Friday, August 29, 2008

J&J, Debbie Phelps, You, Me, Facebook: Is This Social Networking?

NOTE: Please read the comments to this post from Rob at JNJ Healthcare.

A lot of brouhaha is being made about pharmaceutical companies opening channels, pages, and groups on YouTube and Facebook.

Huge multi-national companies with huge promotional budgets like Johnson & Johnson (JNJ) -- number 8 in Advertising Age's list of the TOP 100 US advertisers in terms of measured media spend (see "Marketing Mix of Leading Pharma Advertisers") -- pay exactly the same fee to set up channels, groups, and applications on these social networks as do you and I.

But... and this is a BIG BUT... JNJ has the money to pay for programming, promotion, and celebrity spokespeople. You and I... not so much.

JNJ, for example, pays absolutely NOTHING to set up Facebook "groups" (eg, ADHD Moms, sponsored by McNeil Pediatrics, a JNJ company) and "applications" (eg, Accuminder) and YouTube channels (eg, JNJ's Health Channel).

JNJ's Youtube videos are of the highest quality and, like JNJ's broadcast TV ads, the Youtube videos are without doubt produced by their ad agencies. Do you have an ad agency?

Small point, but if everyone used an ad agency to develop content for social networking sites, we could no longer call content on these sites "user-generated."
BTW, I like the JNJ videos highlighting JNJ employees who also participated in the Olympic Games -- nice to see real, lower echelon employees of pharmaceutical companies and hear about their interests and motivations!
What About Dialog and Sharing Comments?
Part of social networking is the ability of ordinary people like you and me -- JNJ customers -- to add comments to social networks set up by others. Usually when pharmaceutical companies host a social network channel, they turn off the comments for obvious and understandable reasons.

Social networking etiquette, however, requires transparency and drug companies should be upfront about their comment policies on sites.

JNJ's YouTube channel seems to accept comments about their videos, but when I submitted the comment "Nice video!," it somehow "got lost in the tubosphere" and never made it on to the site. I did receive a message apologizing for that from JNJHealth. Kudos to them for that! But I don't see JNJ's comment policy on the site. I responded to JNJ's message and asked them about it, but have not yet heard back from them.

I suspect, however, that my "glitch" was the rule rather than the exception: although some of JNJ's videos have been viewed over 11,000 times, there are NO published comments whatsoever. To use an analogy with Seinfeld's "car reservation skit," JNJ takes comments, but doesn't seem to know how to hold and publish comments, which is the whole point of social networking.

McNeil's Facebook ADHD Moms Group allows you to become a "fan" but that's about it. In all other respects it looks and acts just like any Web 1.0 site!

My "Pharma Marketing News Fans" Facebook group, however, includes a discussion board and "The Wall" where anybody can post messages. You can also be a fan! (I haven't done much with this yet -- I am still learning.)

Celebrity Social Networking
Debbie Phelps -- Olympic Gold Medal winner Michael Phelps' mom -- is a Leader of ADHD Moms and she is a paid spokesperson for McNeil Pediatrics -- a fact that is revealed in her bio. She contributes to a "Monthly Feature" column and this month her piece is entitled "Back to School: Help Your Child with ADHD Succeed In and Out of the Classroom."

I really like and admire Debbie Phelps and her son -- they are REAL people and my son looks enough like Michael that I am sure he would be confused with Michael if he were to walk through Tiananmen Square. But I digress...

Debbie Phelps works as a school principal in what appears to be an inner city Baltimore middle school. On top of all that, she had to deal with Michael's ADHD, which is treatable but incurable -- you have it all your life and you have to learn to deal with it. McNeil's ADHD drug Concerta is one way to deal with it.

But Debbie doesn't talk about Concerta in her piece cited above. She does, however, mention "behavioral modifications combined with medication" several times. Also, I am sure the piece was ghost written, a fact not mentioned -- which is another breach of social networking guidelines.

I asked Debbie to be my friend on Facebook, but so far, I have not heard back from her -- perhaps another communication lost in translating social networking to pharma-style social networking (see "Social Marketing Pharma Style").

Ghost-written content, one-way communications, paid spokespeople, professional production, etc., etc. Seems that pharmaceutical marketers are shoving social networks into the same one-way communications box as all other channels they use for marketing purposes.

P.S. Here's what Marc Monseau, JNJ Corporate Communications Director and blogger over at JNJ BTW, had to say about the ADHD Moms Facebook page:

"Now to be fair, this Facebook page, ADHD Moms, still isn’t all that interactive. Though visitors can download podcasts, articles and participate in instant polls, they can’t post comments to the wall on the page. What they can do, though, is use their own Facebook pages to connect with other ADHD Moms fans. It’s a baby step, to be sure, but I understand the team is looking at other steps they can take to make it easier for people to share their insights into caring for kids with ADHD."

Thursday, August 28, 2008

Merck's Sales Training "Boner"

Ed Silverman, please stop all the great posts! Go back on vacation...I have to get some work done!

Ed has posted a series of Merck sales training videos over at Pharmalot (see "The Vioxx ‘V’ Squad: Reps From Another Universe"). The videos were revealed in documents related to the Vioxx trials.

This brings me back to my days as a developer of video and computer-based sales training programs. But that's another story.

Not only are these videos hilarious, their release to the public is a real "boner," meaning "a spectacularly bad or embarrassing mistake," which is the second definition of the term found on Wikipedia.

But I'd like to point out a different kind of "boner" I found by pausing the first video at just the correct spot. See the image below.

Click on image/boner to enlarge for better viewing!

Don't know what schwing is? Enjoy this:

Are You Passionate About Obama or McCain or Neither?

Recently, the WSJ Health Blog posted results from a survey that concluded if Obama wins the election, he should work to stabilize the economy before pushing to overhaul health insurance or create cap-and-trade system for greenhouse gas emissions.

That's OK as far as it goes, but I'm more interested in which presidential candidate -- John McCain or Barack Obama -- is better for the pharmaceutical industry and why. Specifically, I seek the opinions of people who work within or for the industry.

I don't want to debate the issues here, so I set up a special 2008 Presidential Election News & Views discussion board on Pharma Marketing Network Forums where we can anonymously debate the pros and cons of Barack Obama vs. John McCain.

I invite you to express your opinions about the candidates and debate the issues in this forum.

You are also invited to take the short, online survey "Who's Better for Pharma: Obama or McCain?" to answer the questions "Who do you plan to vote for in the 2008 Presidential election?" and "Why?"

Your comments are confidential (anonymous) unless you specifically provide your contact information at the end of the survey and allow me to attribute comments to you personally.

Wednesday, August 27, 2008

The Cymbalta Buzz Machine is at Full Throttle!

You got to hand it to the Lilly PR people and their minions for creating tremendous buzz about Cymbalta and back pain. Here are a few sample headlines:

* "Cymbalta Found To Reduce Chronic Lower Back Pain"
* "Patients Taking Cymbalta Experienced Reduced Chronic Low Back Pain in New Study"
* "Anti-depressant drug shown to help people with low back pain"

The buzz even confused veteran reporter/blogger Jim Edwards into thinking that Cymbalta had just been approved by the FDA for back pain! Jim's article on BNET ("What Lilly Learned From Steak n Shake: A Q&A on Cymbalta") originally started with this statement:
"Eli Lilly’s Cymbalta is fast adding indications. Today the company announced it was approved for back pain and last week it was approved in Europe for generalized anxiety disorder." [My emphasis.]
Jim has since changed this to read: "Eli Lilly’s Cymbalta is fast adding indications. Today the company announced the results of a trial to see if the drug can be used for back pain and last week it was approved in Europe for generalized anxiety disorder." The Google Blog search results, however, still contain the original wording:

Click on the image to enlarge and read.

I pointed out this error to Jim in a comment to his BNET post, but he neglected to publish it and acknowledge his error. [PLEASE READ JIM'S RESPONSE IN HIS COMMENT TO THIS POST.]

My point is that even veteran reporters can be fooled by the spin put on these kinds of studies.

Keep in mind that the back pain study involved ONLY 236 patients, which is hardly a basis for making any kind of statistically-significant conclusions -- something else I pointed out in my unpublished comment to Jim's original article.

Not only that, the study was performed by a Lilly scientist and the data released at an obscure medical conference in Spain.

Sounds similar to a "seeding study" to me! That is, a study of dubious scientific merit whose purpose is to entice physicians to prescribe Cymbalta off-label (ie, to treat an indication not approved by the FDA or any other regulatory authority).

I pointed out previously that some Cymbalta direct-to-consumer (DTC) TV ads seemed to be promoting Cymbalta for pain beyond the limited "diabetic nerve pain" that it is officially approved for (see "eGAD! How I Learned to Stop Worrying and Love Cymbalta!").

As reported on the Furious Seasons blog: "...last year one academic paper found Lilly's claims of pain reduction in depression via Cymbalta treatment to be overstated and quite small in reality--an 11.5 percent effect size across several trials" (see "Lilly-Led Research Says Weak-Performing Cymbalta Good For Back Pain").

Some more relevant comments from Furious Seasons:
"But the FDA has already approved the drug for use in treating diabetic neuropathic pain and fibromyalgia. The latter approval came only in June [2007]. It's clear that Lilly very much wants to have the drug approved for at least one more pain indication so it can market the hell out of the drug--which is already being used off-label by pain management docs who are too scared of the DEA to treat pain with opiates and the Cymbalta results are not too grand from what patients tell me--but with a 12 percent effect size you've really got to wonder if the FDA would approve the drug because that is barely beating placebo in the real world. And, then, there are the drug's well known side effects--suicidality, nausea, fatigue, and withdrawal problems. One hopes that the FDA takes that sort of thing into consideration.

"And if this new study is part of Lilly's application for chronic pain (and I bet it is), then I'd really like to see Lilly put Cymbalta up against medical marijuana, which is approved for chronic pain treatment (and reportedly works pretty well) in several states. Bet the feds never let that trial happen."
It seems that us bloggers are less prone to the hype than are veteran reporters! Yet the drug industry vilifies the press as being anti-pharma! Go figure. I mean, how much more could the press be under the influence of drug industry spin? Perhaps the industry covets no less than complete ownership of the press.

I'll end this post on that note.

Sunday, August 24, 2008

Introducing the Politically Incorrect AmbienCR Rooster

Have you seen the latest broadcast TV ads for AmbienCR with the rooster and tag line: "silence your inner rooster"?

Tonight, I saw the Sanofi-Aventis "Rooster Car Alarm Commercial," one of several in a series of "unbranded" ads. These ads do not mention the brand, but promote the branded web site The image at the left is taken from this decidedly web noir site.

Thus begins another sleep aid campaign utilizing some kind of creature "spokesperson." The AmbienCR rooster joins the Lunesta moth and the Rozerem beaver. The latter may have been retired by Rozerem -- I haven't seen a Rozerem ad in months. And the moth is no longer featured prominently in the Lunesta ads (see "New Lunesta Print Ad: 70% LESS Moth!").

The campaign began with a bit of expensive buzz marketing with short TV ads that just showed the Web site URL with a voice offer reciting the tag line.

Sanofi-Aventis is also engaging in some inexpensive buzz marketing by uploading 6 different versions of these 15-second "rooster" commercials on its YouTube channel. [Whoops! I guess free buzz was not cheap enough -- those clips on YouTube are no longer available I am told by Chris Truelove. Have no fear, you may still be able to find them here.]

There, you can see: Rooster Drum Set Commercial, Rooster Basketball Commercial, Rooster Hair Dryer Commercial, Rooster Car Alarm Commercial, Rooster Vacuum Commercial, Rooster Pay Phone Commercial.

My favorite is the basketball rooster.

Which Rooster Ad Do You Like Best/Dislike Least?
Pay Phone
Hair Dryer
Vacuum Cleaner
Car Alarm

Politically Incorrect?
Each ad is gender-specific (except for the rooster, which I presume is always a cock): the sports (basketball), car and drummer roosters awaken male sleepers, whereas the vacuum cleaner, hair dryer, and phone roosters awaken female sleepers. The idea is that worry about our daily activities keeps us awake at night. Showing men worried about sports, cars, and creative outlets and women worried about vacuum cleaners and hair dryers is a bit politically incorrect, wouldn't you say?
[Here's a contest: Come up with your own version of a politically incorrect AmbienCR rooster ad and submit it as a comment to this post. In fact, this would be a great contest for S-A to sponsor via YouTube if it really wanted to use social media marketing. What kind of rooster, for example, would keep Barack Obama or John McCain awake at night? Or other celebrities like Michael Phelps. Using celebrities in the rooster ads -- another great idea for S-A!]
The pay phone rooster sketch doesn't quite fit into this theme. Who worries about getting anonymous phone calls? Perhaps this is a subtle statement about women as victims? I could be reading too much into this, but that's why DTC (direct-to-consumer) advertising is so interesting -- it's a great pasttime for us amateur psychoanalysts.

I do not know if ALL of these 15-second unbranded ads have actually been aired on network TV yet (maybe a different one will be aired each night this week). All of them were uploaded to YouTube a mere 3 days ago.

Saturday, August 23, 2008

Social Marketing Pharma Style

I just joined Facebook -- as if I didn't have enough social networking applications to juggle! Although I have complained before about not having time to engage in all this Web 2.0 stuff (see "Social Media Marketing Not All It's Cracked Up to Be"), I am glad that I joined Facebook because I am getting re-introduced to some old friends and discussions among them taking place exclusively via Facebook.

While re-uniting with some friends from the Internet Healthcare Coalition, I came across a discussion started by Bruce Grant (that's his facebook avatar on the left; nice way to make yourself look a lot younger Bruce!).

Bruce posted a link to Rich Meyer's blog post about P&G launching a new product using social media channels, aka "buzz and blogs" (see "P&G launching new product with social media" and "P&G Taps Bloggers, Moms for Unconventional Product Launch").

Both Bruce and Rich wondered why pharmaceutical DTC (direct-to-consumer) marketers don't do what P&G is doing. To which Rich replied: "We’re afraid- Too many DTC marketers hide behind the 'we’re a regulated industry' excuse and that is a load of manure. There are ways to reach out to customers and patients if you are willing to take a risk and be a leader."

Keep in mind that the new P&G product is a once-weekly cleaning paste for your teeth, which is about ten orders of magnitude LESS important to humanity than any Rx drug marketed to consumers! And it breaks MACK"S RULE #1 FOR SOCIAL MARKETING:
Make sure the product is socially worthy because social marketing wastes a lot of peoples' precious time!
But let's put the lack of social significance of this product aside and focus instead on the social marketing.

In a Facebook comment to Bruce's query, I noted that the pharmaceutical industry already does this kind of "buzz" marketing, but with physicians!

One aspect of P&G's "buzz" campaign seems focused on a relatively small group of consumers who were probably profiled as consumer "thought leaders" -- people who can influence other people. P&G sent out a survey to these people and also sent "samples" to influential bloggers.

Isn't that exactly what pharma marketers do with physicians?

Even before a drug is launched, pharma marketers identify physician thought leaders and recruit them by hiring them as consultants or researchers (who have early access to the product). Their job is to start "buzz" in the physician community about the drug.

Then, when the product is launched, pharma sales reps go out and target "high prescribers" first so that there is a quick uptick in new prescriptions, which the company can cite as evidence of efficacy to other physicians.

Of course, pharmaceutical companies also seed thought leaders and high prescribers with "samples" (BTW, have you taken my survey about drug sampling practices? Do patients benefit from free drug samples? Physicians? Do samples promote only high-cost drugs? Should free samples be banned? Take the survey here.)

About the only thing pharma marketers don't do that is similar to what P&G does is reach out to physician bloggers and for good reasons: there are very few of these, most of them are anti-pharma anyway, and there is no need to do it because pharma can send out a real person to visit physicians and this person becomes the physician's friend (see "'Friendly' Pharma Sales Reps Earn More Bucks with Fewer Sales Calls!"). Which is much more powerful than sending samples to consumers, even influential consumers, via the US postal service!

Compared to the amount of money P&G is WASTING doing buzz marketing to consumers, physician "buzz" marketing by drug companies is incredibly efficient; ie, has a high return on investment.

Keep in mind that DTC pharma marketing still plays second fiddle to direct-to-physician marketing. If P&G had to sell its product only through dentists, I am sure they would ignore buzz marketing to consumers just as pharma does.

Tuesday, August 19, 2008

A Pharma Sales Rep and a Used Car Salesman Walk into a Bar...

Before they can even sit down and order their drinks, the bartender says "Let me guess. You guys are salesmen, right?"

"Yes," says salesman #1, "but I bet you can't guess which one of us sells used cars and which one sells overrated expensive drugs. If you can't guess, we get free drinks. OK?"

"Sure," says the agreeable bartender. "But you'll have to answer one question."

"Ask away," says salesman #1.

"What do you call it when you are trying to tell someone about the benefits of your product?"

"I call that a pitch," says salesman #1.

"I call it a discussion," says salesman #2.

Pointing to salesman #2, the bartender exclaims "Not only are you the pharmaceutical salesman, but you probably work for Merck!"

The two salesmen order their drinks and sadly open their wallets to pay for them.

How did the bartender guess correctly? He read this document from Merck in which the author objected to the term "pitch." "Pitching is what used care salesmen do. I'd like to think we are different."

[Read the backstory on PharmaLot: Key Vioxx Study Was Really A ‘Seeding Study’]

I admit that this is not a very good "guy walks into a bar" joke. So I challenge readers to come up with a better one.

Meanwhile, enjoy these other Merck jokes gleaned from CafePharma:
The devil visited a Merck rep's home office and made him an offer. "I can arrange some things for you, " the devil said. "I'll increase your income five-fold. Your cluster mates will love you; your docs will respect you; you'll have four months of vacation each year and live to be a hundred. All I require in return is that your wife's soul, your children's souls, and their children's souls rot in hell for eternity."

The Merck rep thought for a moment. "What's the catch?" he asked.


A grade school teacher was asking students what their parents did for a living. "Tim, you be first," she said. "What does your mother do all day?"

Tim stood up and proudly said, "She's a doctor."

"That's wonderful. How about you, Amie?"

Amie shyly stood up, scuffed her feet and said, "My father is a mailman."

"Thank you, Amie," said the teacher. "What about your father, Billy?"

Billy proudly stood up and announced, "My daddy murders people, steals from them, and drinks."

The teacher was aghast and promptly changed the subject to geography. Later that day she went to Billy's house and rang the bell. Billy's father answered the door. The teacher explained what his son had said and asked if there might be some logical explanation.

Billy's father said, "I'm actually a Merck rep. But how can I explain a thing like that to a seven-year-old?"


A man sat down at a bar, looked into his shirt pocket, and ordered a double scotch.

A few minutes later, the man again peeked into his pocket and ordered another double. This routine was followed for some time, until after looking into his pocket, he told the bartender that he's had enough.

The bartender said, "I've got to ask you - what's with the pocket business?"

The man replied, "I have my Vytorin's rep picture in there. When he starts to look honest, I've had enough."


A Merck rep knew he had it made when the old brass bottle he found in the back yard turned out to have a genie in it. Any three wishes he had would be granted, the genie informed him.

"I wanna be rich," said the Merck rep. The back yard filled up with chests of gold coins and jewels in the blink of an eye.

"I'm no fool," said the Merck Rep. "I wanna be a medical device rep" And there he stood with an Armani suit, custom Italian shoes and a Mercedes for a company car.

"Thirdly, I never want to work another day in my life." And he was a Merck rep again.


What's the difference between a Merck rep and a UPS man in Wisconsin?

The UPS man has better access...


What's the difference between Merck and a greedy, selfish company who pretends that its ALL about patients?

I can't figure it out either!


Recently, Merck hired several cannibals to increase their diversity, 'You are all part of our team now,' said the Human Resources Rep. during the welcoming briefing. 'You get all the usual benefits and you can go to the cafeteria for something to eat, but please don't eat any employees.'

The cannibals promised they would not. Four weeks later their boss remarked, 'You're all working very hard and I'm satisfied with your work. We have noticed a marked increase in the whole company's performance. However, one of our secretaries has disappeared. Do any of you know what happened to her?'

The cannibals all shook their heads, 'No.'

After the boss had left, the leader of the cannibals said to the others, 'Which one of you idiots ate the secretary?' A hand rose hesitantly.

'You fool!' the leader said. 'For four weeks we've been eating managers and no one noticed anything. But NOOOooo, you had to go and eat someone who actually does something.'

Saturday, August 16, 2008

What's Next: Ban Free Drug Samples?

Sometimes, if you want to find the next "crisis issue" that the pharmaceutical industry will face, you don't have to go any further than the industry itself.

Yes, folks, I'm talking about CafePharma!

Recently, I was scouring the CafePharma discussion boards for pharmaceutical sales reps' views on the new PhRMA Code of Interactions with Healthcare Professionals. I found a lot of interesting views on that subject that I will include in an upcoming Pharma Marketing News issue (see the preview here).

But then I came across this post:
Subj: Sign Posted in Doctor's office

This office does not allow visits from pharmaceutical salespeople because we rely on scientific information, not marketing, to decide what treatment is best for you.

This policy also means that we don't provide drug samples.

"Free" drug samples cost you money. Samples are only available for the most expensive, most-promoted drugs, and are a tactic to get you to use drugs that may not be the best therapy for you.
[There were many replies to this post. I won't copy here because I'd like your untainted opinion about the use of drug samples as a promotional tactic by pharmaceutical companies. Please read on and my survey or comment to this post to give me your opinions.]

According to The Prescription Project -- which is funded by the Pew Charitable Trusts and which "seeks to eliminate conflicts of interest created by industry marketing by promoting policy change among academic medical centers, professional medical societies and public and private payers" -- $18 billion a year goes to “free” samples (see "Pharmaceutical Samples"). Other sources confirm that this number is in the right ballpark (see chart, for example, in "Blog Readers' Opinions on Physician Marketing & Education Practices").

While the new PhRMA Code would ban free pens and lunches, it doesn't apply to samples: "It is appropriate," says the Code, "to provide product samples for patient use in accordance with the Prescription Drug Marketing Act."

But the Prescription Project discounts the value to patients of free samples:
Samples encourage physicians and patients to rely on medications that are expensive, but often not more effective than other available drugs. Research has shown that samples can increase physician prescribing of the marketed product, independent of the effect of detailing by industry sales representatives.

Samples serve two distinct marketing purposes. Physicians value samples and are willing to spend time with sales representatives to get them. Secondly, samples serve as “starter” medications – an enticement to prescribe new, heavily marketed and generally more expensive medications. Once therapy has been initiated, patients and their insurers are likely to continue to pay for the new, costly drugs.

Studies indicate that the majority of pharmaceutical samples are not dispensed to low-income or uninsured patients. Nevertheless, many physicians use samples, in part, to provide medications to needy patients. However, the inconsistent availability of samples may limit the utility of this approach.
What's Your Opinion?
Please take a few minutes to respond to the Pharma Marketing News Drug Sampling Survey.

In the meantime, enjoy this sales rep view of sampling (found on CafePharma; sung to the the Eagle's classic "Hotel California"):
Hotel Calipharma

In a dark sample closet, name badge on my coat
when it comes to ambition, I guess I missed the boat.

Up ahead in the hallway, I saw a rep-hating doc.
It was still only 10:00 AM
And I was watching the clock.

There he stood in the hallway
I pulled a detail aid
I was thinking to myself "how can I continue this charade?"
Then he asked for some samples, and I called for a sig
there were nurses down the corridor
I felt like a dumb-ass pig.

Welcome to the Hotel Calipharma
We have lots of lunch
(we have lots of lunch)
for your hungry bunch.
There's plenty of gloom at the Hotel Calipharma
if you're a window witch
(window witch)
we can scratch your itch.

My mind was definitely spinning
Got in my company car
I got a lot of nifty pens and things
but they don't get me too far.

So I called up my DM, and I started to whine
"no success stories today boss,"
"guess your career's in decline."
And still those samples keep coming piled high to the sky
just enough to keep you up all night, still wondering "WHY??"

Welcome to the Hotel Calipharma
Such a dead-end job
(such a dead-end job)
DM's such a slob.

There's plenty of angst at the Hotel Calipharma
Micro-manage you
(micro-manage you)
'till you're worthless too.
We're givin' it up at the Hotel Calipharma
Where the slightest slip
(where the slightest slip)
can result in a PIP [performance improvement plan].

Lots of dumb meetings
Ride-a-longs ain't too nice
and she said, "we are all just corporate bots
"can't get a job in Device."

And in my DM's office
he just sits in his chair.
Doing nothing of value
you know it just ain't fair!

Last thing I remember, I was totally bored.
I had to find an actual job and finally stop driving a Ford.
"Relax" said my DM, we are programmed to deceive.
You can get out any time you like
(I've got some trix up my sleeve!)
And if you need the music to help you sing this song, here's the original soundtrack (open a new window and take the Pharma Marketing News Drug Sampling Survey while you listen):

Friday, August 15, 2008

Counter-counter Detailing

The South Carolina Medicaid Academic Detailing Program, aka SCORxE, which stands for South Carolina Offering Prescribing Excellence, was featured in a recent Time Magazine story (see "The States Take On the Drug Pitchmen").

One scenario described in that article got me thinking about the futility of "counter-detailing."
"...a disagreement among the leaders of the state's SCORxE program — designed to educate physicians with unbiased and accurate information about prescription drugs. The basic issue: Should representatives of the program bring the doctors pizza for lunch? Sarah Ball, the indefatigable pharmacist who leads SCORxE, says no. The whole point of SCORxE, after all, is to counteract Big Pharma's hard-sell drug marketing. But sometimes you have to fight fire with fire, says Dr. Robert Malcolm, a psychiatrist and adviser to SCORxE. 'We are competing with people who bring food,' he says."
Yes Dr. Malcolm, the new PhRMA Code on Interactions with Healthcare Professionals does allow it is appropriate for "occasional meals to be offered as a business courtesy to the healthcare professionals as well as members of their staff attending presentations..."

But, as I pointed out many times here on this blog, pharmaceutical company sales reps have an even greater advantage: good looks!

Let's compare SCORxE's image of a "counter detail" with my image of the drug industry's "counter-counter detail":
Hmmm.. which do YOU think is more effective?

Bob Ehrlich of DTC Perspectives believes counter detailing cannot possibly compete with Pharma's counter-counter detailing because "Counter detail programs are likely to be small scale and unlikely to have the muscle to counter the mass of drug company sales forces" (see "Rx Counter Marketing").

I won't comment on "the mass of drug company sales forces," but I agree with Ehrlich that counter detailing is too small scale for the industry to worry about (see "Counter Detailing -- Pissing into the Wind or Profitable Endeavor?").

One other comment Ehrlich made, however, deserves further comment. He said: "Clearly the state sponsored [counter-detailing] programs have a goal to reduce costs and although they say they want to provide unbiased studies to doctors, I doubt that will be the case. More likely they will find studies that show the branded drugs have marginal value."

I did not know that there WERE studies that show branded drugs have marginal value! If that is true in general, then I guess pharmaceutical sales reps must select just the opposite kind of studies to present at their lunches with physicians. This "selectivity" of scientific evidence will only be exacerbated once FDA allows pharma sales reps to pro-actively provide peer-reviewed literature to doctors (see "Pharma's New Marketing Partner: Medical Journals").

Thursday, August 14, 2008

It's Official! Pharma is in a Recession

What do you think?
Is the Pharma Industry in a Recession?
Not sure
Not yet, but soon
May not be a recession, but it's hurting!

Rethinking the Value of DTC Advertising

Direct-to-Consumer (DTC) advertising is often defended by the drug industry as beneficial to the public's health because it motivates people to visit their doctors. Peter Pitts, president of the Center for Medicine in the Public Interest (a pro-drug industry think tank), for example, said: "The most important thing that DTC advertising does is drive people to their doctor's office to talk about a condition" (see "FDA to Test Risk Info with Mock Ads").

PhRMA, the US drug industry trade organization, says in its DTC Guiding Principles: "DTC advertising of prescription medicines can benefit the public health by increasing awareness about diseases, educating patients about treatment options, motivating patients to contact their physicians and engage in a dialogue about health concerns, increasing the likelihood that patients will receive appropriate care for conditions that are frequently under-diagnosed and under-treated, and encouraging compliance with prescription drug treatment regimens."

It sounds like a compelling argument until you look at the numbers and data supplied by pro-industry groups:

Pitts, for example, cites these numbers from FDA studies in a recent Drug Wonks blog post:
  • 6% [of] all doctors’ appointments are scheduled because a consumer saw a DTC commercial [which means 94% are NOT driven by DTC], and
  • in 6% of those DTC-generated office visits, a previously undiagnosed condition was discovered [which means that only 3.6 out of 1,000 office visits result in discovering an undiagnosed condition as a result of DTC advertising]
Add to this results of a CommonHealth study claiming that DTC advertising is rarely referenced by patients when visiting physicians. This study says this happens only in 0.6% of visits! (See "Advertisers Don't Know How DTC Works. Say wha?").

Keep in mind that not all those undiagnosed conditions will be treated by the advertised brand -- there may be generic brands available or the brand may not be appropriate for a particular patient or the condition may not lend itself to treatment by any drug at all!

If you think about it, all this means that DTC advertising is a terribly inefficient method of getting people diagnosed and treated with the products that are advertised.

Why then does the drug industry spend $5 billion annually on DTC advertising?

Considering that some of the best minds in DTC advertising claim that they do not know how DTC works, I'd like to offer this:
DTC is not an efficient means for generating new prescriptions. It really is a compliance tool! That is, DTC works by convincing people to continue taking the brand advertised. It may also be effective in encouraging people to switch brands, which is something I've often thought about when I see DTC ads.
[Note that this role for DTC was hinted at in the PhRMA statement quoted above, which mentioned compliance at the end of its long list of DTC benefits. My point is that compliance should be put at the beginning of the list of DTC benefits, not at the end.]

Whenever compliance issues are discussed in trade publications and at conferences, DTC advertising is often criticized as being too focused on gaining new scripts and not focused enough on compliance. Yet DTC may be the greatest compliance tool there is! [BTW, that's not saying much. The current rate of compliance -- about 50% -- stinks!]

Wednesday, August 13, 2008

"Friendly" Pharma Sales Reps Earn More Bucks with Fewer Sales Calls!

Did you know that the average pharmaceutical sales rep earned $94,200 in total compensation in 2007, compared with $87,500 in 2006? This was an estimate made by the National Association of Pharmaceutical Sales Representatives (NAPSRx; see "PHARMACEUTICAL SALES COMPENSATION OUTLOOK FOR 2008").

And, according to NAPSRx, the average pharma sales rep is working LESS for that increased income! According to NAPSRx, sales reps are now expected to make 8 calls a day, down from nine, "which is surprising," says NAPSRx.

NAPSRx has an explanation: "This change probably means that pharmaceutical companies are being more realistic in their expectations as they are emphasizing the need for quality interaction with physicians."

I give 'em kudos for being able to use "realistic" and "pharmaceutical companies" in the same sentence. More important than reality, however, is this focus on "quality interactions with physicians" and what that really means.

Of course, the drug industry would like to define a quality interaction as one that provides the physician with the most value. But what do physicians consider valuable about their relationships with pharmaceutical sales reps?

PeopleMetrics, a marketing research firm, thinks it has the answer to that question: friendship!

In April 2008, PeopleMetrics Rx fielded a national self-funded study of 239 PCPs (Primary Care Physicians) and 235 psychiatrists. What they measured was "Physician Engagement" using the "REAP" Model consisting of 4 survey questions:
  1. Retention: Given the choice, I would keep my sales representative as the representative who is assigned to my practice
  2. Extra Effort: I would go out of my way to meet with my sales representative
  3. Advocacy: I would recommend that my colleagues meet with my sales representative
  4. Passion: I enjoy meeting with my sales representative
It turns out -- surprise, surprise -- that these "emotional" determinants of physician engagement (as opposed to functional determinants like the quality of the product and clinical information delivered, the reputation of the company that markets it, and how the rep can help the physician improve the quality of patient care) are "the most impactful drivers of physicians' prescribing behaviors."

Here are the charts to prove it (click on images for an enlarged view):
Physicians with higher levels of engagement are inclined to prescribe more than those who are disengaged.

Fully Engaged physicians spend more than twice as long speaking with their reps on a per-visit basis and meet with them twice as frequently compared to their disengaged counterparts (the latter takeaway is not charted here.)
Ergo, the "friendlier" the rep, the more the doctor will prescribe the product being detailed by the rep. The more prescriptions, the greater the rep's bonus! Of course, spending more time with each physician means that "friendlier" reps see fewer physicians overall.

Forget the technology. Forget the delivery of the message. The key to sales force effectiveness is charm. Good looks also helps.

BTW, now that the kibosh has been placed on tchotches -- free gifts to physicians -- ugly, unfriendly pharma sales reps are at a distinct disadvantage. This means that the pharmaceutical industry will be forced to hire even more cheerleaders as sales reps!

For more information about the PeopleMetrics Rx Physician Engagement research, please contact: Gary White, Executive Vice President, PeopleMetrics Rx at: 215.979.8036 or via email:

DISCLAIMER: I was NOT paid by PeopleMetrics or anyone else write this post!

Tuesday, August 12, 2008

New Image for alliconnect Blog: Skinny Women

"The official blog of GlaxoSmithKline’s Alli diet drug franchise has suddenly adopted a decidedly different voice," points out Jim Edwards over at BNET's Pharma Industry Blog in a post titled "GSK’s Alli Diet Drug Has Problems With Your 'Fat Friend'".

This different voice has coincided with the reorganization of the alli franchise at GSK, which I commented on in a previous post to Pharma Marketing Blog (see "The alli lesson: Pharma marketing is not ready for transparency").

I thought the change would involve the transparency championed by Steve Burton, the blog's founder and former Vice President of Weight Control for GlaxoSmithKline Consumer Healthcare. After all, as Jim points out, Burton was most famous for the straight-talking way in which he tackled Alli’s “treatment effects” (see "My oops experience").

Now that Steve has been replaced by Karen -- Karen Scollick, the newly appointed Vice President for US Weight Control at GSK -- the focus seems to have shifted to more traditional ways of appealing to women in advertising; namely, show thinner images of women in ads.

According to an Advertising Age article, a "study by business professors at Villanova University and the College of New Jersey, inspired by Dove's 'Campaign for Real Beauty' [featuring full-bodied women rather than skinny models], shows that ads featuring thin models made women feel worse about themselves but better about the brands featured."

The research "found that despite the negative effect on their body image, women preferred ads showing thin models and said they were more likely to buy products featured in those ads than in ones showing 'regular-size models,' said Jeremy Kees, a business professor at Villanova."

Which is exactly what the alli brand people want to hear!

[Note: This release of this study coincided almost to the day that Burton resigned. Coincidence?]

Obviously, the new woman in charge of US Weight Control at GSK buys into the "hate the skinny model, love the brand" theory as is evident in the new images of women highlighted in the alliconnect Blog:

I can relate to how women may feel about these images. Who would admit that they looked more like the woman on the left than the one on the right? Sure, we fool ourselves into seeing ourselves a lot skinnier than we really are, but deep down we know better and want to do something about it. So, let's try the product advertised.

In fact, I wanted to try alli myself (see "Take alli - I dare you!"), but backed out at the last moment because of Burton's story about treatment effects (see "I Opt-Out of My alli Challenge!").

So far, other alli sites have not been made over to feature skinny women models. The official product Web site, for example, still use images like this one:

And there are still many "fat friend" stories to be found on the new "allicircles" support community where fatties can upload their profiles. More on that in another post.

Friday, August 08, 2008

FDA Intern Says Obama's Ad is More Pleasing!

In a previous post, FDA Intern asked readers to take part in a little demonstration of the "Affect Misattribution Procedure" that the FDA proposed to use to test DTC broadcast ads (see "FDA Intern Learns All About the 'Affect Misattribution Procedure'").

But instead of applying this rating methodology to boring DTC ads, it was applied to two political broadcast ads -- one by Sen McCain attacking Sen. Obama and one by Sen. Obama giving an uplifting speech. Of course, when doing the test, FDA Intern did not characterize the test ads in any way.

The results, which clearly show that Obama's ad was much more pleasing than McCain's ad, are summarized by FDA Intern below.

Click on image to get an enlarged view.

Wednesday, August 06, 2008

FDA Intern Learns All About the "Affect Misattribution Procedure"

Yes, it's FDA Intern! Strange visitor from an Ivy League school who came to FDA with powers and ability far beyond those of Janet Woodcock or even FDA commish Andy von Eschenbach!

FDA Intern! Who can change the course of mighty clinical trials, approve drug ads faster than a speeding bullet, jump through Congressional Subcommittee hoops of fire and ire, and who disguised as Emily Jameson (no relation to Jenna Jameson), mild-mannered intern for a great regulatory agency, fights a never ending battle for fast-track drug approvals, pharmaceutical company user fees, and the FDA way!

Today, as every day, FDA spends most of her time reading the Federal Register, where she comes across Docket No. FDA-2007-N-0451, formerly the docket known as 2007N-0321. This docket -- as you may recall from a post made on this blog about 1 year ago -- is about FDA's plans to do a study of consumers to evaluate "the impact of distraction on consumer understanding of risk and benefit information in direct-to-consumer (DTC) prescription drug broadcast advertisements."

I previously criticized the methodology of the original study design, which proposed to use a technique called Affect Misattribution Procedure (AMP) to measure consumer reactions. One criticism I had was the use of Chinese characters, which means that people who can read Chinese would be excluded from the study. I submitted my blog post as a comment to the original docket. The FDA obviously took note of my comment but decided against my recommendation to use Mayan hieroglyphics instead of Chinese characters.

Anyway, the AMP technique is what interests me and FDA Intern as well. Let's see if we can demonstrate how it works. If you have trouble reading the text in the following panels, just click on the image to get a larger view.

Here's the test using the AMP technique that the Synovate CEO set up for FDA Intern. He gave FDA Intern these instructions: "I will be showing you two videos each followed by an picture. The videos simply give you something to watch before I show you the pictures, which are images of Chinese characters. Your job is to judge the pleasantness of each Chinese character."

Here's the first video/picture pair:

Now look carefully at this Chinese character (call it Chinese character #1):

Here's the second video/picture pair:

Now look carefully at this Chinese character (call it Chinese character #2):

OK. Please judge the "pleasantness" of each Chinese character by clicking here. You'll be able to see the aggregated results from all respondents after you check your answer. Thanks!
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