a drug rep?

No problem, says Erhlich:

[Media critics of gifts to physicians] "forget that some people who get side effects for one me-too do not get them for another. Therefore, the availability of multiple drug options allows more people to get successful treatment." (DTC Perspectives, May 26, 2006).

Pravachol is one of those "me-too" drugs. Perhaps BMS -- who markets Pravachol -- was owed more favors by my cardiologist than was Pfizer -- which markets the "me-too" anti-cholesterol drug Lipitor.

The problem is that lately I've been having some "side effects" from Pravachol that worry me -- muscle cramps. Luckily, I've heard this mentioned several times in DTC ads, so as a precaution, I have stopped taking Pravachol until I can talk to my cardiologist.

My little antidote -- true or not -- illustrates that a little "favor," which in this world of "me-too" drugs may not seem important in the large picture, is very important to me!

Doctors Need to Be More Transparent About Conflict of Interest
I think it's about time for physicians to come clean! Take the free food, take the free samples, take the money, take the tickets... But let me know about it, just like you let me know my privacy options. Hand out a "Conflict of Interest" notice with that HIPAA notice when I first sign up as a patient. Then I can better make my own decision.

Please note that I am NOT advocating that physicians STOP receiving freebies from the drug industry. I am not even advocating that they list in detail every slice of pizza or dime in cash they receive. Just a statement whether or not they occasionally accept free meals, free samples or work as consultants to the industry and a pledge that this does not unduly influence their prescribing behavior (despite what Mr. Erhlich says).

What I am advocating is transparency and letting the market forces between physicians and patients decide the outcome.

Pfizer's Erection Hardness Meter

According to Jude Selvaraj, Pfizer's medical adviser in Singapore and Malaysia, "an estimated 20 percent of Asian men suffer from erectile dysfunction," whereas on the viagra.com US Web site, Pfizer claims "ED is more common than you might think. More than half of all men over 40 have some difficulty getting and maintaining an erection. The fact is, guys at any age can experience ED." Since this is a US site, I assume Pfizer is talking about US men.

The context of Mr. Selvaraj's remarks, which were published The China Post, aka AFP, was the launch of a new diagnostic kit to help men deal with erectile dysfunction. (Hat tip to Pharmalot for digging this up.)

"It is a prevalent issue," Jude Selvaraj, Pfizer's medical adviser in Singapore and Malaysia, told AFP at the launch of Pfizer's new diagnostic kit to help men deal with erectile dysfunction.

"You are talking about 20 percent plus," he said, giving a rough figure.

OK, which is it? 20%, "20 percent plus," or 40%? Why does Pfizer imply that twice as many men in the US than in Asia suffer from ED? Are we American men inadequate? Is it obesity? Or, perhaps, Pfizer is bowing to cultural norms (you know, kissing some ass before Malaysia breaks Viagra's patent):

Sex is still a taboo subject in much of Asia and many men are reluctant to admit they suffer from the problem, or to seek medical help, said Selvaraj.

A ha! Pfizer better not set the bar too high. But then again, maybe Asian men just don't give a damn about "erectile quality": "A survey released last week," AFP reports, "said Asia's lovers rate sex far less highly than those elsewhere around the globe, spend less time having intercourse and are not as likely to reach orgasm." Their head just isn't in the game!

Some more numbers were mentioned in the article:

According to Pfizer, which makes the anti-impotency drug Viagra, erectile dysfunction affects between 13 and 28 percent of all men aged 40 to 80.

The number of men suffering from the condition is estimated to increase to 322 million by 2025, from more than 152 million in 1995, Pfizer said.

I don't know where Pfizer is getting these numbers from. I have pointed out before than ED drug marketers are engaged in a bit of BS here -- ie, taking some government data and stretching it somewhat:

According to the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, "Incidence [of ED] increases with age: About 5 percent of 40-year-old men and between 15 and 25 percent of 65-year-old men experience ED." (See "ED Drug Sales Limp".)

20%, 28%, 40%, 30 million Americans (Levitra's claim)... whatever! It's all MULTIPLE times the incidence cited by NIH.

But back to the interesting stuff: that new diagnostic kit! (see photo at top)

Pfizer's new diagnostic kit, the Erection Hardness Score (EHS), grades erection hardness from one to four to provide a guide for assessing sexual status.

A score of four means the penis is completely rigid while a score of one means it is larger but not hard, Pfizer said in a statement.

"The EHS provides a quantitative measure of the degree of erection hardness and therefore treatment efficacy in patients with erectile dysfunction," the firm [pun intended?] said.

Victoria Lehmann, a sex therapist from Britain, said the EHS was easy to use and would help couples address the problem. [I don't see how!]

Lehmann likened a score of one to tofu. Four is similar to a cucumber, she said.

Several bloggers in the Pharma Blogosphere want to know what foods a score of 2 and 3 can be likened to. I would say 3 is a banana and 2 is 2-week old rhubarb. What do you think?

What's in the Future for Generics?

Join me for a live Pharma Marketing Talk Podcast Tomorrow!

You can listen live via the Pharma Marketing Talk Channel Page and call in with questions or you can listen to the audio archive afterward.

Guest: Todd Clark, VOI Consulting

Live Podcast Date: Wednesday, April 25, 2007, 1 PM Eastern US time

Duration: Approx. 35 minutes

Go to the Pharma Marketing Talk Channel Page to listen live and for callin instructions.

Background
The Medicare Modernization Act (MMA) of 2003 eliminated many of the techniques that original drug manufacturers employed to protect their franchises from generic competition. However, there was one major brand-preservation avenue - the use of authorized generics (AGs) - that the MMA did not touch. As a result, AGs have become the favored strategy for defending branded drug sales from generic encroachment in recent years and, in the process, AGs have arisen as one of the most controversial issues in the US pharmaceutical industry.

To date, efforts by regulators and the generic industry to combat Authorized Generics have been largely unsuccessful. With the new Democratic-controlled Congress and a federal budget increasingly burdened by pharmaceutical expenditures, that may change in the near future.

Todd Clark
Throughout his career, Todd Clark has worked extensively in healthcare marketing, consulting, consumer goods and technology. His focus for the last ten years has been on the healthcare industry. Since founding VOI Consulting in 1998, he has worked with a range of clients to develop successful valuation, commercialization, marketing and competitive strategies for both US and international efforts. Areas of specialization include market analysis, marketing strategy, business development, regulatory compliance and finance. Todd is the author of PharmaHandbook: A Guide to the International Pharmaceutical Industry an annual publication which provides decision-makers with information on the healthcare business and regulatory environments in over 35 global pharmaceutical markets. He has published in Pharmaceutical Executive and has been quoted as an expert in other industry trade press.

Some topics to be discussed:

• Impact of Wal-Mart's $4 Generic Program
• Define authorized generics
• Impact of new Democratic Congress -- review of some anti-AG legislation under consideration, its likelihood of passage and implementation
• Discuss legislation to allow lower-cost follow-ons of biotechnology drugs while protecting intellectual property and innovation
• Patent Challenges -- summary of recent court decisions on authorized generics, recent out-of-court settlements, etc.
• Would a ban on AGs may actually benefit the branded drug industry while hurting generic manufacturers

J&J to Give 120,000 Employees Their Own Blogs?

Johnson and Johnson (J&J) continues to lead the pack in outreach to Healthcare Bloggers and may also be ready to launch employee blogs! Before getting to the employee blogs, let's look at J&J's blogosphere outreach initiatives.

This Sunday evening, for example, J&J will host a private speaker/blogger reception at the Venetian Hotel in Las Vegas prior to the Healthcare Blogging Summit 2007 that will be held the next day at that location. Beer and wine will be available in addition to a buffet dinner.

J&J has opened up to bloggers previously when it invited several of us to a dinner and drinks at a New York restaurant. That raised some concerns about conflict of interest (see "Dining at Pharma's Table"), mostly because it was exclusively a J&J "event" the purpose of which was to pick bloggers' brains on various topics of interest to them. Frankly, I consider that a consultation, rather than entertainment or a simple night out with the J&J boys. In the end, I opted not to attend.

At the time, I ran a little poll asking readers "Should bloggers accept free meals from pharma?" The majority (51%) of respondents said "No, never", 32% (me included) said "Sometimes, it depends", and the remainder (17%) sad "Yes, no problem."

Transparency is Key
But each individual blogger needs to make up his or her mind how to handle conflicts of interest such as this. After some online discussion amongst bloggers in the Pharma Blogosphere^TM, a general consensus was reached that the conflict raised by the dinner could be mitigated through transparency. Several bloggers -- but not all -- who attended subsequently made their attendance known and expressed their policy regarding accepting "freebies" from the drug industry. Some -- mostly the journalist bloggers -- insisted on paying their share. Others said there was no conflict worth talking or expressing a policy about.

My Policy
Since I am a speaker at the Summit -- where I will be presenting more details of the First Ever Pharma Blogging Reader Survey -- I will be attending J&J's Las Vegas reception.

This is consistent with my policy: at most industry conferences that I attend or speak at, I normally take advantage of sponsored lunches, coffee breaks, cocktail receptions, and dinners. As a speaker, I never accept or expect a speaking fee, but I do normally expect reimbursement for travel and hotel expenses. The free food at the sponsored lunches, etc. is part and parcel of sustaining me while on the road in lieu of asking for a stipend to cover food.

In the case of the Las Vegas Blogging Summit, I will NOT be receiving any reimbursement for my substantial travel and hotel or food expenses. A guy's got to eat!

I expect the reception to be cordial and to offer a great opportunity for me to meet people and make contacts, which is very valuable. I thank J&J for this networking opportunity and I am sure it will unduly influence me to be more positive about J&J in my blog (as in "J&J, You're No Elvis Presley!").

Full Disclosure
While J&J is not totally innocent of the foibles that plaque the drug industry, it ranks high in my and the general public's esteem (see "J&J Scores High in Reputation Quotient Study"). When it does make a misstep, I tend to feel let down (see "Say it isn't so, J&J!"). You can see that my views of J&J have been positive way before the company started offering me and my ilk free dinners or consulting gigs.

Yes, I have done some consulting work for J&J (and other pharma companies) over the years -- mostly internal speaking gigs about compliance and privacy issues and use of new technology for marketing. I do not work with pharmaceutical company brand teams to help them do marketing. I'm more like the hired gun compliance expert who can offer a fresh perspective.

J&J to Give 120,000 Employees Their Own Blogs?
Aside from the Las Vegas reception and the New York private dinner party, how does J&J intend to put its toes in the blogging waters? I've heard -- mostly through Peter Rost who heard it from BrandweekNRX's Jim Edwards -- that J&J may be gearing up to having its employees write blogs. According to Rost:

"The person responsible for snubbing me [for an invitation to the New York Dinner] appears to have been Adriana Cronin-Lukas, whom J&J has hired as a consultant on blogging. Lukas told Jim Edwards that she’s trying to get J&J to give all their 120,000 employees a blog, on which the workers could write whatever they liked. Jim didn't like that idea, since he felt it was a journalist’s dream and a brand manager’s nightmare."

Over the past several months, I have offered the industry some FREE advice on blogging. See, for example, "A Few Rules for Pharma Employee Blogging." My rules were influenced by recent events that demonstrate how giving employees free reign to voice their opinions can easily go horribly wrong (see "The Zubillaga Affair: Effect on the Prospects for Pharma Blogging").

Some more free advice for J&J: Watch out for that bus -- the same one that hit AZ over the Zubillaga Affair!

Trial Ballooning
I also notice that J&J people are talking up corporate blogging strategies at conferences these days perhaps lofting ideas as trial balloons for feedback. Marc Monseau, Director of Corporate Media at J&J, and the person who organized the New York Blogfest dinner, is making a presentation at a "Blogging for Business" conference in May. The title of his presentation is "Developing A Blogging Strategy" and the topics he will cover are:

• Identify Opportunities And Risks
• Understand Your Audience
• Work With The Organization

Hopefully, Marc has read my blog to identify the opportunities and risks. He probably got a good understanding of his audience at the New York dinner and will get some more of the same at the Las Vegas reception. Glad to help you with that, Marc! But how about hiring me to "work with the organization?" I can be a good counter balance to Ms. Cronin-Lukas, who may be a tad too gung-ho. Let's meetup for lunch -- my treat!

This is Your Inner Ear on Drugs!

A traveling art exhibition of photographic images produced through micronphotography produced by Quintiles Transnational Corp. is designed to encouraging discussion of drug safety through the display of these beautiful and somewhat surreal images.

The image shown above illustrates antibiotic damage to the inner ear. Within the area labeled "A", is shown the collapse of stereocilia caused by aminoglycoside antibiotics. In "B," the cells are fused. In both cases, hearing loss is the result.

See more images here...

According to the press release:

The images bring the responsibility of safety to light, and illuminate the beauty of science as an art. Each piece consists shows images of drug-induced events, both positive and negative, at the cellular level.

The purpose of the Art of Safety exhibition is to initiate a dialogue about safety planning with relation to drug development through the impact of the images on display. An open dialog among stakeholders in the drug development industry is critical in continuing to raise awareness regarding the importance and value of safety planning throughout the drug development life cycle.

The Art of Safety, one of Quintiles’ new safety initiatives, is making its first national appearance at BioBay (April 26) and will appear at the following locations this spring:

• BIO International Convention, Boston, Massachusetts, May 6th-9th
• ASCO Annual Meeting, Chicago, Illinois, June 2nd-4th
• DIA Annual Meeting, Atlanta, Georgia, June 17th-21st

I wonder if there is any connection with another antiobiotic: Ketek (as in "FDA Puts Black Box on Ketek" and "Celsius 3014: Ketek, Drug Safety, & Bioterrorism"), which may have been used treat ear infections in children.

Americans Skeptical Of Pharma Cause Marketing

As Congress considers banning direct-to-consumer (DTC) advertising or at least giving the FDA the power to place a 2- or 3-year moratorium on DTC for new drugs (see "Bill Could Block Some Ads for New Drugs"), the industry is gravitating towards more unbranded disease awareness marketing (aka "cause marketing") programs. Pfizer, for example, is on record saying that it will spend at least as much on such programs in one year as it would on a typical branded DTC campaign.

Pharma disease awareness campaigns can take many forms, one of which is giving "buckets of cash" (aka "educational grants") to patient advocacy groups such as the American Heart Association and other, lesser-known, patient groups. Pharma is also known to create such groups de novo (see "Restless Pharma Marketing"). Disease awareness can also cross the line to "Disease Mongering," in which new medical conditions are created or the incidence of the condition is exaggerated (see "Disease Awareness or Disease Mongering?").

Is it any wonder, therefore, that new a survey by Envision Solutions (see press release here) suggests that many Americans are deeply skeptical of pharmaceutical companies' motives for supporting non-profit patient advocacy groups?

According to the survey, 43% of US adults believe that pharmaceutical companies fund groups like the American Heart Association and the National Kidney Foundation in order to get more people to buy their products or medicines, whereas only 21% believe it is to demonstrate that the companies care about a health issue supported by the group.

Don't Blame the Media!
Envision Solutions also analyzed negative media coverage of pharma support for patient groups and other non-profits and found that such coverage has increased. In particular, Envision suggested unease about pharmaceutical industry support of non-profits may be partly fueled by a recent sharp increase in news stories about “disease mongering” (see, for example, "Disease Mongering: When Is the Line Crossed?").

Disease mongering, however, is not the only pharma cause marketing practice getting negative press these days. For example, the recent Boston Globe article "Drug firms' funding of advocates often escapes government scrutiny" revealed that "In 221 [FDA] advisory committee meetings scrutinized [by Public Citizen, which doesn't receive money form the pharmaceutical industry], 32 of 44 speakers representing patients said they had received funding from a company that would be affected by the FDA's decision...While the FDA scours its advisers' backgrounds for such information [see here], the agency does not require disclosures when patients testify."

You can't blame the media for reporting practices that are clearly suspect. It's time to put the horse before the cart and for the industry to accept some responsibility for the negative press it receives!

Don't Let It Happen Here
In Europe and Australia, where DTC is prohibited, pharma-non-profit cause alliances are practically the only way pharmaceutical companies can reach out to patients. However, abuses "over there" have led to restrictions. Envision Solutions warns that "Americans' deep suspicion of pharmaceutical companies and increasing negative media coverage of their support of non-profits is a recipe for disaster." One such "disaster" would be what happened in the UK and elsewhere: "more aggressive government regulation of drug firm-non-profit partnerships."

There have already been moves in Congress to investigate pharmaceutical support of non-profit groups through educational grants, which are "growing rapidly" according to a New York Times article:

"A Congressional investigation of the money that drug companies give as supposed educational grants has found that the payments are growing rapidly and are sometimes steered by marketing executives to doctors and groups who push unapproved uses of drugs.

"Twenty-three drug makers spent a total of $1.47 billion in 2004 on educational grants, or an average of $64 million per company, according to the Senate Finance Committee. That number was a 20 percent increase from the total in 2003, which was $1.23 billion.' [NYT, "Drug Makers Scrutinized Over Grants", January 11, 2006].

To avoid more regulation in the US, Envision Solutions suggests that "drug firms and non-profits must take steps to increase their transparency and communicate more proactively about their alliances."

Envision Solutions has some recommendations to achieve this goal. Good luck with that!


Listen to this podcast:

Pharma Cause Marketing
A discussion with Fard Johnmar of Envision Solutions focused on his company's recent survey about American opinion of pharma-non-profit cause alliances and the implication for the future of pharma cause marketing....More info here...

• Airs live, Wednesday, May 2, 2007, 1 PM Eastern US time
  Guest: Fard Johnmar, Envision Solutions, LLC

Lilly Cuts PAP and Runs from Patients in Need, Putting Profits First

Jim Edwards or Brandweek reported that Lilly dropped its Prescription Assistance Program (PAP) for the poor as of December 31, 2006.

At least one Wall Street analyst -- Merrill Lynch's David Risinger -- points out that Lilly's bottom line is benefiting significantly from this action: "Many prescriptions were transitioned to Medicare Part D and other funding sources, which compensate Lilly at a dramatically higher level for prescriptions. Hence, Lilly is realizing a significant net price benefit in 2007 (vs. 2006) for a number of products (in particular Forteo)."

Risinger implies that Lilly had no choice but to drop its PAP due to Medicare Part D rule. While it may be true to say that Medicare Part D rules prohibit drug company PAP programs, companies can and have had their PAP programs approved by the OIG (see OIG's Advisory Opinion here):

"PAPs operating outside of Medicare Part D that offer free or reduced-cost prescription drugs - mostly to persons with low incomes and no insurance - may still be able to offer assistance to Medicare beneficiaries, according to an advisory opinion released April 18 by the Office of the Inspector General (OIG) [OIG Advisory Opinion No. 06-03]. The opinion warns that its approval applies only to programs offered by the company that requested the opinion (Schering-Plough), and urges each individual PAP to seek an approval, rather than use this advisory opinion as guidance.

The continued existence of PAP assistance for Medicare beneficiaries was put into question recently with the strict rules governing pharmaceutical companies’ ability to contribute to beneficiary’s drug costs without violating the anti-kickback statute. That statute prohibits offering or receiving payment to increase the use of products or services (in this case, to steer prescription drug use) at the cost of federal health care programs. The latest opinion offers qualified confirmation that PAPs are permissible provided they function within certain parameters, while pointing out that that PAP drugs will not count toward an individual’s Medicare Part D true out-of-pocket (TrOOP) costs and cannot be billed to any third party, including Medicare." [Prescription drug Patient Assistance Programs (PAPs) May Work For Some Medicare Part D enrollees]

Some pharmaceutical companies have taken advantage of OIG approval of their PAP programs, including:

• Schering-Plough
• Merck
• AstraZeneca

Cut and Run Away From Patients in Need
It's been tough -- profit-wise -- for Lilly lately. But PR-wise this can be tougher for Lilly because it demonstrates that when things get tough, the Lilly's of this world cut and run away from patients in need to buttress their bottom lines. Shame on Lilly!

New Twist to Pharma Tchotchke Marketing: the Scrubs Affair

Author of the book "The Well-timed Period" and blogger of the blog of the same name, Diana Kroi, wonders if the popular TV show Scrubs is engaging in pharma product placement advertising.

She cites the image on the left as evidence (note the Nuvaring logo on the wall behind Turk). This image also appears on the show's web site according to Diana, who says:

"Interesting example of stealth pharma marketing, but I'm not sure what the point is. It's not product placement, since the product's name isn't actually shown. As such, unless you're already familiar with this birth control method and its packaging, you wouldn't know it's a Nuvaring ad, and you wouldn't be able to investigate further to learn more about a method that might be beneficial for you." (see "Stealth Pharma Marketing").

First, let me say that this is not really "stealth marketing" as I would and have defined it (see "Buzz 'n Blogs -- Stealth Marketing"). To be truly stealthy, marketers must hide the fact that what they are doing is marketing, as when they pay ordinary people to submit comments to blogs or talk up a product at a bar.

What Diana doesn't realize is the power of "branding," which Organon -- the marketers of Nuvaring -- have done very well with this product.

Branding attempts to link a product to image -- not just a physical image, but an emotional/mental image as well. The logo, of course, is an important part of building that image. It helps people identify the product and recall its benefits.

Yes, if you did not have any other experience with the brand and the logo, this particular "product placement" would be lost on you -- zero ROI! Yet, it probably didn't cost Organon much to place the logo on the wall in the background, so they won't expect much.

But let's imagine the opportunity for the producers of Scrubs and other medical TV shows to profit from this.

We all know that most doctors' offices and clinics are festooned with "tchotchkes" -- those ubiquitous posters, calendars, desk pads, pens, refrigerator magnets, etc. that pharmaceutical sales reps give to docs.

If a medical TV drama or sitcom wishes to have authentic looking medical ambiance, it MUST include tchotchkes or else we wouldn't believe it's a doctor's world. I could see the Scrubs set designer asking "How can I make this look like an Ob/Gyn examination room?" She would draw upon her own experience and provide props that she has seen in HER Ob/Gyn's office. It doesn't mean that Organon paid for the placement.

Sorry to say, it did not happen this way. Organon actually paid for this placement as reported by "Inside Branded Entertainment ...where brands entertain and entertainment brands" which reprinted a story from Brandweek. Here's the relevant excerpt from that story:

The only drug company that has come out of the closet regarding product placement is Organon. In 2005, the Roseland, N.J., firm placed posters for its Nuvaring contraceptive in the backgrounds of NBC's Scrubs and CBS' King of Queens. Since then, it has added ABC's Grey's Anatomy to its list, according to brand director Lisa Barkowski. "A lot of the feedback we get is from healthcare professionals," she said. "They mention it to [our] reps, 'Wow, I saw that poster.' It reinforces in their mind; it makes them think of the product." (This Is Your Show On Drugs: Rx Brands Injected Into Action)

Ah ha! It was for the docs watching the show, not the patients! But I think they could have done more!

Rollover Pharma Web Tchotchke Marketing
Now, if Scrubs really wanted to exploit "Tchotchke Marketing", here's a suggestion:

Don't charge pharma companies like Organon to place product chatchkes on the show. Just do it as a loss leader. What you really want them to pay for is advertising on the show's Web site! Here's how it could be done:

Images from the show are featured on the Web site, which should include blogs by the actors to attract viewers -- women, not just docs. The images should be carefully chosen like the one of Turk to include clear shots of the sponsor's chatchke(s). Encourage viewers to roll their mouses over the image to "discover things" or win a free gift (a Nuvaring pen!). BTW, enhance the image to highlight the chatchke -- nobody will rollover a blurry poster in the background. When the user rolls over the chatchke up would pop an ad for the product! Make it a dynamic ad -- a cDetail!

Imagine all the opportunities for that -- it would bring new life to pharma chatchke marketing!

By golly! I think I invented a new marketing paradigm! Check out www.pharmachatchkemarketing.com

BS Pharma Publishing Metrics

Publish or perish is probably still good advice for researchers who wish to keep getting grants and tenure at major universities and medical centers. Of course, the pharmaceutical industry sponsors a lot of this research as well as the publication of the results in the scientific literature.

Pharmalot -- the blog of the Newark Star Ledger -- recently posted results from a Thomson Scientific study purporting to measure the leading organizations sponsoring publications in the medical literature. The report is titled "Who is Making the Biggest Splash" and the Pharmalot post is titled "Glaxo Scientists Are The Brainiest."

Thomson looks at the number of papers published and also rates the quality of each paper to come up with a score for the organization that sponsored the publication of the paper. Here's what Thomspn says:

The international pharmaceutical industry is among the most important sponsors of scientific research, so it is understandable that some of the most widely published authors of scientific articles are affiliated with, or sponsored by, pharmaceutical companies.

In this quarterly review of the scientific literature on drugs and therapies, Thomson Scientific has assessed the quantity and quality of the materials published by pharmaceutical companies, research institutions and other non-commercial bodies in the last three months to identify which organization has made the biggest splash.

You should first note that Thomson is not just rating papers published by scientists working within drug companies. Also included are papers written by scientists sponsored by or affiliated with pharmaceutical companies. To say, therefore, that Glaxo has the brainiest scientists is not accurate. At best you might say they use the brainiest scientists as hired agents.

But you don't have to be very brainy to get a scientific paper published. There are many non-peer reviewed journals out there that will be happy to publish a paper for a fee.

This is something I know a little bit about because I once worked for a small medical communications company that did ghost writing for pharmaceutical companies. Often, the company helped pharmaceutical clients to find physicians who would put their names on the papers -- sometimes, the pharma companies would recommend physicians. Medical writers would do all the writing and the company would take on the responsibility of getting the papers published in a journal. Most often, these would NOT be peer reviewed journals. The medcomm company even developed a methodology for tracking how influential the articles were by counting how often the articles were cited by other articles.

Thomson Scientific bought this small medcomm company and its methodology, which I am sure is the basis of it's "big splash" report.

So before you believe everything you read in blogs -- or in medical journals -- you better look under the hood. Unfortunately, Pharmalot and other blogs in the Pharma Blogosphere these days seem to be more concerned with the quantity of their posts rather than the quality! Perhaps we need a methodology for rating blog publications!

Device DTC Ad Spend Sinks: Trend or Anomaly?

As reported in BrandweekNRX (see "Device DTC Spending Drops"), TNS Healthcare reports that device ad spending dropped in 2006 to a level not seen since 2003. Here are the numbers:

2002 = $384 million
2003 = $444 million
2004 = $483 million
2005 = $510 million
2006 = $443 million

Does this drop off represent a trend or is it an anomaly to be reversed this year? It seems that there is more device DTC this year than last: personally, I have seen more device ads on TV and in print lately and commented on this in previous posts (see, for example, "Device DTC: Imagine How Far It Will Go!").

Let's look more closely at the numbers.

First, as BrandweekNRX points out, $45 million (or 67%) of the overall $67 million fall off was due to one company: Johnson & Johnson, which spent $105 million in device DTC in 2006 compared to $150 million in 2005.

Although BrandweekNRX attributes J&J's cutback to its pledge to decrease TV DTC spending, it's decision could have more to do with the recent revelations concerning drug-eluting stents. These stents, according to reports, have been linked to an increased risk of blood clots which could continue for several years after they are implanted. Other studies just showed that the stents were ineffective:

"Stent makers including Johnson & Johnson and Boston Scientific Corp. took a blow last week when a study revealed that the devices, intended to prop open narrowed coronary arteries after angioplasty procedures clear out blockages, did not decrease mortality or hospitalizations for patients taking medications to blunt the effects of severe but stable heart disease." (NJBIZ)

Compare this with the situation in 2005 when J&J started a stent price war with its competitor Boston Scientific. DTC advertising no doubt played a role in that strategy.

So 67% of the ad spend drop might be anomalous in nature.

In other words, leaving J&J out of the equation, the decrease in device DTC spending is not as dramatic as it looks and may actually continue to increase in the coming years.

Then again, device manufacturers may be finding that DTC just hasn't been working (see "New Medical-Device Ads; Old Concerns").

Pass it on: Blog Silence in Memory of Students Slain at VA Tech

Fard Johnmar at HealthcareVOX has a great idea: a daylong moment of silence on this blog tomorrow in honor of those killed and wounded in today's senseless shooting rampage at Virginia Tech.

Pass it On!

Botox BS Piled Higher and Deeper

Have you seen the latest ads for Botox? The tag line is "freedom of expression..." The ads go on to say "Don't hold back! Express it all!" The copy writers certainly don't hold back on the exclamation points!!

The not-so-subtle subliminal message is "despite what has been reported in the press and on blogs by patients (see "Botox Banality Not a Boon for TV Sitcoms"), use of Botox does not limit your range of facial expressions." To prove the point, ads like the one shown here feature a woman in several different poses, presumably showing a range of impressions.

Pretty impressive evidence, wouldn't you say?

I have tried to fathom the thoughts of the woman in the ad and put these in thought balloons superimposed on the ad (see image). I think I captured the essence of these expressions. Don't you agree? BTW, feel free to suggest your own thought balloons in comments to this post and I will create new graphics that incorporate the best.

Carefully Wrought Bullshit
These new Botox ads, aside from being reminder ads that are frowned upon by responsible pharmaceutical marketers, are examples of "carefully wrought bullshit," in the words of Harry G. Frankfurt, author of the tongue-in-cheek book entitled "On Bullshit."

According to Frankfurt, "the realms of advertising and of public relations, and the nowadays closely related realm of politics, are replete with instances of bullshit so unmitigated that they can serve among the most indisputable and classic paradigms of the concept."

I have devised a Pharma Marketing BS Meter^TM, which rates the BS level of DTC ads. On the left is the BS Meter for these Botox ads.

What's your rating of the BS level of these ads? Take my little survey and let me know. P.S. Don't forget to submit your thought balloons in the comments section. Thanks!

Compared to other DTC ads, what's the level of BS in Botox ads?
	Very High
	Somewhat High
	Average
	Somewhat Low
	Very Low

Is Pfizer Outsourcing Innovation?

According to reports in the Pharma Blogosphere^TM (see below), Pfizer has laid off a "large number of PhD scientists" in an effort to get more lower-level "associates" to shoulder the company's basic research, aka innovation.

Perhaps "PhD Phobia" is behind this rollback of qualified scientists at a time when the industry needs more, not less innovation.

You may recall that back in January, when a study of DTC advertising was published in The Annals of Family Medicine, a Pfizer spokesman said in a phone interview: "It was a bunch of Ph.D.'s sitting around, looking at ads" (see "TV DTC Educate Little, Increase Sales Less").

I thought this apparent expression of "Pfizer PhD Phobia" was a bad image for the leading company in a research-based industry to project.

On the heels of this expression of PhD Phobia, we learn that Pfizer is laying off PhDs, according to Derek Lowe, a recently laid-off PhD chemist himself, and author of the blog In the Pipeline. Derek claims:

"I've heard from more than one source that Pfizer has laid off a large number of research staff this week in Groton. This seems to have taken people by surprise in many cases, since the expectation was just that everyone would find out where they were on the new organization charts. Well, in a way, they did." (See "Layoffs - Again").

"Rumor has it [Pfizer] wants to get to a 4:1 associate: Ph.D ratio..." said a commenter. Presumably, the ratio now is lower than that. Pfizer could have increased the ratio either by increasing the numerator -- ie, hiring more associates -- or by decreasing the denominator -- ie, firing PhDs. Pfizer went the decreasing the denominator route.

Is firing PhDs the best option?

From a financial, Wall Street, point of view, it makes sense. You can save a lot of money by getting rid of high-paid employees , especially if you have an ant-intellectual bias (as in "bunch of PhDs sitting around") to begin with.

From the perspective of winning the all-important PR war to win the hearts and minds of consumers, however, it certainly doesn't look good to be firing PhD researchers. If Americans are asked to pay more for their prescription drugs to finance future innovation -- which is an argument often made by the industry -- where is the money going if you are laying off PhDs who are best qualified to deliver innovation?

Saving Money by Outsourcing Innovation
Perhaps some -- but not all -- of the money is going towards licensing new molecules or outsourcing innovation to other countries where PhDs are cheaper. Sometimes this works and sometimes it doesn't.

Pfizer lost some credibility as an innovator when it had to halt the torcetrapib clinical trials and abandon the drug, which it licensed from Japanese researchers in the first place (see "torcetrapib: $800 Million Failure but Kindler Safe").

Large pharmaceutical companies like Pfizer are evolving to focus on what is becoming their core capability: drug development (ie, running clinical trials and getting FDA approval) and marketing. While it does that, industry proponents like PhRMA even more stridently proclaim that US pharmaceutical companies are "research-based" and "today's drugs [prices] finance tomorrow's innovations."

The talk on Wall Street now revolves around the innovation that Pfizer must buy through mergers, not innovation! In other words, Wall Street investors have little patience for the "Today’s drugs finance tomorrow’s innovation" argument. This is bad news for Pfizer's PhD research scientists!

'Round the Sphere: You're Fired!

First, Mike Zubillaga was fired by AZ. Then Don Imus was fired by CBS! Both for saying something stupid! It goes to show that employees everywhere, not just in pharmaceutical companies, do dumb things.

But these incidents are connected in another way: bloggers in the Pharma Blogosphere may have played a role in getting these guys fired.

Peter Rost (Question Authority) was quick to take credit for Zube's demise. I don't think anyone in the Pharma Blogosphere would dispute that. See "Peter Rost gets an AstraZeneca employee fired." (Medical Weblog)

But did you know that a famous Pharma Blogosphere blogger may have been partially responsible for the firing of Imus? And who would this blogger be? Why, me, of course! Whaaa?!! you say? It's true.

Read more about this and learn about new blogs on The Pharma Blogosphere blog.

zubillaga

Group of 7 (code name "whiskey") Reports Unethical AZ Behavior to OIG

This just in from Peter Rost (personal communication):

We are a group of 7 honest AstraZeneca employees scattered around headquarters and field sales.

Our goal is for AstraZeneca to once again become an ethical pharmaceutical company.

We have been reporting unethical behavior to the Code of Conduct hotline 888 244-1769) for years. However, the company continues to violate policies developed under the HHS OIG Corporate Integrity Agreement. We are afraid that AZ is not properly notifying OIG of these reports, and have begun to copy OIG (800-447-8477)on everything we submit.

For the most part, the policy violations that we see come from management, and resistance from underlings is met with swift retaliation. Anonymity is essential.

Our main concern with the Mid-Atlantic Oncology Newsletter was actually
its directive to misbrand anastrozole by "selling against letrozole" without approved material, head to head studies or data in our prescribing information. The RSD's statements were crude, but not illegal.

We would like to encourage all workers to stand up and report unethical behavior by managers to the Code of Conduct hotline. One of the first directives in our compliance policy is that you have a "duty to report" illegal activity.

File this under further fallout from the "Zubillaga Affair." I'm looking forward to the AZ Group of Seven Blog!

zubillaga

Pharma Still Stinks, But Not as Much as Oil or Tobacco!

According to yet another poll (the second edition of I-Rep, Ipsos’ biannual survey on perceptions of large companies), most US consumers think oil and tobacco (industries) stink. They also think pharmaceuticals stink, but only slightly less than oil and gas (see chart and "Survey Says: Pharma Still Stinks But Not as Much as Oil or Tobacco!"). The good news is that slightly more consumers view pharma favorably than unfavorably (35% vs. 32%, respectively).

Nevertheless, I don't smell any victory and I see no light at the end of the tunnel in pharma's PR war for consumer approval.

GSK's Missed Opportunity to Wipe Off Some Stink
An example of how pharma misses opportunities to win a PR battle for consumers' minds is how and when GSK decided to pull it's ads from the Imus in the morning MSNBC show.

According to TNS, GSK ranked number 5 in advertisers targeted to the Imus in the morning MSNBC show (download data here).

GSK wasn't among the first to pull its ads from MSNBC and it took some prodding from me to help it see the light.

On the other hand, P&G -- #10 on the advertiser list -- was among the first advertisers to announce that it would withdraw its ads. Furthermore, P&G made this unambiguous statement as to where its values lie:

"We think we're accountable first to our consumers. This particular venue where our ad appeared was offensive to our target audience. And so that's not acceptable to us, which is why we're evaluating further." (See "Imus Too Hot for Marketers".)

GSK, on the other hand, only had this to say:

"The bottom line is that we have suspended our advertising with MSNBC until we can determine that we can have a level of confidence that our media standards are being adhered to." (See "GlaxoSmithKline pulls Imus advertising".)

It's too bad that GSK didn't make a statement similar to P&G's. It could have gone even further considering that it soon will be marketing its HPV vaccine Cervarix to young women in the US.

Could GSK have made a point of supporting the young Rutgers' women who were attacked by Imus and thereby enhance its reputation among all young women? Whether or not such a public statement would help GSK market Cervarix is a secondary issue. It would have helped give the public a more positive image of pharmaceutical companies.

NOTE: A call into GSK's media relations office to discuss this went unanswered at the time this post was made.

Industry Considers How to Improve its Image
In the March 2007 issue of Product Management Today magazine, a roundtable of notable advertising mavens (eg, Ron Pantello, Chairman, Euro RSC Life Worldwide) and communications experts (eg, Harry Sweeney, Chairman, Dorland Global) discussed "Changing the Public Perception: The Industry's Role."

Guess what these experts decided the industry should do. Fund a coalition to deliver its message to patients and consumers! Here's what Pantello suggested:

"Is it time for us within the health care communications industry to form a new coalition or to redirect [his word, my emphasis] some of the coalitions that exist today, such as the HBA [healthcare Businesswomen's Association] or the Coalition for Healthcare Communication [the folks who recommended less risk communication in ads] for the common purpose of delivering our message to patients and consumers?"

Instead of pouring millions of dollars into an astroturf PR effort, the industry would be smarter to tale advantage of PR opportunities such as that provided by the Imus Imbroglio to make a statement in support of its patients. P&G, more a packaged goods company than a pharma company, was smart enough to do it; unfortunatley, GSK was not.

My advice to the industry: Be smart, don't fund your lackey non-profit organizations to do your dirty work! It will only provide more grist for the pharma blogging mill. Get some backbone and publicly exhibit your support -- in words as well as deeds -- for issues of importance to your patients; issues such as dignity.

GSK Pulls Imus Ads...BUT, Only Until "Media Standards" Are Met

Within hours of my call for Glaxo to pull its Imus ads (see "Glaxo, Pull Your Imus Ads"), which I posted at around 6 AM this morning, I learn that GSK has heeded my advice (see "GlaxoSmithKline Pulls Imus Ads").

Unfortunately, the action was not accompanied by any press release or statement by GSK other than this bland corporate-speak:

“The bottom line is that we have suspended our advertising with MSNBC until we can determine that we can have a level of confidence that our media standards are being adhered to,” GlaxoSmithKline spokeswoman Nancy Pekarek told MM&M.

GSK missed an opportunity to explain what it's "media standards" are. Imus is well-known to have engaged in racial parodies before:

"He’s ALWAYS said racist remarks. His show often makes fun of African-Americans and Latinos. As with many morning radio shows they do parodies, with favorite targets being Al Sharpton who is depicted in a horribly offensive Ebonic tongue and Omar Miniya, the General Manager for the New York Mets, who is portrayed with a horrible Hispanic accent. (See "Imus Gets Suspended 2 weeks but here’s what the media WON’T TELL YOU.")

Once Imus gets back on the air, will GSK's media standards coincidentally be met?

If anyone can tell me what these media standards are, I will be greatly appreciative!

P.S. I just learned from ABC World News that NBC will no longer simulcast the Imus show on MSNBC. This obviously means that GSK will no longer have ads on Imus/MSNBC no matter if Imus survives on the air or not. It also means that GSK doesn't have to make a tricky decision based on whether or not it's media standards have been met.

Glaxo, Pull Your Imus Ads!

The Wall Street Journal reports that several advertisers, including Pocter & Gamble, announced that are pulling their ad support of the Imus radio show. GlaxoSmithKline is another pharmaceutical company whose ads run on the Imus show.

Glaxo should pull its support and make a strong public statement about it. Not only is this the right thing to do, but it is good marketing considering that the company just applied for U.S. approval of its Cervarix vaccine to prevent cervical cancer. You want to reach out to young women, don't you Glaxo? If nothing else, women's basketball is about respect for young women and their ability to compete and live in a man's world.

Imus, you recall, exhibited his racism on his FCC-regulated talk show by referring to the Rutgers women basketball team as "nappy-headed 'hos." Then, in his apology on the Al Sharpton talk show, he was overheard to say "We Can't win with you people."

Lats year, according to the WSJ, Glaxo spent $277,000 advertising on the Imus show. I am sure the company would never advertise Cervarix on that show if the vaccine were approved -- Among the 2 or 3 million listeners to Imus, I can't image there would be any women teenagers.

Glaxo, listen, this is such a great opportunity to align yourself with women and parents of young teenagers who are outraged about the Imus Affair! And, as I said, it's the right thing to do.

Will you do it?

Should Glaxo Pull Its Imus Ads?
	Yes, and make a big announcement about supporting minority women
	Yes, but do it quietly and come back when this blows over
	No, this is a business, not a social cause

A Few Rules for Pharma Employee Blogging

My post yesterday (see "The Zubillaga Affair: Effect on the Prospects for Pharma Blogging" and " 'Round the Sphere: The Zubillaga Affair and Aftermath") seems to have hit a nerve.

The premise was simple: if a major, sophisticate pharmaceutical company cannot even monitor employee comments published in an internal, company-sponsored, printed newsletter with limited distribution, how can we expect pharmaceutical companies to use blogs?

Given the conservative nature of the industry, the knee-jerk reaction to the Zubillaga Affair is sure to be: "See, this is why we cannot let employees write blogs!" I expect to hear this at upcoming pharmaceutical conferences.

I note that many bloggers picked up the glass half-empty message of my post (see, for example, this entry over at Pfizer Sales Representative Bill of Rights Blog: "Bloggers? Did you say Bloggers? We don't need no stinking bloggers......").

Yet, I continue to see the glass half-full, which caused at least one of my pharma blogger colleagues (ie, Peter Rost) to wonder if I lost my mind!

Some commenters have also doubted that I have any pharma company experience, else I would never suggest that pharma employee blogs are possible:

I had doubts before but this clinches it for me. You definitely have either never have worked at a pharmaceutical company or have not worked in one since 1999. What company would allow this type of feedback and not expect to get investigated is unfathomable. Blogging is for those who wish to remain anonymous in this industry and will never catch on mainstream due to the regulatory reviews that are done.

It's time to come clean. I HAVE NEVER WORKED AS AN EMPLOYEE FOR A PHARMACEUTICAL COMPANY! In this day and age, that's a plus! I will forever remain an outsider pissing in. But, in this case, I am NOT pissing, I am bearing gifts. Still, I get no respect!

The industry, in some cases, can benefit from outside counsel. So let me offer more advice to pharmaceutical companies interested in starting employee blogs. Call it:

A Primer on Pharma Employee Blogging

Start Internally

Whatever you do, start internally in a controlled environment. Of course, this is no guarantee that you won't be outed at CafePharma as happened to AZ in the Zubillaga Affair. But, if you follow my rules, you'll limit your risk. Once you have experience with running your employee blog, you can go public. In the meantime, you will have learned which employees like writing blog posts, which ones have great stories to tell, and, yes, you will receive criticisms, which can only help you improve. You don't want to encourage a bunch of synchopants!

Guarantee Anonymity

An internal blog can be like an old-fashioned suggestion box. But employees must be allowed to submit comments anonymously. To allow for true anonymity, you must have "public" workstations throughout your workplace (in cafeterias, lobbies, etc. ). Your employees are smart -- they know you can identify them by their computer workstation address. Warn them not to submit comments from their workstation IF they wish to remain anonymous.

Moderate Comments

Many of my blogger colleagues are free-thinking liberals who believe that any kind of control of freedom of expression is evil. I feel that way about MY FREEDOM OF EXPRESSION, but not about other people's freedom of expression -- when they wish to express themselves via my blog, that is.

You see, I view my blog as my property, my creation, which belongs to ME, not to EVERYONE! That's one reason why I don't allow comments to be published in my blog without being reviewed by me first. Over the years, there have been only a handful of comments that I have excluded and 90% of them were ads for purchasing drugs over the Internet, or from crazies promoting their own cause, etc. One -- from a CafePharma denizen -- just called me names. None of these comments advanced the discussion.

Therefore, I advocate that a pharma employee blog also be moderated and not allow comments to be published without prior review. You can note these comments and decide what action to take as followup, but you don't have to air all your dirty laundry. It would be a good idea to catalog comments and do some kind of summary report that indicates how many comments were received, how many were published, and why some comments were not published (a kind of "comment audit" that borders on transparency in an aggregate kind of way).

The policy regarding moderating comments depends on the company. Some may not allow comments at all. The ability to submit comments, however, is an important benefit of the blogging experience, and is essential to the main objective of giving employees a voice. Therefore, I recommend as liberal a policy on moderating comments as possible.

Posting

The meat of the blog is the post written by the blogger author. Blogs can be set up to accept posts from a number of people and there can be an editor that accepts or rejects posts, sort of like a Huffington Post. An internal pharma employee blog can be set up that way too. However, rather than going the Huffington route, you can set up a more structured, safe route: one editor accepts stories from employees and submits posts with or without editorial comment. Similar to a newsletter.

However you handle posts from employees, you need to make it as easy for them to submit a posts as Blogger makes it easy for me to submit this post. The only difference is that it goes to the editor first before it gets published. If your submission process is more formal that that, you might as well have a newsletter and not a blog.

The editor either publishes it as is or asks the employee to make changes. The employee either accepts the changes or opts out of submitting the edited post for publication.

As with comment moderation, there should be an editorial policy that is as liberal as possible. Since the blog has a purpose, which is to provide a more positive image of the industry via the voice of the rank-and-file employee (see yesterday's post on which employees I believe qualify), the editorial policy should be consistent with this policy. If employees want to bitch and complain about the company, this blog is not for them. They should go through regular channels. But all "negative" statements in an otherwise positive post should not be edited out. It is important to do as little editing as possible, which may be a challenge for any company and especially for pharmaceutical companies

Always include an employee photo.

Go Public

The main objective of the internal employee blog is to bring it public so that visitors can see the human face of the company and hopefully read authentic comments from employees to learn how they feel about working in the industry.

I notice that some pharma companies feature photos and comments form employees in the career section of their web sites (see, for example, Takeda Employee Profiles).

I have no idea if the words attributed to employees in these profiles are their own words or not. That's a perception that an employee blog must overcome. And the best way to overcome that is by being transparent and laying out exactly what the blog editorial and moderation rules are.

I don't expect this to be the last word on pharma employee blogging. I know there are many challenges that pharma must overcome to initiate employee blogs. These challenges have more to do with transparency than regulation, which is often used as the excuse.

As the Zubillaga Affair demonstrates, transparency is a big stumbling block for most pharmaceutical companies. Perhaps the only pharmaceutical company that may currently have the necessary culture of transparency to embrace employee blogs is Johnson & Johnson. They will be a big presence at the upcoming Healthcare Blogging Summit in Las Vegas and I look forward to talking with them about my ideas for an employee blog.

The Zubillaga Affair: Effect on the Prospects for Pharma Blogging

The Pharma Blogosphere is all a twitter about an AstraZeneca internal Oncology newsletter that published a controversial analogy made by Mike Zubillaga, AZ's Mid-Atlantic regional sales director/oncology.

What Mike said was:

"Call Execution - Not making the calls you are supposed to make does not drive your business. I see it like this: there is a big bucket of money sitting in every office. Every time you go in, you reach your hand in the bucket and grab a handful. The more times you are in, the more money goes in your pocket. Every time you make a call, you are looking to make more money."

The story was first seen on the AZ CafePharma Discussion Board and then Peter Rost over at Question Authority got hold of the "smoking gun" and published a scanned image of the relevant newsletter page.

NOTE: Did Michael Moore -- infamous producer/director of the long-anticipated "Sicko" documentary -- try to get hold of the evidence as well? Someone on CafePharma made this post: "Wow, that would be a great opening narrative to my upcoming movie 'Sicko', due out in September. PLEASE someone send it to me. Michael Moore"

AstraZeneca terminated Mr. Zubillaga on Good Friday and so far he has not risen from his corporate grave to defend himself. AZ had this to say:

"AstraZeneca strongly repudiates the negative comments made in this newsletter," the statement said. "This newsletter was produced outside of AstraZeneca's required approval and review processes."

Much is being written about the stupidity of expressing what's obvious in pharma sales. Mr. Zubillaga could have been more circumspect about it, as pointed out by an anonymous comment left on CafePharma:

"Sure he was trying to motivate his sales force but the guy is 50 years old and has worked in this industry how long? I mean, how stupid do you have to be to make a comment like that and then allow it to be printed in a newsletter? This industry is under intense scrutiny right now both by the government and the media. Any newbie, 22 year old PSS even knows that.

"This guy obviously had lost touch and thought he was so bad, he could say whatever he wanted. I can't think of a more tacky and embarassing example to use. We're not retarded. We know what are jobs are. However, in an area like oncology, his choice of words and actions are particularly unsavory and embarassing."

AZ also could have been more intelligent because nobody believes that such a newsletter could have been written and distributed without internal review and approval. It reminds me of Takeda's "not done here" defense regarding a TV ad that was cited as violative by the FDA (see "Call for a Rozerem Prescription Boycott!").

Pharma Not Ready for Blogging
This whole episode shows that the pharmaceutical industry is NOT ready for blogging, at least not the kind of blogging that I have often recommended, which is employee-written blogs. Several pharmaceutical companies like J&J are thought to be poised to launch such blogs -- at least internally for now. I see them reconsidering the wisdom of this idea, considering the public opinion black eye that AZ and the industry are getting from The Zubillaga Affair.

If a major pharmaceutical company cannot even oversee what employees say in an edited, limited distribution, print newsletter, how can you expect any pharmaceutical company to manage an employee blog?

I never advocated an interactive, unmoderated, free-for-all blog that any employee could contribute comments to. That would be suicide. What I envisioned was an employee blog that was more like an electronic newsletter, where employees submitted true success or motivational personal "stories" and where an editor would select which stories to publish in the blog. Comments from other employees would be allowed and encouraged -- even anonymous comments. But it would be up to the editor which comments to post.

This, I believe, is the closest that pharmaceutical companies can ever come to user-generated content. At least it would be written in the employees' own words and not crafted by the corporate communications or HR people.

But, now that I have seen how inept pharmaceutical companies can be about oversight of internal documents, I have to withdraw my suggestion for employee blogs.

I must say, however, that I never thought marketers and sales personnel made good spokespeople (see "GSK Strikes Back with a Grassroots Campaign" and "Sales Reps Make Poor Spokespeople"). The Zubillaga Affair confirms my opinion. There may still be hope for employee blogs if the following minimal criteria were met.

Rules for Pharma Employee Blogging
The following personnel should NOT be allowed to contribute to employee blogs:

• Marketing, sales, legal, or corporate communications personnel
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zubillaga

Botox Banality Not a Boon for TV Sitcoms

Despite extolling the ability to "express yourself" while under the influence of Botox in recent TV "reminder ads" -- which, BTW, go against the self-imposed industry ban on such ads -- TV studios are finding it increasingly difficult to find women actors who can express themselves, according to Wall Street Journal article ("The Backlash to Botox").

Left, Janice Dickinson (Botox Banal) in scenes from her reality show, 'The Janice Dickinson Modeling Agency'; right, Julia Louis-Dreyfus (Botox Free) in 'The New Adventures of Old Christine.'

"The rarest commodity in TV these days, say veteran casting directors: stars without Restylane-frozen faces and collagen-inflated lips."

Botox Not Comical
"Successful sitcoms," notes the WSJ, "including 'Old Christine,' typically feature actors and actresses who use a heavy arsenal of facial expressions. Failed comedies -- for example, 'Hope & Faith,' 'Listen Up' and '20 Good Years' -- often feature performers that border on cardboard caricatures. 'Frozen isn't funny,' says [Joel Thurm, who served as Aaron Spelling's casting director]."

Also not comical are some of Botox's possible side effects and adverse events, including respiratory arrest, paralysis of swallowing muscles serious enough to require the insertion of a feeding tube, arrhythmia and myocardial infarction. Some cardiovascular events associated with Botox were "fatal" according to the BOTOX package insert.

Of course, none of these have to be mentioned in the "Express Yourself" Botox ads because FDA does not require it in reminder ads, which do not mention what the product is approved to treat. Obviously, Allergan, who makes and markets Botox, would prefer NOT to mention these bad things, hence it continues to run reminder ads despite the drug industry's self-imposed ban on such ads (see "Allergan Ignores Guidelines, Wins Award Anyway" and "PhRMA Intern vs. BOTOX!").

You also won't easily find these possible side effects and adverse reactions on the Botox web site, which merely states "Do not use BOTOX Cosmetic if you:

* have an infection where BOTOX Cosmetic will be injected
* are allergic to any of the ingredients in BOTOX Cosmetic
* are pregnant or think you might be pregnant."

It then states "Ask your doctor or pharmacist for the Professional Package Insert for complete information." And if you scroll way down to the bottom of the screen, you can click on "Prescribing information" and read the package insert. If you make it to page 2, you will find the nasty stuff.

The "Express Yourself" reminder ads are an obvious reaction to the well-documented lack of expression often associated with Botox. This "side effect" of Botox, which is not listed in the package insert as a side effect, is driving US TV studios to hire British actresses who are not so medicated. According to the WSJ, this contributes to the "increasing globalization of television casting."

Web 2.0 Hates Sally

Sally Field is all over the TV these days hawking Boniva. One night she's talking about her own experience with osteoporosis and the next she's talking about "her friend."

The FTC soon may have a thing or two to say about celebrity spokespersons, especially those who do not reveal that they are being paid to mention drug names on talk shows (see, for example, "FTC Begins Review of Celebrities in Ads After Stars Take Undisclosed Drug Money"). Yet, the FTC has traditionally ceded oversight of drug ads and promotions to the FDA (see "If FDA were as Powerful as FTC") and that may give the drug industry a free pass.

Web 2.0 (aka, social networking), however, is not as forgiving.

Over at the National Psoriasis forum, for example, I found this:

To Martha Stewart...Sally Field was on her show today and mentioned that she has osteoporosis and wanted to talk about Bone Health. (She's their spokesperson.) Sally mentioned medications, and said she takes the once-a-month Boniva. Martha interrupted her to ask if it's full of vitamins and minerals. Sally said, "No, it's a treatment." Martha said, "Reeeally, no minerals?" WTF? Then Sally finally said she wanted to talk about Bone Health again, and again, Martha cut her off for a commercial break. (I've worked in television, and I know full-well how that works, but there are much smoother ways to silence a guest - saying, "We'll talk about that, and more, when we come back," is one great way.)

One more segment, Sally has twice said, "I wanna talk about Bone Health," and Martha just went right back to talking about the flowers they were planting and then asked her about The Flying Nun. Now time's up, Martha said, "Good luck with the osteoporosis...thing," and then asked if men can get it. Sally finally got a few seconds to plug the website, and that was it...

This is a post made by "Tao" who is 37 years old, is "originally from WA, now lives in CA, and has a fiance and a kitty."

I got to give Martha credit for side-stepping Sally's attempts to plug Boniva and "bone health."

But here's what I'd like to know: Are celebrities paid more if they mention the drug name? Are they paid less if they cannot get the whole message on the show?

Sally also appears in Boniva TV ads and there's no doubt she gets paid for that. Yet, the ads are not effective, if Web 2.0 rants are any indication of success. Here's a tidbit I picked up from "Goddess on the Loose" (that's her logo above):

"I love the way Sally Fields pimps Boniva: 'My girl friend told me she has to set aside time once a week to take her osteoporosis pill.' And I'm guessing that 'once a week' time probably lasts for all of two or three SECONDS! Can you IMAGINE the inconvenience?!"

I note that Sally was smart enough to attribute the once-a-month benefit to her "girl friend." Obviously, celebrities like Sally are not THAT lazy! Compare this to the real world as laid out in the blog Atmospheric Ruminations:

Well, Sally told her friend that she, Sally, only has to take Boniva once a month. ONCE A MONTH! And her friend said, "Now that's something I can do!" Okay, let's take this apart...with the old medication, Sally's friend takes a pill once a week. HALF A SECOND A WEEK TO TAKE A PILL. Sally takes the new, improved medication. HALF A SECOND A MONTH TO TAKE A PILL.

I personally think BOTH of these ladies should take a pill...a SMART pill, if there's such a thing. Does anyone out there actually complain that they have to take ONE PILL, ONCE A WEEK? Hell, I'm not sick, nor seriously infirmed, but EACH NIGHT I take SIX pills! Three of those pills are for my gouty-arthritis, which I have to take THE REST OF MY LIFE. The other three pills are a very mild anti-depressant, which STILL WORKS after taking it DAILY for SIX YEARS!!!

That totals out to 2,190 pills I take in a 365 day year...add 6 pills for a leap year. Sally takes 12 Boniva pills a year. Sally's friend has been taking 52 pills a year, assuming she hasn't switched to Boniva yet. I am poking fun at this commercial, obviously, but I am somewhat alarmed and disgusted that people can be so damn LAZY. And do the people who write commercials think we're MORONS? You know, I am actually a bit STEAMED about this!

Indeed!