Thursday, June 24, 2010

Survey That Rewarded NYC Physicians with $100 Gift Card Concludes Physicians View Pharma Gifts Positively. Duhhh!

I don't know whether to laugh or cry about all the brouhaha regarding results of a survey of NYC physicians just reported in Archives of Surgery.

The survey finds that 72 percent of the 590 physicians and medical students at the Mount Sinai School of Medicine who responded "have positive attitudes toward various marketing overtures, including small gifts and lunches" (see this Pharmalot post with the headline: "Most Docs Remain Positive About Pharma Marketing").

Not mentioned in the Pharmalot post is the fact that "participants who completed the survey were able to submit their names and e-mail addresses separately for the opportunity to receive 1 of 2 gift cards worth $100 each" (you have to access the METHODS section of the paper to see this; it's not in the abstract, which Pharmalot cited).

To which I say: DUHhh! Whaddaya (NYC-speak) expect from physicians who are offered not just one, but maybe TWO $100 gift cards?

Nevertheless, expect to see many more headlines like "Most Docs Remain Positive About Pharma Marketing" in the future.

Wednesday, June 23, 2010

Should J&J's CEO Weldon Take His Medicine Like a Man and Appear Before Congress as Requested?

Johnson & Johnson CEO William Weldon was asked yesterday to appear before the House Committee on Oversight and Government Reform for a second time to testify on product recalls at its McNeil Consumer Healthcare subsidiary in Fort Washington, Pa. The hearing is scheduled for June 30 in Washington.

Recall that Weldon declined to testify previously claiming he was recovering from back surgery and could not make the trip (see "JNJ's CEO Weldon May Send Underling to Congress. The Aching Back Excuse"). Instead, he sent Colleen A. Goggins, Worldwide Chairman, Consumer Group, Johnson & Johnson, in his place. Ms. Goggins looked like a deer caught in the headlights as she faced lawmakers at that hearing (see "Parallels Between BP and J&J").

This time, Weldon should take notice of the attachment to the invitation that says "Witnesses with disabilities should contact Committee staff to arrange any necessary accommodations." [See "The Video Option" at end of this post.]

I think that Weldon should take his medicine like a man and testify in person. What do you think? Please take my little poll and let me know:
Should J&J's CEO William Weldon Appear Before Congress as Requested?

The Video Option
Aileen Katcher (@AKatcher), a healthcare PR specialist, tweeted me: "You don't give the option of appearing via video feed should his condition require." Maybe that would be an option, but I am afraid Weldon might emulate Clinton and respond to inquires about McNeil's "phantom recall" with "It depends on what you mean by 'recall'". [For more on the phantom recall, see "Parallels Between BP and J&J".]

Finally, A Google Drug Search Ad Format That Has All FDA Could Want... But Pharma Can't Use It!

Google just launched a NEW Rx drug ad format that includes everything FDA requires that a drug company include in its direct-to-consumer advertising: fair balance, and direct links to side effects, precautions, dietary information, etc. It even includes a logo that identifies it as a special ad sanctioned by a trusted authority! Unfortunately, the new format is only for the National Institutes of Health (NIH) and NOT available to pharmaceutical advertisers.

Below is the result shown on Google after a search on "Lipitor" (click on image for an enlarged view):

Click on image for an enlarged view.

At the very top is the typical AdWord that Pfizer paid for. It's puny and uninformative and does not mention what medical condition Lipitor is approved for. Just below it is the NIH ad, which has all the required and interesting information. It even includes a little colorful pill that draws your attention to the ad and marks it as special. When you click on the NIH ad [actually, it's not technically an ad, but a natural search result that ALWAYS appears at the top of the natural search results; in that sense it's an UNPAID ad]. although not a paid ad] you are taken to a page on the NIH site set up especially for atorvastatin, the active ingredient in Lipitor.

This new drug ad format is the latest initiative of Google Health, which last year launched "Health OneBox" that offered easy-to-read details on illnesses and conditions with a single search.

Will these NIH ads compete with drug company's paid search drug ads, not to mention natural search results? Or can the two work in concert to increase the clickthrough rate on the paid ads?

Either way, Google stands to increase revenue from pharma paid ads. The NIH ads are just another instance of pharma losing share of voice on search engines. They must counteract that with even more advertising. Hopefully, Google's new ad format specifically designed for pharma (see here) will win FDA approval. That format can compete more effectively with the NIH ads. Not that there's anything wrong with the NIH ads!

Tuesday, June 22, 2010

Humana's iPhone/iPad "Games for Health": Would You Pay $2.99 to Play?

My Twitter pal @skypen (aka Fabio Gratton) keeps me up to date regarding innovative health apps and games developed by pharmaceutical and other healthcare companies. Today he tweeted:

"Humana develops health game for iPhone"

"Besides developing original games for health," said Paul Puopolo, leader of Humana’s Games for Health, "[we] partner with game developers who are open to new business models to offer unique video games that can improve health and wellness."

That's an interesting goal for an iPhone app worthy of further investigation. So I went to the Humana Games for Health Web site and found this promo for the Humana iPhone game app called "Colorfall":

This is a game similar to Tetris. The objective is to arrange and eliminate cascading color squares before the screen fills up. How does this game "improve health and wellness?" Well, you are prompted to get up off your behind and use the iPhone to photograph colorful objects such as a butter dish (shown below):

The app uses the dominant color in the photo to alter the color of squares, which can help you win the game.

In other words, this game improves health and wellness by encouraging you to move around. Huh? Usually, I play games when I'm stuck in the middle seat of an airplane and not able to move around. If I were at home and went into my fridge looking for colorful foods, I might just pause the game and have a snack. Butter, hmmmmm...

Anyway, Colorfall looks like a game worth trying. But I will never download it because Humana has the nerve to charge $2.99! I asked Fabio: "Why would I pay $2.99 for these games from Humana - an insurance company with $bn in assets????" To which Fabio replied: "i agree. Should be free. Who will pay? Probably Pharma cos and competitors to learn/see what others are doing."

If you are working for a pharma company and thinking of developing iPhone or iPad game apps, I doubt you would want to charge people $2.99. People hate the pharma industry about as much as they hate insurance companies and are sure not to pay. So it's a mystery to me why Humana charges people a fee for this game, especially if they believe it will improve the health of the people covered by their plans and thus lower their costs.

A better business model for game apps is to offer free games that include motivational messages or links to useful information as part of the game.

Monday, June 21, 2010

"You Never Had Coffee Like This Before!": FDA Wants to Keep It That Way

FDA is warning consumers not to use "Magic Power Coffee," an instant coffee product marketed as a dietary supplement for sexual enhancement. FDA says Magic Power Coffee contains the drug ingredient hydroxythiohomosildenafil, a chemical similar to sildenafil, the active ingredient in Viagra. The Website is shown below:

If it weren't for this FDA warning I may never have HEARD of Magic Power Coffee, much less had it. It looks delicious and could solve two of my biggest problems: staying alert AND staying erect! I almost forgot to mention that Magic Power Coffee can also make me rich if I participate in an online multi-level marketing scheme! Wow! I might sign up even if all I get out of it is FREE Magic Power Coffee!

This is only one of several products sold over the Internet containing a Viagra-like substance that the FDA has warned consumers about. Frankly, none of the other products even tempted me. One other such product was "Stud Capsule For Men," which the FDA found to be "adulterated with sildenafil" (ie, Viagra). Unlike Magic Power Coffee, a "stud capsule" does not appeal to me. For one thing, the marketing is atrocious! "Stud Capsule" as a brand name is weak -- it accurately reflects what it is supposed to achieve, but does not conjure up the type of image I'd like to be associated with. "Magic Power Coffee," on the other hand, sounds much more intriguing. Plus, it's also recommended for women!

"Imagine an incredible coffee that not only tastes great," says the Magic Coffee marketing blurb, "but magically has an effect on both men & women! With Magic Power Coffee, your 'special moments' can increase to a level you only dreamed."†

There's even a foot note on the Website reminiscent of side effect warnings seen on sites:
"Individual results may vary. These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. The information on this Website or in emails is designed for educational purposes only and is not intended to be a substitute for informed medical advice or care. Do not use this information to diagnose or treat any health problems or illnesses without consulting your doctor. Magic Power Coffee is not intended or to be used to treat any type of medical condition."
Can the FDA seize this product? I'm not sure. It contains a derivative of sildenafil, an FDA-approved drug, but it is not "counterfeit" Viagra. Also, the marketing does not make any claim that it is Viagra or has a medical use.

Of course, Magic Power Coffee could still contain other dangerous chemicals such as rat poison (for more on that, see "Was a Rat Harmed in the Filming of This Pfizer Commercial?").

Friday, June 18, 2010

I Predicted It: Social Media Guidance Likely To Be Split Into Multiple Documents

"What had been envisioned as a massive, all-encompassing guidance on Internet promotion is being retooled as multiple guidances to address specific issues in the online realm," Tom Abrams, head of the Center for Drug Evaluation and Research's Division of Drug Marketing, Advertising and Communications (DDMAC) said during a panel discussion at the Drug Information Association's annual meeting in Washington, D.C., June 15. (Picked up from a "FDA Library Alert" email -- "DDMAC: Social Media Guidance Likely To Be Split Into Multiple Documents" -- I just received.)

Either I can see into the future, or FDA reads Pharma Marketing Blog and takes my advice. In November, 2009, I said "If FDA decides to bite off more than it can chew, it will take a long time to issue any guidance and whatever it comes up with will be out of date as soon as it is published. A much better approach would be to tackle a few issues at a time" (see "FDA Social Media Guidelines Best Done in Baby Steps").

More from "FDA Library Alert":
Abrams said the planned move from a single document covering all forms of online promotion -- such as social media, webpages and videos -- to multiple, targeted guidances will help future-proof DDMAC's oversight of the web. It would give DDMAC greater flexibility in the event that new technologies emerge to supplant today's online media.

"Technology is evolving so much, we don't want the guidance to become quickly outdated," Abrams explained.

He emphasized that this shift is not set in stone, but is simply the division's "current vision" for the guidance. "It could change at any time," he noted.

If the division does adopt this approach, the guidances will not be rolled out all at once, but over the course of time, Abrams said. He added that the first of these guidances will likely be released this year.

During the conference, Abrams also revealed that the Internet guidances likely would address specific issues or circumstances -- such as the posting of unprompted data on off-label use of a product or the question of responsibility when off-label information is posted on a third-party site -- rather than specific platforms -- such as websites or Twitter.

Abrams declined to give a complete breakdown of the guidance topics envisioned or the number of guidances expected under this approach.

For more details, see the August edition of the FDA Advertising and Promotion Manual.

Sex, Pharmaceuticals, and Selling Sickness: I'm Looking Forward to a Great Time In Amsterdam!

This October I will be in Amsterdam enjoying the sights and pleasures that city has to offer. But I am not planning to buy sex or to smoke pharmaceutical substances. I do plan, however, to attend and make a presentation at the Selling Sickness conference hosted by Healthy Skepticism (Netherlands), assisted by the Dutch Institute for Rational Use of Medicine and Healthy Skepticism (International). The sponsors include the Dutch Ministry of Health and the Dutch Health Care Inspectorate. You can find the program here.

I look forward to this conference because "Female sexual dysfunction will be used as a case study to explore problems with disease promotion as well as policy options." Ray Moynihan, journalist, co-author of the book "Selling Sickness: How The World's Biggest Pharmaceutical Companies Are Turning Us All Into Patients" and author of "Sex, Lies & Pharmaceuticals," is a featured speaker.

In preparation for the conference, I am following closely the news about flibanserin, a new drug developed by the German pharma company Boehringer Ingelheim (BI) for "hypoactive sexual desire disorder" (HSDD) in pre-menopausal women. Today, an FDA advisory committee will meet to review this drug's application for marketing approval. BI must answer the question FDA always asks: is the drug safe and effective. The FDA’s own review, out yesterday, says the overall response rate in clinical trials isn't "particularly compelling," reports the WSJ Health Blog.

Perhaps an even more interesting question is whether or not hypoactive sexual desire disorder is a real medical condition. FDA does not consider that question when approving drugs. Whatever compound comes their way for which a drug company has clinical data, FDA's only duty is to consider if it is safe and effective for whatever "condition" it is designed to treat. A drug company is free to invent a medical condition and FDA can't say a word about that.

Do pharma companies "invent" medical conditions in order to sell drugs? Is hypoactive sexual desire disorder an "invented" medical condition?

One case where there is "smoking gun" evidence of a medical condition being invented by a pharma company is "overactive bladder," another condition affecting mostly women. "Pharmacia instrumental in creating new disease," said a marketing VP in the notes to his PowerPoint presentation made at an industry conference in October, 2002 (see Overactive Bladder: "Pharmacia instrumental in creating new disease" says Former VP).

My fellow blogger, Rich Myer, reviewed all the PR that BI is doing to create awareness of hypoactive sexual desire disorder: "In the last month, Boehringer has been trying to lay the consumer groundwork with a promotional campaign about women’s low libido, including a Web site, a Twitter feed, a Discovery Channel documentary and a publicity tour by Lisa Rinna, a soap opera star and former Playboy model, who describes herself as someone who has suffered from a disorder that Boehringer refers to as a form of 'female sexual dysfunction.'" In his post Rich quotes Dr. Adriane Fugh-Berman, an associate professor at Georgetown University’s medical school: "This is really a classic case of disease branding,” said Fugh-Berman. “The messages are aimed at medicalizing normal conditions, and also preying on the insecurity of both the clinician and the patient."

Oh, Oh, Rich! You are not in command of the facts. You should have read BI's "Key Facts on HSDD and Flibanserin". One fact cited is this: "HSDD is a medical condition – not simply 'low libido.'"

Anyway, this is sure to be a BIG topic for discussion at the Selling Sickness conference in Amsterdam. I wonder if people from BI will be there or invited to speak? Hope so.

Thursday, June 17, 2010

FDA Sucker Punches Sepracor with Warning Letter After the Match Is Over!

On June 9, 2010, Carrie Newcomer, Regulatory Review Officer in FDA's Division of Drug Marketing, Advertising and Communications (DDMAC), sent a "warning" letter to Kathleen Grim, Executive Director, Regulatory Compliance at Sepracor Inc., about a Lunesta TV ad that Newcomer said "presents unsubstantiated claims, including unsubstantiated superiority claims."

The ad in question is the so-called "Boxing Bed" ad, which shows a sleepless woman tossing and turning in a bed that is also a boxing ring. Here's a panel from the storyboard that was submitted to the FDA on November 19, 2009, about the time the ad first ran on TV:
This ad was voted one of "The 10 Worst TV Ads of 2009" (see here).

In other words, the ad appeared way back in 2009 and the FDA is just now sending Sepracor a warning letter after having the storyboard in its possession for 7 months! Of course, the ad has run its course and Sepracor and Lunesta have long left the ring. But the FDA still went after them with this sucker punch.

What is FDA demanding? "DDMAC requests that Sepracor immediately cease the dissemination of violative promotional materials for Lunesta such as those described above. Please submit a written response to this letter on or before June 23, 2010, stating whether you intend to comply with this request..."

I imagine a grin on Ms. Grim's face as she sits in her office somewhere in Malborough, MA reading Newcomer's letter. "Yes," says Grim, "we'll cease airing that commercial three months ago and I will write this 'newcomer' a response as soon as I return from my vacation on the Cape. Meanwhile, I'll have my staff frame this letter to add to the collection hanging behind my desk."

BTW, while searching Google for this ad, I found an interesting Lunesta paid search ad as seen here:
This is the first time I have ever seen a drug ad that talks ONLY about side effects! I assure you that the ad linked to the official Lunesta Web site and NOT a lawyer's class action Web site. Perhaps Sepracor is trying to atone for running those infamous "badWords," which violated FDA regulations (see Lunesta, Google, and "bAdWords").

Are Docs Being Banished from Pharma's Garden of Eden?

"It is a breathtaking sweep to squash something that is really important to us, the science going on in the private sector," said Francis Collins, director of the National Institutes of Health, at a meeting in Bethesda, Md. At issue is a decision by the American Heart Association (AHA) to ban pharmaceutical industry employees from making medical education presentations later this year at the AHA's annual scientific sessions (see "Drug firms banished from medical talks").

"The policy is blood-curdling," said Keith Yamamoto, executive vice dean of the University of California, San Francisco School of Medicine. "This is conflict-of-interest considerations run amok."

Wow! It's as if physicians were banished from an Eden where they enjoyed the fruits of the tree of knowledge made accessible by the pharmaceutical industry. To some, it's a development of biblical proportions that deserves an appropriate image:

Before the drug industry advocates get their panties in a bundle over this, let's see exactly what the AHA says about the policy (find it here):
"In compliance with ACCME requirements, employees of a commercial interest entity cannot be the presenting author of the abstract. A commercial interest is defined as any entity producing, marketing, re-selling, or distributing healthcare goods or services consumed by, or used on, patients. For our purposes, an employee is defined as someone who is directly working for the commercial interest as their primary employer and the commercial interest provides their primary source of income. A person acting as a contractor to a commercial interest, providing consultation, or other services secondary to their primary appointment at, for example, a university, would not be considered an employee."

"If the abstract is selected for presentation (oral or poster)," says AHA, "the employee of the commercial interest cannot present but must select another author."
What this means is that an abstract that is authored soley by a physician or physicians DIRECTLY employed full-time by a pharmaceutical company can be blocked. Otherwise, another, non-pharma employee author can make the presentation. There is almost always other non-pharma authors, including the physicians who ran the clinical studies being reported. Also, ghostwriters can make presentations, as indicated by this FAQ from AHA:
Q: I am the primary author of an abstract and designated as the presenter. I am currently employed by a home health agency. Can I still present my abstract?

A. Yes, the ACCME does not consider providers of clinical service directly to patients to be commercial interests.
IMHO, all the fuss over this AHA decision is unjustified as far as physician education is concerned. It may, however, be a blow to pharma research physicians who do all their clinical trials in-house without using independent physicians outside the firm. And that kind of "science" we can do without.

The Kölner Dom, Wise Men Relics, and Pharma Social Media

The Cologne Cathedral (German: Kölner Dom) is a Roman Catholic cathedral in Cologne, Germany. It took over 600 years to complete the construction of this famous church.

The Dom is said to house the "relics" of the three wise men. According to wikipedia, "the relics of the Magi were taken from Milan by Holy Roman Emperor Fredrick Barbarossa and given to the Archbishop of Cologne, Rainald of Dassel in 1164. The Three Kings have since attracted a constant stream of pilgrims to Cologne," and this made Cologne a major Germany city.

Last week I visited Cologne on invitation from Dr. Frank Antwerpes, shown in the photo below standing next to his new "vineyard" on his farm somewhere about 30 minutes - Autobahn time - outside Cologne.

Dr. Antwerpes is the CEO of DocCheck, a publicly-held company that specializes in healthcare marketing, customer relationship management and eCommerce.

DocCheck comprises a health professional portal web site and a creative ad agency (antwerpes ag), which develops and implements communication strategies for new and traditional media with an emphasis on healthcare and business-to-business. For more about DocCheck, read "DocCheck: Das Portal" and listen to this podcast interview of Dr. Antwerpes: "Building the First Global Community of Doctors".

I first met Frank about 13 years ago at a Pharma Internet conference in Philadelphia. At that time, the "hot topic" was the fact that the World Wide Web (WWW) was surpassing Gopher as the Internet protocol of choice. I doubt if anyone today remembers Gopher.

Also at that time, the FDA held its first public hearing on the regulation of pharma use by the Internet. Many of us recalled THAT hearing because of FDA's NEW hearing on the Internet, which was held last November.

Anyway, Dr. Antwerpes invited me to speak to his agency's clients about social media*. While there, I joked that it may take as long for the pharmaceutical industry to "master" social media as it took Kölners to complete the Dom.

It was a bit frustrating to speak to European pharma people about social media because I knew that most of the interesting stuff that pharmaceutical companies can use social media for -- ie, to communicate with patients -- cannot be done in Europe. Therefore, it may be a cold day in hell before European companies can master the use of social media to communicate with European citizens. Or maybe it will be only 600 years! But first, they have to find some wise men relics. Hmm... maybe that's why I was invited to speak!

[ *Antwerpes paid my travel expenses plus a fee to speak to his clients.]

Wednesday, June 16, 2010

Can You Read This "Fair Balance" on Race With Insulin Twitter Page, or Is It Just Me Having Problems?

The "Race with Insulin" branded Twitter account is old news (listen to this podcast "Novo Nordisk's Race With Insulin Campaign: It's Not Just About Twitter").

Celebrity racecar driver and Levemir spokesperson Charlie Kimball is still posting interesting and informative tweets such as "Heading to bed. Just used my Levemir® FlexPen®. For Levemir® (insulin detemir [rDNA origin]) prescribing Info:" and Novo Nordisk is making the rounds at industry conferences describing how they were able to do this while staying within FDA regulatory boundaries.

I am not going to complain about "sleazy spam tweets" and wonder what value such tweets are to patients. Instead, I'd like to point out how UNREADBALE the "fair balance" (safety) information is on the Race With Insulin Twitter page, which you can find here. I've reproduced that part of the page on the left. 

I challenge you to read this either using this image or viewing the original statement on the Race With Insulin Twitter page. It's impossible!

Novo Nordisk should realize that many people with diabetes are older and may have vision problems made worse by diabetes. For the sake of these patients, shouldn't Novo make this safety information more readable?

I also think the FDA should take an interest in this and issue Novo Nordisk a "warning letter" as it has done in other cases where fair balance information is not as prominent as benefit information.

To be fair, however, the Twitter page shows no "benefit" statements at all! It just mentions the medical condition and the brand name. Technically, therefore, while the safety information is required by the FDA, it's probably OK with the FDA that it is unreadable because there is no benefit statements to compare it with. What a dilemma!

This is a case where the pharma company should go beyond what is merely required by the regulators and provide a useful service to the patients who are using their products. What do you think?

Aged Female "Ka-Boomers" Shun Social Media, Favor Email

A recent "She Says" survey, conducted by Pink Tank, a division of GSW Worldwide specializing in women and health, and Meredith Research Solutions, has been cited to show that "women are highly cynical about pharmaceutical marketing efforts, with 56% of those surveyed believing that pharmaceutical marketing does more harm than good" (see "'Ka-Boomers' blow up more perceptions of pharma advertising").

That's nothing new to me and not the most important piece of information I got from this study, which you can find here.

The most important insight I received from this survey is that these women -- whose MEDIAN age is 53.1 years! -- shun social media and favor email for spreading interesting health news via the Internet (see chart below).

Click on the chart to enlarge.

Sorry if this chart is difficult to read, but the "pink tank" pdf survey summary is so muted with feminine colors that it is very difficult to read with my baby-boomer eyes! I had to darken the image in PhotoShop considerably to get even this barely readable version. I guess the report is not meant to be read by the half of the survey respondents who are over 53.1 years old!

Whatever! The point is that only 4% of these baby boomer women (MEDIAN age = 53.1 years) use social media to discuss and share interesting health information with their peers. Only 1% (a rounding error) use Twitter for that purpose. Meanwhile, 34% of these women use good old, antiquated Email!

As reported in MedAd Blog, "Based on the survey results, Ms. Goffe-Wagner [senior VP and brand manager for Pink Tank] says there are some tactics pharmaceutical companies should be following when evaluating their marketing. 'When the brand is all about itself, women feel, as one put it in the survey, that it's patient before pocketbook,' [sic? should this read 'pocketbook before patient'?] Ms. Goffe-Wagner says. 'That’s the lens they are looking at; they are looking at what you say, and what you do, to see whether they feel that you’re just all about growing sales of your brand, or whether you’re really about improving health and the lives of women."

Another tactic that pharmaceutical companies should be following is to use Email to reach these women rather than social media.

BTW, I would be interested in seeing how women in different age groups feel about the issues studied in this survey. For example, women between the ages of 18 and 44 years may be more likely to use social media and 46.6% of them are using at least one prescription drug according to the survey.

Tuesday, June 15, 2010

Is Pharma Blocking or Supporting iPad Use by Sales Reps?

"Has anyone had any luck getting the iPad to connect to J&J email system," asks an anonymous sales rep on the J&J IT board of CafePharma. "My iPhone connects perfectly and I believe that the iPad should work just the same way. However, even with exactly the same settings it isn't working for me..."

"I called helpdesk," said another poster, "he said iPads, Android, and a few other things are blocked at a device family level from activesynching. Didn't say why."

On the Eisai Pharmaceuticals discussion board, another anonymous poster said "I heard that we are getting new ipads for e-detailing. Great now we have 2 systems for inventory and 2 systems for account management. I better be able to dowload some games and it better have a decent battery. Prob nope on the last 2 requests."

In response was this post: "Who wants an Eisai neutered iPAD? You know they will block all downloads. No apps, movies, or music. Screw that!"

On the other hand, it seems that Genentech is providing iPads to its sales force: "iPads will be overnighted to the entire sales force next Tuesday," said an anonymous poster to the Genentech board on June 8, 2010.

According to Quang Pham, CEO, LathianHealth - an eDetailing company - iPads definitely have a place in the future of eDetailing. He was speaking at a MedAdNews webinar on sales force effectiveness today. Pham did mention, however, that many eDetailing programs currently use Adobe Flash, which is not supported by iPad. Yet the low price point for iPads is a great incentive for pharma to goose its eDetailing vendors to develop programs specifically for the iPad.

In the same webinar, David Kerr, SVP Business Development at PDI, Inc. (a company that provides outsourced sales and marketing services) wondered whether the iPad was robust enough to be thrown around in a sales rep's bag. I use the iPad Case (see photo) to protect my iPad and have taken it everywhere in my backpack without any worries.

DTC Marketing Mix: Radio & Outdoor Ad Spend Soars, Internet Not So Much.

As reported by Nielsen Monitor Plus and reported in the June, 2010, issue of DTC Perspectives, direct-to-consumer (DTC) advertising spend by the pharma industry increased by nearly 2% in 2009 versus 2008 (see trend chart below).
 As reported by DTC Perspectives, radio and outdoor "see largest increases in 2009 DTC promotion" (112% and 55%, respectively), whereas Internet spending (display ads only) saw a 31% increase. About 2.6% (a meager $117 MM) of pharma's DTC ad spend budget in 2009 was devoted to Internet display ads (4.4% if you include search advertising, which is estimated to be about 40% of the total Internet spend). The following chart compares the 2009 mix with the 2008 mix.

Not much of a change.

Monday, June 14, 2010

Take Your Medicine, Win the Lottery! Void Where Prohibited.

New England Healthcare Institute (NEHI), a nonprofit research organization with ties to the pharmaceutical industry, health insurers and academia, estimates that one third to one half of all patients in the U.S. do not take their medications as prescribed by their doctors. [Actually, regarding that percentage, NEHI may be quoting the World Health Organization, which may be getting its figures from the pharmaceutical industry, which may just be making them up.]

"Adherence" is the technical term used by the pharma industry for "following doctor's orders" about taking medication. NEHI suggests many reasons for the poor "adherence" behavior of Americans, including:
  • cost
  • side effects
  • the challenge of managing multiple prescriptions (polypharmacy)
  • patients’ understanding of their disease
  • forgetfulness
  • cultural and belief systems
  • imperfect drug regimens
  • patients’ ability to navigate the health care system
  • cognitive impairments
  • a reduced sense of urgency due to asymptomatic conditions
"In general," says NEHI, "adherence rates are lower among patients with chronic conditions than among those with acute conditions." NEHI estimates poor adherence poses an increased risk of hospitalizations due to poor health outcomes, resulting in significant excess costs that are passed along to everyone via higher insurance/co-pay rates. "Since a full 75 percent of U.S. health care spending goes to the treatment of chronic disease, poor medication adherence presents a serious roadblock to efforts to improve health care efficiency and affordability."

Not to mention the roadblock to increased pharma industry profits!

There have been many strategies to overcome poor adherence. Drug companies, for example, have incentive programs that include coupons for the partial or total re-imbursement of copayments.

A new strategy embraced by pharmaceutical companies, pharmacies and insurers, reported today in the New York Times, is a lottery whereby patients can win cash for taking their medication! "In a Philadelphia program people prescribed warfarin, an anti-blood-clot medication, can win $10 or $100 each day they take the drug," reported the NYT (see "Cash Helps the Medicine Go Down"). The program uses a computerized pillbox to record if patients took the medicine and whether they won that day.

First of all, no computerized pillbox can actually know if patients swallowed the pill or merely threw it down the drain, which they might do if non-adherence was due primarily to bad side effects. For more about electronic pill boxes, see, "Can an In-home Electronic Pillbox Solve Our Medication Error Problem?"

You can, however, place an electronic collar around patients' necks and detect if specially-designed pills were actually swallowed. As if that will ever happen! (See "Invasive Compliance: A Bitter Pill to Swallow.")

Aside from gaming the system by throwing the pill down the drain, the lottery idea is intriguing. It is well-suited to the American psyche, which now expects bad behavior to be rewarded (as in getting great refinancing deals and government subsidies when you decide not to make your monthly mortgage payments). You can also look at this as rewarding good behavior, except I suspect that those patients who prudently have taken their medication all along are not included in such incentive programs.

I am waiting for such a program to be offered to the millions of men who suffer from erectile dysfunction and who "forget" to take their daily dose of Cialis! When that happens, I'll be the first to sign up!

Monday, June 07, 2010

How Much Does Pharma Spend on ePromtion? The Mystery Continues - UPDATE

Depending upon what publication reports the data, the TOP 12 pharma companies either spent $287.60 or $168.12 million on "ePromotion" in 2008. The two publications I am talking about are Medical Marketing & Media (MM&M; see "Pharma Report: When Generics Attack") and AdAge (see "Marketing Mix of Leading Pharma Advertisers in 2008"). The "measured media" DTC data reproduced in these publications come from the same source: TNS, which is now part of Kantar Health.

I focus on the 2008 data because I don't have 2009 data from AdAge, but I DO have 2009 data from the May 2010 issue of MM&M, which reported promotional spending in several categories: DTC, detailing, ePromotion, meetings, and journal advertising. Some of the data -- it's not clear which data -- come from SDI's Promotional Audit. 

The 2009 data reported in MM&M covers the TOP 20 pharma companies in terms of "Total Promo Spend" (see chart below, which shows the Detailing, DTC, and ePromotion spend for the 20 companies; not included are the data for meetings and journal advertising; click on the chart for an enlarged view):

What's immediately evident is how LITTLE each company spends on "ePromotion," which -- I assume -- includes only display ads placed on 3rd-party Web sites and specifically not search advertising. This is part of what's called "measured" media spending, which many experts say overstates the actual amount that companies spend on advertising -- because of discounting. Let's not worry about that because discounts probably apply to both types of media.

What % of total measured media spending is devoted to ePromotion? To calculate that I added the spending on DTC, ePromotion, and Journal Ads to get the total measured media spend, which was $4.208 Bn in 2009 according to data reported in MM&M. The total ePromotion spend was $0.3037 Bn, which is 7.2% of the total.

The 7.2% figure is suspect. Measured media data reported in AdAge ("Marketing Mix of Leading Pharma Advertisers in 2008") indicate that Internet display ad spending was 2.4% of total measured media spending in 2008 and 3.1% in 2007. Unless I am missing some data from the MM&M source or made an error in math, I don't see how you can go from 2.4% to 7.4% in one year.

Meanwhile, Melissa Leonhauser, director at SDI, was quoted in MM&M as saying that 2009 pharma ePromotion spending increased 6.6% compared to 2008. Total industry promotional spending increased 2% according to Leonhauser

The other thing I notice from the data reported in MM&M (see chart) is that some companies spend nearly as much or more on DTC as they do on detailing to physicians (eg, Pfizer, BMS, Amgen, BI, and Daiichi-Sankyo). If true, that's pretty amazing. Amazing, because I've seen estimates of physician detail spending of $12 billion industrywide, whereas overall DTC spending is more in the range of $4-5 billion. That yields a Detailing/DTC spending ratio of about 3 to 1. For the biggest spender -- ie, Pfizer -- to have a Detailing/DTC ratio of 1.12 to 1 (based on data reported by MM&M; ie, $1.223 Bn/$1.089 Bn) seems very suspect to me.

I have more suspicions about the data reported in MM&M. In the case of Daiichi-Sankyo, for example, when you add up the columns (ie, different types of promotion) you get $554.50 million, whereas the table has $300.75 million in the Total column.

Let's get back to comparing 2008 ePromotion pharma spending reported in AdAge vs the spending calculated from data reported in MM&M. These numbers are very different for most of the companies on the two lists. Again, I am comparing data for 2008. To do that, I used the % change reported in MM&M to calculate the ePromotion spend for 2008 from the 2009 data. This calculation for Merck, for example, yields $95.5 million whereas AdAge reported that Merck spent only $8.60 on ePromotion (Internet display ads) in 2008 -- a difference of $86.9 million! Anyway, here are the numbers (note:for the AdAge data I merged SP data into Merck and Wyeth data into Pfizer to account for mergers after 2008 and to make a fair comparison to what MM&M reported; 2008 data from MM&M were calculated from % change information published in MM&M):

What can account for the huge differences seen for many companies on this list? There must be a mistake somewhere -- as I said, I may have made a mistake in my math or assumptions. But I know for sure that there is at least one error in the MM&M table -- the data for Daiichi-Sankyo just doesn't add up to the total reported.

UPDATE (6/12/2010):

Bob Harrell commented on my Facebook page: "Are you sure the definition of "ePromotion" in either or both cases is *really just* online display advertising (basically banner ads)? That seems like a very odd and narrow definition to use for ePromotion in pharma - putting aside the question of what can easily be tracked/indexed - and thus a questionable assumption for your comments above."

It's not clear from MM&M Table 4 ("Total Promo Spend, DTC SPend, ePromotional Spend") whether or not the ePromotion numbers refer only to display ads. It is also not clear if the numbers refer to direct-to-consumer ePromotion or ePromotion to physicians, which can include eDetailing, etc, or to BOTH consumers and physicians. Since MM&M put ePromotion and DTC in the same table and had another table (Table 5) devoted to physician promotion, I assumed that the ePromotion numbers in Table 4 referred to consumer ad spending.

The source of the ePromotion numbers reported in MM&M (Table 4) is "SDI's ePromtion Audit," which I now have learned "tracks online promotional activities for physicians" (see "SDI Reports: Pharmaceutical Promotional Spending Indicates Trend Toward Electronic and Online..."). This would explain the inconsistencies I calculated in the table above. It would not explain, however, what the the level of ePromotion to consumers is.

SDI noted an increase of more than 32% in industry spending on ePromotion (to physicians). Kelly Sborlini, Vice President of Market Research Audits at SDI said "we're also seeing a similar shift in pharmaceutical direct-to-consumer advertising. The largest growth area in DTC advertising is on the Internet, whereas spending on consumer magazine print ads is decreasing." I cannot find the numbers that SDI used to support this statement.

Friday, June 04, 2010

Kellogg Engages in Serial Advertising Misbehavior

"Leading cereal maker Kellogg Company has agreed to new advertising restrictions to resolve a Federal Trade Commission (FTC) investigation into questionable immunity-related claims for Rice Krispies cereal," said FTC in a press release (see "FTC Investigation of Rice Krispies Ad Claims"). "This is the second time in the last year that the FTC has taken action against the company."

What's disturbing is the fact that Kellog went ahead with its questionable Rice Krispies campaign while being investigated by the FTC for other "cereal" health claims:

"We are concerned that while Kellogg was developing its questionable Rice Krispies campaign last year, it was simultaneously negotiating with the FTC to resolve earlier allegations that the company had deceptively marketed Frosted Mini-Wheats as improving children’s attentiveness," said FTC Commissioner Julie Brill and Chairman Jon Leibowitz in a concurring statement. "What is particularly disconcerting to us," said Brill and Leibowitz, "is that at the same time that Kellogg was making promises to the Commission regarding Frosted Mini-Wheats, the company was preparing to make problematic claims about Rice Krispies."

This makes Kellogg a "serial" misbehaving "cereal" advertiser, if you get my drift.

This is another example of "a trusted, long-established company with a presence in millions of American homes" (FTC Commissioner's words) that makes products we put into the mouths of our children "[shirking] its responsibility to do the right thing" (FTC Commissioner's words). The other company is Johnson & Johnson (see "Parallels Between BP and J&J").
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