Friday, July 27, 2007

GSK's Race-based Herpes Awareness Campaign

Both the Department of Health and Human Services and the American College of Obstetricians and Gynecologists reject routine screening for genital herpes. A federal survey in the early 1990s found that 21 percent of American adults had the infection and a follow-up survey this decade found that the national prevalence had fallen to 17 percent, according to a recent article in the Washington Post.

So why is GlaxoSmithKline, maker and marketer of Valtrex, an expensive brand name drug for the treatment of herpes symptoms (not a cure), running a campaign that includes an advertisement in publications and on radio stations with largely black audiences in cities including Baltimore, Detroit and Atlanta?

According to the Post story:
The "Say Yes to Knowing" campaign partners Glaxo with the National Medical Association, the country's main society of black physicians, and the American Social Health Association (ASHA), a nearly century-old organization devoted to fighting what used to be called "venereal disease." Each has received money from Glaxo in the past, although no donations were made in connection with this effort.

The campaign was introduced last month in Detroit, where it had the support of the local health department. In Baltimore the health commissioner has declined to endorse it.
So why is there this division among healthcare experts about the campaign? Has it something to do with race?

"Consider the facts specific to African Americans and genital herpes," says Jay Bolling, President of Roska Healthcare Advertising:
  • Blacks have greater than twice the rate of infection by herpes than whites (48% vs. 21%)
  • Only 10% who tested positive knew they were infected (asymptomatic)
  • People without symptoms can transmit the virus
  • Infection triples the risk of acquiring AIDS from an HIV-infected person
  • Treatment cuts the odds of transmission in half
[Note: I have interviewed Bolling in a recent Pharma Marketing Talk podcast: Faith-based Unbranded Marketing: How to Educate, Engage and Empower members of the African American Community.]
"If these statistics were associated with hypertension, high cholesterol, asthma or breast cancer -all disease states for which African Americans are at considerably higher risk - would we even be having this conversation??", asks Bolling. "Just because people are 'uncomfortable' talking about sexually-transmitted diseases, should we bury our heads in the sand and avoid the discussion? Have we learned nothing from the success of raising AIDS awareness and its significant impact on diagnosis/treatment/death rates?"
It seems that the main benefit of treatment of herpes with Valtrex is the claim that it "cuts the odds of transmission in half." Sounds like a big deal, except when you look at the actual data. Without treatment: 4%, with treatment: 2%.

An axiom of pharma marketing is: When speaking of benefits, use relative terms ("decrease by half", etc.), but when discussing risks, use absolute numbers ("4% vs. 2%", for example). If the odds of having a heart attack using Valtrex were higher than placebo, I am sure absolute numbers would be trotted out.

Besides, there are other ways of decreasing the rate of transmission, including use of condoms:
Do condoms protect from Herpes and is their a vaccine for herpes? I believe that black folks need to get together amongst our selves and have serious and real conversation about health.

One aspect of the conversation on health should include teaching that all unmarried black people having sex should be using condoms. Period.

It is the only way to cut the rate of aids I believe the preachers (many of whom carry on extra marrital affairs) should start advising the brothas in church to use condoms if they dont wait until marraige. A female elder in the church should advise very strongly that unmarried women having sex make sure their partners use condoms during sex.

The church needs to start talking about responsible sexual behavior as well as the monumental importance of brothas taking care of their children but black parents being proactive and talking to their children honestly about responsible sexual behavior and protection.

I think the black church needs to start talking about herpes and all other sexually transmitted diseases, they need to set up hiv testing and treatment centers in all of their churches they can teach each other how to set up these services one by one.

Black people really need to stop living in denial and do something to change our all to often sad realities.

- a comment posted to "Mirror On America: The Black Community and Herpes"
"Kudos to GSK for investing in an effort that raises awareness of a significant health issue that plagues the African American community (48% rate of infection!)," says Bolling. "By making it a public health issue and concentrating dollars/efforts on the communities at greatest risk, the only outcome is a positive one. And, with the National Medical Association (NMA) on board, they’re raising awareness among healthcare professionals and providing them the tools they need to counsel patients and diagnose/treat the disease."

Obviously, GSK's intentions are not altogether altruistic. It has a vested interest in getting more people using its product.

Another organization with a vested interest in this is the National Medical Association (NMA) -- "the largest and oldest national organization representing the interests of more than 25,000 African-American physicians" -- which receives funding from GSK for a number of projects NMA is "on board" with.

Bolling doesn't agree with ANY of the arguments the Washington Post has against the herpes awareness campaign:
  1. Telling people they have an incurable, sexually transmitted disease can have serious social and emotional consequences. "Are we saying that it’s better for people to have and spread this disease, but not know it, to spare them the social/emotional consequences??"
  2. Whether testing and treatment of a subpopulation, such as black adults, are useful and cost-effective has not been studied. "Regardless of the facts (see above), I guess we shouldn't do anything unless we've studied it; and since we're not going to do anything, I guess there's no reason to study it..."
  3. Treatment can be expensive. While generic acyclovir costs as little as $9.96 for a month's supply, Glaxo's Valtrex costs $192.88. "GSK's efforts can't dictate whether patients get generic acyclovir or Valtrex – last I knew that role is specifically in the hands of healthcare professionals (and insurers)."
GSK may not be dictating what white patients are prescribed by their doctors, but if the herpes campaign gets more black patients into offices of black doctors -- whose medical association is generously supported by GSK and who are targeted by GSK sales reps about the herpes campaign -- I am sure Valtrex will get the lion's share of NRx.

Measuring the ROE or Should I Say ROI?
According to the Post article, Glaxo officials describe the campaign as largely an educational experiment. "The company is surveying about 100 people in each city before and after the campaign to see if they learned anything about genital herpes." Can't wait to see the results!

This is what's often called "return on education (ROE)" in non-branded marketing arenas.

I bet that's not all they are going to look at after the campaign. In the real world of pharma marketing, there's really only one important measure of success: ROI as in $ returned for every $ invested.

I would like to be the fly on the wall when the Valtrex product team reviews the prescribing behavior of the black doctors in Baltimore, Detroit and Atlanta where the campaign is running vs. those in Los Angeles, for example, where it is not.
"I only wish they [GSK] had gone further to engage the faith-based communities, initiate target marketing efforts across all 'grassroots' media and support screening/health events to promote action and 'connect' patients with healthcare professionals," says Bolling.
"As a healthcare community all of us need to focus our energies in areas we can make a significant difference -- and the under-served, under-diagnosed, under-treated, at-risk patient populations are a damn good place to start. Congratulations to GSK, the NMA, ASHA and the local health department in Detroit for 'getting it' -- one can only hope that the Health Commissioner in Baltimore retires soon..."
Hmmm.. I am not sure Jay is not keen on Baltimore's health commissioner, Joshua M. Sharfstein, because he turned down Glaxo's request to become a local partner in its campaign or because Sharfstein formerly was a senior aide to U.S. Rep. Henry A. Waxman, a long-time drug industry foe.

According to the Washington Post story, Sharfstein turned down GSK's offer "because of the lack of evidence to support, as a public health strategy, screening for herpes in people without symptoms." He added that "the racial targeting was not an issue that we needed to address to make a decision."

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