Monday, October 31, 2011

Pharma Sponsored YouTube Patient Videos "Not Transparent" Says Cleveland Clinic Researcher

According to the results of two separate social media-related studies unveiled today at the American College of Gastroenterology’s (ACG) 76th Annual Scientific meeting in Washington, DC, social networking sites like Facebook and YouTube may lack patient-centered information and can also be sources of misleading information that could potentially do more harm than good (see the ACG press release here).

What I found interesting was the comment made by researcher Saurabh Mukewar, MD, the author of the second study ("YouTube: A Friend or Foe When You Are Taking Care of IBD Patients"):

“Clinicians and their patients need to be aware of misleading information posted by patients or particularly by pharmaceutical companies who often post videos to make it seem like they are coming from a patient when in actuality it is a company advertisement,” said Dr. Mukewar. “These sources are not transparent.”

I have often siad that "patient" promotional videos made by pharmaceutical companies can be mistaken for authentic patient stories. See, for example, "Method Acting for Real Patients Who Play Themselves on Pharma YouTube Channels".

Both Dr. Wolfsen and Dr. Mukewar agree that Internet and social media can benefit patients and enhance their care. But Dr. Mukewar said his findings are concerning to him since IBD patients may get misleading information via YouTube that could be harmful to their health.

Pharmacutical companies say that they must be allowed more freedom to put "credible information" on YouTube, Facebook, and other social media sites to counteract the misleading and potentially harmful information that is already out there! But here we have physicians who say that pharma companies share the responsibility for posting misleading information on social media sites.

Who are we to believe?

Friday, October 28, 2011

Angry PhRMA, Level 1: PDUFA

Yesterday I suggested a real "kick-ass" pharma-related game would be ANGRY PHRMA (see "Pharma & Fun, Not Oxymoronic? Here Comes Gamification!"). Below is shown "Level 1: PDUFA," the goal of which is to "knock down" those Senators trying to give FDA new regulatory powers as part of the bill -- or as PhRMA describes it, those "additional provisions that could create unintended burdens on the regulatory process" (see "PhRMA Statement Regarding Prescription Drug User Fee Act Reauthorization"). PhRMA specifically disagrees with REMS because it “has led to a breakdown in FDA’s review process and has eroded some of the positive progress derived from earlier PDUFA agreements" (see "PDUFA 2012 – Background From PhRMA’s Perspective").

OK, that's the boring, policy wonk explanation. Let's get down to  some serious Senatorial "butt whooping" fun!


EXTRA CREDIT: Name at least 2 Senators that PhRMA needs to work on.

I'll try and come up with more levels of play for my ANGRY PHARMA game, but I need your help. Suggest an issue that PhRMA is or needs to be angry about and who the adversaries (little piggies) are. Also, describe the pigs' fortress that the Angry PhRMA Birds must knock down.

BI's Facebook Game Syrum to be Launched "When It's Ready." Needs to Obey Privacy & FTC Laws First!

I wrote a review of Boehringer Ingelheim's (BI's) long-awaited -- but not yet available -- Facebook game, Syrum, in yesterday's post to Pharma Marketing Blog (see "Pharma & Fun, Not Oxymoronic? Here Comes Gamification!"). Today, I brought up the topic of pharma-sponsored "gamification" during the #hcsmeu chat. BI's John Pugh -- who is in charge of the Syrum project -- saw the "bat signal" that was raised when the subject of Syrum came up and he joined the conversation.

One question I asked during the chat was "@JohnPugh When is Syrum actually going to be launched? Hope not same schedule as FDA guidelines! :-)" to which John responded: "@pharmaguy Syrum will be launched when its ready, but I expect the first round of testing to be B4 the end of this year."

Oh, Oh! This sounds suspiciously like FDA's "promise" to come up with social media guidelines by the "end of the year" (ie, 2010).

So the timeline for the ACTUAL release of Syrum is sometime in 2012 (after 1st round of testing) -- maybe even ONE WHOLE YEAR after the game was announced on Facebook! Related to that, I posted this comment to the #hcsmeu chat: "Personally, I'm a little miffed at BI for promoting Syrum so far in advance of its actual launch date! All hype, no substance!"

How can BI justify announcing Syrum on Facebook (and at several industry conference presentations) a year or more before the game is actually available to be played? Hint: note the signup section at the bottom of the screen:

Thursday, October 27, 2011

Pharma & Fun, Not Oxymoronic? Here Comes Gamification!

Speaking of Boehringer Ingelheim's (BI's) long-awaited -- but not yet available -- Facebook game, Syrum, John Pugh, head of BI online communications, said it's about "pharma and fun.” He quickly added “This is not an oxymoron. You can have the two in the same sentence.”

The objective of the game is to "save the world, one disease at a time, by harvesting molecules (a little like Farmville) and then using them as trading cards to play against diseases (a little like Pokemon). A player must first investigate molecular compounds at a research desk before putting them to the test in the laboratory, then conduct clinical trials and, if successful, advance a treatment to market" (see the MM&M review here). You can see a Syrum "trailer" here.

BI's objective is to create a "kick-ass game," says Pugh. A game that is for everyone, not just pharma wonks -- a game that "different that people will love playing."

I can't wait to try out the game and get to the last level, which I presume is "marketing." I imagine that once I master that level, I will find a pot of gold at the end (maybe not a POT, but I did see a BAG of gold!).

Is this game -- or any other game dreamed up by pharma marketers/PR people -- really "kick-ass?" Just looking at the 1980's style graphics makes me think not. Here's an example (showing the bag-o-gold):


Looks a bit nerdy.

If you really want a "kick-ass" game, first start with a "kick-ass" subject. For example, the pharmaceutical industry is kicking ass public-relations-wise on topics such as Medicare rebates, drug re-importation, patent law reform, and FDA PDUFA. This is a kick-ass fight for survival of the industry.

The second ingredient necessary for creating a "kick-ass" game is "kick-ass" graphics. I don't have to say much about that except that BI may be limited implementing the game as a Facebook app or maybe it's a budget issue.

The third ingredient of a truly "kick-ass" game is the ability to create some havoc. Killing terrorists, enemy troops, random pedestrians, etc., is a popular "kick-ass" gaming past-time, but not appropriate for use by the pharma industry. But you got to have "kick-ass" characters actually kicking ass!

So here's my idea for a "kick-ass" game that PhRMA could sponsor: ANGRY PHRMA!


Is this a game for everyone? Maybe not. I see it as a game for busy pharmaceutical executives to play on their commute to work or while attending boring meetings. The game will adequately inform these executives about the issues and help them bond with their trade association, which is at the forefront of the fight!

The objective of the ANGRY PHRMA game is simply to have fun slinging angry PhRMA birds and knocking over those piggy houses representing anti-pharma issues.  You're not going to learn much playing this game, especially if you are playing on a small screen like an iPhone. The text would be too small! It's just mindless, fun mayhem!

Now that's a "kick-ass" game!

Pfizer's Facebook Fiasco: Chapstick Slapstick Ad Uses Woman's Ass as a Prop

The AdWeek article "ChapStick Gets Itself in a Social Media Death Spiral" caught my attention yesterday. It describes how Pfizer mishandled negative comments about a Chapstick ad image posted on its Chapstick Facebook page. Here's the play-by-play of the "death spiral" as reported by AdWeek:

"ChapStick posts weird image on Facebook of a woman, ass in the air [see photo at left], looking for her ChapStick behind a couch. Blogger is disgusted, blogs about it. Blogger tries to reply on Facebook too. ChapStick deletes her comments. Others object to the image. ChapStick deletes their comments. ChapStick's ads with the line "Be heard at Facebook.com/ChapStick" start to look foolish. People keep commenting. ChapStick keeps deleting. People get angry. ChapStick gets worried. The image isn't even that big of a deal—it's ChapStick's reaction to the criticism that galls. 'What asses,' people say of ChapStick (get it?). People start commenting about why they can't see their old comments. ChapStick can't keep up with all the deleting. Comments are getting through, and they're nasty."

Eventually, Pfizer apologized (sort of). The official Pfizer Twitter account (@pfizer_news) said: "The ChapStick ad was not intended to offend anyone & we R pulling it ASAP. Thank you to our ChapStick fans for providing this feedback". It also apologized on Facebook:
"We see that not everyone likes our new ad, and please know that we certainly didn't mean to offend anyone!" the post says. "Our fans and their voices are at the heart of our new advertising campaign, but we know we don't always get it right. We've removed the image and will share a newer ad with our fans soon!"
But then, says AdWeek, there's this "very strange" second paragraph: "We apologize that fans have felt like their posts are being deleted and while we never intend to pull anyone's comments off our wall, we do comply with Facebook guidelines and remove posts that use foul language, have repetitive messaging, those that are considered spam-like (multiple posts from a person within a short period of time) and are menacing to fans and employees."

I emphasized "have repetitive messaging" and "those that are considered spam-like." "Repetitive" and "spam-like" are pretty subjective terms that can be interpreted differently by different people. I wonder if this comment moderation policy can be found in Pfizer's secretive social media "playbook" (for more on that, see here).

Obviously, this moderation policy can be used selectively to allow only positive posts such as these "repetitive" messages currently found on Chapstick's FB page: "I ALWAYS have Chapstick with me everywhere I go.", "ChapStick is an everday part of me:)", "Chapstick and my lips are bffs.", "i always have one in my pocket!", "I LOVE CHAP STICK".

But it's not Pfizer's moderation policy that Chapstick consumers originally complained about. It's the image of a "woman, ass in the air" that compelled this sort of comment:
"Have we really become so desensitized as women that we just ACCEPT that our bodies are used as props to sell products? That women in sexually suggestive poses and naked women (google "Chapstick and Amanda Ware") are being used to sell LIP BALM? That we just look the other way and say "eh, what's the problem?" There is a problem. A big one. By sitting on the sidelines and being ok with such images, you essentially give a thumbs up to the overt sexualization of women in the media. Look around. Pay attention. If that was your daughter's rear end showcased for all the world to see, how would you feel about it? -- Tasha Burwinkle Murphy (Redmond, WA)."
Of course, not all women commenters agree:
"People have too much time on their hands if they are worried (and harassing) a company for a silly ad like this. There is NOTHING offensive about it, unless someone is looking to make something offensive out of it." -- Nicole Leigh (Chalfont, PA)
There's a long-standing tradition of using women in ads -- including most direct-to-consumer (DTC) Rx drug ads. I've pointed this out many times here on Pharma Marketing Blog (most recently here and here). Until social media, however, women haven't been able to submit comments directly to advertisers about offensive ads. And women are VERY important when it comes to social media marketing and communications.

Women and Social Media
According to a Pew Research Center Internet & American Life Project survey (see here), "Young adult women ages 18-29 are the power users of social networking; fully 89% of those who are online use the sites overall and 69% do so on an average day. Looking more closely at gender differences, women have been significantly more likely to use social networking sites than men since 2009' (see chart below).


PEW SM Survey Gender Data


How can marketers better communicate with women via social media? That's a topic that I will explore in an upcoming Pharma Marketing Talk LIVE podcast: "How to Score With Women (as a Marketer) via Social Media." I invite you to participate and/or listen live or listen to the podcast archive afterward (here). You can also participate in the ongoing Twitter discussion using the hash tag #SMXFactor.

Wednesday, October 26, 2011

Channeling Steve Jobs to Solve Pharma's Innovator's Dilemma

There's a lot of buzz about pharma's current lack of innovative new products in the "pipeline" and what needs to be done about it.

"Innovation" itself is such a buzz word these days that AstraZeneca decided to sponsor an international "Innovation Survey" to find out "it means to different people and how valuable they thought it was to society" (see here).

When drug executives talk about innovation, they often use phrases like "drive value for our stakeholders and our business" as the focus of innovation.

Who are pharma's "stakeholders" and what drives value for business? Mostly investors.

Today, more than ever, pharmaceutical companies are fixated on profits and have lost the vision of the founder of Merck (George Merck) who said "We try to remember that medicine is for the patient. We try never to forget that medicine is for the people. It is not for the profits. The profits follow, and if we have remembered that, they will never fail to appear. The better we have remembered that, the larger they have been."

That sentiment sounds a lot like what Steve Jobs believed. Regarding how he turned Apple around after 1996, Jobs said "My passion has been to build an enduring company where people were motivated to make great products. The products, not the profits, were the motivation. Sculley [who replaced Steve Jobs as Apple's CEO for a short time] flipped these priorities to where the goal was to make money. It's a subtle difference, but it ends up meaning everything" (see "Steve Jobs Solved the Innovator's Dilemma").

The book Innovator's Dilemma by Clay Christensen was on Jobs' reading list. What's interesting to James Allworth, Fellow at the Forum for Growth and Innovation at Harvard Business School, is that Jobs "solved the conundrum." Aliworth noted that the causal mechanism at the heart of the Innovator's Dilemma is the pursuit of profit. "The best professional managers — doing all the right things and following all the best advice — lead their companies all the way to the top of their markets in that pursuit... only to fall straight off the edge of a cliff after getting there," says Aliworth. By flipping Apple's priorities away from profit and back to great products, Jobs took Apple from three months away from bankruptcy, to one of the most valuable and influential companies in the world.

I'm finding a lot of writings about Steve Jobs, whose management style and vision are being studied and applied to other industries. Here are some examples related to the pharmaceutical sector:


Adapting the learnings from Steve Jobs' career to the pharmaceutical industry may even be a "hot" enough topic to warrant at least a Pharma Marketing Talk podcast discussion or a Twitter chat. Who knows, it may even be worthy of a full industry conference! What do you think?

Monday, October 24, 2011

Physician Bailout Part Deux: On Average, Device Manufacturers Pay Every US Orthopedic Surgeon Over $9,000 Per Year!

File this under Pharmaguy's Believe It or Not! An analysis of financial payments made by orthopedic device manufacturers to orthopedic surgeons -- published today in the Archives of Internal Medicine (Arch Intern Med. 2011;171[19]:1759-1765) -- documents that if these payments were evenly distributed to all 25,000 surgeons, each surgeon would have received $9,120! This dwarfs the $750 per US physician that the drug industry pays to physicians every year (see "Physician Bailout: On Average, Pharma Pays Every US Physician Over $750 Per Year").

Of course, not every orthopedic surgeon receives money from the 5 largest orthopedic implant makers responsible for approximately 95% of all knee and hip implants used in the United States. (FYI: the 5 are Biomet Orthopedics, DePuy Orthopaedics, Smith & Nephew, Stryker Orthopaedics, and Zimmer.) In 2008, only 526 orthopedic surgeons received a total of more than $228 million (including $109 million in royalty payouts). On average, each of THESE surgeons received $433,460!

NOTE: 2008 may have been an unusual year due to royalty payouts. In 2007, 939 orthopedic surgeons received more than $198 million, which works out to $210, 863 on average per surgeon. Also, these figures do NOT include remuneration for meals and travel. Most payments are for consulting, royalties, and "research."

[In comparison, drug companies paid, on average, $1,520 to each physician that received payments, which DO incude meals and travel expenses.]

The authors were able to study payment trends for 3 of the 5 companies -- DuPuy, Smith & Nephew, Stryker -- over a 4-year period from 2007 through 2010. The mean payments per surgeon are plotted in the following chart.


The authors note that the average surgeon's salary is between $370,000 and $525,000 and they calculate that these payments by device companies would "likely represent 25% or more of an average orthopedic surgeon's annual income."

The 939 surgeons paid big bucks by device companies in 2008 represents only about 4% of the 25,000 orthopedic surgeons in the US. In comparison, drug companies made payments of some kind (including meals and travel reimbursement) to approximately 50% of ALL US physicians.

Apparently, device manufacturers are more selective than are drug companies regarding the physicians who receive payments. At least 44% of surgeons receiving money from device makers had an academic affiliation. The study's authors suggest that device makers may "curry relationships" with academic surgeons because they have the "potential to influence the future implant choices of all residents passing through a given program." Other critics have noted that high-volume surgeons also receive large consulting payments from device companies.

In a commentary published along with the study cited above, Robert Steinbrook, MD, of the Yale School of Medicine, noted that the term “consulting” is ambiguous. "Consulting related to research and development differs from consulting related to sales or marketing, and payments for consulting differ from research support or royalties. Consulting should be explicitly defined, and different types should be reported separately."

Meanwhile, CMS has yet to specify in regulations exactly how payments are to be classified when it comes time for ALL drug and device companies to report these payments to the federal government as required by the Patient Protection and Affordable Care Act (payments for 2012 must be reported by March 2013 and HHS will make these data public in September 2013).

Antidepressants: Top Advertised & 3rd Most Commonly Used Rx Drug

According to a recent CDC Data Brief (find it here), antidepressants were the third most common prescription drug taken by Americans of all ages in 2005–2008 and the most frequently used by persons aged 18–44 years. From 1988–1994 through 2005–2008, the rate of antidepressant use in the United States among all ages increased nearly 400%.

Key findings (2005–2008):

  • Eleven percent of Americans aged 12 years and over take antidepressant medication.
  • Females are more likely to take antidepressants than are males, and non-Hispanic white persons are more likely to take antidepressants than are nonHispanic black and MexicanAmerican persons.
  • About one-third of persons with severe depressive symptoms take antidepressant medication.
  • More than 60% of Americans taking antidepressant medication have taken it for 2 years or longer, with 14% having taken the medication for 10 years or more.
  • Less than one-third of Americans taking one antidepressant medication and less than one-half of those taking multiple antidepressants have seen a mental health professional in the past year
Here's a chart that breaks it down by age group and males vs. females:

Click the image for an enlarged view

Perhaps not so coincidentally, antidepressants are among the TOP advertised Rx category in 2010, according to the recent AdAge analysis I summarized in a previous post (see "Double Dip in DTC Spending Plus 33% Drop in Internet Display Ad Spending!" and pie chart below). 



Of the TOP 25 advertised drugs in 2010, DTC ad spends for antidepressants was 20% of the total (24% if you include Lyrica, which is not indicated for depression but is often prescribed for depression off-label).



The CDC data covers the time period 2005-2008, which is somewhat prior to when the full effects of the recession were felt by the recently unemployed. 


Women are twice as likely to take anti-depressants than men (Overall, 40% of females and 20% of males with severe depressive symptoms take antidepressant medication says CDC). Actually, for all degrees of symptoms, women are 2,5 times more likely to take antidepressants than men (see data in chart above).


Why are proportionately more women taking antidepressants than men? The CDC News brief doesn't say, but news reporters have suggested that more women are caregivers and therefore subject to depression linked to that.


Or could it be the DTC advertising of antidepressants that lead more women to ask their doctors about antidepressants (see, for example, "Women Need More Love, Less Drugs")?


Actually, practically every DTC ad (except ads for Viagra) "speaks" to women -- the ads most often focus on the woman as the sufferer of the indicated condition or the caregiver. 


This is part of an issue that I will discuss with several experts in an upcoming LIVE podcast titled "How to Score With Women (as a Marketer) via Social Media." One question I'd like to ask the experts is this: Do pharma marketers focus on women because they are the majority of the audience or because they buy more products (including drugs) than men (ie, are more prolific consumers than are men)? I tend to favor the latter over the former. What do you think?

Saturday, October 22, 2011

Double Dip in DTC Spending Plus 33% Drop in Internet Display Ad Spending!

Direct-to-Consumer (DTC) pharmaceutical advertising spending suffered a "double dip" recession between 2007 and 2010, according to  data presented in the AdAge Insights Whitepaper "Pharmaceutical Marketing: Targeting Consumers & Connecting Online" (find the link to that report here).

Spending dipped 14% from a high of $5.4 billion in 2006 to $4.7 billion in 2008 and dipped again 9% in 2010 compared to 2009, which saw a modest 2.4% increase over 2008. This "double dip" in DTC spending is apparent in the following chart (click on chart for larger view):

Measured media includes Internet display ads, but not search ads.
The industry spent $4.34 billion on DTC advertising in 2010. This is the lowest spend since 2004, when the industry spent $4.43 billion. There are many reasons cited for this decrease but the "main reason they’ve cut back is, like many other companies and consumers in the recession and tepid recovery, they simply have less to spend," according to the AdAge report.

The top 25 advertisers in 2010 accounted for 98.5% of the total spend. Pfizer was the biggest DTC spender. It's $967.5 million DTC budget in 2010 was more than double the DTC spend of its closest rival, Eli Lilly, which spent $470.8 million on DTC advertising in 2010 (see chart below; click on chart for larger view).


LIPITOR was the #1 most-advertised Rx drug in 2010. In 2010, Pfizer spent a whopping $272 million on DTC advertising for LIPITOR, which is scheduled to go off patent in November, 2011 (see chart below; click on chart for larger view).


I don't have data for 2011, but I notice a lot more LIPITOR ads these final days before the end of LIPITOR's market exclusivity. My doctor also recommended I switch from generic pravastatin to LIPITOR, assuring me that it will go generic by the end of the year. Some of that DTC advertising must have reached my doc, who previously had recommended CRESTOR, which spent only a minuscule $95 million on DTC advertising 2010! Maybe, however, it was the speaker fees Pfizer paid my doctor that changed her mind (see here).

As I have often noted, digital display ad spending is only a minor fraction of pharma's overall DTC budget. In 2010, digital represented only 4.7% of total DTC spending (see chart below).


Although Pfizer was the top spender on Internet display ads in 2010, it cut its digital budget by 55% compared to 2009 ($28.6 million spent in 2010 vs. $64 million in 2009).

Here's is how much the top 10 Internet display advertisers spent in 2010 compared to 2009:

The spending of these top 10 advertisers represent 74% of the total $204 million spent on Internet display advertising by the pharmaceutical industry in 2010. These companies spent 33% less on the Internet in 2010 than they did in 2009. It's likely the same is true for other companies as well.

Again, I do not have data for 2011 Internet spending by pharma. I do know, however, that a representative of Google just recently said "pharma needs to leverage the Internet" and that "pharma was not considered a key client by Google because of pharma’s low spend" (see here). That suggests to me that 2011 will NOT shape up much better than 2010.

If you look at the number of drug industry conferences devoted to digital marketing and the record attendance at some of these conferences, however, you might believe there is a turnaround in the works. Only time will tell.

Wednesday, October 19, 2011

AZ's Tony Jewell Receives 2nd Annual Pharmaguy Social Media Pioneer Award

Yesterday, I figuratively gave the Hawaiian shirt off my back to Tony Jewell (@tonyjewell), Senior Director of External Communications at AstraZeneca US, for his pioneering use of Twitter. I picked Tony specifically because AZ was the first pharmaceutical company to host a Twitter chat (#rxsave; see "OMG! AstraZeneca Hosts Twitter Chat & World Does NOT End!").

This memorable event was captured on video by the Pixels & Pills/Zomega people at the Digital Pharma East conference in Philadelphia:


Pharma Guy Gives Tony Jewell the Shirt Off His Back from Zemoga on Vimeo.

There were several other contenders worthy of this honor, including
  • Brad Pendergraph, Novartis
  • Dennis Urbaniak, Sanofi
  • Kevin Nalty, Janssen
  • Ray Kerins, Pfizer
  • John Pugh, Boehringer Ingelheim
  • Craig DeLarge, Novo Nordisk
Over 100 readers of this blog voted for their candidate in an unofficial poll (see "2nd Annual Pharmaguy Social Media Pioneer Award Goes to..."). Although Tony did not garner the most votes in this poll, I still picked him as MY favorite -- after all, this is the PHARMAGUY award, which is not a popularity contest.

Tony received many kudos via Twitter, but at least one fellow blogger -- PharmaGossip -- was not pleased because of Tony's PR role in defending Seroquel against critics (see "What a week for AstraZeneca's Tony Jewell!").

The open #rxsave chat was a pioneering event not just because it was the first ever pharma chat. It was pioneering because AZ did it even though it knew that Seroquel critics might try and "hijack" the discussion. In a Twitter chat it is not possible to "edit" or "not publish" comments made by participants. And the conversation can actually be hijacked by "disgruntled" patients or employees (see here).

As I noted previously, two critics were by far the most prolific tweeters during the chat. These 2 people made 256 posts -- about 30% of the total -- during the one hour chat session. @AstrazenecaUS made just 37 tweets and mostly listened and learned. AZ (ie, Tony Jewell) did not ignore the "critics," who posted off-topics tweets about Seroquel.

Despite the volume of off-topic, critical, and branded tweets made by a few people during the chat, the conversation about how AZ can help more consumers save money on prescription drugs went on and was, IMHO, successful.

So, even though Tony may be a PR person whose job is to promote good news about AZ and "spin" bad news, he deserves my award and I hope his pioneer social media effort is emulated by other pharmaceutical companies.

Friday, October 14, 2011

Was Lilly's #mmeds Twitter Chat a Discussion or a Press Conference?

Yesterday, I participated in the #mmeds Twitter chat regarding Medicare hosted by Lilly (see "More Pharma Twitter Chats: Medicare is Topic"). I had high hopes that this would be an informative discussion, but those hopes faded once the official "chat" began.

Before the chat began, Lilly encouraged followers to ask questions: "Hope you can join @Modernmeds for a Twitter chat on #Medicare tomorrow at 4:00. Ask questions now via #mmeds" @Modernmeds is the Twitter account associated with The Campaign for Modern Medicines, which is sponsored by Eli Lilly and Company.

The TOP TEN contributors (in terms of posts made) to the #mmeds chat were:
  1.  @Modernmeds 
  2.  @pharmaguy 
  3.  @LillyPad 
  4.  @WVRx 
  5.  @HoosiersWFH 
  6.  @PhRMA 
  7.  @GHLForg 
  8.  @mikecapaldi 
  9.  @Outlandes 
  10.  @patientaccess
I am #2 primarily because I kept asking questions, many of which went unanswered, such as:
  • What's Lilly's position viz-a-viz republican proposals to privatize Medicare or raise premiums for higher-income seniors?
  • To reduce deficit, should gov't raise the age of Medicare eligibility to 67 from 65?
  • Who wants to "break" Medicare Part D and how exactly? Let's go lite on the buzz words, pls. (posted in response to @Modernmeds tweet: "Medicare Part D is a government program that is not broken; let's not break it.")
  • why does pharma think Part D is at risk of being "broken?"
  • Can you summarize the "proposed changes" u are talking about please? (posted in response to @Modernmeds tweet: "The proposed changes would also cause higher Part D premiums for seniors.")
Finally, @Lillypad got so disgusted, it tweeted "we understand that you may not agree with us-- this is a discussion!" to which I replied "I haven't disagreed with anything u hv said so far - none of my Qs have been addressed."

I wasn't the only one to ask questions. Just before the official chat began, @ellsbelles3 posted this question: "I keep hearing that Medicare Part D is working and not to change it. what does that mean?" This sounded suspiciously like a setup from a phony ordinary citizen similar to "Joe the Plumber."

I immediately opened up @ellsbelles3's Twitter profile and found that despite the fact that the account was opened up more than 6 months ago, this was @ellsbelles3's FIRST and only tweet!

I just had to ask her: "@ellsbelles3 C'mon... you're a PhRMA agent, right? #mmeds". No answer.

That's @ellsbelles3 profile photo above (entitled "xmas_card_reasonably_small.jpg"). She's located in Washington, DC. The vast majority of people that @ellsbelles3 follows on Twitter are politicians and media correspondents -- exactly the types of people a public policy wonk like Amy O'Connor (aka, @Modernmeds and @LillyPad) would follow. In fact, Twitter says @aoconnorND (Amy O'Connor's personal Twitter account) is an account with a very similar profile to @ellsbelles3. So, sorry, Amy. You don't work for PhRMA (directly).

During the chat @Modernmeds and @PhRMA pushed out talking points such as "Medicare Part D is a government program that is not broken; let's not break it.", "Medicare Part D works, has high satisfaction rates, and the select committee should avoid mirroring Medicaid", "Recent #JAMA study found access to Part D saves $1200/yr per senior in healthcare costs", and "We are supportive of a market based system for Medicare Part D." @LillyPad mostly RT'd these points.

Eventually, I figured out what Lilly et al were most concerned about: a proposal by lawmakers (democrats, I presume) to require pharma companies to offer "rebates" to help cover the out-of-pocket costs incurred by seniors who find themselves in Medicare Part D's infamous "doughnut hole" (ie, where Medicare no longer pays for meds). The industry labels this proposal "price controls."

In the end, after 30 minutes, we all agreed that the discussion just began. I wish there was more discussion in the beginning rather than the very end. I tried my best, but it's difficult when the chat organizers have an agenda and dominate the "discussion" with talking points, buzz phrases, and calls to action.

Lilly et al obviously have a different view of what a Twitter chat should be than do I. To them it's a press conference, not a conversation. Like a press conference, they can duck tough questions or just ignore inquisitive journalists (and bloggers) in the "audience." In fact, that's what I felt like during this chat: just another member of the "audience" who is expected to soak up and repeat talking points.

"We will have a chat next Wed at 10 AM, with our President of Lilly USA, Dave Ricks," said @Modernmeds at the end of yesterday's chat. Unfortunately, Mr. Ricks won't be using his own Twitter account (I don't believe he has one), but will "he will be using @Modernmeds's Twitter handle next week," said @Modernmeds. Which leads me to question whether Dave Ricks will actually participate in the chat or if @Modernmeds (Amy O'Connor) will just play the part of Dave Ricks (ie, be his "mouthpiece" as they say in the PR world).

Thursday, October 13, 2011

Is There an Upward Career Path Within Pharma for Social Media Pioneers?

I just tweeted this bit of news: ".@Alex__Butler - 1st recipient of Pharmaguy SM Pioneer Award - leaves J&J to start online comms agency: @The_Social_Moon #hcsmeu #hcsmuk" Alex received the FIRST Pharmaguy Social Media Pioneer Award last year when he was Digital Strategy and Social Media Manager at Janssen UK (see "First Pharmaguy Social Media Pioneer Award Given to Janssen's Alex Butler"). His pioneering work was the Psoriasis 360 Facebook page (see "Markets as Conversations: Can You Have a Discussion with 'Psoriasis 360' on Facebook?").

At that time, I presented the following chart showing how readers of Pharma Marketing Blog voted for a list of nominees:


Since then, several people on the list are no longer employees of pharmaceutical companies. Aside from Alex Butler, the "dropouts" include Marc Monseau, Shwen Gwee, Len Starnes, Gary Monk, and Michael Parks.


More Pharma Twitter Chats: Medicare is Topic

The Campaign for Modern Medicines (@Modernmeds) and Eli Lilly & Company (@LillyPad) will host two separate Tweetchats on Medicare Part D to "help raise awareness on the value of the current system, and to learn how to prevent potential changes to it." As reported by PhRMA in a blog post (see "Join the Chatter on Medicare"), "the first chat will be held on Thursday, Oct. 13th from 4-4:30PM EST, with Bart Peterson, Sr. Vice President of Lilly Corporate Affairs & Communication" and the second will be held on Wednesday, Oct. 19th at 9-9:30AM EST "to share your thoughts on the economic implications of proposed changes to Part D, with President of Lilly USA, Dave Ricks as host." Join the conversation using the hash tag #mmeds.

The latter chat is a milestone because it is the first time ever that the president of a pharmaceutical company will host an open Twitter chat.

Recall that the first ever PHARMA Twitter chat was hosted by Astrazeneca in February, 2011 (see "OMG! AstraZeneca Hosts Twitter Chat & World Does NOT End!"). The subject of that #rxsave chat was how to "raise awareness about helping patients save money through prescription savings programs." The discussion was led by Jennifer McGovern, the director of the AZ&Me prescription savings programs.

Eli Lilly is on a campaign to block any changes in Medicare that implement price controls in the prescription drug payment section (Part D) of Medicare. "A new congressional super committee has been charged with raising the debt ceiling and eliminating more than $1 trillion in spending by the end of the year," noted Lilly's Amy O'Connor -- Associate Consultant, Channel Payer Marketing, Managed Healthcare Services; @ambro93 -- in a blog post (see "If It’s Not Broke… Preserving Medicare Part D"). "One of the current proposals includes instituting a Medicaid-like government price control in Medicare Part D."

What Lilly and other pharmaceutical companies are concerned about is a proposal to add Medicaid-style rebates to the Medicare Part D program that has been introduced in Congress by Representative Henry Waxman (D-CA) and Senator Jay Rockefeller (D-WV). The proposal (S.1206 - Medicare Drug Savings Act of 2011) would require drug manufacturers to provide drug rebates for drugs dispensed to low-income individuals under the Medicare prescription drug benefit program.

Meanwhile, a congressional deficit-reduction panel has a Nov. 23 deadline on what cuts, if any, to make to Medicare, Social Security, Medicaid and other entitlement programs.

Thus, there is an ad hoc coalition of industry and senior citizen groups (ie, PhRMA and AARP) opposed to changes in Medicare: the industry doesn't want to see rebates and seniors don't want to see cuts to benefits or raising premiums.

@lilypad tweeted: "Hope you can join @Modernmeds for a Twitter chat on #Medicare tomorrow [ie, TODAY] at 4:00. Ask questions now via #mmeds"

As of now there are no pre-chat questions on the #mmeds list, so I will ask a few that address ideas for keeping Medicare solvent aside fro instituting rebates. such as:

"What's Lilly's position viz-a-viz republican proposals to privatize Medicare or raise premiums for higher-income seniors?" Another question I have is "To reduce the deficit, should the gov't raise the age of Medicare eligibility to 67 from 65?"

I encourage readers to ask their own questions and join the chat later today.

Tuesday, October 11, 2011

Without Free Gifts from Pharma to Docs, Would Research be Useless?

In a recent blog post (here), PhRMA said "Without Promotion Research will be Useless." To support its case, PhRMA cited "an interesting opinion editorial" in the latest edition of the Annals of Emergency Medicine – the medical journal of the American College of Emergency Physicians (ACEP). In the op-ed, entitled "Limiting Gifts, Harming Patients," Emory University economist Paul Rubin, Ph.D. expressed concern that ACEP policy regarding Gifts to Emergency Physicians from Industry "could have the unfortunate effect of limiting the exchange of critical information between medicine makers and physicians about the benefits and risks of new medicines, how to use them properly and how best to diagnose the right candidates for particular treatments."

Basically, Rubin and PhRMA are saying that gifts to physicians are an integral part of promoting new discoveries to physicians and without these gifts and promotion, medical research would be "useless."

I haven't read the op-ed piece because it cost about $32 to download the pdf file for 24 hours! Highway robbery is all I have to say about that! I did, however, request a complimentary copy, but haven't received any response yet. No matter. The op-ed piece obviously is attacking ACEP policy on the subject of free gifts to emergency physicians. You can find that policy here.

What's so onerous about the ACEP policy that an op-ed piece would attack it as "harmful to patients" and PhRMA would claim it renders research useless?  I looked at the policy to learn first hand why it's research Agamemnon.

First, the ACEP policy does NOT make ALL gifts to physicians from pharma unacceptable by their members. Here are gifts ACEP says are perfectly acceptable:

Emergency physicians may accept educational gifts that are not of substantial value ($100 or less). Examples include:
  • Occasional modest meals in an office, clinic, or hospital setting that accompany an educational presentation 
  • Evidence-based clinical care guidelines or pocket handbooks 
  • Anatomical models designed for patient education 
  • Informational materials to facilitate patient understanding of a disease or treatment
This sounds familiar. The PhRMA Code on Interactions with Healthcare Professionals says essentially the same thing. Code #11 states "It is appropriate for companies, where permitted by law, to offer items designed primarily for the education of patients or healthcare professionals if the items are not of substantial value ($100 or less) and do not have value to healthcare professionals outside of his or her professional responsibilities. For example, an anatomical model for use in an examination room is intended for the education of the patients and is therefore appropriate..."

The ACEP policy, however, cites examples of gifts that should NOT be accepted. These include:
  • Meals provided for physicians or their family members, staff, or guests (other than modest meals accompanying educational presentations, as noted above)
  • Personal or recreational items, such as tickets to theatrical or sporting events
  • Direct subsidy of any expenses (such as registration, travel, lodging, meals) incurred in attending CME events or other educational or professional meetings (All industry support for such activities should be provided directly to the activity provider to offset program costs or to a general fund for continuing education programs.)
  • Cash or cash equivalents such as gift certificates or vouchers
  • Gifts offered in exchange for prescribing or using a product
  • Medical equipment, such as stethoscopes or otoscopes
  • Payment for token consultant or advisory arrangements
  • Medical products for the personal use of the physician, the physician's staff, or family members
Again, PhRMA takes a similar stance. Code #3 states: "To ensure the appropriate focus on education and informational exchange and to avoid the appearance of impropriety, companies should not provide any entertainment or recreational items, such as tickets to the theater or sporting events, sporting equipment, or leisure or vacation trips, to any healthcare professional who is not a salaried employee of the company."

It seems tio me that Dr. Rubin could just as well criticized the PhRMA Code, which limits gifts to physicians, as being "harmful to patients." So, I am confused why PhRMA would cite Rubin's op-ed piece in defense of promotion being necessary for research success.

Of course, the drug industry is free to promote drugs to emergency and other physicians. There's nothing in the ACEP policy that limits access to physicians for promotional purposes. In fact, the policy states:
"The College also recognizes that emergency physicians should be free to interact with industry representatives if they choose, and that physicians may receive useful information about particular products from industry representatives. Emergency physicians may receive compensation at fair market value from pharmaceutical and biomedical device companies for legitimate professional services rendered, including participation in research and service as faculty in continuing education programs."
What PhRMA and Dr. Rubin should have focused on is the role of "promotion" in general and not the free gifts to physicians straw man. Rubin, for example, says that "Research and promotion are merely 2 sides of the same coin," which is a more rational point of view that deserves a bit more analysis.

What PhRMA and Rubin are claiming is that pharmaceutical companies need to have the freedom to promote new medicines to physicians (and "maybe" consumers too, says Rubin) in order for research to have a successful commercial outcome. I can agree with that. But are gifts to physicians really necessary to achieve that outcome? I don't think so.

There are many other ways for pharmaceutical companies to reach physicians with promotional messages, including social media (eg, Twitter posts). If a gift is required to get the message out about research, then pharma is in deep doo doo.

What's needed is NOT promotion. What's needed is true two-way communication. Without that kind of communication, research truly is useless.

The Pharma Marketing News article "Physician Participation in Peer-to-Peer Social Media Sites," which will be published on October 12, 2011 (free to subscribers; available here to everyone else for $4.95) speaks about what physicians want from pharma: users of online physician peer-to-peer communities want open and transparent participation by pharma and non-promotional information: “Give us the data, let us make up our minds, don’t try to spin me, I’ve got a rep who does that,” is a typical physician comment. “Make dialogue two-way, respect us, and focus on scientific exchange,” is another. Physicians are looking for negative findings also!

Some other information physicians want from pharma companies include:
  • Drug pipeline information. 
  • New information about product—not interested in being detailed, however. 
  • Focus on topics like re-imbursement, patient education materials, etc.
So there's a lot more to "promotion" than detailing physicians after gaining access made possible by free gifts!

P.S. I finally did get a copy of Dr. Rubin's Op-Ed piece from ACEP. Thanks very much. The Annals of Emergency Medicine will publish a "rebuttal" to Dr. Rubin in the next few weeks. Meanwhile, here's my rebuttal:
After reading just the first three paragraphs of Dr. Rubin's op-ed, I am bowled over by his cherry picking of "the best evidence" (eg, 3 citations of the same author). Dr. Rubin also said that "the best evidence" indicates that ACEP's policies are "likely to lead to worse outcomes for patients." He did not cite any references to "the best evidence." 
Dr. Rubin's naivete regarding the FDA approval process is breathtaking. According to Dr. Rubin,  the FDA drug approval is "restrictive"; ergo "this means that we would expect that newer drugs would be better than older drugs. Because this is so [my emphasis], actions that lead to increased sales of newer drugs [eg, free gifts for physicians] would be expected to improve patient health." Whaaa? Dr. Rubin offered no proof -- eg, clinical outcomes -- that this is so. That did not stop him, however, from criticizing studies that find fault with pharma advertising because they too offered no real proof; ie, "clinical outcomes."
It doesn't take a PhD in economics to rebut Dr, Rubin's shoddy analysis. Even so, I can't wait to see the rebuttal to be published in the Annals of Emergency Medicine!

Thursday, October 06, 2011

In Memory of Steve Jobs Will Novartis Sales Reps Really Embrace iPads?

Pharmalot reported today that "In a memo this morning, David Epstein, who heads Novartis Pharmaceuticals, wrote that before the end of next year, more than 80 percent of the sales reps will give up their PCs and switch all detailing and related work to iPads.'' The memo, which can be found here, is reproduced below:
Posted on 9:52 AM, 06 October 2011
In memory of Steve Jobs - a role model 
"Today a great man has died - one who has forever changed the world. A great innovator, a corporate leader and a visionary who would not take no for an answer. A man who could perceive customer desire in a very clear way, marry it with technology and compel an organization to execute at the highest level to deliver customers a truly unique and compelling experience. A man I adopted as a role model as we began to galvanize our organization to launch Afinitor at a meeting of our Oncology leadership held in Mexico in 2008. 
"Ultimately, after a long fight, he succumbed to the ravages of PNet (pancreatic neuroendocrine tumor), a cancer for which Novartis now has two approved medicines: Sandostatin LAR and Afinitor. With Steve Job's death it is clear that we cannot rest as we work to discover, develop and commercialize still better medicines. It is medical intervention - great doctors, surgery, medicines and more - that allowed us to enjoy having Steve on this planet just a little bit longer so he could inspire a new generation and give us great inventions like portable digital music, the iPhone, the iPad and iCloud. 
"In his memory we commit today that more than 80 percent of Novartis Pharmaceutical field forces around the world will give up their PCs and be executing their call planning, detailing, emailing, and communicating with each other and physicians via iPads before the end of 2012. Please help me to make this a reality. As a result we will be able to make more impactful calls thus better able to ensure that every patient who should be on one of our medicines has access. Our marketers will be empowered to more quickly update digital detail aids and interactive apps with the latest information. Our marketers will better understand almost instantly what our field forces find helpful in their daily work and what is useless. Our field forces will be able to get more of their work done during the day while waiting for their next appointment rather than doing administrative work later in the day. And there are many other possibilities. Let’s use our positive memory of Steve to do some more good in the world. I know we can."
Not so long ago, I was hearing that pharma companies bought iPADs without having a clear strategy for how they were going to be used. It was believed that thousands of these iPads were housed in warehouses and not deployed.

It seems that Epstein is using the "in memory of Steve Jobs" memo as a tool to empty his warehouses of iPads and encourage reps to use them "to get more of their work done during the day" and "do some more good in the world."

But what are Novartis reps saying about the iPad? Here are some tidbits I found on the Novartis board over at Cafe Pharma:
  • We are the laughingstock. 'Oh look, there goes the reps that are so incompetent in getting their message across, they are replaced by an iPad!' Hey doc, wanna play Angry Birds with me? 
  • Next step in e-detailing is downloading "e-rep" app (doc gets to pick male/female e-rep to interact with,,need samples? click!, need a quick product review? click, heard the latest about managed care in your area? click! 
  • Actually...with iPads why do we need high priced reps? The managers will be fine...you...I wouldn't be too sure. 
  • I'm going to record all calls with the ipads camera & upload to youtube & publish live as soon as the next severence (sic) is paid out
At least pharma reps are not "selling sugar water to kids" as Steve Jobs once said of John Scully when he hired him to run Apple. Scully promptly ran it into the ground.

Does this memo violate FDA Regulations?

P.S. Epstein's memo was posted to a site called FreePDFhosting.com, which allows anyone to upload PDF files for free (duh!). I am not sure who posted Epstein's memo to this site, but I doubt it was Epstein, who probably intended it to remain an internal document. 

However, now that it is a PUBLIC document, easily accessible by any one, is it subject to FDA regulation regarding branded communications?

I notice that the memo refers to Novartis anti-cancer drugs by brand name and includes the FDA-approved indication: pancreatic neuroendocrine tumor. However, the memo does NOT include any fair balance (major side effect information). Technically, therefore, this memo -- as it appears on FreePDFhosting.com -- violates FDA law. Since FreePDFhosting.com has a rule against uploading PDFs that are "illegal or violates any laws," the memo should be removed from the site (hopefully before the FDA sees it).

Tuesday, October 04, 2011

2nd Annual Pharmaguy Social Media Pioneer Award Goes to...

Pharmaguy Social Media Pioneer AwardReaders of Pharma Marketing Blog may recall that last year I presented the first ever "Pharmaguy Social Media Pioneer Award" to Alex Butler, Digital Strategy and Social Media Manager at Janssen UK (see here).

I've decided to make this an annual event and will present this year's award -- which is the coveted Pharmaguy Hawaiian shirt depicted in the illustration on the left -- to another pharmaceutical company employee who I believe deserves recognition for doing pioneer work in social media.

I will make the presentation at ExL's 5th Annual Digital Pharma East conference in Philadelphia (day and time TBD). I hope you will be there to witness this major event.

During the presentation, I will "pass on" the shirt that Alex Butler has been keeping safe in a secret location in the UK.

Who will be the lucky recipient of this year's award? Will the shirt return to America and reside in the closet of an American? Time will tell.

Here's a list of contenders. Pick the one you like. While this little poll will not determine the winner -- that's Pharmaguy's prerogative -- it will be interesting to see who readers of this blog think should be the winner.

Who Should Get the 2011 Pharmaguy Social Media Pioneer Award?
Craig DeLarge, Novo Nordisk
Tony Jewel, AstraZeneca
Ray Kerins, Pfizer
Kevin Nalty, Janssen
Brad Pendergraph, Novartis
John Pugh, Boehringer Ingelheim
Dennis Urbaniak, Sanofi
None of the above


  
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