Friday, July 31, 2009

In Medical Publishing, Is Disclosure Enough?

"Full disclosure" (aka, "transparency") is a term used so often these days that it is becoming meaningless or at least so transparent as to be invisible.

A case in point is the brouhaha regarding Elsevier's publication of "fake" medical journals in Australia, which is seemingly another hotbed for pharmaceutical marketing excess.

It has been said that Elsevier "colluded with Merck to produce a fake journal, the Australasian Journal of Bone and Joint Medicine (AJBJM) to promote rofecoxib and other Merck products." That's how critics described it in correspondence to The Lancet -- a real medical journal published by Elsevier. The authors call for Elsevier to either divest itself of of either its medical publishing or pharmaceutical services division (see here).

Elsevier admits it should not have called these publications "journals," but was silent on whether or not it "colluded" with Merck. It just says, in effect, such a lack of "disclosure" will not happen again: "We have done a full internal review of all our publishing practices and are finalising a set of revised guidelines to ensure that this type of misrepresentation and lack of disclosure is not repeated," Elsevier said in reply to the letter to The Lancet.

Elsevier fully intends to continue its marketing relationship -- or "collusion," if you prefer -- with the pharmaceutical industry.
"It is certainly fair to raise the issue of the compatibility of medical publishing and service to the pharmaceutical industry, and we value input from the scientific community on this subject. However, it should be noted that Excerpta Medica is very clear and transparent in stating that its mission is to help pharmaceutical companies publish and market their research. This is a legitimate and important function, assisting in the dissemination of advancements in pharmaceutical research that aid medical professionals every day. When one or more companies fund the research or the publication, that information is clearly disclosed."
There's that word again, "disclosure" or "disclosed."

But is disclosure enough?

I empathize with a publisher that wishes to help its advertising clients promote their products within their publications, even to the point of publishing sponsored articles. I do that myself in Pharma Marketing News. That's all well and good for trade publications. But mixing up marketing and editorial content in the medical field is another thing altogether.

That's why I believe there must be at least a "firewall" between marketing and publishing within the medical publishing arena. Transparency is just not enough.

If medical publishers don't take steps more drastic than issuing guidelines about transparency, they will come under increasing scrutiny from regulators similar to that leveled against the for-profit CME industry (for more about that, see "Pharma Shifts Support of CME from MECCs to Physician Societies").

Related blog post: "Pharma's New Marketing Partner: Medical Journals"

Thursday, July 30, 2009

Nissen Puts Stake Through ACCME's Heart at Senate Hearing on Industry-Funded CME

At yesterday's United States Senate Special Committee on Aging hearing on "Medical Research and Education: Higher Learning or Higher Earning?", most of the testimony focused on pharma industry support of continuing medical education (CME).

Senators Kohl, Martinez, and Franken heard from speakers who were pro and con regarding the benefits of industry-sponsored support of CME, which is waning (see "Pharma Shifts Support of CME from MECCs to Physician Societies").

Testimony form Steven Nissen, MD, Chairman, Department of Cardiovascular Medicine, Cleveland Clinic, was especially critical of industry-funded CME in general and of the Accreditation Council for Continuing Medical Education (ACCME) -- the organization that accredits CME providers -- in particular.

"With the billions of dollars of industry money flowing into CME, who is guarding the integrity of the CME process?," asked Nissen. "Current oversight by the Accreditation Council for Continuing Medical Education (ACCME) is largely ineffective. The ACCME has strict rules governing educational activities, but appears uninterested or incapable of enforcing them. I am unaware of any communications companies that have lost their accreditation because of biased CME."

"Maybe they don't have resources, maybe they do not have the will," said Nissen. "We need ACCME to go away." He said that while Murray Kopelow, CEO of ACCME, was sitting in the same small room!

"In recent years, CME has been increasingly used to conceal payments to physicians that would otherwise be disclosed by transparency rules at hospitals and medical schools," said Nissen. "Since the honorarium comes from a third party and is used to support CME, recipients are shielded from disclosure. Essentially, communications companies are used to 'launder' money to avoid disclosure." Speaking of money laundering, maybe Nissen read my post on the subject: "Welcome to the CME Laundromat!"

Kopelow, in his testimony, did not mention any CME providers who have lost their accreditation due to violations, but he did mention many recent improvements in oversight implemented at ACCME. Providers, for example, have been put on "probation," said Kopelow without describing what that meant. He also mentioned that "just this month," ACCME made public those CME providers that accept pharma funding. Haven't the cows left the barn by now? I mean many MECCs -- commercial providers who are funded almost 100% by industry -- have already gone out of business because of the cut in their funding (op cit).
[NOTE: Although I found a complete list of accredited providers on the ACCME site, I did not find a specific list of providers that accept industry funding that Kopelow mentioned. The list I did find, however, included "Provider Type" as one of the fields of the list. That tells me if the provider is non-profit, Publishing/Education company, or simply "Not Classified." It does not tell me if the provider accepts industry funding (even non-profits can accept such funding), nor what percent of their CME programs are industry-funded. I sent ACCME an email (to "") asking them to send me that information. I suspect, however, like Nissen, I will never hear back from them. ADDENDUM: I DID hear back!
"Hi John, thank you for your inquiry. The list that you refer to will be posted by the end of August. It will include whether or not a provider accepts commercial support, but will not include information about the amount of commercial support received by an individual provider." -- Tamar Hosansky, Director of Communications, Accreditation Council for Continuing Medical Education]
Kopelow's written testimony mentions applications for accreditation that failed and providers who were placed on probation:
  • Fourteen of the 22 Initial Applicants for accreditation received decisions of NON ACCREDITATION for failure to demonstrate compliance in all ACCME accreditation elements. All, but one, was found in non compliance with the SCS (Standards for Commercial Support).

  • Fifteen Providers were placed on PROBATION for: a) a failure to demonstrate any implementation of the 2006 educational accreditation criteria; or b) recidivism with respect to compliance with the ACCME SCS. (This represents some providers that were found in non-compliance with the SCS four years previously, demonstrated correction with a Progress Report and then were found in non-compliance with the SCS during this re-accreditation review.); or c) failure to address some components of the ACCME Standards for Commercial Support.
Thomas Stossel, MD, Translation Medicine Division and Senior Physician, Hematology Division, Brigham & Women's Hospital, Harvard Medical School, asked "Is it really broke? Do we need to fix it? I see CME as pretty darn effective as currently constituted."

Stossel suggested that improvements in medical care were a direct result of industry-funded CME. Fellow Tweeter @garyschwitzer tweeted Sen Franken's comment on that: "Sen. Franken: it doesn't follow that industry should fund CME just because medicine is better today than when we were kids."

Stossel at one point in his testimony also said his "family members get the best information from commercial sources." A senator -- I forget who -- wondered if Stossel meant direct-to-consumer (DTC) advertising, which was not the subject of the hearing. I guess he meant family members who were also doctors getting information from industry-funded CME. Whatever he meant, Sen Franken retorted: "You draw conclusions from stories. Accumulation of anecdotes that you quote don't equal data." Stossel did indeed resort to anecdotal evidence several times throughout his testimony.

The first two pages of Stossel's written testimony just reviews the advances of medicine to treat diseases like heart failure, which he attributed to the drugs developed by commercial entities like pharmaceutical companies. This, of course, may be true, but Stossel failed to prove that industry-sponsored CME played a major role.

"Do the allegations concerning the parasitic and devious aspects of the medical products industry survive analytical scrutiny to justify concluding that conflict of interest degrades medical integrity?," asked Stossel in his written testimony. "They do not," he answered.

Stossel concluded his written testimony with "History has repeatedly demonstrated that top-down, central planning impedes innovation. Unless we resist the zealots driving conflict of interest regulations, progress will slow – and patients will suffer."

I live Tweeted during the event. See Twitter hashtag #SenCME.

Wednesday, July 29, 2009

Novo to Social Media: Report the Facts

A Twitter friend was surprised I did not respond "2 the Charlie Kimball thing- esp since your journalistic integrity was questioned. :("

I had no idea what "thing" he was referring to, but rather than email him and check the facts as any good journalist would do, I just searched Twitter and found a post on Kerri's Six Until Me blog about Charlie Kimball that mentioned me, social media, and journalism "principals" (see "Charlie and the Twitter Factory"). This has to be what my friend was referring to. It's just an assumption, mind you, but if it walks like a duck and quacks like a duck...

Kerri was obviously concerned about the "backlash towards Charlie" and cited my post "Novo Nordisk's Branded (Levemir) Tweet is Sleazy Twitter Spam!."

"I do not like to see Charlie, the guy, under such attack," says Kerri. For the record, I did not "attack" Charlie, "the guy" and I challenge Kerri to quote me where I attack Charlie Kimball personally.

But that's not my main issue. In the post Kerri interviews Ambre Morley, Associate Director of Product Communications at Novo Nordisk. You can read the interview. I just want to focus on the the journalism "principal" aspect.

Here's the relevant section:
Kerri: How has Novo felt about the blog backlash to @racewithinsulin, and how has Novo moved to protect themselves and Charlie?

Novo: If no one talks about what you do, you probably haven't made much of an impact. That said, it would be nice if the talk was all positive and more importantly, true. We encourage people to ask questions and give us an opportunity answer. We're pretty transparent about our challenges and open to discussion about any ideas to make it better. There were some false assumptions gaining traction, but that's also the nature of this business. You can never please everyone, but you can only hope that social media will adopt some of the principals of traditional journalism and report the facts, [my emphasis] before making assumptions. We're working to move quicker to respond but also encouraging anyone to just ask. As for Charlie, he has been great. He's in a profession where he already has a lot of attention on him and is working with us to help make the page a success.
"you can only hope that social media will adopt some of the principals (sic) of traditional journalism and report the facts..."

First of all, it's principles, not principals. I didn't go to journalism school, but a "principal" is someone to whose office you are sent when you misbehave in school. "Principle," on the other hand, is a rule, law or general truth.

Let's get to the journalism principles, which Morely implied I lacked.

As I have said before, I don't need no stinkin' journalism principles because I refuse to be boxed into a journalism niche that corporate PR people like Morley feel comfortable with (see "The Social Media Revolution Will Not Be Televised").

Morley speaks about assumptions. She claims, for example, that all the posts are written by Charlie himself. Novo only advises him about how to phrase things when mentioning brand names so that FDA regulations are obeyed.

Any good journalist, of course, would ask Charile if he wrote all those posts on Race with Insulin. But I could not ask him, because he does not follow anyone on that account. When I found the @CharlieKimball personal account, I noted a suspicious retweeting of posts from that account to the @racewithinsulin account. It didn't take any journalistic principles to see that the heart and soul of Charlie was being edited out of his personal posts before they made it over to Race with Insulin (see "Novo Nordisk Selectively Copies & Edits Kimball's Tweets").

Kerri likes Charlie Kimball and so do I. A personal friend of Charlie's emailed me and told me what a great guy he is. But this friend also wished Charlie had not made that post about Levemir because it didn't sound like something Charlie would do. See, like any good journalist, I also have my deep throats. If that's not principled journalism, then I don't know what is!

On Twitter, A Patient Photo is Worth a Thousand Characters!

Pharma brand marketers have a problem with Twitter. They can only use 140 characters (about 20 words) at a time. That limitation, however, has not stopped some drug marketers from posting branded Tweets (see "Novo Nordisk's Branded (Levemir) Tweet is Sleazy Twitter Spam!").

If the goal, however, is to amass followers, pharma brands on Twitter should use a nice image of a patient as part of the brand's profile rather than the brand logo. It's even better to use a "conceptual image" of the patient enjoying the benefits than a "professional head shot" of a person.

This was one takeaway from a Twitter experiment performed by Krū Research (see "DTC Pharma-Twitter Experiment"). The purpose of the experiment was to determine the optimal way a pharma brand can connect with health consumers on Twitter.

In this experiment, Krū Research created several fictitious Twitter accounts:
  1. A regular person with no association to insomnia or a drug; this was our control
  2. A person who mentions they have insomnia in their profile; this was considered a patient-peer unaffiliated with pharma
  3. A person with insomnia who is representing an unbranded insomnia website; this was our paid patient opinion leader profile
  4. An insomnia brand
The fictitious brand was named "Restira" and the Twitter brand account, which no longer exists, was @RestiraRx.

I won't get into the details, but the experiment measured the follow-back rate for these accounts after each made one Tweet. The results are shown in the figure below:

Kevin Kruse, President of Kru Research, summed up the experiment's results this way:
"The results of the first two phases of our research suggest that brand managers would be wise to use patient opinion leaders tied to an unbranded website to maximize their Twitter followers. If the preference is to tweet from the brand itself, the use of an interesting photo that is not the brand logo will get the best results."
Kruse will be a guest on my Pharma Marketing Talk live talk show/podcast on Friday, July 31, 2009 at 10:30 AM Eastern US. More details here.

Disclaimer: Kru Research is an Pharma Marketing News advertising client. I am the owner and publisher of Pharma Marketing News.

Tuesday, July 28, 2009

The Social Media Revolution Will Not Be "Televised"

I spent the day yesterday attending ExL Pharma's 5th Annual Public Relations & Communications Summit, which was held at Pfizer headquarters in New York City.

Assembled there were some of the best and brightest people in pharma corporate communications, including at least a dozen people from Pfizer. Unfortunately, Ray Kerins, Pfizer's Head of Global Media Relations, couldn't make it. He is in China with Jeff Kindler, Pfizer's CEO.

Hosting a conference inside the "belly of the beast" is a novel idea. I say "beast" in the most respectful manner. Pfizer is a "beast" in more ways than one. It is, for example, the #1 pharma company in the world in terms of sales. And when it finally swallows up Wyeth, there will be about 130,000 people employed by Pfizer -- at least before the inevitable layoffs happen.

But Wyeth employees won't have to worry about the Pfizer medications they are taking because they may qualify for Pfizer's MAINTAIN program, which offers free Pfizer drugs to people recently laid off. "Laid off, but still getting laid!" is how some news reporters describe this program, according to Sally Susman, Senior Vice President & Chief Communications Officer at Pfizer, who gave the Keynote Presentation.

Susman formerly worked for Estee Lauder, where everyone was sure she had a much easier job with better freebies than she has at Pfizer. She put this into perspective by citing some poll results showing an increasing public animosity towards the healthcare industry: 42% of Americans trust healthcare industry to do the right things -- a 16% drop from last year.

But the main worry among PR professionals is the "rapid" decline in traditional media and the evolution of new media (more than the economy, the rise of new media was considered the #1 global issue facing pharma PR, according to audience poll results). This was also something Kerins referred to last week at the BDI social media conference (see "Pfizer's Social Media Strategy: Piss Off John Mack, Get Hundreds of New Followers!").

"We're not dead yet," said a newspaper guy in audience. He pointed out that only 100 out of 7,000 newspapers nationwide went out of business last year. Susman and others noted, however, that cutbacks across the board at newspapers left fewer beat reporters to cover the pharmaceutical industry. As Susman described it "there are fewer outlets for promotion."

Of course, there are many, many MORE outlets available to pharma PR people for promotion, most notably blogs. That's the real problem for PR professionals who are not sure how to leverage bloggers like they have learned to leverage pharma beat reporters. They worry that bloggers are not professional journalists and have no uniform code of conduct. And there are many, many bloggers out there to contend with.

PR people are used to issuing press releases to a few journalists at the top of the traditional news pyramid. When the top was blown off by the social media revolution, these professionals had no proven mechanism by which to reach the many thousands of bloggers at the BOTTOM of the pyramid -- until now. That mechanism is Twitter, which is being adopted rapidly by most pharmaceutical companies (the latest is Astellas, see @AstellasUS). "Twitter works," said Co_chairperson Karen Carolonza, principal at Green Room Public Relations. "Whoever thought I would mention Twitter and pharma in the same sentence!"

PR people refer to social media as "evolution, not revolution." IMHO, they are wrong. We all are uncomfortable with revolution, which means we have to completely and radically change the way we do business. We much prefer "evolution," which implies we just have to make a few adjustments and adapt gradually to change. That's why many pharma PR people are beginning to schmooze bloggers as they do reporters -- by having them over to dinner (see "Thank You Johnson & Johnson for Dinner") and inviting them to "roundtables" (see "Chantix 'Roundtable' Apparently Not Round and Not a Table"). [Also see "A New Era of Pharma Marketing: Direct to Journalist (DTJ)" for other tactics employed.]

Personally, I do not mind being invited "inside the tent." Ray Kerins was kind enough to go out of his way to make sure I was able to attend yesterday's conference. But I am not going to act like a journalist here in this blog. I think most people like me blog in order to put their personal spin on issues of importance to them. I'm interested in checking the facts, but I am not going to call the PR department every time I post something to Pharma Marketing Blog. If you have been reading this blog for some time, you know about the many instances when I have called or emailed the corporate communications people at pharmaceutical companies and never heard back from them. This problem was pointed out by several speakers at yesterday's summit.

It's been a lazy, slow moving world for PR up until now. Beat reporters used to work months on a story and had well-defined deadlines. PR people always began a conversation with reporters with "What's your deadline?" -- a question that has lost its significance in a world where the deadline for every story is NOW!

But reaching out to bloggers like me is not the revolution, it's part of the evolution that pharma PR people are trying to create. No matter how much they reach out, they will not be able to control the news, which is what they want to do.

The real revolution is people telling their own stories, creating the news that other people want to read. Pharma PR people understand this and they will co-opt the revolution, not just adapt to the evolution of media. They want, for example, to "change the debate" about drug pricing and one of the chief tactics they use is to get patients to tell their stories. This is how social media is currently being employed by pharmaceutical companies. It's not about the brand, it's about survival of the pharmaceutical industry.

Hopefully, the social media revolution will not be "televised" as was the fate of a previous "revolution" I witnessed.

P.S. I hope and trust that all the PR people I met yesterday continue to invite me into the tent. I would like to invite you all to a roundtable discussion of the issues I raised here. I wasn't able to collect all your cards. Let's get connected through LinkedIn. My profile is here:

Friday, July 24, 2009

Pfizer's Social Media Strategy: Piss Off John Mack, Get Hundreds of New Followers!

Ray Kerins (LinkedIn profile and @RayKerins?) -- Head, Global Media Relations at Pfizer -- and I were among the few people attending yesterday's "Social Communications & Healthcare" conference who did NOT have a bad hair day in humid New York City. We both have no hair on our heads to speak of!

I made the mistake of Tweeting about that at the beginning of the conference. Later it came back to me. No good Tweet goes unpunished as they say.

Here's the story:

First, Mario Nacinovich (@nacinovich), Editor-in-Chief of the Journal of Communication in Healthcare, Tweeted that Kerins and I were pretty popular people at the conference: "Kerins: Best in show. Geoghegan: ADHD Moms + Allies bchmk FB case. @pharmaguy: John Mack most referenced in SM next to FB + Twitter."

Then, Jonathan Richman (@jonmrich) tweeted "Free plugs for @pharmaguy at #bdi."

Steve Woodruff (@swoodruff) soon reTweeted Jonathan's comment and added his own remarks: "Free plugs for @pharmaguy at #bdi Hair plugs????"

See? That's how Twitter works.

It would have been bad enough if all this happened in the privacy of our own notebook computers and iPhones. This Twitter exchange, however, was available to all attendees to see on a separate huge screen on the stage! The conference organizers were using some diabolical Twitter app to project on that screen all the #BDI Tweets as soon as they were made! The technology, however, did not work fast enough so they had a good-looking young woman sit on stage to click "update" every so often. I think her presence added a certain je ne sais quo to the thing.

How did I achieve my 15 minutes of fame? It was all due to Ray Kerins, who mentioned me so often in his presentation ("Pfizer's Social Media Strategy"), that Fabio Gratton (@skypen) Tweeted: "How to get followers on Twitter: Piss off John Mack ;)"

Yes, Kerins confirmed that because of me, Pfizer's official Twitter account (@Pfizer_News), garnered a couple of hundred followers within minutes! And I had to pay $149 to some other diabolical Twitter app to get that! So, the way I figure it, Pfizer owes me a $149 dinner! (I am on a mission: to get a free dinner from each of the top ten pharma companies. See "Thank You Johnson & Johnson for Dinner".)

In case you have not been following me (@pharmaguy) on Twitter (shame on you if you are not!), let me tell you the story of how I quadrupled Pfizer's Twitter followers in a single blow!

Pharma Marketing Forums, which I moderate, has an "Industry News" forum in which is archived pharma news feeds from various publications. It's a good way to keep up with news about the pharmaceutical industry from third-party sources.

Now that several pharmaceutical PR departments are using Twitter to Tweet about their companies (eg, @Boehringer; see "Pharma on Twitter: Boehringer Ingelheim"), I decided on Tuesday to start a new forum -- "Direct from Pharma News" -- dedicated to news feeds from these Twitter accounts. I included the @Pfizer_News news feed.

Soon afterward, however, I began to suspect that @Pfizer_News may not be an authentic Pfizer Twitter account. I have found other Pfizer Poser Twitter accounts (see, for example, "Follow Who's Following Me on Twitter. But NOT Phishy "pfizer" Please!"). Jonathan Richman also suggested that @Pfizer_News might be "phishy."

What followed was a very interesting exchange of Tweets about whether or not @Pfizer_News was authentic or not (see the entire Tweet stream, with time stamps, at the end of this post). At a couple of points during this exchange, Pfizer reps -- including @RayKerins -- Tweeted "we're real!"

What's the world coming to when the world's largest pharmaceutical company has to issue Tweets claiming to be "real?" (Also see: "Pfizer's PR Chief: "How in the hell do we have such a bad reputation?")

It took some time for Kerins to respond to our inquiries -- a full two hours, which is an eternity these days (a lesson learned by Kerins). While we were all having some fun at Pfizer's expense on Twitter, Kerins was stuck in traffic court and couldn't respond! He revealed this during his presentation yesterday.

In the end, I was convinced that @Pfizer_News was real and announced to the Twitterverse: "It's official! @Pfizer_News & @RayKerins are the real deal on Twitter! I lose my bet." That was enough to close the case and get @Pfizer_News hundreds of new followers. @lanes0220 said: "@pharmaguy and SM area helped prove @pfizer_news was real - true SM power"
ASIDE: A couple of other things about @Pfizer_News that telegraphed "phony" were noted by me and others:

(1) the Pfizer logo graphic used by @Pfizer_News was of such low quality, it was difficult to imagine the real Pfizer would approve it (@jonmrich offered Pfizer a high quality logo to use), and

(2) most of the Tweets from @Pfizer_News were simply the results of searches for "PFE" (Pfizer's stock symbol) on Yahoo! and Google news. It looked like some Pfizer short (or long) seller was running the account rather than a corporate communications department.

Because of (2) I still do not include the @Pfizer_News feed in my "Direct from Pharma News" forum. I told my Twitter followers: "Kerins made a good impression on people here. He should have the same voice on @Pfizer_News Forget the PFE stuff!" I said the same thing to Ray at the conference.
Kerins was very gracious in his presentation and made a big hit at the conference. He captured our hearts when he showed a picture of his baby daughter and impressed me when he mentioned he was a volunteer firefighter. Ray Kerins is a real person! Or as my Jewish friends might say, he's a mensch!

The @Pfizer_News Real/Not Real Tweet Stream
From @pharmaguy (me): @Boehringer & @Pfizer_News tweets now on Direct from Pharma News. More to come. 7:56 AM Jul 21st from TweetDeck

From @jonmrich: @pharmaguy Have you confirmed with anyone from Pfizer that this is their official account? @pfizer_news. I haven't yet. 8:10 AM Jul 21st from TweetDeck in reply to pharmaguy

From @pharmaguy: @jonmrich Good point re: @pfizer_news looks official & it's on your wiki! What more proof is needed? :-) Have you called? 8:47 AM Jul 21st from TweetDeck in reply to jonmrich

From @pharmaguy: @pharmaguy It's actually not on my wiki b/c I haven't confirmed. I haven't called, Usually someone contacts me, but not this time. 8:54 AM Jul 21st from TweetDeck in reply to pharmaguy

From @pharmaguy: @jonmrich Sorry. I thought I saw Pfizer on ur list. I sent Ray Kerins a note via LinkedIn. 8:57 AM Jul 21st from TweetDeck in reply to jonmrich

From @jonmrich: @pfizer_news Can you give me a contact number I can call to confirm? Not that I don't trust you, but a reply could come from anyone. Thx! 1:36 PM Jul 21st from TweetDeck in reply to pfizer_news

From @jonmrich: What'd you think @pharmaguy? RT @pfizer_news: @jonmrich: Pfizer Twitter is real and official. Thanks for inquiring!1:42 PM Jul 21st from TweetDeck

From @pharmaguy: @jonmrich Well that certainly convinces me! What about you? @pfizer_news have Kerins respond to me via LinkedIn & confirm. 2:05 PM Jul 21st from TweetDeck in reply to jonmrich

From @pharmaguy: @Pfizer_News I believe is a fake - jut reposting Yahoo & Google news items that contain word "Pfizer." My advice: Block 'em! 2:48 PM Jul 21st from TweetDeck

From @Pfizer_News: @pharmaguy: John Mack – We are real! Ray Kerins will call you shortly. 2:58 PM Jul 21st from web

From @pharmaguy: @val1a My gut tells me I'm right. Just look at the pixelated logo! Amateurs. #1 pharma would never dis their image that way! 2:59 PM Jul 21st from TweetDeck

From @pharmaguy: RT @pfizer_news: @pharmaguy: "John Mack – We are real!" No you're not! Wait! Is that my phone ringing? 3:01 PM Jul 21st from TweetDeck

From @pharmaguy: @brianreid I bet two Tweets that they are fake, fake, fake. 3:06 PM Jul 21st from TweetDeck in reply to brianreid

From @pharmaguy: @shwen Nobody knows if you're a Pfizer or a P[f]oser in the Twitterverse! 3:08 PM Jul 21st from TweetDeck in reply to shwen

From @pharmaguy: "On Twitter, only Mack knows I'm NOT Pfizer!" 3:14 PM Jul 21st from TweetDeck

From @pharmaguy: @RayKerins Is this the "real" Ray Kerins, VP of Communications at Pfizer? Or another P[f]oser? 3:30 PM Jul 21st from TweetDeck in reply to RayKerins

From @RayKerins: I guess we will find out when I see pharmaguy on Thursday 3:35 PM Jul 21st from web

From @pharmaguy: @RayKerins How about adding me to your LinkedIn network now? See your in box. 3:44 PM Jul 21st from TweetDeck in reply to RayKerins

From @pharmaguy: It's official! @Pfizer_News & @RayKerins are the real deal on Twitter! I lose my bet. 4:01 PM Jul 21st from TweetDeck

Wednesday, July 22, 2009

Pharma Shifts Support of CME from MECCs to Physician Societies

The 2009 annual report the Accreditation Council for Continuing Medical Education (ACCME's) is out and there are a few interesting takeaways:
  1. Overall Continuing Medical Education (CME) spending in the US is down from $2.54B in 2007 to $2.36B in 2008, the first year-to-year drop since ACCME was founded.
  2. The reduction is almost completely due to reductions in commercial CME sponsorship, which fell from $1.2B to about $1B.
  3. In turn, this reduction was highly selective among CME sponsors. The medical education and communication companies (MECCs) that are almost solely engaged in for-profit work on behalf of commercial sponsors, had their revenues hit by $131M, or a 22% reduction.
[Courtesy of Hooked on Ethics Blog]

Pharmaceutical industry ("commercial") support of CME has been declining since 2004 when OIG began scrutinizing just where that money was coming from (ie, marketing budgets). The following chart shows the trend:

OK, there was a slight uptick in 2006. Other than that there has been a steady decline in pharma funding of CME year over year since 2004.

The pharma industry supports CME by funding different types of ACCME-accredited CME providers. These include for-profit Medical Education Communications Companies (MECCs), medical schools, and physician societies. The following chart shows how this funding has changed over the years:

As pointed out by Danny Carlat in his blog, "commercial support for MECCs has entered free fall mode" (see here).

Such is NOT the case, however, for medical schools and physician societies. Although pharma funding of their CME activities has contracted somewhat, the decline has not been nearly as dramatic as the decline in pharma-funded MECC CME activities.

It's not surprising, therefore, that physician societies have overtaken MECCs in terms of the percentage of total CME income made (see chart on left).

Pharma funding of CME comes in the form of grants and CME event advertising/exhibit fees. Most of the latter money goes to physician societies that provide CME at elaborate annual and regional meetings of its members. The chart below shows the trend in advertising/exhibit income that physician societies have received from pharma:

There obviously has not been any recession in this kind of advertising, at least not in 2008 when pharma spent $219.54 Million to advertise and exhibit at physician society CME events (compared to $217.91 Million in 2007). At the same time, pharma CME grants to physician societies declined from $215.39 Million in 2007 to $202.54 Million in 2008. In other words, more pharma-sponsored biased advertising and less pharma-sponsored unbiased education at these CME events!

Online CME Flourishes
More and more physicians are getting their CME online. The chart on the left shows the number of physicians who participated in online CME by reading printed pages ("enduring" CME content), not by participating in live CME events, which are still rare.

Does all this portend the end of MECCs? Danny Carlat thinks so:

"The 2009 [ACCME] report will look even worse for MECCs," says Carlat. "Pfizer has announced that it will no longer fund them. The American Psychiatric Association is ending industry sponsored symposia, all of which are administered by MECCs. The AMA, in its latest CEJA report, said that commercial funding should be allowed only if the CME provider is deemed "not overly reliant on funding from industry sources." Translation: for-profit MECCs will no longer be kosher. So goodbye MECCs. Your Christmas and Hannukah lasted a long time, but it's finally winding down." [Also see "Is CME in the US Doomed? Or Just For-Profit MECC's?"]

What do you think? Please take the following survey and give me your opinion: What's the Best Way for Pharma to Support CME?

What's the Best Way for Pharma to Sponsor CME?

Tuesday, July 21, 2009

FDA Cannot Track Its Own Review of Adverse Event Reports!

I don't know whether to laugh or cry regarding a Government Accounting Office (GAO) report that said while the number of adverse-event reports - which help the agency track drug and medical-device safety problems - increased during 2004 to 2008, FDA officials couldn't provide data about how many reports it reviewed! (See "GAO: FDA Can't Determine How Much Money It Needs".)

I laugh because the pharmaceutical industry's fear of adverse event reports is unfounded! That fear has been the industry's excuse for not transitioning from "interruption" advertising with its one-way monologue from pharma to consumer to "conversation", two-way dialogue, advertising via social media (see, for example, "Finally, a Drug Company Embraces Social Media, AEs Included!"). If the FDA doesn't know if it has reviewed an adverse event report, pharma gets a free ride.

Of course, I cry because the number one priority of the FDA - not to mention the drug industry - is to ensure drug safety. A consistent and fair review of adverse event reports is FDA's main tool for monitoring drug safety after marketing approval.

According to the GAO report:

"The FDA received 522,871 drug-related adverse-event reports in 2008 compared with 426,016 in 2004. Device reports jumped to 588,161 from 189,450 while reports involving biologics also showed large gains. FDA told GAO while they place a priority on reviewing serious adverse-event reports, they receive "substantially" more adverse-event reports than staff can review. The FDA said the adverse-event reporting systems don't allow agency to track whether individual reports have been reviewed."

Compare these numbers to what the FDA recently reported (see "New FDA Data: Adverse Event Reporting Increases Dramatically"). FDA counted 496,412 adverse event reports (AERs) in 2008 whereas GAO counted 522,871, a difference of 26,459. Seems small. but since the FDA does not know which AERs it has reviewed, how do we know there are no serious events among those 26,000 that the FDA did not count?

Monday, July 20, 2009

Health Communications: Creative, Complex, and in Need of Collaboration

"Health Communicators" have a tough job that must be "carefully nurtured," says Fard Johnmar of Envision Solutions. Johnmar has just pre-launched his "Path of the Blue Eye" project to help nurture health communicators via a collaborative community.

Johnmar decided to launch (er, I mean, pre-launch) the project "a bit differently" using a super hero comic strip featuring Specto Laurus who protects the "cverse" - the creative universe - which is the source of creativity and inspiration for health communicators. The villain is Davdos James, erstwhile friend of Specto, now an agent of the "enemy" who "lives only to suck the cverse dry."
[I wonder who, in the "reality universe" or "rverse," Johnmar has in mind as the enemy? This is just one of the questions I will ask him in an upcoming Pharma Marketing Talk interview.]
Here's the first few panels of the comic (click for a more readable, enlarged view; go here to read the entire comic):

"Some may react negatively to the approach, while others will think it's interesting," said Johnmar.

I certainly think it's an interesting approach and that's why I have invited Johnmar to talk about it in an upcoming Pharma Marketing Talk interview (go here for more information about joining in the discussion LIVE or listening to the podcast archive).

Here's another few panels from the comic strip showing desperate health communicators in need of nurturing (click for an enlarged view):

In the "rverse" there are many companies and consultants that help nurture pharmaceutical marketers, who I suppose could be called "health communicators." Johnmar's company, Envision Solutions, is one of them.

Another "nurturing" company is TNS Healthcare (a Kantar Health Company), which is an advertising client of mine. In the upcoming 2009 Summer (August) issue of Pharma Marketing News, I will publish a review of a recent TNS webinar entitled "Owning the Prescription Pad: Driving Brand Decisions in a Multi-Influence World."

TNS, like Johnmar, believes that health communications is a complex business.

“Brands face dynamic environments with many influencers," said Jonathan Kay, TNS's Global Practice Head, Brand and Communications at the close of the above-mentioned webinar. "Brand managers need to observe, gauge and seek to influence those influencers. Therefore, we need a new model that helps us make sense of a complex world of communications. In addition, we need some measurements. Before measuring, we need to take a holistic view of the market and consider the various influencers on prescribing, their direction, positive or negative, and their relative impact. Then we can examine them in depth. The 'ecosystem' varies over the course of the disease and there are varying points of impact and during a product’s lifecycle there are various ways to make an impact. Taking these points in mind will equip the brand manager to incorporate the 'art of influence' into the brand plan and help management make an optimized investment."

Kay is talking about influencers of physician prescribing, an all important concern of pharma marketing communicatiors.

One of the things that is making health communications so complex these days is the social media revolution, especially among patients who are now one of the major influencers of physician prescribing.

TNS has studied several factors influencing physician prescribing and created an index to measure the influence, positive and negative. This was done via a brief survey of primary care physicians in the US and other countries. The chart below shows results pertaining to influencers of diabetes drug prescribing by US physicians (click for an enlarged view).

What I find interesting is that "Social networks" are among the "negative" influencers, most of which are related to the cost of the product. In this context, social networks can be either patient or physician networks. TNS can break these out to determine how each kind of network might influence physicians (not in this chart, however).

All this complexity and need to pay attention to details is why companies like TNS and Envision Solutions thrive (that is, I assume they are thriving) within the pharma industry. Most pharma brand managers do not have the marketing expertise in house to deal with all this complexity much less measure the success or failure of their campaigns. They need "super heroes" - maybe a little less super than Specto, however.

Friday, July 17, 2009

Harry and Louise Return This Weekend to TV

Remember those Health Insurance Association of America "Harry and Louise" TV ads that were instrumental in scuttling Hillary Clinton's health reform efforts in 1993? Well, Harry and Louise are back! This time, however, they support health reform. "A little more cooperation, a little less politics, and we can get the job done this time," says Louise as a halo swirls around her head and eventually forms the URL: Seems to me we could have gotten the job done in 1993 with a little less Harry and Louise!

[UPDATE, 31-May-2012: Read "Pfizer & PhRMA Instrumental in Passing Health Reform"]

Here's the ad you'll see this weekend (sponsored by PhRMA and Families USA):

Harry and Louise talk behind the scenes about healthcare reform during the 2008 election campaign:

Here's the original anti-government campaign:

Here's a spoof by Hillary and Bill:

Wednesday, July 15, 2009

When is it Acceptable for Pharma Marketers to Use Behavioral Targeting?

"The practice of advertising has clearly been revolutionized by the emergence of the Internet," said Nancy Hill, President & CEO, 4A's.

"Today, we can match the content of an ad to the interests of the consumer in ways undreamed of just a few short years ago' (see Industry Tightens Its Standards for Tracking Web Surfers).

One way of matching content of ads to the interests of the consumer is by using Behavioral Targeting (BT) techniques.

BT (aka interest-based advertising) uses information collected on an individual's web-browsing behavior, such as the pages they have visited or the searches they have made, to select which advertisements to display to that individual. Practitioners believe this helps them deliver their online advertisements to the users who are most likely to be interested.

To implement BT, users are tracked using invisible cookies stored on their computers. That is the only way that site D can know a visitor to the site previously visited sites A, B, and C. Site D can then use this information to serve the appropriate ads or other content based on previous visits.

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

The FTC has an interest in behavioral targeting. It recently confirmed it will let marketers self-regulate behavioral-marketing privacy issues in cyberspace, rather than introduce government regulation. However, many consumer groups criticized the FTC's view that self-regulation of online targeted advertising was sufficient and the new FTC chairman, Jon Leibowitz, has stated: "Industry needs to do a better job of meaningful, rigorous self-regulation, or it will certainly invite legislation by Congress and a more regulatory approach by our commission," he said earlier this month.

When is it acceptable for pharma marketers to use behavioral targeting to deliver ads online?

I am doing some research regarding the appropriateness of using behavioral targeting techniques in pharmaceutical marketing and hope you will help by taking my Use of Behavioral Targeting by Pharma Marketers" survey.

SURVEY: Use of Behavioral Targeting by Pharma Marketers

Questions include:
  • Have you ever used behavioral targeting in an online advertising campaign?
  • Should the pharmaceutical industry adopt similar self-regulatory principles that were established by media and marketing trade associations to protect consumer privacy when employing behavioral targeting.
  • Should pharma marketers use behavioral targeting at all?
  • If they do use it, when is it appropriate?
Take the Survey
Please take 2 minutes to answer this survey relating to appropriate use of behavioral targeting techniques by pharmaceutical marketers. Take the survey here.

You will be able to see a summary of up-to-date de-identified results upon completion of the survey.

Results of this survey may be summarized in an issue of Pharma Marketing News.

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

After completing the survey you will be able to see a summary of results (de-identified, excludes open-ended responses and comments that may identify the respondent).
Resources & Further Reading:

A New Era of Pharma Marketing: Direct to Journalist (DTJ)

Direct-to-Consumer (DTC) and Direct-to-Physician (DTP) marketing have been the two staples of pharmaceutical marketing for many years. Now there is another kind of pharma marketing emerging: Direct to Journalist (DTJ)!

I have written previously about Pfizer's new strategy to "woo" journalists (see "Chantix 'Roundtable' Apparently Not Round and Not a Table" and "Pfizer's PR Chief: 'How in the hell do we have such a bad reputation?'"). This is a followup with a new twist to the story.

With regard to journalists, "our core strategy," said Pfizer's global PR chief, Ray Kerins, is "engage and educate," which, IMHO, can be loosely translated to "free lunch and schmooze," the same strategy that has worked so well in marketing to physicians.

Unable to send physicians on all-expenses paid junkets due to self-imposed industry restrictions on gifts to physicians, Pfizer apparently has shifted its junket budget to journalists who seem eager to accept the offer.

On the right is an ad from an e-newsletter sent by the Society of Professional Journalists (SPJ). I found this on the Schwitzer health news blog written by Gary Schwitzer of the University of Minnesota School of Journalism & Mass Communication.

"Fifteen fellowships will be awarded and they all include lodging, airfare and most meals," says the ad copy.

The ad mentions the focus of the program will be "using journalism to inform the public about the leading cause of illness and death worldwide," but then reveals that the fellowship will actually be focused on "Cancer Issues."

The World Health Organization lists cardiovascular disease as one of the Top 10 Causes of Death worldwide. No form of cancer makes the list. It's interesting that Pfizer has said it will no longer focus its research on cardiovascular disease -- but it WILL focus on cancer. Coincidentally (?), I noticed this story: "Pfizer Seeks 10-fold Rise in Global Cancer-Drug Sales by 2018."

Ah Ha! It all seems to make sense now. Pfizer is schmoozing -- sorry "engaging" -- budding journalists who, in the future, are likely to be writing about Pfizer's new products designed to treat cancer, which is NOT a "leading cause of illness and death worldwide," but certainly the most expensive-to-treat and most profitable-to-treat illness worldwide.

It's very important to Pfizer to get journalists on its side when reporting about the new, expensive drugs it has in store for treating cancer. The money that governments and insurance companies will have to spend for these drugs, which may extend life for very short periods of time, is staggering (see "New Cancer Drugs: Most Not Worth the Cost?"; obviously written by a journalist who needs this fellowship!). Consequently, any pharmaceutical company wishing to be successful in the cancer market has to prove that its products are worth the money. It will need data, of course, to do this and it will need to "spin" the data to "prove" that the product is well worth the money. That's where journalists come into the picture and to pharma's table.

Most cancer treatments are complex biologics, not pills, which are easy to produce and administer. Doctors who treat cancer are allowed to resell these biologics at a great profit. It is not necessary, therefore, to schmooze doctors in order to get market share for your product. On the other hand, journalists -- if not properly "engaged" -- can ruin your success by publishing the wrong kind of stories (like the one cited above).

One of the topics to be addressed at the National Press Foundation's "Cancer Issues III 2009" 4-day program for journalists ("Underwritten by Pfizer, Inc.") is:
"Reporting published research: Translating medical journal articles is an acquired art. Some tips on understanding, dissecting and writing on the latest research"
Should this "acquired art," which journalists must master, be taught via a Pfizer-sponsored program? Isn't there a definite conflict of interest here? It is very similar to the case of pharma-sponsored continuing medical education (CME) programs offered to doctors. But in the case of this and other "continuing journalism education" programs, there are no rules and regulations as there is for pharma-sponsored CME. No accreditation organization. No separation between "church and state" in the sponsoring company.

Here's what Gary Schwitzer has to say from a journalist's perspective:

"As an SPJ member, and as the keynote speaker at a recent SPJ ethics week event... the national president gave me a plaque with the SPJ code of ethics on it. I remind SPJ that its own code of ethics includes these clauses:

"Journalists should:
  • Avoid conflicts of interest, real or perceived.

  • Remain free of associations and activities that may compromise integrity or damage credibility.

  • Refuse gifts, favors, fees, free travel and special treatment, and shun secondary employment, political involvement, public office and service in community organizations if they compromise journalistic integrity.
"If taking free airfare, lodging and meals from a drug company whose work you cover isn't at least a perceived conflict of interest, I don't know what it is. And I don't think SPJ should promote events in its own newsletter that, in my reading, invites journalists to violate the SPJ code."

BTW, I applied for a fellowship. Hope I get chosen!

Related article: Are Clinical Trial Results Compromised By Money?

Tuesday, July 14, 2009

Summertime and Twitter is Easy

"There comes a point in time in your life when you ask 'where did all the summers of my youth go?'...marketers need to tap into this emotion" -- @richmeyer

And Twitter is easy
Tweets are jumpin'
And the RT count is high

Oh, Novo’s rich
And Marc Monseau1 is good lookin'
So hush little marketer
Don't you cry

One of these mornings
Pharma’s going to tweetup singing
Then you marketers will spread your wings
And you'll take to the sky

But until that morning
Not even FDA can harm you
With PharmExec and AdAge standing by2

And Twitter is easy
Tweets are jumpin'
And the RT count is high

Novo’s rich
And Marc Monseau is good lookin'
So hush little baby
Don't you cry

1Marc is the force behind JNJBTW Blog. Catch his tweets @JNJComm
2PharmExec and AdAge are two trade publications that reported on the use of Twitter by Novo Nordisk ONLY after Novo issued a press release AFTER my post critical of Race with Insulin. Novo denied my criticisms and claimed they comply with all DTC guidelines. PharmaExec and AdAge basically rehashed the press release and focused mostly on Novo's side of the story. In other words, these publications did not take much of a critical POV.

Can Pharma Use Social Media to Provide Patient Support?

This morning, I received a note from a visitor to Pharma Marketing Network. It was submitted via one of the forms I have on the site. It said:

'I have a low-income friend, 69 yrs of age. She is almost a cripple without celebrex but Humana refused to pay for it altho the Dr. orders. Is there a program that could help her get the celebrex.'

Well, there is a program, which you can find on here. [The image on the left is in the header of Pfizer's "helpful answers" Web site. I am a little confused by this image, which outlines people's heads with medicine bottles, Rx pill containers, and cups. Why was that necessary?]

Pfizer's "helpful answers" site offers a pretty comprehensive list of assistance programs offered by Pfizer, the pharma industry in general, and by the government.

Why didn't this person go to (or where this information can easily be found? I don't know. But maybe she trusts me more than Pfizer or Celebrex marketers.

All the talk about how to use social media to drive consumers to branded Rx sites without pissing off the FDA (aka violating FDA regulations) is really about how to use social media to advance pharma's self-centered approach to marketing, the goal of which is to answer the question "How can I get the consumer to do what I want?"

Using social media to answer THAT question is a fruitless enterprise. The Levemir Tweet heard round the pharma marketing world (see here) is an example. Who among the 300 or so people who read that Tweet gives a crap? Nada! They didn't ask for it and they got nothing out of it.

But social media will eventually force pharma to shift from "marketer-centric" push messages to "consumer-centric" pull messages. That is, marketers will be pulled into responding directly to consumer inquiries such as the one above. When the response is published within a social media application such as a discussion forum, it benefits everyone else reading that message who is faced with a similar problem.

Maybe Celebrex is not indicated for treating crippling conditions and the FDA would not want to see that mentioned on a Pfizer site. Do you think for one moment that the FDA would slap Pfizer with a warning letter because it allowed the question above to be posted to a site that Pfizer maintains or sponsors? Even if the letter came, the answer from Pfizer would have been received and people would have been helped.

No, the FDA is not the problem.

The above message also says something not too nice about one of Pfizer's main customers: a big insurance company that probably has lots of other Pfizer drugs on its formulary. Pfizer wouldn't want to piss off Humana, so it would be in a conundrum about how to handle such a message.

Can it redact part of the message as in: 'I have a low-income friend, 69 yrs of age. She is almost a cripple without celebrex but [her insurance company] refused to pay for it altho the Dr. orders. Is there a program that could help her get the celebrex.'?

I dunno. Consumers may not like it that Pfizer edits user-generated content. Pfizer would have to have a clear publicly-stated policy about that and even then it may not be acceptable.

My reason for posting this is to point out that:
  1. patients need support and social media may be one way to provide that support so that the answers/knowledge can be shared by the whole community, and

  2. there's more than FDA regulations to worry about when implementing such an application.
Unfortunately, I do not have all the answers. Maybe someone reading this can help.

Wednesday, July 08, 2009

Pfizer's Slumdog Sales Rep

"Julio Rodriguez was on a sales call at a clinic in this slum overlooking Caracas recently when he heard four gunshots go off nearby," is how the Wall Street Journal begins its story of Big Pharma's newest "strategy" to "target the working poor in the developing world" (see "Drug Firms See Poorer Nations as Sales Cure").

Shown in the photo on the left is Mr. Rodriguez -- a Pfizer sales representative in Venezuela -- walking through one of Latin America's most dangerous neighborhoods.

Looks a bit like Washington Heights in NYC where I used to live while attending graduate school (see here)!

"To avoid attracting attention, he wears a polo shirt with a red logo, the color worn by supporters of President Hugo Chávez."

Yeah, he "blends" with that shirt!

On the right are some other people in that neighborhood. None of them seems to be wearing a red logo on their polo shirts. Wait! None of them even have a polo shirt!

I don't know if Pfizer has any sales reps in Washington Heights dodging bullets to bring Lipitor to the "working poor" of THAT neighborhood. If there are any, I suppose they are wearing Obama logos on their polo shirts!

Why is Pfizer "targeting" working poor in "developing" nations -- as opposed to the working poor of this nation?

"For the first time in a half-century, sales of prescription drugs are forecast to decline this year in the U.S., historically the industry's biggest and most profitable market...As a result, developing countries like Venezuela have begun to look more attractive to the industry. Sales of prescription drugs in emerging markets reached $152.7 billion in 2008, up from $67.2 billion in 2003, according to IMS Health, which tracks the industry. IMS forecasts sales will climb to $265 billion by 2013."

Pfizer is offering some pretty choice deals in these countries. For one thing, it gives away computers to doctors and pays for their Internet access. Of course, the docs have to sign a waiver stating they understand they're not intended to influence their prescribing.

Sure, sure.

Dr. Serrano is one of the docs receiving the kickback... er, I mean free gift with no strings attached. He says the 40% increase in the number of Pfizer drugs he prescribes since Mr. Rodriguez started calling on him in late 2007 was not due to the free gifts. "There are some illnesses that have to be treated with a good product, no matter what the cost," Dr. Serrano says.

Sure, sure.

Not all Venezuelans are as gullible (maybe corrupt is a better term) as Dr. Serrano. Luis Osuna, a member of the working poor class, "was happy when the pharmacist gave him a generic version of Pfizer's Zithromax that cost $12. 'I don't think there was too much of a difference,'" he says.

Not until the Obama administration and Congress pass legislation overhauling the health-care system, including provisions that could lower the cost of medicine, would we see Big Pharma lowering prices in support of the working poor in the good, ole USA!

Tuesday, July 07, 2009

Pharma Marketers are Salivating in Anticipation of Mental Health "Epidemic"

Pharma marketers once "salivated" when they saw US obesity statistics such as these reported by CDC: "During the past 20 years there has been a dramatic increase in obesity in the United States. In 2007, only one state (Colorado) had a prevalence of obesity less than 20%. Thirty states had a prevalence equal to or greater than 25%; three of these states (Alabama, Mississippi and Tennessee) had a prevalence of obesity equal to or greater than 30%."

Although the drug industry has not been able to develop financially-successful products to tackle obesity directly, there are other conditions triggered by obesity -- eg, diabetes -- that pharma is having some success developing new drugs to treat.

The next big boon for pharmaceutical marketers will be in the mental health field. But in this case, there is virtually no worry about effectiveness because (1) there are no biological tests to support mental illness diagnoses, and (2) changes are in the works that will create many new mental illness diagnoses for which there are no biological tests to substantiate.

According to an editorial by Dr. Allen Frances, the chairman of the committee that created the current version of the the DSM (DSM-IV, psychiatry’s diagnostic manual), drug marketers are eagerly awaiting the publication of DSM-V, changes in which will lead to many new "epidemics" (see "A Warning Sign on the Road to DSM‐5: Beware of its Unintended Consequences").

"The sudden increase in the diagnosis of autistic disorder, attention‐deficit/hyperactivity disorder, and bipolar disorder may in part reflect changes made in the DSM‐IV definitions," says Frances. "The crucial lesson here is that even careful field testing is never completely accurate in predicting what will happen when the system is eventually used in the actual field. This issue becomes particularly poignant when one considers the great and skillful pressure that is likely to be applied by the pharmaceutical industry after the publication of DSM‐5. It has to be assumed that they will attempt to identify every change that could conceivably lead to a marketing advantage‐often in ways that will not have occurred to the DSM‐5 Task Force. In order to promote drug sales, the companies may well sponsor expensive 'education' campaigns focusing on the diagnostic changes that most enhance the rate of diagnosis for those disorders that will lead to the increased writing of prescriptions. It should, therefore, be no surprise if there are many new 'epidemics' based on changes in DSM‐V."

DSM-V is adding a new "pre‐psychotic" category for individuals supposedly at high risk for later developing a psychotic disorder.

"This is a drug company's dream come true," says Frances. "Pre‐psychotic" diagnoses "would inevitably also capture an overwhelmingly large group of false positives who would never go on to have a psychotic illness. They would nonetheless be exposed to the stigma of having a pre‐psychotic diagnosis and would be overmedicated. Similarly, wouldn't it be nice to diagnose and treat early cognitive failure before it becomes dementia? But then almost everyone over sixty might qualify to receive a probably useless, but highly promoted treatment."

Drug companies, says Frances, "would undoubtedly find ways of penetrating the huge new markets with medications having largely unproven benefit and very substantial side effects."

Pre-psychotic is the new obesity!

Monday, July 06, 2009

Will Pharma Lobbying Ensure Lynching of Public Insurance Option?

According to an article in the Washington Post, "The nation's largest insurers, hospitals and medical groups have hired more than 350 former government staff members and retired members of Congress in hopes of influencing their old bosses and colleagues, according to an analysis of lobbying disclosures and other records...

"Nearly half of the insiders previously worked for the key committees and lawmakers, including Sens. Max Baucus (D-Mont.) and Charles E. Grassley (R-Iowa), debating whether to adopt a public insurance option opposed by major industry groups. At least 10 others have been members of Congress, such as former House majority leaders Richard K. Armey (R-Tex.) and Richard A. Gephardt (D-Mo.), both of whom represent a New Jersey pharmaceutical firm...

"The hirings are part of a record-breaking influence campaign by the health-care industry, which is spending more than $1.4 million a day on lobbying in the current fight, according to disclosure records. And even in a city where lobbying is a part of life, the scale of the effort has drawn attention. For example, the Pharmaceutical Research and Manufacturers of America (PhRMA) doubled its spending to nearly $7 million in the first quarter of 2009, followed by Pfizer, with more than $6 million" (see "Familiar Players in Health Bill Lobbying").

I found data from for the top 30 pharma lobbying clients in 2008 and plotted the data to create the following interesting chart (click on it for an enlarged view).

Friday, July 03, 2009

Update on the Pharma Financial Crisis

"The financial crisis currently spreading around the world has exerted negative impacts on both the pharmaceutical and biotech industries," according to a Life Science leader article (see "The Impact Of The Financial Crisis On The Pharma And Biotech Industries"). "A large number of R&D programs have been either cut or put on the shelf."

The chart below summarizes the number of pharmaceutical and biotech companies that announced restructuring plans between September 2008 and April 2009 (click on chart to for an enlarged view):

With regard to advertising, respondents to the Pharma Marketing News "Future of DTC Advertising" survey (here) are still pessimistic about 2009 (see chart below). While 52% of respondents who took the survey in 2008 predicted a decrease in spending, 62% who took the survey in 2009 predicted a decrease (vs. 28% and 23%, respectively, who believe spending will increase in 2009).
(Click on chart for an enlarged view.)

Wednesday, July 01, 2009

A "Hubble" View Into the Pharma Cosmos

Edwin Powell Hubble -- the astronomer after whom the telescope in space is named -- was the first astronomer to find observable evidence that the universe is expanding. He also observed what he determined to be galaxies beyond our own, opening up the study of space beyond the Milky Way.

Click on the image on the right, which was taken by the Hubble telescope. Each of those dots is a galaxy! Surely there is a planet revolving around one of the zillions of stars in one of these zillions of galaxies where there is a pharmaceutical industry and an FDA similar to ours, with one difference: that pharma industry has learned how to truly use social media to engage and have "human" conversations with patients.

That bizzaro-world pharma industry has learned how to deal with adverse event information it gathers from patients via social networks. It has also learned how to allow its employees to communicate directly with patients via blogs and carry on "human" conversations.

Now it may be that the bizzaro-world FDA on that planet is very inept and does not have any regulations about reporting adverse events or providing fair balance whenever a drug is named and benefits are mentioned. But I'm not talking about that bizzaro-world. I'm talking about another one on some other of those zillions of planets out there -- one that has an FDA just like ours! Maybe even a stricter one -- like the one they have in China were they execute people for violating regulations!

I'm no Hubble, but you can call me the Mulder of pharma marketing: "The Truth Is Out There." There's got to be a combination that works, somewhere. The odds are in my favor here. If it's out there, it can be implemented here. QED.

Thanks to my friend Craig DeLarge for the discussion on my Facebook page ( regarding this. I invite you to join in that discussion.

Genuine Conversation: The Big Kahuna of Social Media Marketing

[Make that "Genuine HUMAN Conversation." See comments to this post.]

The best scene in the 1999 movie The Big Kahuna (see wikipedia review) comes at the end when Phil (played by Danny Devito) -- a world-weary "marketing representative" (ie, sales person) for an industrial lubricants company -- puts down Bob (played by Peter Facinelli) -- an idealist R&D guy.

Bob has just come back from a late night conversation with a rich businessman (The Big Kahuna) that Phil and his partner Larry (played by Kevin Spacey) have been trying to close a deal with. Bob, however, only talked about Jesus with The Big Kahuna and neglected to talk about industrial lubricants at all.

At first, you thought that Bob was making a genuine human connection with the businessman and that this would eventually win the account, but Phil views its as the epiphany of "ingenuine" human conversation.

Thanks to YouTube, here's the scene.

"It doesn't matter whether you're selling Jesus or Buddha or civil rights or 'How to Make Money in Real Estate With No Money Down'," says Phil. "That doesn't make you a human being; it makes you a marketing rep. If you want to talk to somebody honestly, as a human being, ask him about his kids. Find out what his dreams are – just to find out, for no other reason. Because as soon as you lay your hands on a conversation to steer it, it's not a conversation anymore; it's a pitch. And you're not a human being; you're a marketing rep."

This is precisely why, in my opinion, no marketer -- and certainly no pharmaceutical marketer -- can carry on a real conversation with people via social media no matter how many times consultants and new media mavens urge them to do it.

Show me a marketing person that does NOT want to steer the conversation and I'll show you a marketing person that should be fired!

Marketing is not about conversation, so stop trying to fit that square peg into a round hole. I'm not saying that marketers cannot participate in discussions and try to steer them -- I do that all the time. Just don't call it genuine.
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