Metformin, "the only pill approved in the U.S. for treatment of children with type 2 diabetes is proving surprisingly ineffective, according to a new study, heightening worries about the fast-growing and largely preventable disease," reports the Wall Street Journal (see here).
The study also included GSK's Avnadia, which is not approved for use in children and has been linked to an increase of heart attacks, curtailing its use in treatment.
699 children between 10 and 17 years old, essentially all of whom were obese and who had been diagnosed with type 2 diabetes for an average of eight months were randomly assigned to one of three treatments: metformin, the mainstay diabetes medicine; metformin plus a lifestyle-intervention program; or metformin plus Avandia.
52% of those on metformin alone had failed, compared with 47% on metformin plus lifestyle change and 39% on the two-drug regimen. Statistically, only the two-drug treatment was considered superior to metformin.
The results prompted other experts to renew calls for societal efforts to combat diabetes and obesity among young people. Here is a chart showing the prevalence of obesity among young people in the U.S.:
Coincidentally (or maybe not), the National Institutes of Health (NIH) sent out a press release today announcing "The Weight of the Nation" documentary series and public awareness campaign focused on obesity in the U.S. HBO, in association with the Institute of Medicine, NIH and the Centers for Disease Control and Prevention, and in partnership with the Michael & Susan Dell Foundation and Kaiser Permanente Foundation, developed four documentaries focused on obesity. The project also includes a three-part HBO Family series for kids, 12 short features, a social media campaign, and a nationwide community-based campaign to mobilize action to move the country to a healthier weight. See the press release here.
According to Open Secrets, which tracks industry lobbying, "the pharmaceutical industry as a whole spent $69.6 million on lobbying in the first three months" of 2012 (see "Pharma, Utilities and Big Ag Lead Lobbying in 2012"). Included in that category are "Health products" other than Rx medicines. Looking at just "Pharmaceutical Manufacturers" (including PhRMA, the drug industry's U.S. trade association), the total lobbying spend in the first quarter of 2012 was $48.1 million.
Here's a chart of the biggest spenders in this category so far:
Annual pharmaceutical lobbying -- as measured in dollars -- increased more or less steadily since 1998, but peaked in 2009 at $186.1 million. If the spending in 2012 continues at the pace of the first three months, the pharmaceutical industry will spend approximately $192.4 million in lobbying for the year (see chart; the 2012 bar is projected as 4 X Q1).
Open Secrets contends that the pharmaceutical industry is "clearly focused on protecting the existing provisions of Medicare Part D, which subsidizes the cost of drugs. Critics in Congress have targeted the program for its huge cost, and some want it to be more transparent about how reimbursements are set. Also at issue," says Open Secrets, "is whether the government should be able to negotiate drug prices with the companies, something that is currently prohibited."
The pharmaceutical industry is keen on preventing changes to Medicare -- especially changes that would allow the government to negotiate prices. Back in October, 2011, the Campaign for Modern Medicines (@Modernmeds) and Eli Lilly & Company (@LillyPad) hosted at least one Tweetchat 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" (see "More Pharma Twitter Chats: Medicare is Topic" and "Was Lilly's #mmeds Twitter Chat a Discussion or a Press Conference?").
Although it is difficult to link lobbying spending with specific bills in Congress, the drug industry -- especially through PhRMA -- is also lobbying hard to get a favorable PFUFA (FDA funding) bill passed (see, for example, "Angry PhRMA, Level 1: PDUFA").
Of course, 2012 is also a presidential election year and that will likely keep lobbying -- including donations to candidates and their political parties -- at a high level throughout the year. Here's some interesting data showing the trend in pharma donations by political party (see more such data here):
It seems that the drug industry was intent on getting Republicans elected in 2000 and 2002 and when that was accomplished, they cut back and reaped the benefits of the status quo, or as some would say the "do nothing" Congress.
Novo Nordisk is back on Pinterest! Recall that Novo "de-pinned" all its images a few days after I first discovered them on Pinterest (see "Pharma Pinterest Update: Bayer US Pins, Novo Nordisk Depins!"). Novo now has 3 "boards" and 15 images on the site.
The most interesting "board" is the one devoted to "Patient Stories." The images pinned to this board link to videos that feature narratives spoken by real patients who suffer from various forms of diabetes. Here are the images:
This, I believe, is a very good use of Pinterest by a pharmaceutical company and I expect others to follow Novo's lead. I am sure, however, that everyone is waiting to see what mischief will befall Novo. So to hurry this process along, I did two things:
I reported one pin to Pinterest and "complained" that it lead to a "drug site."
I added a comment to another pin asking Novo if the patient was paid to participate in the video.
I'm a trouble-maker, I know. But someone has to test pharma's use of Pinterest. Let's see if they pass the Pharmaguy Stress Test.
Currently, there is a lot of worry about spammers using Pinterest. Spam pins, for example, link to pages that only contain Google Adwords. Pinterest is trying to deal with this, but many people, like myself are becoming victims of their over zealousness.
Every one of my pins that has a link in the comment section is "blocked" by Pinterest when users click on the link. Pinterest says that the pin has been "reported" as being spam or leading to "objectionable content." All the links are to this blog.
I doubt that Pinterest has bothered to investigate "reports" to determine if they are legitimate or not. They are simply "blocking first and asking questions later." Actually, Pinterest doesn't even tell you that you are being blocked and they certainly haven't asked me any questions about whether or not I am a spammer.
So, I am testing Pinterest by reporting one of Novo's pins.
As I mentioned in the previous post cited above, comments are Pinterest's Achilles heel as far as pharma companies are concerned. It's as easy to make comments on Pinterest as it is on Facebook. We have seen how pharma has run away from Facebook because comments cannot be turned off. Will the same happen with Pinterest?
Meanwhile, you might be interested in taking the following survey. Afterward. you'll be able to view a de-identified summary of results:
Create your free online surveys with SurveyMonkey, the world's leading questionnaire tool.
"Put simply," says AdvaMed, the trade association of the medical device industry, "the [user fee agreement recently reached between FDA and the medical technology industry] is good for FDA; it is good for industry; and most of all, it is good for American patients."
The House version of the FDA user fee bill, which is currently being marked up, is "widely expected to contain more industry-friendly provisions, especially for medical device makers," according to Politico (here).
"One in particular is the HELP bill’s efforts to streamline the FDA’s ability to reclassify the risk level of devices. Whether a device is deemed more, or less, risky can dramatically change the amount of clinical data and other studies required for approval.
"Currently, such reclassification is a long-term rulemaking process that must be cleared by Health and Human Services and the Office of Management and Budget along with the full complement of public hearings and comment periods. The HELP bill would turn that into a faster administrative process without the extra layers of oversight."
According to Politico, AdvaMed is still pushing something in between "to preserve some of our due process rights,” AdvaMed's head of government relations (ie, chief lobbyist).
Details of "FDA’s ability to reclassify the risk level of devices" may be hidden in the bills. One of these details may concern "a loophole in the law that allows [medical device manufacturers] to submit new products to the FDA for instant review as long as they classify them as an upgrade even if the product has changes that could affect safety," says Consumer Reports. "Companies now use the process 90 percent of the time, according to a report published by Rep. Ed Markey, D-Mass., who is an advocate for industry reform."
Meanwhile, the FDA wants to assign a new bar-code-like identification number to medical devices to help it detect malfunctions in devices AFTER they have been approved. By tapping into medical and billing records from hospitals and insurance companies, FDA hopes to identify faulty devices before they cause deaths, such as the 686 deaths from 2009 to last year connected to automated external defibrillators and at least 20 deaths recently linked to surgically-implanted heart defibrillator wires.
One of the leading manufacturers of heart defibrillation devices is Guidant. A few years ago, it had to recall one of its devices that was linked to several deaths (see NYT article). That derailed a takeover bid by Johnson and Johnson (JNJ). Meanwhile, JNJ is actively growing its medical device business and will soon acquire Synthes -- a Swiss manufacturer of orthopaedic devices -- for $21.3 billion. Devices now account for 40% of JNJ's worldwide sales (see chart below; source of data: CNNMoney.com and Q1 2012 financial statement).
JNJ may position itself as a "consumer" products company, but its main business is pharmaceutical drugs and medical devices. With the acquisition of Synthes, which had sales of nearly $4 billion last year, JNJ's device business will be an even bigger slice of its global sales pie (maybe 43%).
Pharmaceutical brand teams are generally dissatisfied with their outsourced digital marketing, according to a study by Cutting Edge Information (see press release).
In surveys and interviews, executives acknowledged the challenges that their industry presents to external communication agencies, not the least being the lack of clear regulatory guidelines for pharmaceutical digital marketing. Despite that, pharmaceutical brand teams' opinions of agency performance are generally negative. Across all activity categories, only 21 percent of responses were "good" while 35 percent were "poor." No respondent ranked their experience with outsourced digital marketing as "very good." This is based on 34 responses.
It seems that familiarity breeds contempt -- the poor rating of digital agencies comes at a time when pharma marketers have increased the proportion of marketing dollars spent on digital.
Data from the summary report claims that "traditional digital marketing" (Web sites, web display ads/banners, email, search) represented 26.6% of the overall pharma marketing budget in 2011 compared to 23.7% in 2010; a 12% increase. These absolute percentages are similar to what PwC/IAB reported for all industries (see, for example, this chart). But my analysis suggests only 11% of pharma's total DTC marketing budget is devoted to "traditional digital marketing" (see "Ad Dollars Follow Eyeballs to Web").
Social and Mobile marketing are not "traditional digital marketing" according to Cutting Edge's definition. While the share of marketing dollars spent on traditional digital marketing has increased 12% from 2009 to 2011, the share for Social and Mobile digital "channels"/technologies (which is it?) have increased by 99% and 288%, respectively, according to Cutting Edge data (see chart below created from Cutting Edge data).
The report cites this caveat about the data: "this data does not suggest that actual spending by pharmaceutical companies on print media declined 26% between 2009 and 2011 but that print media is taking on a less significant role as a percentage of the total marketing mix." The same is true for the increase in share of social media and mobile: these "channels" are taking on a MORE significant role, especially since there are data suggesting that the OVERALL pharma DTC (direct-to-consumer) marketing budget decreased from 2009 to 2011 (see this chart).
Have you ever seen those animated stories any one can create using a service called "Xtranormal?" According to the web site, "Xtranormal helps you create amazing interactive stories with a few clicks and a little imagination."
Basically, you create a script, choose characters, scenery, gestures, etc. and "Ta-da! You're instantly an animator, poet, pundit, educator or comic. Couldn't be easier," says Xtranormal.
Janssen Therapeutics -- a division of Janssen Products, LP, which is part of Janssen Pharmaceuticals, which in turn is a Johnson and Johnson company -- is currently "piloting" a series of animations that remind me of Xtranormal scripted animations like the one above. The script for the Janssen pilot, however, comes from the patient information sheet that accompanies the prescription medicine PREZISTA® (darunavir), which is used in the treatment of HIV.
To enhance patients’ access to and use of this information, Janssen launched this pilot program -- called The PREZISTA Zone (here) -- designed to "transform the experience of exploring this information online through digital storytelling and animation."
Features include the story of Jacob, a man who has just been diagnosed with a "chronic disease" (ie, HIV infection), told through a series of seven animated clips that help illustrate sections of the Patient Information (read more about this here).
Unfortunately, showing you the animations embedded in this blog post is problematic because they were created with Adobe Flash. If you have a flash-enabled browser, you'll be able to view the "trailer" video created by Janssen. I have embedded that bit of flash code below. If, however, you are viewing the mobile version of this blog on your iPhone or iPad (two of the leading mobile devices used by physicians and by patients like Jacob), you won't be able to see the "trailer." You also won't be able to view any of the animations over on the PREZISTA Zone web site.
You can see why these animations remind me of "movies" created with Xtranormal.
The following screen shot shows Jacob's physician explaining the side effects of PREZISTA to Jacob using what might be an iPad (probably would be in the real world).
Too bad Jacob's physician can't show Jacob the relevant PREZISTA Zone animation. She could be attending other patients while Jacob watched the animation and then answered any questions he may have had when she returned. That would have improved her practice. But she has to go through the list of side effects just as if she were reading them from the patient information sheet. That's what it sounds like when watching this animation, which reminds me of how the characters sound in the Healthprize animation.
Of course, Jacob has a smartphone (most likely an iPhone), which he is seen using in the following frame where he is talking to his sister about how to store PREZISTA:
“As a physician, I know from experience that people tend to learn in different ways, and that can pose different kinds of challenges for patients trying to educate themselves about their medications,” said Bryan Baugh, MD, Medical Director at Janssen Therapeutics. “We designed The PREZISTA Zone to meet a variety of personal preferences for learning and interacting with online information.
Too bad Jacob cannot "learn and interact" with The PREZISTA Zone via his iPhone!
1Healthprize is an advertising client of Pharma Marketing News but I have not been paid to mention Healthprize in this blog post.
New prescriptions written per month for Victoza -- diabetes treatment sold by Novo Nordisk -- have leveled off just after Novo signed on celebrity chef Paula Deen as a spokesperson. Prescriptions for the drug were rising steadily for a year and a half prior to that.
The two events may be coincidental (and the flattening may be temporary), but interesting nevertheless because it puts a hole in the theory that the return on celebrity endorsements of pharma products is worth the investment.
The Victoza Rx data comes from a chart I found in the petition filed by Public Citizen with the FDA that asked the agency to withdraw Victoza because of increased risks that patients may developed pancreatitis, serious allergic reactions and kidney failure (find the petition here).
The chart shows a plot of "Number of Prescriptions" of Victoza (liraglutide) versus Byetta (exenatide), a competing drug marketed by Amylin (see below):
It appears that the number of (new) prescriptions written per month has leveled off at about 150,000 -- a number that has not increased since about January 2012 when Novo announced that Deen would be a spokesperson (see "My Bad! Paula Dean Shills for Novo Nordisk, Not Novartis").
In its petition, Public Citizen states "As can be seen by subsequent FDA safety alerts issued for acute pancreatitis, thyroid toxicity, and kidney failure over liraglutide’s first year and a half of marketing, warnings have not succeeded in preventing serious adverse reactions. This is especially unfortunate because diabetics are already at increased risk for pancreatic and kidney toxicity. ... The number of prescriptions for liraglutide has been steadily rising, putting increasing numbers of patients at risk of adverse reactions to this drug. The increase in adverse reactions is seen in the continuing reports in the FDA’s database, making it clear that the FDA’s use of warnings is not sufficient protection."
Public Citizen, however, does not report that based on post-marketing data, BYETTA has also been "associated with acute pancreatitis, including fatal and non-fatal hemorrhagic or necrotizing pancreatitis" according to the safety information that is part of its "package insert."
A couple of questions:
Will this new focus on Victoza safety information scare Paula Deen?
Can she discontinue taking Victoza if she felt it was necessary or would her contract with Novo prevent her from doing that (she does take other medications to control her diabetes)?
A Twitter pal suggested I would "enjoy" this Los Angeles Times article: "Consumers using social media for medical information, report says." The report from PwC’s Health Research Institute found that "one-third of consumers are using Facebook, Twitter and other social media sites to seek medical information, discuss symptoms and express their opinions about doctors, drugs and health insurers."
This sounds like good news for pharmaceutical marketers who want to "engage more with consumers online since they are increasingly making medical decisions based on the information they find there."
While surfing the Health Research Institute's web site for the details, I stumbled upon a chart summarizing a previous survey of 1,000 US adults in the fall of 2011. The chart, which I found here, allowed me to segment the data by age and gender, which are two demographics that are very important to the pharmaceutical industry.
First of all, most pharma marketers want to reach an somewhat older population who are most likely to be suffering from some medical condition for which new drugs are being developed - type 2 diabetes, for example.
Here are the data for two age groups (25-34 and 45-54):
I imagine that the 45 to 54 age group is the "sweet spot" for pharmaceutical marketers. According to this survey only 25% of consumers in that group uses any type of social media for healthcare purposes.
NOTE: Comparable data from Manhattan Research’s Cybercitizen Health® U.S. 2011 study, suggests that 65% of U.S. adults in the 25-34 age group use health-related social media, whereas 43% in the 45-54 age group use health-related social media. It should be noted that MR focused on consumers who have created or consumed health-related user-generated content on blogs, social networks, health ratings websites, online health communities and message boards, or patient testimonials, whereas PwC focused only on the six specific social media sites indicated in the above charts.
IMHO, the PwC data is more useful to pharmaceutical marketers interested in reaching consumers via social media. Often, online health communities and message boards -- which are included in the MR anlaysis -- are not accessible to unregistered users and search engines and are therefore of limited benefit to advertisers (see "Data Mining in the Deep, Dark Social Networks of Patients").
Women are also very important to pharma marketers -- they are the caregivers and make most of the health decisions for their families. Here are the data comparing the use of social media for healthcare purposes for women versus men:
This is a surprise. First, I was lead to believe that women dominate social media (see, for example, "How to Score With Women (as a Marketer) via Social Media"). Well, that may very well be true for general use, but a significantly greater % of men use social media for healthcare purposes than do women if we believe the data shown here. Twitter is not favored by women at all!
NOTE: MR data from a survey cited above says that 45% of BOTH U.S. adult men and women use "health-related social media." Again, I think MR includes social media sites in its data that are not very relevant to pharmaceutical marketers (see note above).
This is not good news for the marketers in the pharma industry who proselytize the use of social media. Beware of the Kool-aid being served!
Johnson and Johnson is acting more and more like an "old school," mill town Big Pharma company -- like the circa 1900 photo shown on left that was featured recently on the JNJBTW Blog -- instead of a warm & fuzzy, mommy-friendly consumer goods company, which is how it prefers to be known.
As revealed by Pharmalot (here), the United States has "respectfully" sent a memo to J&J in "support of its motion to compel the deposition... of Alex Gorsky, who recently became the Chief Executive Officer of J&J, but was the Vice President of Sales and Marketing and then President of J&J’s Janssen unit during the late 1990s and early 2000s, the time period covered by the United States’ Complaint."
The "complaint," reports Pharmalot, concerns a "whistleblower lawsuit, which was joined by the US government, that charges Omnicare [nursing home pharmacy] received kickbacks – in the form of rebates, educational grants and payments for marketing data – so the Risperdal antipsychotic would be prescribed more often. The lawsuit also alleged J&J’s Janssen unit hid the payments from Medicaid to avoid reporting a ‘best price’ that would have triggered rebates to the agency."
"The feds contend that, unlike the lawyers who had difficulty recalling certain key details and interactions [when they were deposed], Gorksy should know a thing or two," reports Pharmalot. "J&J argues that Gorsky 'has no reasonable connection to the subject matter of the government’s complaint and was not involved in the facts underlying this case.' But the feds point out that he was the go-to guy when it came to Omnicare and Risperdal, and no one else possesses the same level of knowledge."
This is reminiscent of the time that Colleen A. Goggins, Worldwide Chairman, Consumer Group, Johnson & Johnson, was sent to testify in place of Bill Weldon, JNJ's CEO at the time, who declined to attend due to medical problems (see "JNJ's CEO Weldon May Send Underling to Congress. The Aching Back Excuse"). Afterward, Goggins left J&J, probably with a nice severance package. It's good to be the Minion!
Like Weldon, Gorsky will likely be a no-show and send his own minion instead.
Eventually, Weldon did confront Congress and he even wrote a blog post as a mea culpa. Given Gorsky's reaction to this whistleblower lawsuit and his apparent culpability, it is not likely that he will do what Weldon did or take my advice (see here) and "Start Tweeting, Blogging, and YouTubing." J&J goes back to "old school" communications, circa 1999.
If you are in or near Miami on Thursday, April 19, 2012, I hope you can come to The Angler's Resort and meet me for drinks during Happy Hour or, as they call it, "Loco 4 Locals." You might call this a Tweetup because I am inviting all my 11,100 Twitter followers too!
I'll be there in my Hawaiian shirt along with Mrs. Pharmaguy and a few friends. I'm also expecting Mark Bard (@markbard), founder of the Digital Health Coalition, and Todd Clark (@VOIConsulting), President of VOI and author of many pharmaceutical industry publications. Mark recommended the place.
Sorry, but you have to pay for your own drinks!
Followup: Of course, I ended up paying for the drinks. My pleasure! Thanks to everyone who attended.
Keeping up with all the changes implemented by social media sites such as Facebook and Twitter can be a challenge for anyone. But it is especially important for pharmaceutical marketers to understand how such changes can impact their use of these sites and potentially get them into trouble with the FDA. An example of this was Facebook's new policy about comments and the implementation of Timelines. I have covered those issues by interviewing experts (listen, for example, to these podcast: "Facebook Timelines for Brands: The Implications for Pharma Companies" and "Pharma Facebook Commenting Changes: The Final Story").
Some changes, however, are virtually unannounced and may go unnoticed by brand teams. Twitter, for example, has made some changes to how things are displayed on its website when people are viewing accounts like Novo Nordisk's @racewithinsulin Twitter account. This is a fully "branded" account that features a celebrity endorsement of Levemir, Novo's long acting insulin used to treat diabetes. It's tag line is: "Racecar driver Charlie Kimball partners with Novo Nordisk to prove his high performance career is possible with insulin."
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"). What is new, however, is how information is laid out on the screen. Here's a screen shot (click on the image if you need a better view):
What I noticed is that the box that provides the "fair balance"/safety information is partially hidden by Charlie's tweet stream. I commented previously how this information is virtually impossible to read even when it is fully visible (read "Can You Read This Fair Balance on Race With Insulin Twitter Page, or Is It Just Me Having Problems?"). Now, however, it is even impossible for people with perfect eyesight to read fully.
No matter how wide I pull the screen, the safety information is blocked by the tweet stream. I also cannot scroll down to bring the bottom part of the safety information into view because that info is a static image in the background and only the tweet stream middle section of the screen scrolls up and down.
Novo Nordisk has changed the background image since the last time I visited the @racewithinsulin site. Part of that change was to move the safety information further down, which has lead to the second problem I noted above.
The first problem, however, is likely due to the new design implemented by Twitter. Novo Nordisk has not updated the background image to be compatible with this new design.
It's possible that the FDA may look at this branded site and determine that it violates regulations because the display of major safety information is not fully part of the branded message, which clearly is that Levemir is used for the treatment of diabetes and that you can live a "high performance career" with Novo's brand of insulin.
Of course, the FDA would have to read this blog post to learn about this.
As reported by Nielsen, direct-to-consumer (DTC) advertising spending by the pharmaceutical industry was down by 1% compared to 2010. I used that bit of information to update my chart of DTC spending trend over the years (see below).
This chart actually plots measured media data (excluding Internet display and search advertising) through 2010 from AdAge, which got the data from TNS Health. I calculated the 2011 total based on the 1% decrease reported by Nielsen (sorry, I don't have TNS data for 2011).
The final bar of the chart is my estimate for 2012, which is based on the premise that DTC ad spending for Lipitor will be less than half of what it was in 2011. Of course, Lipitor is now available in generic form, so we would expect Pfizer to spend less on its advertising. However, for the first 6 months or so in 2012, Pfizer will continue to spend money on advertising its $4 co-pay coupon for branded Lipitor. But after that, I expect spending to drop precipitously.
I did a little exercise to predict that DTC spending in 2012 will be down by over 3% compared to 2011 solely due to the drop in Lipitor advertising. Here's how I came up with that estimate.
First, let's look at the TOP 20 brands by DTC spending in 2011 (this chart is based on Nielsen data that I found in the April 2012 issue of MM&M):
In 2011, Pfizer spent $220 million on Lipitor DTC advertising according to Nielsen. That compares to $272 million in 2010 (a 20% decrease). So, right away, we know that Lipitor DTC spending is dropping although it still represents 5.5% of the total spend in 2011 (it was 6.3% in 2010).
Based on what I said above and a poll of readers (see here), I estimate that Pfizer will spend less than $100 million (ie, $90 million) on Lipitor DTC in 2012. If we assume everything else remains the same, that decrease of $130 million represents a 3.3% decrease in overall DTC spending!
Of course, not everything else will "remain the same." Other drugs may come on the market that may be have substantial DTC advertising budgets. But I don't think that is likely -- more and more drugs in the TOP 20 list will be coming off patent.
In any case, this is just a little thought exercise that demonstrates how much a SINGLE drug can impact the overall DTC spending trend. Not only that, but a single drug company -- Pfizer -- accounts for nearly one-quarter (22.3%) of the total (see chart below)! Seven of the TOP 20 drugs are marketed by Pfizer.
One of the TOP 20 advertised Pfizer drugs is VIAGRA. Currently, it appears that Pfizer is focusing on the counterfeit Viagra problem to bring in web visitors to viagra.com (see display ad on left).
Another TOP 20 advertised Pfizer drug is ENBREL. Pfizer & Amgen spent nearly $100 million on Enbrel DTC advertising in 2011 (compared to $71 million in 2010). And this number does NOT include what the Amgen/Pfizer has paid Phil Mickelson to be the Enbrel celebrity spokesperson (see "Amgen Blows Its Marketing Budget on Phil Mickelson Campaign" for more on that). On TV, Mickelson promotes Enbrel for the treatment of his psoriatic arthritis. According to the MM&M article cited above, psoriatic arthritis afflicts "around one in 20 of the 2% of Americans who suffer from psoriasis." That works out to be 375,000 people (1 in 20 of 7.5 million).
Approximately 63 cents out of every DTC ad dollar goes to TV. So, Pfizer/Amgen spend about $63 million to reach 375,000 people via TV ads! It seems a bit exorbitant to spend so much for broadcasting versus a more targeted approach. Anyway, that's the crazy world of Pharma DTC advertising! Go figure.
to see if the people who "talk the talk" of pharma social media actually "walk the walk" (only 40% of pharma people who have taken my Social Marketing Readiness Self-Assessment personally use social media "frequently; fill out the assessment here and see more results),
to keep track of how these pioneers are using social media, and
to help me communicate with them (it's often impossible to reach them via email or by phone).
A majority of these pioneers have LinkedIn accounts for professional use and probably many also have Facebook pages. While I also keep track of pharma pioneer LinkedIn pages, I generally do not bother to peer into their personal lives that they may chronicle on personal Facebook pages.
Recently, I've been interested in Pinterest for my own use and started searching for pharma companies who have Pinterest accounts (see "Should Pharma Ponder Pinterest? Novo Nordisk Is!" and "Pharma Pinterest Update: Bayer US Pins, Novo Nordisk Depins!"). Yesterday, however, I received an email notice from Pinterest that Craig DeLarge, Director, Healthcare Professional Relationship Marketing at Novo Nordisk, who liked my pin "Charlie Kimball, Novo Nordisk, and Me Make Up. http://bit.ly/kjIAH." (This link is to the blog post in which that pin/image appears.)
Craig has a very interesting Pinterest page (here) that includes the following "boards" (ie, categories of images):
Places I've Been
Brands I Love (Live)!
Health
Wisdom
eMarketing
Social Media
Politics
Craig likes some of the brands I like, including BMW, Movado (watches), and Apple ("Apple MacBook Air My latest tech crush"). Novo Nordisk, of course, is also on his list of brands that he likes and obviously lives by.
I was also interested in what Craig pinned on his "Politics" board, especially this one about Mitt Romney:
I've learned a lot about Craig DeLarge in a very short time via the images he has posted to his [emphasis]personal[end emphasis] Pinterest page. While Facebook also now is very visually focused, it takes me longer on Facebook to discover a person's true beliefs and interests than it does on Pinterest. As they say, an image is worth a thousand words.
I searched Pinterest for other pharma people social media pioneers on my list, but found only 2 others: Kevin Nalty, Consumer Product Director, Psychiatry, Janssen, and Brad Pendergraph, Manager, Consumer Digital & Social Engagement at Novartis (recently or soon to be laid off). These people -- and Craig -- are among the most followed pharma people on Twitter, so it makes sense that they would lead the way on Pinterest.
I look forward to finding more pharma people/social media pioneers on Pinterest. In fact, I think I will start a new board on my Pinterest page dedicated to "repins" from pharma people (I already have one for repins from pharma companies).
When asked "How high was that blood sugar reading?" during a routine doctor visit more than 3 years ago, Deen said "I don't know. They just said it was high." Then her doctor said, "I'm going to start you on some medicine," and wham, bam, thank y'all ma'am, Deen started her secret life as a diabetic.
Furthermore, Deen does not remember her doctor saying anything about lifestyle changes. "Now, she might have," said Deen diplomatically, "but I don't recall coming out of that visit with a lot of literature. She just started me on the drug."
It's hard to believe any doctor worthy of treating a wealthy celebrity would not have given her a bit more education regarding living with diabetes. One important bit of education is "Know Your Blood Sugar Levels." That's the title of a National Institutes of Health National Diabetes Education Program pamphlet (see here). "If you have diabetes," says NIH, "keeping your blood glucose (sugar) numbers in your target range can help you feel good today and stay healthy in the future."
After Novo Nordisk approached her to be a spokesperson, Deen "asked the doctor if I could switch over from the [combo drug]" to Victoza. Of course, her doctor complied because Deen knows best, although she doesn't know her numbers (or choses not to say what they are). Or perhaps the doctor was also "approached" by Novo Nordisk.
Whatever! Deen is now taking not only Victoza but also metformin and "a small dose of Actos." I'm not an expert on diabetes treatments, but because Deen is on multiple drugs and because she hasn't revealed her initial high blood glucose reading, we will never know if Victoza is really helping her control her diabetes.
Deen has the right to keep her blood glucose levels and other medical information confidential. She also has the right not to reveal how much money Novo Nordisk is paying her. "I am being compensated for my time and work," said Deen.
But should pharmaceutical companies be required to reveal how much they pay celebrity spokespeople just as they are now required to reveal how much they pay physicians (celebrities or otherwise)? If Nike reveals that it paid Tiger Woods $105 million, why shouldn't pharma companies reveal how much they pay celebrities (including Phil Mickelson who is a paid ENBREL spokesperson; see here)? What are they hiding?
BTW, there seems to be a pattern of pharmaceutical celebrity spokespeople defending themselves in consumer magazines like Prevention. Mickelson, for example, "opened up" in an interview published in Arthritis Today (see "Phil Mickelson 'Opens Up" to Arthritis Today Magazine").
Of course, these magazines also make a lot of money from drug advertising. In fact, there is a nice 2-page ad spread for Victoza featuring Paula Deen in the same issue of Prevention as her less than "tell all" interview. In the ad, Deen is NOT depicted creating her famous bacon, cheeseburger, Krsipy Creme donut sandwich! (See the video of THAT here).
In a recent survey, I asked respondents to say whether they agreed or disagreed with the following statement: "Each pharmaceutical company should be required by law to publicly disclose how much money it pays every celebrity for being a spokesperson." 38% (N=112) said they "strongly agreed, " another 21% said the "somewhat agreed," and 36% said they strongly or somewhat disagreed.
One pharmaceutical company employee respondent made this comment: "What is the point of all this pharma reporting? If I tell you that Paula Deen is making $10M or $1M, what difference does it make? I'm sure she's making a lot of money. But that is driven by her market worth and the specifics of the contract (length of contract, number of events, etc.). There's no realistic way for the public to understand (or care about) that context. So what is the point?"
The third edition of "What Physicians Want!," a biennial survey conducted by Publicis Touchpoint Solutions and Sermo, offers evidence that tech-savvy physicians are not embracing social media to communicate with patients. The survey questioned more than 250 Sermo physicians, sixty-two percent of whom were primary care providers (FP, IM, Ped), while the remaining 38% comprised more than 20 surgical and nonsurgical specialties.
Only 19% of the surveyed physicians use Twitter. That compares with 22% of respondents to the 2010 survey. These physicians, however, are flocking to LinkedIn, Facebook, and Google+ for personal and professional use (see chart below). LinkedIn showed rapid growth in users, from 18% in 2010 to 40% in this year’s survey. Google+ is surging quickly, with 38% using this site.
As for communicating with patients, physicians prefer the good old telephone and email rather than Facebook or Twitter (see chart below). Only 15% of respondents are currently using Facebook or plan to use it in the near future to communicate with their patients. Less than 10% of respondents use or plan to use other social media -- including Twitter -- to communicate with patients.
Given that these are tech-savvy registered SERMO physicians, I would have expected them to be more interested in using social media to communicate with patients. There are obvious privacy and other issues involved. The American Medical Association (AMA) warns physicians that "Social networks, blogs, and other forms of communication online ... create new challenges to the patient-physician relationship" (see "AMA Policy on Use of Social Media Sees the Glass Half Empty").
Despite such concerns, physicians use email to communicate with patients. Why not social media like Twitter and Facebook? Both allow private messaging between parties. I don't expect a lot of physicians to do this, but I expected to see a trend in that direction. These surveys, however, reveal no such trend.
One trend that the survey DOES clearly show is physician interest in iPads! 82% of survey respondents want to
see “more” or “significantly more” use of iPads or other tablets by pharma representatives calling on their practices.
Over half of the survey respondents (54%) are using iPads/tablets for personal and/or professional use. And of the 46% who don’t yet
use tablets, nearly three-quarters plan to use one for personal and/or professional use in the near future.
Perhaps with the NEW iPads, more physicians will communicate with some of their patients via FaceTime -- a nifty Skype-like app that allows you to talk to and view friends, colleagues, patients.
Novo Nordisk "depinned" (deleted) everything on its Pinterest boards (here).
"Bayer has joined up-and-coming social network Pinterest and is using it to share images and information about its activities in the US" (Hat Tip to PMLive: "Bayer starts using Pinterest").
Bayer snapped up the Pinterest username "bayerus" ("bayer" is being used by an individual named "Courtney Bayer"). It currently has three Pinterest boards: (1) Bayer's Business, (2) Sustainability, and (3) Innovation. Twenty-eight items (including at least one video!) are posted to these boards.
Bayer has pinned a couple of product images, including this one for Bayer Aspirin (shown on the left; click on it for an enlarged view).
As you can see, visitors are able to add comments to these pins. Always the "spoiler," I added a comment that was a truthful concern of mine, but one that points out a possible "adverse event."
Aspirin, of course, is an over-the-counter drug not regulated by the FDA like Rx drugs are regulated. Therefore, Bayer does not have to worry about reporting this adverse event to the FDA. But will it allow the comment to stand and/or make a reply? I'll let you know.
I have also "repinned" this image to my Pinterest "Pins from Pharmaceutical Companies" board (here). I notice that my comment does not carry over to the "repinned" image, so I added a comment about the comment I made over on the Bayer US Pinterest site.
I have found no way to edit or otherwise manage comments on Pinterest. It appears that the only option is to delete the pin and then repin it without the comments. This inability to moderate comments may be Pinterest's Archilles heel as far as pharma is concerned. But as of this date, pharma's presence on Pinterest is virtually unnoticed except for me and a few other pharma social media followers!
P.S. As I mentioned, Bayer included at least one video as a pin. I didn't know you could do this. Kudos to Bayer for taking advantage of that capability!
UPDATE: Bayer responded to my comment today (4/9/2012) - about 4 days after I submitted my comment. Their response was:
"It is important that you speak with your doctor before you begin a daily aspirin regimen, only your doctor can determine if you are an appropriate candidate for aspirin therapy. Please contact us at 800-331-4536 (M-F 9:00AM -5:00PM Eastern Standard Time) we would like to learn more about your use of Bayer Aspirin."
At least Bayer responded rather than deleting the pin as I suggested was an option (see above).
It's still early in the game for Pinterest as a viable social media site. However, Pinterest is now the 3rd most popular social networking site behind Facebook and Twitter (see here).
I think pharma needs to provide support to patients through every channel at its disposal, including social media. When Bayer, for example, suggested I call their phone number (M-F 9:00AM -5:00PM Eastern Standard Time) in response to the comment I made on their Pinterest site, I was surprised they didn't just continue the conversation on Pinterest since that was the channel I used to open the conversation and thus clearly my preferred channel.
Two commentaries caught my attention this morning. Both offered solutions to the drug industry's "fundamental problems."
Each solution, of course, defines the "fundamental problem" differently.
Solution #1 says the problem is the drug industry does not deliver "precisely what the world's health care systems need from it — therapies to materially advance the standards of care." The author blames top-heavy management populated with "protected dimwits and timeservers who fail to grasp the current dynamics."
"The management approach traditionally used by pharma also fails to hone the skills that the industry needs right now," according to the author (see "What pharma needs to evolve" here). "...it makes for a slow pace because, figuratively, everyone learns to raise his hand before going to the bathroom. Pharma, for example, generally frowns on setting up innovative, skunk works projects."
Solution #2 says successful pharma companies must drive revenue growth by acquisitions. Management is also to blame according to the author.
"The high-growth companies have clearly aligned their capital-deployment strategies with growth investments. They have done this instead of trying to achieve a balanced capital-allocation strategy that sacrifices reinvestment in exchange for greater dividends, buybacks, or cash accumulation" (see "The Prescription for Pharma Is Revenue Growth" here).
The first solution could be categorized as a "patient/customer" focused solution, whereas the second one can be said to be an "investor/stock holder" focused solution.
Which approach do you think can help pharma in the long run?
If you think waiting over two years for FDA to issue guidelines it promised for regulation of "Promotion of Prescription Drug Products Using Social Media Tools," then you should take a look at the following timeline and weep.
This timeline documents the major steps in FDA's process of developing guidance for direct to consumer television (DTC) and radio ads; ie, "standards that would be considered in determining whether the major statement in direct-to-consumer television and radio advertisements relating to the side effects and contraindications of an advertised prescription drug intended for use by humans is presented in a clear, conspicuous, and neutral manner":
21 August 2007: FDA announces it will conduct a study of "consumer evaluations of variations in communicating risk information in direct-to-consumer (DTC) prescription drug broadcast advertisements." It opens a 90-day period to submit comments regarding this study. This study used the latest cognitive science technique called Affect Misattribution Procedure (AMP), in which participants are asked not to judge the TV ads' imagery directly, but to judge whether or not a Chinese character shown to them afterward is positive or negative. I suggested FDA NOT use Chinese characters because that would be discriminatory, but they did not listen to me (see "FDA at a Mall Near You: The Manchurian Connection"). With regard to social media guidelines, the FDA has also announced it will do some studies before issuing guidance (see "FDA's Proposed Web Study Will Further Delay Social Media Guidelines"). Deja vu all over again!
29 March 2010: FDA finally publishes the draft guidance, more than 4 years after the public hearing (see Federal register ref: 75 FR 15376). FDA was goosed along by an act of Congress: the
Food and Drug Administration Amendments Act of 2007 (FDAAA), which required that the major statement in DTC television or radio advertisements (or ads) relating to the side effects and contraindications of an advertised prescription drug intended for use by humans be presented in a clear, conspicuous, and neutral manner. FDA was forced into RULEMAKING mode rather than GUIDANCE mode, which is how the pharma industry wants the agency to approach the regulation social media drug promotion as well (see "Pfizer Asks for New FDA Regulations, Not Guidance, for Social Media").
June 2011: FDA published an executive summary of a study of the methodology of the AMP study cited above entitled "A Supplementary Test of Distraction in DTC Advertising Using an Implicit Measure, The Affect Misattribution Procedure" (find it here). Maybe FDA read my comments after all!
27 January 2012: FDA announced that it added a document to the docket for the proposed rulemaking concerning a study entitled: "Experimental Evaluation of the Impact of Distraction on Consumer Understanding of Risk and Benefit Information in Direct-to-Consumer Prescription Drug Television Advertisements" (Distraction Study; see Docket No. FDA–2009–N–0582). This document reopened the comment period (extending the deadline to February 27, 2012) for the rulemaking proceeding to allow an opportunity for comment on the study as it relates to the proposed standards. Way back during the public hearing in 2005 I was unimpressed by research claiming that TV drug ads were designed to "distract" viewers from reading the fair balance (see op cit and "Ruth Day and the Bees Repeat Performance at House DTC Hearing" for an update on that).
23 March 2012: FDA reopens the comment period for a second time "in response to a request for more time to submit comments to the Agency." The new comment period will expire on April 9, 2012. According to the FDA, the "Pharmaceutical Research and Manufacturers of America (PhRMA) submitted a letter dated February 20, 2012, requesting an additional 15 days for interested persons to comment. FDA believes that an additional 15 days to comment on the Distraction Study as it relates to the proposed standards is appropriate."
What strikes me are the similarities between the evolution of these DTC guidelines/rules and the long-awaited social media guidelines.
First, there are the delaying studies and studies of studies. It's well-known that if you wish to halt progress, do a study.
Second, I sense that the drug industry pushed the FDA into RULEMAKING rather than issuing guidelines although it took an act of Congress to do that in this case. The drug industry may use the courts in the case of social media (another example of how an "activist" judiciary can work both sides of the aisle).
If it takes the FDA SEVEN or more years to complete this process for TV ads, I imagine it will take them 10 years to finalize guidance or rules (whatever!) for regulation of the use of social media for drug promotion. While TV has more or less stagnated during the seven years since 2005, social media will look completely different by the time those 10 years are up in 2019!
No wonder CBS refused to run the following "Stoogesta" ad during the NCAA basketball tournament. According to Deadline, network execs were concerned because the spoof, which promotes the forthcoming “The Three Stooges” movie, makes "light of prescription drug ads."
I've seen some pretty funny spoofs of drug DTC ads in my time (eg, see "ADHD Boy"), but this is the best I have ever seen. It convinced me to visit my movie theater & ask for an Rx of silly!
I imagine that pharmaceutical advertisers sent a clear message to CBS that they did NOT find the spoof funny. Rx drugs, after all, are serious and should not be made "light of."
However, it's not the drugs that are being spoofed. It is the drug advertisers who have rolled out the same formulaic DTC TV ads for years and years. Even kids think most of these ads are a joke.
Will the formula ever change? I don't think so. Here's why.
One of the funniest lines in the spoof is "Three in 6 billion people are afflicted by Stoogation (?), a disorder that causes the brain to ricochet and bounce..." That's just slightly more outrageous than some claims made in real drug ads about the prevalence of some "disease" you never heard of before.
I've commented on the topic of DTC ads making outrageous disease prevalence claims before (see "Disease Awareness or 'Disease Mongering'?", for example). In many cases, it is absolutely necessary for drug ads to make such claims to justify the millions of dollars spent on mass media TV ads to reach the "three in 6 billion" people who may suffer from the condition advertised.
So, the tradition of "making light of drug ads" will live on as long as advertising agencies and TV networks rake in millions of dollars to air ads that would be better off targeted to the truly appropriate audience.
BTW, the NCAA basketball tournament audience is PERFECT for the Stoogesta ad! But the ad that was chosen to run in its place is totally wrong; that ad spoofs Christianity! Where's the religious right when you need them?
Laura Kolodjeski (@lkolodjeski), Community Manager for Sanofi US Diabetes, sent me a Twitter DM this morning announcing the launch of Diabetapedia (di-ah-bee-tah-pee-dee-ah), a new site "to help meet educational needs of diabetes community." According to Laura, the goal is to create "a single, comprehensive place where anyone can find and share definitions of diabetes-related terms and phrases." The site's tag line is "Diabetes doesn't define you... so define diabetes."
The name "Diabetapedia" invokes a comparison to "Wikipedia," the online encyclopedia comprised of user-generated content. Diabetapedia does accept contributions from visitors who can use a form on the site to suggest a new term. To use the site, however, you first search for a term as if you were using Google. In fact, the site's home page has the simple look of a "Google" for diabetes site: a single large box for entering a term located under a large logo:
The results of a search also resemble what you would get with Google. It remains to be seen if Diabetapedia will jazz up it's logo and modify it to celebrate certain holidays the way Google does.
The simplicity of the interface also makes the site easy to access from your mobile phone. However, it is NOT optimized for mobile use (eg, the search results, etc., do not line break to enable you to read the entire definition without scrolling side to side).
Of course, there are guidelines. Terms that are appropriate for inclusion in the site include:
Terms that directly relate to diabetes (e.g. blood glucose meter)
Diabetes jargon, slang, or abbreviations (e.g. DOC, d-mom, blue Fridays)
Twitter hashtags that are specific to diabetes discussions (e.g. #dsma, #sweatbetes, #bgnow)
Diabetes-focused advocacy groups (e.g. The American Diabetes Association, The Diabetes Hands Foundation)
The most important guideline as far as pharmaceutical companies are concerned is: "do not post terms that are specific to brand names of diabetes management products."
Sanofi previews all suggestions and Sanofi promises to contact users if it requires clarification about submissions.
The site currently comes with 119 common diabetes terms and corresponding definitions. "All of the terms include a general definition from the online version of the Merriam-Webster dictionary (when available), a more specific diabetes-related definition, and any alternate uses of the term that might apply. For some," says Laura in her post introducing Diabetapedia (here), "we even included an example of a tweet or a post that demonstrates how the term is commonly used."
I hope to have Laura as a guest on my Pharma Marketing Talk show and get some more details about the site and how Sanofi hopes it will grow. One question I would ask: "Do you plan to release a Diabetapedia mobile application?"
See the questionnaire at the end of this post where you can suggest improvements for Diabetapedia and ask your own questions for Laura to answer.
P.S. Laura points out that Diabetapedia visitors' "Likes and Tweets" "may help create" a program called Diabetes Advocates run by the Diabetes Hands Foundation (DHF). The purpose, says Laura, is to "connect individuals and small organizations that have taken a leadership role in improving the world for people touched by diabetes. In 2012, Sanofi US Diabetes is proud to sponsor the Diabetes Advocates program to help empower its members to have a greater impact by helping them improve their reach and effectiveness."
pharmaguy: @ddwebster All? Including "d-mom"? Whatever, good way to start. #diabetes9:00am, Apr 02 from HootSuite
ddwebster: @pharmaguy Yet to find one w/a comprehensive definition. Even A1c doesn't explain ranges, just says a test performed every 2-3 mos#diabetes9:06am, Apr 02 from TweetDeck
ddwebster: @pharmaguy Agreed! I love the idea of the site-find info to be too generic. Pts need more detail-diabetes is complicated9:21am, Apr 02 from TweetDeck
pharmaguy: @ddwebster This could develop into good resource - what happens, however, when it is no longer sponsored by S-A? #diabetes9:32am, Apr 02 from HootSuite
