A Call for Pharma Social Media Transparency Guidelines for Patient Bloggers

"Political strategists agree that the acrimony that has tinged many of the attacks on the news media this year feels different," according to a story in today's New York Times (see "Politicians Are Fighting Mad, at the News Media"). “Everyone has always bashed the media,” said Dana Perino, a Republican consultant who was a White House press secretary under Mr. Bush, “but I do think there’s something larger going on.”

What's going on is this: "the eagerness of many candidates to bypass the mainstream news media in favor of social networking or media outlets that they perceive to be embracing of their political platforms."

I believe the pharmaceutical industry has the same "eagerness" to bypass mainstream news media in favor of social networking. This is evident by the growth in Twitter use by pharma companies to push out news that it used to do via press releases distributed through channels cherished by reporters (eg, prnewswire).

Pharma PR and corporate communications professionals have been courting bloggers with dinner meetings and invites to events that previously only mainstream media journalists were privy to. Johnson & Johnson and Pfizer have lead the way ("Bloggers Dining at Pharma's Table", "Thank You Johnson & Johnson for Dinner", and "Chantix 'Roundtable' Apparently Not Round and Not a Table"). Of course, as a blogger, I have encouraged this.

But influential patients and physicians are becoming more important to pharmaceutical companies than industry bloggers like me. Patient bloggers, for example, are high up on pharma's list of people they'd like to influence. At least some influential patient bloggers have put out the PHARMA WELCOME mat (see "Some Social Media Patient Opinion Leaders Want to be Paid Pharma Professionals").

Many patient bloggers claim that it is important for pharmaceutical companies to "join the discussion." But pharma marketers and PR people -- who control the communications budgets within pharma -- want to "influence the discussion" and not merely "join the discussion" on social networks frequented by patients and physicians.

Within these online communities are "thought leaders" who feel equal to or superior to institutions such as the press, or government agencies. Pharma is poised to exploit these feelings and is probably doing so now as I write this.

The only issue I have with this is that a lot of it may be happening "behind the curtain" (see "Pharma Social Media Behind the Curtain"). Often, neither the pharma company nor the social media patient leader reveals the relationship. New guidelines from the FDA will NOT address this issue because the FDA is concerned only that pharma commercial speech stick to the approved labeling when discussing brand name drugs. FDA cannot, for example, regulate non-branded, disease information that pharma companies may share with patients and physicians. Furthermore, FDA cannot enforce transparency -- it has no authority over patients who are free to do and say what they like without mentioning any relationship they may have with pharma companies.

That's why I say that pharma companies MUST make known their transparency policy with regard to social media. I'm not talking about their policy for how they expect their employees to behave when engaged in social media discussions. I'm talking about policy about how the corporation will behave in relationships with patients and how they will reveal those relationships.

For example, imagine that a pharmaceutical company has invited several influential patient bloggers and social network leaders to a 2-day "conference" at a resort in Orlando, Florida, all expenses paid. The "conference" is all about diabetes and support for diabetes, but not about specific diabetes treatments. It's all about "opening up a dialogue," that sort of thing.

Like a physician author in a medical journal, should patients who receive such largesse from pharma companies be required to reveal that? If the answer is "yes," who requires it? It can't be the government. It must be what I call the pharma company's "social media transparency policy," which might state something like "We require all patients who receive money or goods in kind such as free lunches and airplane tickets and other travel-related expenses to reveal that to their readers and social media followers in an appropriate fashion."

I have revealed my relationships with pharma companies many times, but not every time I write a blog post. What I have done, however, is to update my profile by adding this statement:

"I am not a paid consultant to the pharmaceutical industry, but I occasionally get invited to speak within pharma companies or at industry conferences. For this I receive reimbursement for travel expenses and ask that any speaker fee be donated to a charity. As a publisher, I do accept paid advertising mostly from agencies that work for the pharmaceutical industry."

I think patient bloggers should have something similar in their profiles (or whatever is appropriate for their relationship with the drug industry). Patients who participate in social networks and are considered "leaders" in the community might include the transparency statement in their profiles and/or signature files as well. And pharma companies should encourage this by publishing social media transparency guidelines for their patient blogger/social media partners.

P.S.  Recently, GSK invited eight bloggers to visit its manufacturing facility to "tour the facility and learn about the role that vaccination plays in keeping adults and families healthy" (see "Opening Our Doors--Again").

At least two of the bloggers wrote about their experience (see here and here). At the beginning of each blogger's post was a disclosure. Here's what they said:

"My travel, accommodations and food (except for the bagel and an extremely necessary cup of tea) were covered by GlaxoSmithKline. They did not require me to write about the trip at all, nor did they pay me, review this post or dictate what I have to say. Which is a really impressive release of control for these folks." -- Nutgraf

I don't know who "Nutgraf" is -- life's too short to track down a name when it's not mentioned in the "about me" section of the blog -- but he/she states in her/his "A Note on Integrity":

"I review things – including books, products and advice submissions – in my own time and on my own terms. I need your input to make the advice project a success, and you can rely on me to clearly disclose my policies, protect your privacy and generally deal with you and others in an above-board manner. As for products, books, pitches or anything else of that nature, I’m a big fan of disclosure. I disclose early, loudly and often. I am easily skeezed out and want to be proud of what I do here."

Meanwhile, the other blogger (see profile here, which does not include a blanket disclosure statement as above) states at the beginning of her blog post:

"I went on a trip to Philidelphia to tour the GlaxoSmithKline vaccine plant. My flight, hotel, cab fare and meals were covered expenses. The opinions represented in this post are all mine and were not compensated in any way.This is a VERY long post, and yet I feel strongly about it and would really appreciate if you would take the time to read it in it's entirety." -- Scrutiny by the Masses

Be a Macho Man! Ask Your Doctor for Viagra!

I came across this Viagra print ad in this week's Time magazine.

"You may be a man of FEW WORDS," proclaims the large headline of the ad, "but you know when to make them count. When there's something worth saying, you say it."

I will try and be a man of few words as I critique this ad; you tell me if they are worth anything.

This ad is a bit unusual in several respects, the most important of which is that it is "dark." The ad's dominant color scheme is black and dark green, which is more reminiscent of ads I've seen for men's deodorants in Playboy magazine, which I read for the interviews.

The ad also prominently features an African-American male. I suppose not enough men of color are speaking up and asking their doctors about Viagra.

It's a fact that a higher proportion of blacks in the U.S. -- but NOT worldwide --  have high blood pressure than whiles (41% of blacks have high blood pressure, as compared to 27% of whites; see here). One complication of high blood pressure is erectile dysfunction. The connection between high blood pressure and ED used to be the focus of ED awareness ads way back when certain lawmakers were critical of daytime DTC ads in the category (see "Deconstructing Frist on DTC"). I guess that wasn't enough to convince blacks to be a "man" and ask their doctors about Viagra. A more dramatic appeal to "machismo" such as in this ad seems necessary.

To keep this to as few words as possible, I will not talk about how often I have noticed that the men in many of these erectile dysfunction ads seem a lot younger than warranted by the incidence of ED in men under 40 (in the UK, Lilly targets men OVER 40 in its "40over40 ED Awareness Campaign"). Pfizer covers its ass on  this point by using these few words: "so, if you're like millions of men who have some degree of erectile dysfunction..." [my emphasis].

Here's something worth saying: what man among us has NOT had some degree of ED at one time or another (see, for example, "You Must Score Better than 84% on Viagra's Sexual Health Quiz to NOT Have Signs of ED")? We can ALL relate to that and also to the closing machismo statement, just before the VIAGRA logo:  "THIS IS THE AGE OF TAKING ACTION."

At the beginning of the "fair balance" portion of the ad -- the part that contains MANY words -- Pfizer qualifies the "age of action" call to action by saying that "with every age comes responsibility." This is another machismo axiom. "Dude," Pfizer seems to say, "you are responsible for your actions. If you suffer any of the following side effects, that's your responsibility. We warned you!"

Pharma Social Media Behind the Curtain

Like the Wizard of Oz performing his "magic" behind the curtain, there may be many pharma "wizards" happily managing social media projects behind the scenes and out of public view. All it takes is a new age "Dorothy" to pull back the curtain. That "Dorothy" is Jess Seilheimer (@Jaeselle), who alerted me about the possibilities in a comment to yesterday's post  about Shwen Gwee (see "Happy Pharma Social Media Halloween!"). Shwen leads Digital Strategy and Social Media within the Marketing department at Vertex Pharmaceuticals.

There's a bit of a brouhaha coursing through Twitterdom and the pharma blogosphere about Shwen. Some critics (eg, Rich Meyer, @richmeyer) say that Shwen "has not really done anything of substance yet and works for a company that does not even have any approved drugs yet." I pointed out that "Shwen may actually be working on ... a [social media] project within Vertex but not talking about it."

Today, the WSJ  published an article touting a drug under development at Vertex that may CURE Hepatitis C! (see "New Hepatitis C Drugs May Be Blockbusters"). Surely, Shwen is hard at work "behind the curtain" developing a social media marketing strategy that will launch in concert with the new drug. In fact, as Jess points out, there may be "plenty of initiatives that pre-launch brands focus on in this phase, some of which may not be public knowledge."

Here is what Jess had to say about that and other ways that pharmaceutical companies may be using social media "behind the curtain:"

I'm of the belief that no one should try to validate who "does what" in social media when you're only qualifying it to an approved brand or initiatives in the public domain.

Exhibit A) There are plenty of ways to utilize social media engagement and digital channel in the pre-launch market awareness phase. Initiatives that pre-launch brands focus on in this phase, some of which may not be public knowledge.

- crowd sourcing HCPs input re: R&D initiatives

- utilizing PatientsLikeMe to identify, recruit and communicate with appropriate patients for phase III trial enrollment

- private HCP advisory board networks built through Ozmosis or Within3 social platforms

- 3rd party social sentiment/listening analysis through Buzz Metrics, et al (something that takes months to garner learnings then analyzed/utilized internally to inform target engagement strategies for launch)

- Unbranded disease awareness campaigns development- creating a need for new market entry (again something that may take months to create---tactics which may be teased out on a phased approach

Exhibit B) There are also corporate level initiatives that utilize building policy around a company's POV on how they approach using these channels to optimize their communications.

- these initiatives happen behind the scenes for months

- corporate initiatives are sometimes not publicly published/available for analysis like Roche or AZ

- corporate level investment in internal staff onboarding, education and applicability of using social media as a means to communicate internally with each other.

My point: Having a public brand/corporate supported "patient community" does not equate to "I have done social media', and we should use caution when trying to qualify someone;s knowldeg or within the area. Lastly, let's please consider using appropriate terminology when referring to utilizing social engagement channels for our business/brand objective-- it's not "doing social media".

Al things to take into consideration when proclaiming "people haven't done anything in social media".

They are.
We all are.
You may just not know it.

Happy Pharma Social Media Halloween!

Shwen Gwee recently received the Pharmaguy Social Media Pioneer lapel pin in recognition of his pioneering work as a pharmaceutical social media evangelist.

Just today, Shwen received this mummy on his doorstep from an anonymous source. Needless to say, he's pretty confused. Who would send him such a thing? Perhaps it was an old mummified Web 1.0 pharma pioneer? We may never know.

Shwen leads Digital Strategy and Social Media within the Marketing department at Vertex Pharmaceuticals where I am sure he is playing a major role in educating his colleagues and preparing for the day when his company may launch a social media initiative.

How can someone who has not yet actually been involved in a pharma company social media project receive such a coveted award? Well, first of all, Shwen may actually be working on such a project within Vertex but not talking about it*. More importantly, he is everywhere that social media is discussed within pharmaceutical and healthcare circles.

Like one of the original seven U.S. astronauts, who may not have traveled in space, Shwen is training those who will be there someday and may yet be called to duty himself. So stop trying to scare him, whoever you are!

*Vertex may soon get approval for a blockbuster Hepatitis C "cure" (see "New Hepatitis C Drugs May Be Blockbusters"). Four million Americans may have Hepatitis C and as many as 3 million of them don't know it. This is ripe territory for a social media campaign focused on a population of younger people that includes celebrities.

CORRECTION: Shwen tells me that "most prevalent pop for HCV is baby boomers" like me. Even better I would say. According to Deloitte data, 2009 was the year that social media bloomed for Baby Boomers, with nearly 47% of them actively maintaining a profile on the social web, which is up 15% from 2008 (see "Baby Boomers and Seniors Are Flocking to Facebook").

Answers That Won't Matter: Critique of Lilly's Defense of DTC Advertising

The pharmaceutical industry is fighting a losing battle (IMHO) against negative public opinion. The latest weapon to be employed in this battle is a 52-page "booklet" entitled "The Value of Medicine, Improving Health...Improving Life" published by Eli Lilly (find pdf here).

World of DTC Marketing blogger Rich Meyer asks "The real question is will consumers buy it in an era of mistrust and misinformation?" (see Lilly fights back with “The Value of Medicine”). I think the real question is "Will consumers read it in an era of apps and sound bites?"

A 52-page PDF document is a bit much to ask the average consumer to digest even with all the pretty charts and graphs with circles and arrows and paragraphs explaining what each chart is about.

Also, I must say that Lilly engages in some "misinformation" itself, or at least conflicting information (keep reading to see what I mean).

It's all very well to blame the so-called "era of mistrust and misinformation" for pharma's failure to win over the hearts and minds of consumers, but we all know some of the blame falls squarely on pharma's shoulders. It's unfortunate, for example, that this booklet comes out around the same time that AP reported "pharmaceutical companies made up eight of the government's top 10 settlements related to fraud in the last year" (see "Drugmakers top list of DOJ fraud settlements").

But enough about fraud, let's talk about Lilly's defense of DTC (direct-to-consumer) advertising, which is presented in pages 32 to 36 of the booklet.

First, let me say that it's ironic that an industry that spends so much money, time, and effort to produce DTC ads -- including wonderfully creative TV commercials -- to "educate" consumers, relies on pdf files and web sites to defend its products, advertising tactics, and public image. Where's the TV ads? If, as Lilly claims, 30 to 60 second TV ads are so effective in educating consumers about "diseases, about the symptoms that may help their health care provider identify the diseases, and about available therapies to treat these conditions," then why not use TV ads to provide "answers that matter" about "tough questions about access, costs, safety, and ultimately the value that we can bring to patients in preventing and fighting disease" (quoting John C. Lechleiter, PhD, Chief Executive Officer and President, Eli Lilly and Company)?

It can't be that TV ads are too expensive. Lilly claims that the drug industry's spending on DTC advertising (about 65% of which goes to TV) "represents only about 2% of pharmaceutical company sales." BTW, Lilly doesn't mention the $ amount of sales, but it does mention that DTC spending is about $4.4 Bn per year. If you do the math -- something most consumers I regret will not or cannot do -- you get $220 Bn per year for the sales number. I think Lilly is selling itself short here. I find from IMS data that US drug sales in 2009 was more like $300 Bn. Ergo, DTC spending is only 1.4667% of sales. Perhaps Lilly was rounding up -- but it could have rounded down to 1%! Whatever.

Lilly also presents a nice chart to illustrate the point that the pharmaceutical industry "spends less on advertising as a percent of sales than many other industries" (see chart below). Of course, by "less" Lilly really means on a percentage basis. The sporting and athletics goods industry spends MUCH more than pharma on advertising (as a percentage of sales), but not so much more on a dollar basis ($5.6 Bn vs pharma's $4.4 Bn).

According to this chart, pharma advertising spending is 4.2% of sales. How come the discrepancy between this % and the 2% Lilly quoted on the page before the chart? Could it be that this chart includes "advertising" to doctors as well as DTC? Lilly does NOT mention how much the drug industry spends on "marketing" to doctors, but I've seen an estimate of $12 Bn per year for that (see here). But $12 Bn + $4.4 Bn = $16.4 Bn, which is 5.4% of $300 Bn in sales (as reported by IMS) or 7.4% of $220 Bn in sales (as calculated from Lilly's figures).

OK, so the numbers don't jive. I've notice that's often the case when analyzing data about the pharmaceutical industry. I'm used to it. Just another form of "misinformation."

Aside from touting how economical drug companies are regarding advertising, Lilly also claims that "limiting prescription drug promotion may negatively affect patients and health care providers by restricting access to important information about diseases and proper medical treatment. Also, consumers may not as easily receive information about the benefits and risks of prescription medicines."

I can write a whole book in response to that! Let me just say, that in this day and age of Internet technology, which Lilly does not seem to be part of, DTC advertising is an insignificant source of "information about diseases and proper medical treatment" for consumers and physicians alike. Does Lilly really expect us to believe that limiting DTC advertising will negatively affect patients and healthcare providers?

OK. I've spent enough time on this. I assume all of you will download this 52-page booklet and read it from cover to cover. Actually, there are a lot of pictures, so don't worry, you should be able to read the whole thing in about 20-30 minutes or so. Let me know what you think.

Negative Facial Coding Hamstrings Patient Testimonials in DTC Ads

Even though pharmaceutical marketers are NOT exploiting social media to the degree that industry consultants and agencies would like them to, they have learned one important lesson from social media: people trust people like themselves more than they trust company spokespeople or even so-called experts. That may be why you are seeing more and more direct-to-consumer (DTC) ads on TV and in print that feature real patients who offer testimonials to the advertised Rx drug.

Pfizer, for example, is currently running Lipitor and Chantix ads in which real patient users of the drug tell their stories. Previously, Pfizer, like so many other drug companies, employed actors that portrayed physicians or "real" physicians in these ads. That, however, backfired spectacularly when it was discovered that one physician spokesperson -- Dr. Jarvik -- was not actually a practicing physician.

Dan Hill, President of Sensory Logic, Inc., contends that there is a problem with this. Hill was guest on my Pharma Marketing Talk BlogTalkRadio show yesterday -- October 26, 2010 -- where claimed that two-thirds of the ads are "not so good, especially with the would-be testimonials" of real, everyday patients.

Hill bases reached this conclusion by applying "Facial (Action) Coding" techniques to analyze the effectiveness of the ads. If you have ever watched FOX's "Lie to Me" drama series, you may familiar with this technique, which involves analyzes facial expressions to determine the emotional state of a person.

Facial coding was first developed by Dr. Paul Ekman -- who is an adviser for the show "Lie to Me" -- and is featured for 30 pages in Malcolm Gladwell's "Blink." Hill claims that this non-invasive tool -- which breaks down 23 facial expressions (Action Units) into 7 core emotions -- allows him to help clients understand the emotional connection of their market research efforts (for example, what consumer are really feeling about their TV commercials, print ads, websites, as opposed to what they say.)

Hill says the goal of Facial Coding is "Get[ting] the Right Emotions at the Right Time." That sounds like a nice complement to the often-heard axiom of "getting the right message to the right audience at the right time."


Hill offered one example of how the "wrong" emotion exhibited by an actor in a GSK TV ad sent the wrong message to the audience.

At second 17 in the timeline, the test audience -- claims Hill -- had a "fear reaction." There was really no intent by GSK to illicit fear, so Hill was stunned. The verbal comments from the test audience couldn't explain it, so Hill used his facial coding ability to look at the facial activity of the actors. "Lo a behold," said Hill, "at second 17, the male lead showed fear on his face. My suspicion," said Hill, "was that he forgot his line for a nano second." Emotions are so contagious that this flash of fear on the actor's face that the audience "[went] there with him."

With regard to real patient testimonials in TV commercials, Hill says that the actors often look "uneasy, stilted, and don't show the emotions that are meant to be shown." This, Hill claims, hamstrings the commercial so that it is not as effective as it could be.

You Audience Has Left the Building
Another interesting point that Hill made was in regard to the voice-overs (VO) of TV Rx ads. VOs usually occur during the "fair balance" (ie, side effect disclosure) portion of the ad, which may consume 30% of the total running time. Hill said that "the sad truth is that many voice overs kill the commercial. It is the moment when marketers think they are bringing home the message, but instead the audience has left the building." Perhaps the reason why voice overs are used most often during the fair balance portion of the ad is precisely to drive the audience away from the ad once they have already been exposed to the benefit portion.

"A monologue simply does not work for people," said Hill. A Cialis ad was cited by Hill as doing a "very good job with the legalese at the backend of the commercial." The ad keeps switching between the man and the woman delivering the fair balance message. "At least that variation, going from the male to the female and then back to the male, at least make it more noticeable," claims Hill.

One observation in closing is this: current social media lacks the dimension of facial coding and using real patients in social media campaigns retains the advantages of credibility without the disadvantages that Hill pointed out.You can listen to my conversation with Hill using this BogTalkRadio widget:

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A Breast Cancer Patient's Painful, Difficult Therapy Choice: Generic vs. Brand?

Since this is national Breast Cancer Month and I am forced to watch NFL linebackers wear pink shoes and mouth guards, I thought it would be appropriate to discuss an issue that just came up in comments to my post about Sanofi-Aventis, Taxotere, and the disgruntled patient (see "Should Sanofi-Aventis Submit an Adverse Event Report Based on 'Disgruntled Patient's' Comments to VOICES FB Page?" and comments).

An anonymous comment to that blog post opened my eyes about issues facing breast cancer patients beyond what I believe many proponents of the "pink" promotional campaign envisioned. Here's the comment:

"It's not just one disgruntled cancer survivor. There are over a hundred of us. Of course, there's no promise that our hair would grow back. GENERALLY grows back. Well for those of us who battled breast cancer but are forced to look at our bald selves in the mirror every day, "generally" isn't good enough. Yes, we're alive. I'm grateful for that. But again, no promise of how long...and with small children, that's another painful reminder of what I've been through. The thing about S-A and Taxotere is this: there's another drug, Taxol, which doesn't cause this permanent alopecia we're dealing with. But we were never told that there was a choice. And what do you think I would have chosen if I'd had a choice? I'm in my early 40s so dealing with permanent alopecial is especially difficult. I have a job in a senior management position. Hard to earn respect when I look like Ben Franklin. We're not mad that Taxotere caused us to experience permanent alopecia...we're mad that we weren't given the choice of the more hair-friendly medication. And why is that? Our oncologists didn't even know. Don't you think they should be made aware of this fact?"

To which I responded:

"While I am not knowledgeable regarding the benefits vs risks of one treatment vs another, shame on your oncologist for not knowing or caring enough to offer you a choice!"

This gave me an idea of how important hair loss can be to breast cancer patients, something that other commenters to my blog post dismissed by saying things like "you should be happy you are alive," etc. Do many pharmaceutical marketers realize this? My friend Rich Meyer thinks not. "Pharma’s priority is still spreadsheets not patients," says Rich (here). "Patients are leaving pharma marketers behind and pharma marketers act like they still matter."

But is Taxol really better than Taxotere with regard to hair loss? To answer this question, I used Google to search on "taxol vs taxotere" and found some interesting online forums and discussions devoted to the issue. Here's a representative post by "billsgirl" that I found on the community.breastcancer.org/ site:

"I have one more A/C tx 2/22, and have done really well with little se to complain about. Now I must decide which Taxane I should go with. I'm leaning toward taxotere because my onc agrees that the bone marrow issues would be easier for my body to tolerate given my positive experience with the A/C, rather than risk neuropathy.

"Also, what about the hair? I've read some who said their hair started growing back after A/C and through T. I've read some scary stories about permanent hair loss. I'd hate that - I mourned my heai more than my breasts (I know that's odd...)

"I'd love your comments. Anything to help me make my decision."

What "help" did "billsgirl" get? There were several somewhat helpful comments and encouraging posts in this forum, but none really answered the question about which drug is best.

On www.medhelp.org -- a Cleveland Clinic "partner" -- I found a similar question by a patient ("Pam") and an "answer" from a physician.

"This forum is just fantastic!! Thank you Cleveland Clinic and Med Help Int'l. for giving people like me a reliable place to ask questions!!!

"My question is: Can you tell me the difference (if any) between Taxol and Taxotere? Does one work better than the other for particular types of breast cancer? My doctor suggested Taxotere, but didn't really give me a good explanation as to why. Your thoughts will be most appreciated."

Doctor's Answer:

"Dear Pam, Thank you for your complimentary comments regarding this Forum.

"Taxol (paclitaxel) and Taxotere (docetaxel) are both from the same family of medications - the taxanes. Both of these show a high level of activity when used as single agents in metastatic breast cancer.

"In reviews of reported studies, when compared with standard therapies Taxotere looks to be the most active single agent in treatment of metastatic breast cancer.

"There are some differences in the treatment schedules of the 2 medications, and there are some differences in the side effects of these 2 medications. I have listed the side effects of both medications.

"Taxotere: decrease of white blood cells, red blood cells and platelets, flu-like symptoms, fluid retention, numbness and/or tingling to fingers and toes, muscle aches or bone pain for a few days after each treatment, mouth sores, hair loss, decreased appetite.

"Uncommon Side Effects: allergic-type reaction, blood pressure and heart rate changes, nausea and vomiting, diarrhea, skin rash usually occurs on hands and feet, nail changes, menstrual cycle may become irregular or stop permanently, menopausal effects including hot flashes and vaginal dryness. Decreased desire for sex during treatment.

"Taxol: decrease of white blood cells, red blood cells and platelets, allergic-like reaction, blood pressure or heart rate changes during the infusion of the medication, mouth ulcers, numbness and/or tingling to fingers and toes, muscle aches or bone pain for a few days after each treatment, mouth sores, hair loss, diarrhea.

"Uncommon Side Effects: nausea and vomiting, nail changes, menstrual cycle may become irregular or stop permanently, menopausal effects including hot flashes and vaginal dryness. Decreased desire for sex during treatment."

Hair loss is mentioned (buried) as one side effect for both drugs.

So, I am still not sure that Anonymous was correct in her assertion that Taxol does not cause hair loss. But it's clear that her oncologist didn't offer her the kind of comparison that was offered to "Pam" online. Could it be that her oncologist had a conflict of interest? I suggested that in my response to Anonymous:

"It's my understanding that oncologists often make a profit 'reselling' these drugs. Obviously, in that case, they have a vested interest in offering patients the drug that gives them the highest profit. I do not know if Taxotere and Taxol differ in this respect."

What I DO know is this: Taxol is a generic medication and Taxotere is a brand medication. And back in 2007, Sanofi-Aventis, which manufactures and markets Taxotere, received a letter from the FDA warning the company not to make superiority claims for Taxotere vs. Taxol (see here).

Social Media's OK Corral: Docs vs. Patients

The O.K. Corral was a site in Tombstone, Arizona Territory where a gunfight took place on October 26, 1881. In that fight, the Earp brothers and "Doc" Holliday killed some cowboys who refused to disarm.

I mention this as a analogy to what I foresee happening in the health social media realm where the conversation is not as friendly or beneficial as some pharma social media pundits would have us believe. If pharma marketers are not careful, they may find themselves in the middle of the crossfire.

I am talking about the crossfire between physicians and patients, especially with regard as to which "stakeholder" group will be more credible as hired "opinion leaders."

You probably already know all about physician KOLs ("key opinion leaders") and how pharma hires KOLs to influence doctors. I predict that in order to be effective in social media that are inhabited by patients, pharma will hire respected patients to follow the discussion and to point their followers to "key" information, which includes key Rx-related information or information that supports the benefits of Rx products (see "Some Social Media Patient Opinion Leaders Want to be Paid Pharma Professionals" and "PHARMA Co Patient Opinion Leader Programs").

This will lead to the inevitable conflict with physicians who may have different ideas as to what "key" patient information should be.

At two recent industry conferences, I witnessed what I think is the opening salvo between the two opposing camps. First, at a multi-channel pharma marketing conference that I chaired in Princeton, NJ, a physical wall was erected between a physician panel on one side of the room and a patient panel on the other side. Both were supposed to talk about what they wanted from the pharmaceutical industry. As I reported, the patients essentially wanted money and were quite forthright about it. The physicians, on the other hand, were too sophisticated to ask for money directly -- they already are getting plenty of money from pharma. They asked for technology or rather free technology such as iPhone apps.

But the conversation that hinted at the coming Social Media OK Corral Docs vs Patients struggle occurred during a patient panel at the Digital Pharma East conference (ie, "A Panel of ePatients Discuss Key Issues that Affect their Lives, Relationships and Treatment").

Part of the discussion revolved around how the "value proposition" of patient online communities was the vast amount of information available from patients that is "more accurate" than information that patients typically get from healthcare providers/physicians. That, in itself, is not surprising or dangerous. But another statement made by a patient panel member sets the stage for the coming gunfight. That statement concerned patient evaluation of specific brands. The patient said that her physician was of the opinion that all branded Rx drugs for treating her condition were essentially the same. She begged to differ and pushed for her favorite brand.

It seems that patients are more in tune with pharma's direct-to-consumer (DTC) advertising premise: one brand of insulin or ACE inhibitor is better than another brand. Usually, it's the advertised brand that's better than a competitor brand or the unadvertised generic brand.

Since Rx DTC advertising has ingrained the belief in consumers and patients that one brand of Rx is better than another, it benefits pharma marketers to use online patient opinion leaders such as those on the above-mentioned panel to influence other patients online. Once they do that, marketers are again placing themselves in the middle of the patient and his or her physician just as they have been accused of doing with mass media DTC advertising.

There is a wall between physicians and patients not only at industry conferences, but also within online communities. Patients have their communities and physicians have theirs. Unless the two stakeholders can meet online and have a dialogue, someday there will be a gunfight. Pharma marketers will continue to arm both sides. Maybe they'll get caught in the crossfire, maybe not. Time will tell.

Pharmaguy's Comedy Improv(e) Club -- An New Idea for "Unconference" Entertainment

The pharmaceutical industry is neither funny nor improvisational, yet those two attributes are precisely what I have depended upon to make Pharma Marketing Blog entertaining as well as informative.

But there are quite a few "funny" people currently or previously associated with the pharmaceutical industry. Kevin Nalts (aka Kevin Nalty), for example, is a former Merck Marketing Director and now makes a living -- I hope -- as a self-proclaimed YouTube comedian (see "Enlightened Stupid Marketer"). I also believe that my Twitter pal Lawrence Sherman (@meducate) dabbles in  the comedic arts.

At ExL's Digital Pharma East I learned that Jason Youner, ExL Conference Director, does standup comedy on the side at a comedy club in Jersey City, NJ (ie, Stockinette Café at 581 Jersey Ave; the 2nd Friday of every month; Jason not only performs, he hosts and produces the show). He was quite funny roasting me during his introduction to my Pharmaguy Social Media Pioneer Award "unceremony" (see "First Pharmaguy Social Media Pioneer Award Given to Janssen's Alex Butler"). At the Pixels & Pills cocktail party, DJ Edgerton (@wiltonbound), CEO of Zemoga, revealed his humorous side by suggesting various kinds of undershirts I should wear when I gave the Hawaiian shirt off my back to Alex Butler.

Perhaps a few of us "comedians" should get together and form the "Pharmaguy Comedy Improv^(e) Club" and volunteer to perform at industry conferences. I am sure it will liven these up considerably. As always, I appreciate your feedback, especially if you wish to join the troupe. Send your email to pharmaguy@pharmaguy.com

PHARMA Co Patient Opinion Leader Programs

[Below is a blog post that someday SOON may appear on a PHARMA Co Blog such as AZ Health Connections, which recently posted a notice about "AstraZeneca And Doctor Speakers Programs" (read it here). I substituted "patient" for "physician" in the following post to illustrate a point.

In this new social media era, where there is much discussion about pharma participating in patient discussions online, there is a possibility that pharma will hire influential online patients to act as "opinion leaders" just as they have hired physicians to be key opinion leaders (KOLs). Patients have already been hired by pharma companies and their agents to troll patient sites for comments made by patients online (see, for example, "Did J&J Troll Social Media Sites to Ensure Its Motrin "Recall" was a Secret?")].

Beginning soon, news organizations will be publishing a series of stories examining the financial relationships between patients and the pharmaceutical industry. Their focus will be on payments made to patients who serve as “social media moderators” or "opinion leaders" on behalf of companies and their medicines.

PHARMA Co would like to provide our perspective on the issue by having Marie M. – PHARMA Co’s US compliance officer – answer the key questions we’ll be asked by reporters in coming years.

Why does PHARMA Co engage with patients as moderators/opinion leaders?
Marie: PHARMA Co works with online patient opinion leaders (POLs) or moderators to provide other patients online with accurate and balanced information about the use, safety, benefits and risks of our medicines. POLs have the expertise and credibility necessary to educate colleagues to ensure they have the information they need to make informed treatment decisions.

Patients ultimately benefit when they are well informed and knowledgeable about our medicines, treatment options and standards of care.

Why does PHARMA Co pay patients to participate?
Marie: It is appropriate to compensate POLs for the time they dedicate to providing information to other patients about our medicines and who act as moderators of our online discussion boards. Patients who tweet or post information online about our medicines are compensated at a fair market value based on their qualifications and the amount of time they dedicate to the task. We never pay patients in exchange as an incentive to promote our products.

There currently is NO cap on how much each POL can receive from PHARMA Co each year.

How does PHARMA Co ensure laws and industry policies are followed?
Marie: Before a POL can tweet or post information on our behalf online, they must participate in extensive training on our medicines, policies, and the laws and regulations that apply to industry-sponsored presentations. Actually, however, there are NO laws and regulations that apply to industry-sponsored tweets and posts made by patients online. But, be assured, our policies prevent the company from paying POLs in exchange for asking their physicians to prescribe our medicines or as an incentive to promote our products.

How does PHARMA Co select patient opinion leaders?
Marie: There are several criteria that PHARMA Co evaluates when a patient is nominated to be a tweeter or online poster on behalf of the company, including positions within leading online patient social networks, national patient advocacy organizations; membership in special patient opinion leader networks such as WEGO; consistent tweeting and posting records; participation in research trials; and regularly tweets or posts information online.

First Pharmaguy Social Media Pioneer Award Given to Janssen's Alex Butler

I have finally gotten rid of that seriously yellow Hawaiian shirt that has symbolized the Pharmaguy Social Media Pioneer Award and my involvement with pharma's slow march into social media over the past year.  

Alex Butler (see http://bit.ly/AlexButler), Digital Strategy and Social Media Manager at Janssen UK, graciously received the "shirt off my back" at lunch yesterday during the 4th Annual Digital Pharma East conference. That's Alex, the shirt, and my disrobed self pictured on the left. Thanks to Steve Woodruff (@swoodruff) for the photo documenting this historic event.

Kudos for Alex came immediately via Twitter:

@DigitalPharma: Congrats to @Alex__Butler, winner of @pharmaguy's first ever Social Media Pioneer Award! Hope yellow's your color. #digpharm

@pixelandpills: Aaaand the shirt comes off...congrats to @Alex_Butler for his @pharmaguy Digital Pioneer Award win. We think you should frame it. #digpharm

@skoko: Well deserved! Congrats! @Alex__Butler, winner of @pharmaguy's Social Media Pioneer Award /Wish I had seen that shirt come off ;-) #digpharm

@GaryMonk: Well done mate! RT@Alex__Butler: Thnx to @pharmaguy for giving me the famous shirt 2 look after for 1 yr re: social media pioneer award....

@newstream: Congrats! @Alex__Butler, winner of @pharmaguy's Social Media Pioneer Award /Wish I had seen that shirt come off ;-) #digpharm”

As I mentioned in this Pixel & Pills video interview by the lovely Sarah Mclellanny (@sarahmclellanny), I based my choice partially on input from respondents to an online survey. About 65 people participated and the results are shown in the following chart. Each respondent was able to vote for more than one candidate; see the list of ALL the 2010 Pharmaguy Social Media Award candidates here (pdf).

NOTE: ALL candidates will receive the coveted Pharmaguy Social Media Pioneer Lapel Pin (shown on the left).

Aside form the votes and comments that I received via the survey, I also was very much impressed with a presentation Alex made in September at the DigiPharm conference in London. He talked about the launch of Janssen UK's Psoriasis 360 Facebook page (see "Markets as Conversations: Can You Have a Discussion with 'Psoriasis 360' on Facebook?").

When I handed over the Hawaiian shirt to Alex, I stated that another important factor in my decision was that Psoriasis 360 is the first consumer-oriented pharma FaceBook page to allow comments without pre-moderation. All comments are posted first and then reviewed afterward. So far, only a few comments had to be removed -- mostly because of vulgar language or mentions of product names. If a comment includes a product  name, the moderator(s) ask that the comment be resubmitted with the product name removed.

Psoriasis 360, however, may NOT be the FIRST pharma Facebook page that allowed unmoderated comments to be posted. Sanofi-Aventis' VOICES Facebook was probably the first, but only unintentionally! Listen to that story and its aftermath here: "What Sanofi-Aventis Learned from Its FaceBook Experience & What the Experts Recommend It Do Now".

Also, after I made my presentation, Joan Mikardos, Senior Director, Business Innovation, Sanofi-Aventis, reminded me that another S-A Facebook page -- "THE COALITION TO PREVENT DEEP-VEIN THROMBOSIS (DVT)" -- which was launched BEFORE Psoriasis 360, also allows unmoderated posts.

Actually, the DVT Facebook page is technically owned by "The Coalition to Prevent Deep-Vein Thrombosis (DVT)," which is "funded by sanofi-aventis U.S. LLC," as revealed on the Coalition's .org site (see http://www.preventdvt.org/). The "about" page of the site states "In February 2003, more than 60 organizations assembled at the Public Health Leadership Conference on Deep-Vein Thrombosis (DVT) in Washington, D.C. to discuss the urgent need to make DVT a major U.S. public health priority."

Technically, therefore, the DVT Facebook page is not a true S-A site, unless the Coalition is just a front for S-A and not a coalition at all.

Whatever the true provenance of the DVT Facebook page -- a topic I may blog about at some other time -- my award was not a contest to determine who did what first. It is more about people such as S-A's Dennis Urbaniak, who is a bona fide social media pioneer and who received recognition as such in my award "unceremony."

Pay It Forward!
What will happen now? Will another pharma social media pioneer receive another Hawaiian shirt next year?

There WILL be another award, but NOT another shirt. As Alex said in his Pixels & Pills interview, he is now the custodian of the Hawaiian shirt, which he will pass on to the next deserving pioneer a year from now. Just like the Masters green jacket! Meanwhile, keep those nominations coming by taking my survey here.

Proper Care and Handling of the Shirt
Alex and any future Pharmaguy Social Media Pioneer custodians of the Hawaiian shirt award have an obligation to maintain the shirt in its original condition. Here are a few proper care suggestions:

1. Wear the shirt with pride on special occasions such as when attending industry conferences, in-house meetings with your managers, etc. However, avoid wearing the shirt to dinner parties or sporting events where it may suffer irreparable staining or ripping!
2. Do NOT machine wash the shirt! Dry cleaning is recommended.
3. You may mount the shirt for display on your office wall, but do not use any mounting technique that will permanently harm the shirt. To protect it while on display, it is best to frame it behind UV-protective glass.
4. Do NOT allow anyone else to wear the shirt! Not even your significant other who you may wish to appear more sexy "when the time is right."

Some Social Media Patient Opinion Leaders Want to be Paid Pharma Professionals

Last week at the Multi Channel Pharma Marketing Event, where I was interviewed by Pixels & Pills' Sarah McLellan ("John Mack Goes Back to His PharmaGuy Roots!"), I heard a lot about "patient self-advocacy." Lately, this term -- aka, patient empowerment -- has come to mean more than a desire by patients for more information and involvement in the health care process. It's also being used to describe a few "Health Activists" like Allison Blass (Patient Blogger, Diabetes Activist, Lemonade Life) and Megan Oltman (Certified Migraine Coach, Patient Blogger, FreeMyBrain). Allison and Megan participated in a panel discussion entitled "Understanding the Needs of Today's Empowered Consumer," which was led by Jack Barrette, CEO, WEGO Health.

Barrette has been taking health activists -- or "Consumer Opinion Leaders" (COLs) as he likes to call them -- to pharma companies for private discussions similar to this panel discussion in which I participated. Allison seems particularly busy making the rounds among pharma companies and pharma conferences (see her review: "Health Activism").

Jack, Allison, and Megan emphasized that online patients are looking for conversations with real people from pharma companies, not brands. This is a point I have often made (see, for example, "Markets as Conversations: Can You Have a Discussion with "Psoriasis 360" on Facebook?"). This desire was opposed to what physician panelists were requesting in a simultaneous panel being held behind the sound wall that separated the two camps. The physicians desired technology and apps to be supplied by pharma.

Allison told the audience about attending a "Diabetes Social Media Summit" sponsored by Roche in Orlando, Florida. Allison came away from that Summit feeling much closer to Roche and now has a more personal relationship with "Todd," one of the Roche Summit organizers who was communicating with Allison before the event. "Oh my God," said Allison at the Summit, "I'm finally getting to meet you!"

The physicians' ears next door were probably burning with envy. They probably miss the good old days when pharma companies could invite THEM to outings at resort locations. But that's now verboten by PhRMA! There are no PhRMA guidelines, however, about paying "patient self advocates" to attend "summits" at resort locations. Not that's there's anything wrong with that! I'm just wondering if "COLs" are the new "KOLs" (ie, physician Key Opinion Leaders) and where this will all lead. In fact, I know where it may all lead: to Senator Grassley, who may be writing letters to pharma CEOs requesting information about such "summits."

Near the end of the patient panel discussion, Jack asked Allison and Megan to tell the audience what they want from pharmaceutical companies. "You need to pay some one's full time salary," said Allison referring to the desire of some pharma companies to interact with patients in online communities. "The only way to sustain growth and involvement in a [online] community," said Allison, "is to have someone who actually does it [manage social media interactions with patients] as their job... to become the person who is known and loved by the community."

I think Allison was talking about an online patient community set up and run by a pharmaceutical company as opposed to an independent online patient community that already exists. Pharma companies should just give bundles of money to the latter.

It makes perfect sense that pharma should have full-time employees managing their social media initiatives. However, it becomes problematic when pharma companies hire patient advocates to monitor other communities (see, for example, "Did J&J Troll Social Media Sites to Ensure Its Motrin "Recall" was a Secret?") or to represent them in online communities.

The main issue is "transparency," which may be a new concept for eager patient advocates who wish to be hired as pharma COLs. It's a question I asked Allison when she mentioned receiving glucose meters and other goodies from pharma companies hoping she would endorse them. Allison is familiar with FTC guidelines regarding that issue, but I wondered how many other patient bloggers are.

Should Pharma Hire Online "Patient Opinion Leaders"? Take my survey: http://tinyurl.com/2fr784u

Pre-Emptive Medication Adherence. Is Pre-Emptive DTC Next?

Computers are intruding into our lives more and more these days. I'm not talking necessarily about the Internet, but about automated programs that different industries use to do things like initiate stock market trades without human intervention, which is a story I saw last night on 60 Minutes. It's reputed that one such trade sent the market in a momentary tailspin that could have lead to a monetary crisis. According experts, such automated trades are undermining the general public's trust in the stock market. I for one have taken a lot of my retirement money out of stocks.

Today I read about how Express Scripts, a pharmacy benefit management (PBM) company, is now able to accurately predict up to a year in advance which patients are most at risk of falling off their physician-prescribed drug therapy -- and to intervene in customized ways to improve those patients' adherence. To do this, Express Scripts uses "a set of proprietary computer models" that analyzes personal data of patients in its database. The data includes such things as prescription history, whether the patient has kids living at home, etc.

"Previous industry attempts to predict therapy adherence were hampered by both the types and quantity of data available," said David Tomala, director of advanced analytics at Express Scripts. "Our tens of millions of members, hundreds of millions of annual prescriptions, and advanced understanding of human behavior were key to 'cracking the code' on therapy adherence. We are now the first pharmacy benefit manager to be able to -- with high fidelity -- discriminate in advance and intervene in an effective manner. This approach addresses adherence problems among those patients who need our help the most. Improved adherence is the hallmark of better quality care, healthier patients, and reduced overall medical costs" (see press release).

Of course, it is nothing new for PBMs to mine their patient data and find those patients who have not filled prescriptions.  According to the Wall Street Journal, "the new efforts are broader, and can focus on apparently healthy people. They use models developed from enormous troves of medical and other data. These are then applied to each patient's own claims information."

PBMs often get paid by pharmaceutical companies to identify patients who are not refilling their prescriptions and to send them prescription refill reminders by mail or call them. Increasing adherence can greatly help pharmaceutical bottom lines and PBMs also benefit when more prescriptions are filled. Conventional wisdom -- and maybe even some research data -- suggests that patients will also benefit.

But computer models often result in unintended consequences as evidenced by automated stock market trades. What could be the equivalent breakdown in the health market? Obviously, there's the privacy issue: "Ethics researchers say such efforts can raise privacy and other concerns if people don't deliberately grant permission for such use of their data, as well as potentially usurp the role of doctors, who know patients best," notes the Wall Street Journal.

"It undermines the trust an individual has in their physician," said Mark A. Rothstein, a bioethics professor at the University of Louisville," who was quoted in the WSJ article.

It could also undermine the trust in the pharmaceutical industry, I suppose.

One further thought. If these computer programs can identify future health problems in otherwise healthy people, will there be pre-emptive pharma-sponsored notices sent out to patients advising them to see their doctors? As consumers provide more and more private information to pharmaceutical companies, I can even imagine pre-emptive direct-to-consumer advertising!

Social Media Can't Fix This Limitation of Disease Awareness Campaigns

At the Digipharm EU conference last week, I presented an update on expected FDA guidance regarding pharma's use of the Internet. The last slide of my presentation (find it here) was my take on what effect this guidance would have on EU-based pharmaceutical marketers. The last bullet point stated:

"When all is said and done by the FDA, we may realize that social media really fits BETTER with the European way of pharma marketing, which focuses on disease awareness and direct-to-patient response only upon request by the patient."

I've expressed that view several times here on Pharma Marketing Blog (see, for example, "Some Pharma Marketers Can't See the Unbranded SM Forest for the Branded SM Tree").

Also, I have noticed that almost ALL pharma social media campaigns are unbranded, disease awareness/support campaigns sponsored by EU-based companies that are used to focusing on this type of communication because of EU laws that forbid branded advertising.

Recently, however, such campaigns have come under attack because they may be pushing more patients into treatment unnecessarily. Such was the point made in a recent LA Times article regarding breast cancer awareness campaigns (see here). That article, which reminded us that October is National Breast Cancer Awareness Month, pointed out that disease awareness campaigns lead to more screening and "the more we screen, the more women we subject to surgery, chemotherapy and radiation for cancers that never would have harmed them. A New England Journal of Medicine article," said the LA Times, "estimated that for every life saved by a screening mammogram, five to 15 other women needlessly became diagnosed and treated."

To top it all off, according to the National Breast Cancer Coalition in Washington, D.C., 117 women in the U.S. died of breast cancer every day in 1991; today that number is 110.

The founding sponsor of National Breast Cancer Awareness Month is AstraZeneca, which responded to the LA Times article by saying "If it's not broken, I don't think we should try and fix it." AZ cited data available from the National Cancer Institute, which suggested that "the mortality rate for women with breast cancer was 32.6 percent [in 1991]. That had fallen to 22.8 percent in 2007..." (see "National Breast Cancer Awareness Month as relevant as ever").

Aside from the issue of effectiveness of disease awareness campaigns, there's the issue of patient empowerment, which we often hear in conjunction with these campaigns. "Some critics," notes the LA Times article, "object to messages that emphasize the need for women to 'take charge' of their breast health because they imply that women are at fault if they get the disease, says Angela Wall, communications manager for Breast Cancer Action, a San Francisco-based advocacy group."

Of course, an issue I've often mentioned in this blog is pharma's tendency to make it seem that more people may have the disease du jour than is warranted by the data (see, for example, "OMG! Do I Have ED or 'Low T?' Or Both?! Pharma 'Symptom Quizzes' Are NOT in the Best Interest of Patient Health!" and "You Must Score Better than 84% on Viagra's Sexual Health Quiz to NOT Have Signs of ED.").

Still, a disease awareness campaign, if done right, can benefit from a social media component. First, these campaigns are usually not on FDA's regulatory radar. Second, consumers and patients are more likely to engage with social media campaigns than with branded campaigns. You can motivate more people to walk 10 miles for breast cancer awareness than for Zoladex, which is AZ's FDA-approved drug for use against breast cancer.

Markets as Conversations: Can You Have a Discussion with "Psoriasis 360" on Facebook?

Alex Butler, Digital Strategy and Social Media Manager at Janssen and candidate for the Pharmaguy Social Media Pioneer Award, just informed me by email that he and his team have launched the Psoriasis 360 Facebook page, which is part of a larger disease-awareness campaign.

Alex wrote:

"The Psoriasis 360 campaign has been developed by Janssen as part of an ongoing commitment to improving the lives of patients through the provision of useful and relevant information about psoriasis. We know that people who live with psoriasis don’t always get the help and support they need to manage their condition. Many people are not aware how severe their psoriasis is, the impact that this has on their life and how to speak to their doctor about managing the condition.

"This information forms the core of the content on the psoriasis 360 website. We would like people to join our community on Facebook and share their experiences with ourselves and others. They can also connect with us and follow the latest psoriasis and 360 community news on twitter. Shortly there will also be a YouTube channel that has been set up with the primary goal of YouTube itself in mind-letting people touched by the condition broadcast themselves and share their stories with others, helping people to live better with psoriasis.

"We believe strongly that people should be able to share their views in an open a manner as possible for a regulated industry and the commenting policy reflects this attitude."

I think this pharma social media site is the first to publish ALL comments BEFORE they are reviewed. Janssen, however, reserves the right to remove any comments "if they directly talk about medication or could be offensive to people."

It also appears that Janssen will allow links to third-party videos and other information: "Janssen are (sic) not responsible for third-party materials appearing on the Psoriasis 360, including but not limited to linked third-party videos, linked third-party sites, and third-party advertisements," says the comment policy. "Janssen does not control or endorse this third-party content and makes no representations regarding its accuracy."

Of course, this leaves the door open for Janssen and/or their agency partners to post all kinds of links to information that Janssen MAY endorse and be responsible for under other circumstances.

But let's not put the cart before the horse and start criticizing this policy before we see more "conversations" on the site.

Speaking of "conversations," I will be interviewing Doc Searls, one of the authors of the Cluetrain Manifesto, about the relevance of the Manifesto for the pharmaceutical industry in today's social media world.

According to the ClueTrain Manifesto "A powerful global conversation has begun. Through the Internet, people are discovering and inventing new ways to share relevant knowledge with blinding speed. As a direct result, markets are getting smarter—and getting smarter faster than most companies."

The first 6 theses of the Manifesto state:

1. Markets are conversations.
2. Markets consist of human beings, not demographic sectors.
3. Conversations among human beings sound human. They are conducted in a human voice.
4. Whether delivering information, opinions, perspectives, dissenting arguments or humorous asides, the human voice is typically open, natural, uncontrived.
5. People recognize each other as such from the sound of this voice.
6. The Internet is enabling conversations among human beings that were simply not possible in the era of mass media.

I'm most interested, however, in latter theses that are relevant to the growing list of pharmaceutical Facebook pages; namely "The ideal, according to the manifesto," as reported in wikipedia, "is for the networked marketplace to be connected to the networked intranet so that full communication can exist between those within the marketplace and those within the company itself (thesis 53.) Achieving this level of communication is hindered by the imposition of ‘command and control’ structures (thesis 54-58) but, ultimately, organizations will need to allow this level of communication to exist as the new marketplace will no longer respond to the mass-media ‘voice’ of the organization (theses 59-71)."

What I notice on the "Psoriasis 360" FB Wall as well as other pharma FB Walls is that often the response to comments come from unidentified, branded accounts that may or may not be real "human beings." On Psoriasis 360, the responses come from "Psoriasis 360." It's a closed loop that does not bring me to any real human being.

Therefore, I made this post today to the Psoriasis 360 FB Wall:

"Good luck on your new FB page. A piece of advice I'd like to see implemented is for the Janssen people who are responsible for this FB page AND for the ppl who are part of the psoriasis team at Janssen to perhaps identify themselves and/or post their photos to the site. I know this is sometimes a problem because of pri...vacy issues, but eventually the general public would like to know who they are talking to. Having replies come from REAL identifiable ppl may help generate discussion better than having replies come from 'Psoriasis 360.' What do you think?"

Until pharma can break down the "command and control" structure within its marketing organization and allow voices from real people within the organization to respond to consumers, it will never achieve the vision of the ClueTrain Manifesto.

---

The Relevance of the Cluetrain Manifesto in a Social Media WorldWhat's Still Not "Conversational" in Today's Markets?


A conversation with Doc Searls, Senior Editor of Linux Journal and co-author of The Cluetrain Manifesto, about the relevance of the Manifesto for the pharmaceutical industry in today's social media world. Doc will preview the keynote presentation he plans to make at the upcoming Digital Pharma East conference. (See guest bio.)



Airs LIVE on: Thursday, October 7, 2010 * 2 PM Eastern USA

Go to this Pharma Marketing Talk Segment Page to listen to the LIVE show via streaming audio on the Web or to listen to the podcast archive afterward.

How FDA Warnings & DTC Advertising Increase Sales of Sexual Enhancement Dietary Supplements

Here's an example of how the Internet and direct-to-consumer (DTC) advertising empowers consumers.

For several years now the FDA has been issuing warnings to consumers about "dietary supplements" that claim to enhance sexual performance or treat erectile dysfunction. According to the FDA, although it has issued "many alerts about these types of supplements over the past several years, ... their number seems to be growing" (see "FDA Consumer Corner: Cautions about Sexual Enhancement Products").

Using the Internet, FDA now has a much more direct line of communication to consumers. And consumers use the Internet to buy dietary supplements. This concerns drug companies and the FDA.

What concerns the FDA about these products? FDA states:

"FDA has found that many of these supposedly 'all natural' products actually contain ingredients that aren't on the label, and these ingredients could lead to serious and even fatal effects."

Is FDA talking about rat poison? That's what Pfizer says MAY be in such products sold over the Internet (see "Was a Rat Harmed in the Filming of This Pfizer Commercial?" and "Unsafe Drugs: Is It Counterfeiters or the Supply Chain That's the Problem?").

Nope.

FDA isn't saying that these products contain dangerous ingredients like rat poison. It is claiming that they contain dangerous ingredients such as the ACTIVE ingredients of VIAGRA, CIALIS, and LEVITRA -- all FDA-approved Rx drugs.

"An FDA investigation of a number of these sexual enhancement supplements found that a third of them actually contained the same or similar ingredients to the class of prescription drugs that includes Viagra (sildenafil citrate), Cialis (tadalafil) and Levitra (vardenafil HCl)."

Hmmm... so if I buy one of these products, the chances are 1 in 3 that I will get the same active ingredient as found in Viagra/Cialis/Levitra?

OK, I know that these active ingredients can be dangerous even when sold as Viagra, Cialis, or Levitra (is Levitra still on the market?). But the TV commercials make these products sound pretty safe to me. In fact, the commercials tell me exactly what I should be concerned about: e.g., "Don't take Cialis if your take prescription drugs that contain nitrates, such as nitroglycerin."

Thanks FDA for alerting me to the fact that these dietary supplements may contain active ingredients that you have approved for human use in Rx drugs and thanks DTC advertising for educating me about the risks.

Excuse me while I search online for the best selling Sexual Enhancement Dietary Supplement.

In fact, I found a handy side-by-side comparison easily via Google search on "Sexual Enhancement Dietary Supplement" (see below). Unfortunately, I had to black out the rating symbols that appear on the original chart (which I found on JournalScopereviews.com, here) because Consumers Union (CU) lawyers informed me that the "rating symbols ... are confusingly similar or identical to Consumer Reports' trademarked icons and Ratings symbols. When consumers see your (sic) chart, they will not know if there is some connection between Consumers Union and the creator of these ratings. Obviously, there is not. The confusion this can engender is all the more pronounced given that Consumer Reports does write about dietary supplements, and has recently published information relating to sexual enhancement dietary supplements in particular. Needless to say, our views do not necessarily mirror yours, or those of the originator of the chart. This makes it still more crucial that all such confusion be avoided. To that end, therefore, we ask that you remove this chart from your blogs and refrain from using these particular Rating symbols in the future. Using some other shape or design will help ensure there is no confusion as to the source of the ratings."

BTW, I look forward to seeing CR's report on sexual enhancement dietary supplements. I wonder if the report includes the FDA warnings?

The CU lawyers also wanted to know how to find the original chart. It seems they are not as adept at using Google as am I!

Anyway, here's the blacked out version of the chart:

Lilly vs. AstraZeneca on Covering the Medicare "Doughnut Hole" Gap

Two pharma companies have responded very differently to recent stories in the press about pharma's "deal" with democrats to help cover the gap ("doughnut hole") in Medicare drug coverage. Whereas Lilly hemmed and hawed and skirted the issue and mainly defended high drug prices (see "Why Price Controls Are Not The Right Answer" and my comments here: "LillyPad Launches Specious Rocket Attack Against Drug Price Control Straw Man" and ), AstaZeneca seized the moment to support the coverage and explain how else it is helping senior citizens pay for their prescription drugs (see "Our Fair Share: Closing the Coverage Gap").

[For background, see "Medicare "Doughnut Hole" to Cost Pharma Less Than 1% of US Sales."]

Just on the basis of the two blog post titles, I have to give AZ kudos for its positive stance vs. Lilly's negative stance. It's interesting that the negative commentary comes from a drug company that is US-based, whereas the positive stance comes from a UK-based drug company. Lilly also seems to be directing its comments to lawmakers and not senior citizens, which seems to be who AZ is talking to.

Pharma Brands Benefit from "Mack Attacks" Say Attendees at DigiPharma EU

Last week I attended the DigiPharm EU conference in London and had a great time meeting old friends and people I have only interacted with through social media such as Twitter and FaceBook. Several EU pharma people presented at the conference, including candidates for the Pharmaguy Social Media Pioneer Award. I'll have more to say about these people and their presentations later, but right now I'd like to focus on me.

First of all, I gained 2 lbs! It was the English comfort food I was exposed to at a couple of tweetups and during the buffet lunch at the conference. Food such as bangers and mash, roasted pork belly, and Shepherds pie. And the drinking!

I blame it all on Alexandra Fulford (@pharmaguapa) and Sam Walmsley (@sammielw), two English women who are my new best friends on FaceBook.

Alexandra coined her Twitter handle after some Spanish guy said she was "muy guapa," which means "very pretty." Of course, I immediately said I was going to reserve "pharmaguapo" -- handsome pharmaguy -- as a new twitter handle.

I don't think anyone in Spain would say I was "muy guapo," but Miguel A. Tovar (@blogaceutics), who is a native of Barcelona, was happy to see me and I him.

Alexandra likes to cook and gave me some Aromat Savoury Seasoning, which I smuggled back to the US. I used it last night to season my roasted chicken and salad. Alexandra, meanwhile, cooks Bangers and Mash for her lunch! I look forward to having Alexandra on my BlogTalkRadio show as a guest and learn more about her pharma-related expertise. We'll also talk about cooking.

Sam Walmsley and I shared an interesting Q&A session at the DigiPharm conference. Sam is the head of digital & social media at Chandler Chicco Companies, an advertising agency. One question Sam came up with was "Did a 'Mack Attack' help your brand?"

I didn't have to explain what a "Mack Attack" was because I had just finished my presentation (find it here), which included a reference to my famous attack against Novo Nordisk's Levemir-branded tweet (see "Novo Nordisk's Branded (Levemir) Tweet is Sleazy Twitter Spam!"). I don't know if that attack helped Levemir sales, but I am sure it helped drive traffic to the @RaceWithInsulin Twitter account and Ambre Morley (@ambremorley), Associate Director of Product Communications at Novo Nordisk always favorably refers to me in her presentations.

Surprisingly, practically everyone agreed that a "Mack Attack" helps brands. Judith von Gordon, Head of External Communications at Boehringer Ingelheim, commented that BI experienced a "Mack Attack" in relation to its COPD Youtube channel (see "Danica Patrick: NASCAR Driver, Super Model, Superbowl Lingerie Ad Model, & COPD Spokesperson All Rolled Into one!").

"The 'Mack Attack' helped us internally tremendously," said von Gordon. "Our US colleagues cried 'fire' and as a consequence I had three US lawyers [contact me] complaining about what headquarters in Europe was doing." It turns out that the US lawyers were "terrified that the FDA would see the Mack Attack."

von Gordon said BI learned from this experience. "The [Mack Attack] helped us define our position," said von Gordon, "what can we do, how far can we go. More importantly, we learned we can contact John and have a debate on his website (see "Pharma on Twitter: Boehringer Ingelheim")."

I was very happy to hear von Gordon's comments and hope that all the pharma "victims" of a "Mack Attack" agree with her. But you don't have to be a Mack Attack victim to be a guest on my Pharma Marketing Talk show or a candidate for the Pharmaguy Social Media Pioneer Award. Just send a message to pharmaguapo@pharma-mkting.com and ask if you qualify!