Monday, October 30, 2006

AmbienCR and Lunesta Duke It Out on Web

AmbienCR and Lunesta are battling for the leader position in the sleep aid market and are currently "duking it out" on the Internet via search engine ad campaigns.

I've shown the following chart before (see "Rozerem Ads Innovatively Ineffectual") that implies that these two products are the major contenders in this market while Rozerem is a distant third.

You may have seen AmbienCR banners served by Google Adwords appearing on various Web sites. The following are a couple of examples:


These are "nonbranded" text ads that at first glance appear to be bogus ads put up by sleazy companies to get you to their Web sites where there are dozens of other ads. These sorts of sites make money by serving Google Adword ads.

Do a Google search on "Sleep Medication." What do you find? This:

Sleep Medication
SleepMedication.Info Find
Medication to Get You to Sleep Fast & Stay Asleep - Free Trial

Sleep Medication Try our sleep aid free for 7 nights with the Lunesta 7-Night Challenge.

That's at the top of the page in the "Sponsored Links" area. The first listing in the natural results section is this: Consider Medications
When you first start taking any
sleep medication, use extreme care while doing anything that requires complete alertness, such as driving a car or operating ... is merely an AmbienCR free trial offer page. Too bad Sanofi-Aventis couldn't get That's one of the "sleazy" sites I was talking about. I guess ".info" is a notch less sleazy.

The AmbienCR folks are being very aggressive in collecting personal information from you when you apply for the 7-day free trial (why 7 days?). You have to opt-out rather than opt-in to receive further communications from "sanofi-aventis U.S. LLC, its affiliates, and the business service companies working with the company". By not unchecking this box, you give S-A permission to use the data to:
  • Provide information about insomnia, related conditions and products; and
  • Develop products and services concerning insomnia which may include market research.
If you are not careful and forget to uncheck another box, you will also receive an Email "Newsletter," which we all know is more advertising.

Of course, I left every box checked just to see what would happen. I did get a printable coupon, but forgot to print it. I haven't received any email newsletter. Oh, well! At least there is a way to "unsubscribe" online and by phone. I'll let you know how that works later.

Friday, October 27, 2006

Awards: The Good, The Bad, The Ugly

Everybody likes to win awards and there are many awards for advertising and for pharmaceutical industry advertising in particular.

DTC Perspectives, a fine trade publication focused on direct-to-consumer advertising, gives out several awards each year. The DTC National Advertising Award, for example, was given to Lunesta at The 2006 DTC National Conference in the spring. To counter that, Prescription Access Litigation (PAL) Project, a critic of DTC, handed Lunesta it's "Bitter Pill Award" (see "Lunesta: Golden or Bitter Pill?").

In yesterday's posts to Pharma Marketing Blog, I mentioned a few winners of the 5th Annual "Perspectives in Excellence" (POE) Award that were announced at the DTC in the New Era conference (see "Allergan Ignores Guidelines, Wins Award Anyway" and "Rozerem Ads Innovatively Ineffectual").

According to the POE Award promo, "The POE Awards provide the industry with an opportunity to recognize the companies and agencies that are leading the industry with
responsible [my emphasis] and innovative DTC communications."

I'd like to offer you my comments on the POE Award winners and losers and see how many of you agree with me about the "good, the bad, and the ugly" vs. how many agree with DTC Perspectives and the judges in their panel.

I am doing this partly to respond to a recent comment I received, which is:
"Okay, so you've picked on Dr. Jarvik, the Beaver, and even Abe Lincoln. [See "Lipitor's Jarvik: Fop or Flop?" and "Rozerem Ads Dis Lincoln, Show Beaver".]

Are there any pharmaceutical marketing ads that you DO like and that you DO think are effective? Inquiring blog readers' minds want to know!"
Of course there are pharmaceutical marketing ads that I like and that I think should win awards. But since these get so much attention in the trade publications and at award dinners, etc., I don't feel that there is much I can add that has not already been said.

What I find is that many journalists and trade publications cannot or will not say the "Emperor has no clothes!" when it is often necessary to do so.

I cannot tell you how often I've heard from industry professionals -- including people within pharma companies -- how much they appreciate and enjoy my commentary, primarily because they wish they could say it themselves. These are the people I speak for.

When it comes to the POEs, I feel more comfortable focusing on evaluating the contenders according to whether they are
responsible DTC communications rather than how innovative they are. Not that the two attributes cannot go hand in hand. It's just that many agencies now say that they can be both responsible and creative, yet they tend to give out awards to themselves based almost exclusively on innovation and creativity, not on "responsibilty." Also, I find that awards -- and I not talking just about the POEs -- do not necessarily award the communications that are the most effective in terms of ROI.

Anyway, here are selected POE Award results:

Best 'New' Brand of the Year (DTC campaign launched after June 2005)
  • Avodart
  • Requip
  • Rozerem
  • VesiCare
  • Zetia
Before you are tainted by my views and the actual winning brands, take a moment to vote yourself:

Free polls from
What's Your Choice for Best New Brand of the Year?
Avodart Requip Rozerem VESIcare Zetia

If you are a regular reader of this blog, you know that I am no fan of the Rozerem or Requip campaigns. Most people I've spoken to -- including industry professionals -- agree that the Rozerem ad campaign is a disaster. It doesn't communicate in a straight-forward way the main advantage the product has over its competition. But it's creative!

My vote goes to Zetia. As opposed to the other products, I think it treats a real medical problem rather than tingling or tinkling problems. A friend calls these drugs "below the belt" products.

Also, the Zetia ads are creative -- some use the "doctors in white coats" approach, which "creative" people are bored with; but other Zetia ads feature regular people. The ads show how the product works and why it is different and effective.

It turns out that I picked a winner? Did you? Here are the winners:
  • Gold: Zetia
  • Silver: Avodart
  • Bronze: Rozerem

Best Use of PR in a DTC Campaign
  • Depression Hurts (Cymbalta Unbranded), Eli Lilly
  • If You Were My Sister (Arimidex Unbranded, Disease Education), AstraZeneca
  • Premarin --– Talking to Your Doctor with Cheryl Ladd by Wyeth
  • Sally Field / Rally With Sally for Bone Health, Roche and GSK for Boniva
  • The Flomax One Week Challenge
I may have been exposed to all these campaigns, but I cannot recall if they were PR (ie, in the newspaper or on talk shows, etc.) or as unbranded or branded ads. Unbranded, disease awareness ads are in the gray area betweenn PR and advertising, if there is such an area (see "Marketing Disguised as PR").

Vote now:

Which is the Best Use of PR in a DTC Campaign?
Depression Hurts
If You Were My Sister
Talking to Your Doctor with Cheryl Ladd
Rally With Sally for Bone Health
The Flomax One Week Challenge
Free polls from

My vote was for "If Your Were My Sister" although I cannot explain why the equally effective and important HPV campaign by Merck was not included in the list. Perhaps it started too late in the year to be considered by the judges (although the HPV Vaccine ad campaignn made the list of contenders for the Most Creative Ad Campaign).

Here are the winners:
  • Gold: If You Were My Sister
  • Silver: Depression Hurts
  • Bronze: Sally Field
Again, I'm not a fan of the "Depression Hurts" campaign. But you already know that (see "Pharma Marketing Blog: Immutable Laws of DTC Domain Naming").

The final category I will comment on is:

Most Innovative DTC Campaign
  • Arimidex
  • HPV Vaccine
  • Rozerem
  • VesiCare
  • Vytorin
This is where the rubber meets the road as far as awards are concerned. What do you think?

Free polls from
What is the Most Innovative Campaign?
Arimidex HPV Vaccine Rozerem VESIcare Vytorin

My vote went to Vytorin. I really like these ads. The colors are great and a lot of care went in to the design -- even the backgrounds. Also, the people look real; they are not perfect physical specimens like you see in most ads. I can relate. I really want to ask my doctor for Vytorin next time I see her.

The Vytorin campaign is very creative, although I'd hate to see what dish I look like. That thought just gave me an idea for social networking Vytorin advertising: host a site where people can upload family portraits and match them with food photos in a library. Create online "cards" from these that users can send to their family members. Include a promo for Vytorin, of course!

I already commented on Rozerem, which is a good example of creativity and innovation trumping effectiveness (see "Rozerem Ads Innovatively Ineffectual").

And the winners are:
  • Gold: Vytorin
  • Silver: HPV Vaccine
  • Bronze: Rozerem
I'm batting 1000! Who would have thought it? Me agreeing with the industry leaders and shakers!

Don't get too excited. I've only shown you the results of a few of the categories in which POE Awards were given. I didn't do too well in the other categories. But that's how you promote products -- selective use of data. Works for me!

Thursday, October 26, 2006

Rozerem Ads Innovatively Ineffectual

At yesterday's "DTC in the New Era" conference organized by DTC Perspectives, Inc., Dale Taylor, President & CEO of AbelsonTaylor, Inc., which is the agency responsible for the Rozerem ads, made several revealing comments about the Rozerem DTC ads even though he coyly said that he was "not going to talk about the Rozerem campaign."

He confirmed what most of us already suspected: the ads were created to be "different," "to create buzz," and to make sure there was "a lot of talk about" the ads. Note that he didn't say the goal was to generate a lot of talk about Rozerem -- just about the ads.

Mission Accomplished, Dale!

Unfortunately, all the benefit goes to AbelsonTaylor, not to its client, which is Takeda Pharmaceuticals.

Dale gets to sit on the "Expert" Panel Discussion on Creative Innovations and his agency gets to win a POE award (see below) while his Takeda client must have been hanging his head in shame in the back recesses of the audience.

That's because Rozerem sales have not taken off and, in fact, are pretty darn flat. This was revealed by an amazing plot of new prescriptions for sleep aid drugs that was included in a presentation on AmbienCR made just before Dale's panel discussion on "innovation."

In that plot -- shown below -- are prescription volume sales of AmbienCR, Lunesta, and Rozerem over a 53-week period ending about mid-October, 2006. The data show growth relative to the starting point more than a year ago. Note that both AmbienCR and Lunesta both showed good growth, whereas Rozerem is a distant third and shows lackluster growth over this period.

Jean-Luc Pilon, Director of Consumer Marketing for Ambien at Sanofi-Aventis, used this chart to show that despite Lunesta's 2 to 1 spending over AmbienCR, its performance is stable to declining whereas AmbienCR is enjoying a rising trend despite "adverse media events" in which sleep binge eating and dangerous sleep driving stories were attributed to Ambien. Mr. Pilon credits the turnaround to S-A's "effective and responsible" PR campaign.

I hope he doesn't mind me using the chart for other purposes!

You can see that there is a slight "blip" in the Rozerem curve in the weeks following my July 18, 2006 post (see "Rozerem Ads Dis Lincoln, Show Beaver"). Of course, the blip could have been the result of the ad campaign itself and not my blog. But I posit that my post created substantial buzz about the ad, which helped Mr. Taylor's cause.

What is that blip worth in dollars? If we knew that, we could estimate if Takeda got its money worth from AbelsonTaylor's creative effort.

According to Wolters Kluwer, "from March through August 2006, Rozerem sales grew to $38 million, capturing a 1.9 percent market share" (as reported in "Surreal Dream Ads No Snoozer For Sleep Aid").

It's amazing how some publications can put a happy face on facts; calling a 1.9% share "no snoozer" is classic
jingo-pharma journalism! But I digress.

Comparing the height of the blip to the flat curve before the blip, I am willing to concede that Rozerem sales doubled over that period. Therefore, as a result of the Rozerem ad campaign and/or my blog post, Takeda earned an additional $19 million. [I'll take my 10% now.]

How much did it cost Takeda to make that $19 million? Sepracor/Lunesta is spending about $140 million per year or let's say about $50 for the 5 or 6-month period between March and August of 2006. Dare I say that Takeda/Rozerem spent an equivalent amount? That would mean it lost $31 million. Another way to look at it is return on investment. The AbelsonTaylor "innovative" campaign had a huge negative return on investment (my math is poor today, so I can't calculate what it is).

Even if Takeda spent half as much as I estimate, the ROI for the campaign is still in negative territory.

To be fair to AbelsonTaylor, maybe it took it's lead from Takeda rather than the other way around. "We knew our ads had to cut through the clutter," says Chris Benecchi, senior product manager of consumer strategies for Rozerem.

Unfortunately, cutting through the clutter with nothing comprehensible to say is a monumental waste of money and time.

POE Award Update
Did I mention that the Rozerem campaign won a POE ("Perspectives on Excellence") award in the most innovative campaign category? But it was only a Bronze. The Gold went to Vytorin, which I think deserved it. The Silver went to Merck's HPV Vaccine campaign. The other contenders were VESIcare (aka, pipe people ads) and AstraZeneca's Arimidex, which, to be frank, I never heard of before. I guess it was the dark horse in the race.

Allergan Ignores Guidelines, Wins Award Anyway

I spent all day yesterday at the "DTC in the New Era" conference organized by my colleagues at DTC Perspectives, Inc. One of the most valuable things I came away with was an AmbienCR goody bag that included a pen (with "stylus for PDA"), two logo-emblazoned file cabinet magnets, and a scratch pad (also with logo).

At the end of the day I attended the 2006 Perspectives On Excellence Awards Presentation and Dinner. The awards are affectionately called the POEs. POEs are sponsored exclusively by Parade Magazine, which according to Randy Siegel, Parade President & Publisher, "appreciates the value of reaching the public with informative messaging, especially when it comes to important developments in health and medicine. These companies and agencies deserve recognition for being leaders in their field. Congratulations."

It was fun trying to guess who the winners were before they were announced. But that's not what I want to talk about now ... maybe later today in another post.

One POE Award winner surprised me and a few others sitting at my table. The category was "DTC Company of the Year (sales under $5 billion per year)" and finalists included Allergan, medPointe, Merck/Schering-Plough, Sepracor, and Serono.

Sepracor (Lunesta) received the Gold Award, Allergan (Botox, Restasis) got the Silver and Merck/Schering-Plough (Zetia) received the Bronze.

Sepracor I can understand -- it only violated its agreement to abide by PhRMA's DTC Guidelines a couple of times (see, for example, "Sepracor Sneaks In Lunesta Reminder Ad"), and since the PhRMA Office of Accountability did not name the violators (see "PhRMA's OOA Issues First Report"), the POE judges could claim they had no knowledge of any violation by Sepracor.

No such defense, however, is possible for the Silver Award given to Allergan, which has not even signed on to PhRMA's Guidelines (see, for example, "PhRMA Intern vs. BOTOX!"). I, for one, think it is outrageous that they received such recognition.

[BTW, no one from Allergan or its ad agency stood up to claim the award. Perhaps they were not there or perhaps they were afraid of being booed -- I swear, I would have done it! Maybe... probably not.]

I don't know what criteria POE judges used to come up with the winners. Obviously, adherence to PhRMA DTC Guidelines was not on the list. In my view, any company that hasn't agreed to the Guidelines should not even be a contender, let alone receive an award!

DTC Magazine and Parade -- as well as other DTC advocates -- need to get in synch with the industry on DTC. DTC is under attack. The best defensive tactic the industry has come up with is PhRMA's voluntary Guidelines. DTC advocates do the industry a disservice by not supporting the PhRMA guidelines in DEED as well as in word.

By rewarding Allergan at a prestigious event (sure to be followed by press releases all around), DTC Perspectives and Parade are sending the wrong message -- namely, you can shun the industry's voluntary DTC guidelines and be rewarded by your peers for doing it!

What do you think?

Does Allergan Deserve an Award?

Tuesday, October 24, 2006

Interpretation of Ads: Hokey vs. Horny

Quoting a Wikipedia entry:

"Dreams, in Freud's view, were all forms of 'wish-fulfillment' -- attempts by the unconscious to resolve a conflict of some sort, whether something recent or something from the recessess of the past. However, because the information in the unconscious is in an unruly and often disturbing form, a 'censor' in the preconscious will not allow it to pass unaltered into the conscious. During dreams, the preconscious is more lax in this duty than in waking hours, but is still attentive: as such, the unconscious must distort and warp the meaning of its information to make it through the censorship. As such, images in dreams are often not what they appear to be, according to Freud, and need deeper interpretation if they are to inform on the structures of the unconscious."

Are TV DTC ads becoming more like dreams, requiring interpretation? Just as Freud interpreted dreams of his neurotic patients to expose the unconscious meanings, it seems we have to interpret some ads to understand their messages.

Take the Rozerem TV ads that feature Abraham Lincoln and a beaver. Forget for a moment that the ad says "Your dreams miss you." That's not what I am getting at.

The ad itself is as distorted as any dream and requires interpretation to understand.

Ever since I posted a critique of the Rozerem ad on Pharma Marketing Blog (see "Rozerem Ads Dis Lincoln, Show Beaver"), it has been the most viewed page on that site and generated more comments from visitors than any other post.

Most of the comments were attempts to understand the message of the ad. Just like Freud interpreting dreams, people were interpreting the ad, trying to decode the symbols.

"…seems to me to be some ad person's notion of what constitutes a Freudian dream," said one commenter, "which tells me how hokey is the thinking of some ad people."

Maybe they aren't as hokey as they are horny!

Although some people -- including myself -- thought the beaver had a politically-incorrect sexual connotation, others thought it represented being "busy as a beaver," which could lead to insomnia. What about Lincoln? "Lincoln with his stove pipe hat on is about as close to a talking Phallic symbol as you can get," one commenter asserted.

It appears that the elaborate symbolism in the ad was meant to convey a benefit that if expressed unaltered would not have gotten through the FDA "censor." Namely, "Rozerem is the only sleep aid that DOES NOT have a risk of suppressing stages 3, 4 and REM (dream) sleep." So says a Rozerem "team" member in a blog comment.

What's pharmaceutical marketing coming to if we have to interpret the ads that marketers produce?

"Only your doctor can tell you why Rozerem is so different," says the ad. And here I thought that ads were supposed to do that! Silly me.

P.S. As opposed to the ads, the Rozerem product Web site ("Rozerem and the Sleep-Wake Cycle") actually attempts to explain just how Rozerem is different.

There, the beaver tells us about the "Master Clock" in our heads. There's even an animation -- albeit not a very exciting animation -- that shows the clock at work in our brains.

Eventually, this message might work its way into the TV and print ads.

Escuse me while I go set my master clock to snooze.

Monday, October 23, 2006

CGC: Old Wine in New Bottles

If chatter and palaver of buzz marketing vendors at industry conferences is any gauge, pharmaceutical companies are very interested in consumer-generated content (CGC), which is touted as the next "new thing" on the Internet.

As if that were news!

Pharmaceutical companies have been soliciting consumer content in the form of patient stories for a long time. In fact, my sojourn into the dotcom boom of the nineties began at a Princeton Diner meeting with a heart bypass patient who parlayed his stories about STATIN P (fake name to protect the brand) into a Web site sponsored by the pharmaceutical manufacturer and marketer of STATIN P.

Here's how it works, based on my experience.

First, the company solicits "success stories" from patients. This may be done via the product Web site, through physicians, health fairs, public relations ... whatever.

As an example, consider the story told by my friend Richard Myer over at The World of DTC Marketing:

"When I launched Sarafem online, a re-branding of Prozac for severe PMS, we allowed women to send us their stories, and post them, regarding their experiences with PMS and PMDD. I was surprised when the first week of going live we had over 200 stories."

Rich is being a little coy -- I am sure he was a bit more proactive about this and did more to obtain stories than just "allow" them to flow in. Nobody -- not even me -- is going to waste any time sending stories to pharma companies without some kind of tit-for-tat. Usually, it's a contest -- someone with the most compelling story may win a trip for two to Hawaii or get their 15 minutes of fame by having their faces and story plastered all over product brochures. They might even get some newspaper or TV coverage!

Fame -- rather than cash equivalents -- was what lured my heart bypass friend to tell his story to the pharmaceutical company responsible for STATIN P.

He was also smart or lucky enough to ally himself with his physician who just so happened to be a consultant to the pharmaceutical company. Together, they proposed to this company -- or the company proposed to them (I don't know which) -- that it would be a good idea to launch an independent Web site to tell these stories and present heart-related medical news vetted by the physician. What the company offered was an educational grant.

Don't get me wrong! I thought this was a good idea. At the time, I was receiving educational grants to provide physician education via e-mail and the Web -- specifically, highlights from medical conferences, satellite symposia, case studies, and literature reviews.

The thing is this. Many vendors are selling pharmaceutical companies on the benefits of consumer-generated content when in fact this is "old wine in new bottles."

What's new is the technology "bottles" used to push this "wine" out to consumers: blogs, podcasts, cell phones, etc.

So, CGC (Consumer Generated Content) is a misnomer as far as being the "next new thing" is concerned. Rich uses another term: Consumer Generated Media. That's not too good either. Apologies to Marshall McLuhan, but as far as marketing is concerned, the message -- not the media -- is the message.

As Rich points out, what is important about pharmaceutical companies getting involved with generating consumer content is "transparency." Some CGC sites currently sponsored by pharmaceutical companies are flying under the transparenecy radar. See, "Question Everything," a previous post to this blog, which talks about the GSK-sponsored weight loss site,

Friday, October 20, 2006

Lipitor's Jarvik: Fop or Flop?

Is Dr. Robert Jarvik, inventor of the Jarvik artificial heart, a fop? Or is he a flop?

Dr. Jarvik appears in all the recent Lipitor ads such as the print ad shown below, which I scanned from the recent issue of the The New Yorker.

I was struck by the TV version of this ad where Dr. Jarvik strolls "foppily" through and around a hologram -- or it seems like one -- of a heart.

When I saw that natty suit, just the right amount of cuff showing, the PURPLE tie and matching handkerchief in the jacket pocket, and his peculiar way of walking, I thought immediately "gay!" Not that there's anything wrong with that! (I also thought maybe the color scheme was more appropriate for Nexium -- the Purple Pill.)

But "fop" may be a better term to describe Jarvik in these ads. I found this definition of fop at
fop (fŏp) n: A man who is preoccupied with and often vain about his clothes and manners
Dr. Jarvik, dressed up in that purple tie ensemble, would be a perfect picture of a fop to include next to the definition in a dictionary.

Is there anything wrong with being a fop? You betcha! There is something odd about a foppy image of a doctor in a DTC ad. I just think it goes over like a lead balloon.

Inventor of an artificial heart or not, what guy wants to be examined by a doctor who looks like this! Maybe it's an OK look for an OB/Gyn, but not a cardiologist -- which, next to a brain surgeon, is the most manly medical specialty.

So much for Jarvik the fop, but what about Jarvik the flop?

I ask that because recently I've seen a new version of the TV spot where Jarvik is dressed in a sports coat and open shirt. No purple tie -- no tie all. I took the following photo off my TV:

Much better, don't you agree? And the blue shirt is true to the Lipitor brand color scheme.

Perhaps Pfizer CEO Jeffrey Kindler, who does not look like a man who has many fops as friends, saw the purple tie ad on TV and that's why it was pulled.

Jarvik was touted as the first "real" doctor to be used in a drug ad -- as opposed to fake doctors like the one suggested by Mandy Patinkin (who played Dr. Jeffrey Geiger on CBS's Chicago Hope TV show) in the Crestor ads.

I am wondering which costs more -- fake doctor or real doctor? Looking at the choice of clothes, I'd say Jarvik costs more than Patinkin.

But it's all good. According to Robin Koval, president of Kaplan Thaler, the agency Pfizer hired to create the Jarvik ads, "We think Dr. Jarvik is an amazing spokesperson, [as the inventor of the artificial heart] he's beyond a celebrity spokesperson." Yeah, way more expensive and certainly more foppy!

Thursday, October 19, 2006

Marketing 101: Newer is Better

I found this in a recent USA Today story:
When it comes to prescription drugs, the Public Citizen Health Research Group advises consumers to follow the Seven-Year Rule: Unless there is no effective alternative, avoid taking any medication that hasn't been on the market at least seven years.

"To take a drug in the first seven years it's on the market is really to be a participant in an experiment," says Sidney Wolfe, director of the Washington, D.C.-based consumer advocacy organization.

Drugs are tested in relatively few people before entering the market, so some serious side effects might not be noticed until they are widely prescribed.

In a 2002 study, Wolfe and his co-authors found that one of five prescription drugs require stronger label warnings or get pulled from the market because of serious side effects. In his study, half of the black-box warnings were added less than seven years after the drug entered the market.

If an equally effective drug with a longer track record is available, "why take the chance" of going with the newer competitor?
This advice sort of reminds me of advice I've often received about other consumer products, especially technically complex products like cars, computers, etc.

Who hasn't bought the first model of one of these and later regretted it? The kinks haven't been worked out and your model is a lemon or the rear-window defogger doesn't work. The worst is when a new, improved model comes out the next year -- like when BMW's sound system became compatible with iPod in all 3 Series AFTER my model year!

Of course, I could have purchased a Chrysler and maybe gotten that feature. But the BMW 3 Series was hot! I had to have it. For 15 minutes I basked in the glory of it as passers-by would ask me about it or look inside while it was parked.

Now, everybody has a 3 Series! Common as dirt where I live. And mine is getting old. I need the next new thing!

That's what the USA Today article, "Newest drugs not always the best," is all about: consumers and even physicians are "tricked" into buying into the belief that "newer is better" when it comes to prescription drugs.

"Newer is Better" is Marketing 101. Many ads focus on that theme; even drug ads. Ads for Crestor come to mind, in which "newer" is replaced by "lower" as in "lower is better."

Is newer (or lower) better? Can you never be too thin or too rich? Is it necessary for a drug to be on the market for seven years before it is safe to use? Nothing changes about the drug -- there's no new model (unless you consider combination drugs like Vytorin new models). You just get a chance to see if it has fatal side effects without being part of the experiment.

But seven years! C'mon Sidney! You just don't like these new fangled things, do you? I bet you don't drive a 3 Series!

I don't go around bragging about my Pravachol the way I did about my BMW. I feel that Pravachol is "old" and I should be on the newer stuff like Crestor or Caduet or Vytorin. Then I would have some bragging rights when I sit down to one of those chicken lunches at the many pharmaceutical industry conferences I attend.

"Yeah, I'm on Vytorin! Great stuff. Ask your doctor about it." (Whoops! I forgot. Patients don't ask their doctors about brands -- see "Advertisers Don't Know How DTC Works. Say wha?")

I guess my doctor doesn't feel that Pravachol is bad just because it is old. Maybe he's a consultant for BMS and prescribes Pravachol as a favor to BMS. He certainly is not being "tricked" by Pravachol ads -- when was the last time you saw one of those?

Or maybe he just thinks that Pravachol is working for me, so why change horses in midstream?

But you know what bugs me? Maybe he's been "tricked" by the Vytorin or Crestor ads and is secretly prescribing these new and "better" drugs for his other patients! That bastard!

Wednesday, October 18, 2006

Product Web Sites Not Up to Par

Campbell-Ewald Health, a consultancy company, performed a proprietary "Digital Diagnosis" of 58 direct-to-consumer (DTC) pharmaceutical product Web sites and found them to be incomprehensible to 45% of the US population (see Campbell-Ewald Health Announces "Digital Diagnosis" Findings). OK, maybe not incomprehensible, but not fully understandable by a segment of the population with a 6th grade reading level.

More than a few experts noted that this is "not news," including Bill Vaughan, senior policy analyst with Consumers Union, who said "The American public are not doctors and have trouble understanding [drug information], and doctors have trouble conveying it, and we all need to work together to do a better job."

Nope, the American public are not doctors. But, what about doctors? It's interesting that Mr. Vaughan asserts that doctors have trouble conveying drug information to patients. Recently, a grassroots coalition of healthcare advocates launched a campaign dubbed "Just Say Know to Prescription Drugs," which attempts to make healthcare professionals more accountable for conveying this information to patients.

I downloaded the form that this campaign is asking patients to hand to their doctors and pharmacists. The form instructs patients as follows:
  • List all the prescription medications in you are taking in the form below. (make copies as needed)
  • Visit or send this form (keep a copy) to the prescribing doctors, pharmacists and other health care providers. Ask for an itemized listing below, of benefits, the side-effects of each drug.
  • Ask the prescribing doctor to list references for non-drug alternatives.
  • Ask for the healthcare providerÂ’s signature acknowledging that, they have briefed you to the best of their ability.
I intend to fax copies of the form to my doctors and pharmacists and see what their reactions will be.

I fully expect that they will direct me to the product Web sites. Circle closed!

Problem with Web Standards
The Campbell-Ewald audit also found that half of the pharmaceutical Web sites did not adhere to generally accepted Web standards established by the World Wide Web Consortium (W3C) to ensure usability for all consumers, including full accessibility for disabled Web users.

Web standards are guidelines for:
- Platform variation
- Browser type
- Consistency in hyperlinks & title text

Implementation of standards improve:
- Consumer usability and satisfaction
- Accessibility for disabled users
- Organic search results

Lori Laurent Smith, director of Campbell-Ewald Health, told me that 19% of Americans fall into the disabled category and sight-impaired people who use software reader programs to access drug sites may have a problem with sites that are not compliant with W3C standards.

"“If you use bold text to highlight the drug'’s name, which is often the case,"” says Smith, "“these readers simply stop reading when they get to the product name. I cannot think of anything more frustrating when you are trying to learn more about a product."”

It's a bit ironic, however, that even if the readers continued to do their job, almost half of the people using them would not understand the information being given them.

Smith pointed out some other problems that incompatible sites have -- problems more marketers might be concerned about. Namely, incompatible sites will also have problems getting the highest ranking among natural search results in search engines.

I was a bit surprised that so many product Web sites were not developed to be compatible with the latest Web standards, especially since pharmaceutical companies spend good money -- maybe $500,000 to $1 million per site -- hiring specialists to create these sites. The products we are talking about are the top advertised brands, not the ones scrimping on promotion.

Benefit vs Risk on Drug Web Sites
Campbell-Ewald also looked at the presentation of benefit and risk information on product Web sites. They didn'’t do a quantitative analysis like I did with print DTC ads (see XXX), but they asked the following questions:
  • Will the average consumer understand how the drug works and what they can expect?
  • Are warning signs and symptoms explained clearly and simply?
All this got me to thinking about how benefit and risk information is presented on product Web sites and how one can determine if there is proper "“balance" in the presentation.

For TV and print ads, balance might mean equal time and space, respectively, devoted to benefits and risks. On the Web, however, time and space are unlimited and are not useful measures.

What IS important on the Web is NAVIGATION, specifically how easy it is to find the information Navigation is one of the criteria that Campbell-Ewald evaluated, but Smith didn'’t share those results with me.

Friday, October 13, 2006

Print DTC, PhRMA Guidelines, and Balance

When the drug industry US trade association PhRMA released its Guiding Principles for Direct-to-Consumer (DTC) Advertising in 2005, it was thought that they would affect mostly television DTC ads. Many of the principles apply strictly to TV. However, what effect -- if any -- has the guidelines had on print DTC ads?

The share of pharma spending on print ads in magazines in the first half of 2006 is up sharply, according to a TNS Media Intelligence study cited in a report by MM&M. Magazines grabbed 34% of total pharma company DTC ad spending during the first half of 2006, up from 29% in the same period in 2005. In comparison, the share allocated to TV DTC decreased from 64% to 59%.

Some analysts contend that print DTC is enjoying a windfall due to the PhRMA guidelines, which became effective in January, 2006.
"Following the adoption of PhRMA'’s voluntary guidelines earlier this year, most companies pledged to improve accuracy and balance in ads. Since this is easier to accomplish in magazine ads, drug makers are using that medium more frequently, TNS research director Jon Swallen told the Associated Press." (MM&M story)
Principle 11 (Balanced Representation of Benefits and Risks) of the PhRMA Guidelines is the relevant principle here.
"DTC television and print advertising should be designed to achieve a balanced presentation of both the benefits and the risks associated with the advertised prescription medicine. Specifically, risks and safety information in DTC television advertising should be presented in clear, understandable language, without distraction from the content, and in a manner that supports the responsible dialogue between patients and health care professionals."
You can see that this principle is focused almost exclusively on TV and, at best, is ambivalent with regard to print. Swallen's point may be that drug advertisers are unsure how to apply this principle to TV ads and are scaling back on TV DTC ads until they can figure it out. Meanwhile, that money has to go somewhere, therefore print ad spending is up.

Is increased print ad spending due to PhRMA's guidelines?
Don't know

Following the money, we may need to pay more attention to print DTC than we have in the past. For example, how "balanced" are print DTC ads? If it's easier to achieve balance in print than in TV ads, then we should see more balance in print, right?

One way to look at this is to measure how much time in TV ads and space in print ads is devoted to risk information.

I have looked at over 60 print ads and measured the ad space is devoted to risk information vs. benefit information in these ads. To get access to the complete dataset, please download the entire September issue of Pharma Marketing News (FREE!).

I haven't done a study of TV DTC ads, but from what I see and hear, perhaps 20% to 30% (12 to 18 seconds in a 60-second spot) of such ads are devoted to presentation of major risk (fair balance) information.

How do print ads stack up against that?

In my study, print ads I studied that appeared in publications from June through October, 2006, devote only an average of 12% of the creative ad space (not including the "brief summary" page) to risk information.

On that basis, print ads devote even less attention to risk information that do TV ads! Note, however, that I am talking only about the creative area of the ad, not the "brief summary," which is often the entire drug label that is reproduced on the opposite side of the ad page. Nobody reads this, so I don't count it.
[About half of the print ads I looked at presented a patient-friendly brief summary page. This Q&A large format style was pioneered by Pfizer. The problem is that even this friendly version is not likely to be read because it appears on the reverse side of the ad page.]
In print ads appearing in publications from February through March, 2004, about 9% of the creative ad space was devoted to risk information.

This tells me two things:
  1. Print DTC ads devote considerably less ad space to presenting risk information than does TV DTC, and
  2. Print DTC ads appearing in publications after the PhRMA DTC principles became effective devote more space to risk information (about 33% more) than ads published before the principles became effective.
It appears that print ads rely too much on consumers reading the "brief summary" and therefore less creative ad space is devoted to presenting the major risks. On the other hand, print ads devote an average of 19% of the ad space to benefit statements. If you ad in the graphics, which almost always depict benefits, the total ad space devoted to benefits is 65%.

Do print DTC ads provide enough risk information? It depends. Some brands have more risk potential or potential for more serious risks than other brands and therefore require more space to explain the risks. Some brands, like Botox, are rogues and run only reminder print ads without any risk information at all even though the risks may be devastating.

Among the Top Ten "DTC Spending Champs" in the first half of 2006, here's the space they devote to risk information in their print DTC ads (sorry, I don't have data for Ambien/AmbienCR):

Except for Crestor, all of these top advertised brands devote less than average ad space to risk information in their print ads.

Of course, it's not just the amount of information that's important, but the quality of that information. These days, there is a lot of lip service being paid to how to improve the quality of risk information presented in DTC ads. Yet it is very difficult to define "quality." The FDA is "studying" the issue.

I just don't believe that presenting "less" risk information in DTC ads as some critics have proposed (see "DTC Without the Risk") will lead to better quality information.

Wednesday, October 11, 2006

Free Lunch Redux

The recent post about the pharmaceutical industry "free lunch" program for physicians -- see "Free Lunch for Physicians: Newsweek Misleads" -- generated some feedback from members of the Pharma Marketing Online Discussion Board that I believe is worth repeating here.

[BTW, all this discussion may actually be benefiting vendors that help sales reps order and deliver lunches to physicians. You might see Google ads on this blog and on the Pharma Marketing Network web site advertising these services. You can also find a list of these vendors on the online Pharma Marketing Vendor Directory.

Keep in mind that these ads are delivered via Google based on the content of Web pages -- I do not choose the ads. The most I can do is not allow ads from certain domains. My policy, however, is that unless an ad is offensive or not relevant to my readers, I leave it alone. In other words, these ads are NOT chosen by me purposefully to run alongside this commentary. Just for the record.]

Back to free lunches. Michael Weintraub had this to say:
"[$7.3 billion -- the number cited by Newsweek] Sounds high...

"Pharma spends $30B annually on Marketing. About $10B of that goes to field force activities, including the cost to have 110,000 sales reps in the field, drug samples as well as pens, lunches, etc.

"However, bulk of cost is the Rep and samples, not the other freebies. Another $6B goes to DTC and DTP programs. About $1B for data and market research activities. The rest goes to all of their other Marketing activities. They spend about 12% of sales on Rebates, so that's as big as marketing spend. They also spend slightly less to same on R & D."
To which Michael Li, who works at a company that measures sales rep visits and other data, responded with this:

"The IMS promotion audit, called IPS, does not track free lunches or pens. So $7.3 could well be someone's estimate. I worked there for many years.

"The trend of using meals in promotion detail has been up recent years.

"[The chart on the left is based on data] from ImpactRx PCP network database, which shows meal usage in detail increased from 10.1% in 2002 to 20.1% in 2006 (ending September).

"Among top 100 detailed brands for PCP in 2005, Lilly's Forteo had highest percentage of meal provided in detail, 28.6%.

"Overall all, specialties had higher percentages of meal provided.

"ONCOLOGY had higher percentages (55%) of given meals in 2005, followed by NEURO, PSY and URO. DERM received least in free meals."

This is a very interesting bit of data. In the chart I note that PhRMA's Code of Interaction with Health Care Professionals became effective in July 2002. In the Q&A section of that document we find this:
"...if a sales representative is providing substantial scientific or educational information regarding a companyÂ’s products to one or a few healthcare practitioners, this could also be done during a modest meal which could be at or outside of a physicianÂ’s office.

"However, if the nature or location of the meal would not facilitate communication of the information, then a meal would not be appropriate. Further, the use of modest meals on more than an occasional basis would not be appropriate."
I question if supplying meals during 20% of sales calls is "occasional." Perhaps PhRMA Intern needs to investigate!

Interestingly, pharma meals (including mostly lunches) for physicians seems to have taken off soon after this Code was adopted. Many of the companies offering logistical support for reps to deliver meals on wheels to physicians also came into being around that time or soon afterward.

Effective of PhRMA Codes on Physician and Consumer Marketing
PhRMA codes of practice often shift spending by pharmaceutical marketers rather than decrease the spending overall. While free meals to physicians benefited from the 2002 code, companies offering golf balls and other, non-medically-related "chatchkas" suffered.

An analogous shift seems to be happening as a result of PhRMA's Guiding Principles for DTC, which became effective in 2005.

MM&M Online reports that "DTC advertising spending by pharmaceutical companies was up 9% during the first half of 2006, according to data released this week by marketing information firm TNS Media Intelligence." But the % allocated to TV was down while that allocated to print (magazines) was up. "Following the adoption of PhRMAÂ’s voluntary guidelines earlier this year, most companies pledged to improve accuracy and balance in ads. Since this is easier to accomplish in magazine ads, drug makers are using that medium more frequently, TNS research director Jon Swallen told the Associated Press."

How Much Is Actually Spent on Free Lunches?
I tried to estimate this in my previous post and came up with $1.65 billion per year based on estimates of sales rep budgets.

You can use the ImpactRx data and make another estimate: I have no idea how many details an average pharma rep delivers in a year -- say it's 1000. If 200 (using the 20% estimate above) of these include lunch at $90 a pop, that's $1.62 billion per year for 90,000 drug reps. That jibes well with my estimate of $1.65 billion.

Kevin Kaul from Scriplogix came up with a different number based on personal experience:
"Another way to estimate this is to take the number of sales reps in the US and estimate what their monthly promotional spending allowance is. For example, my reps used to get $1,000 a month, 75% of which was spent on lunches, donuts and other food throughout the course of a day.

"Obviously, some companies don't have such a high budget, others have something bigger and others none. So, if we assume there are only 70,000 reps, which is just a guess at this point due to the downsizing which has taken place, and the average monthly budget for food is $400 per rep per month, one comes up with a number in excess of $3 billion per annum."
Kevin made a decimal point error -- 70,000 reps spending $400 per month on lunch equals $330,000,000 or $0.33 billion per year (I used 90,000 reps with a budget of $1000 per month for my estimate of $1.1 billion).

We have ranges: Are there 70,000 reps in the US or 90,000 (or 110,000)? Is the lunch budget $400 per rep per month or $1,000 or $2,000? The resulting calculation of $ spent on free lunch per year using these numbers also ranges: from $0.33 billion to $2.2 billion. Split the difference and you get $1 billion, which is more than the $836,400,000 the industry spent on print DTC advertising for the first half of 2006.

What's the Harm?
Many commenters suggested that free lunches do not influence physicians.

Kevin McColgan said:
"I was a representative myself for many years in the UK & Ireland before moving to the USA. It was standard practice to provide light refreshments for practice staff & most reps were happy to do so. One of the main reasons being that health service staff (with the exception of the medics) were very poorly paid and had usually had a morning of stress dealing with up to 50 patients, most of whom don't appreciate the service being provided to them - the downside of a free universal health service.

"Seeing a rep. with some nourishment & a smile on their face was a welcome break from their morning's drudgery so we were welcomed with open arms!!

"The UK has a very strict code of conduct governing the pharma industry (The ABPI,) & this includes a stipulation that you must not offer excessive hospitality to members of the health service, the figure of anything above five pounds was deemed excessive. A sandwich usually costs from 2 to 3 pounds and fell within that figure, and considering it would cost many times that amount to take the medics to an expensive restaurant, I always considered that lunches were value for money, were a good use of my budget & I was giving something back to the hard working health care personnel who tolerated me as well as the grumpy patients. It also earned me no end of goodwill which allowed me the opportunity to be INVITED back which was very important, both in terms of building customer relationships and as a way of circumventing the ABPI code of conduct which said that you can only call on a medic THREE times in a 12 month period unless you were invited to come back to see the Dr. at his/her request.

"I agree that to imply anything sinister in this simple but cost effective practice is way over the top."
Therese Padilla said:
"One of the small investments I made was in a deli. A pharmacist Customer (who happened to walk in one day and enjoyed the food) connected the Deli with a drug co sales representative. The rep was looking for good Sources to provide lunches for doctors etc. After that connection, the deli Provided lunches for a variety of the rep's clients. Nothing excessive, and certainly in line with other deli catering clients like automobile dealerships, corporate workshops and lawyers. It seems to me that food was about building personal relationships. Pens, note pads, etc seem more impersonal and impractical (how many stress balls can you give a client?).

"Newsweek took something that has little conflict of interest and made it sound sinister."
Michael Li said:
"Another important question is - did meals have any influence on physician's brand choice? From a large amount of custom modeling projects, we found that meals sometimes had a positive impact and sometimes no impact at all. It depends on other aspects of promotion and marketing measures, as well as brand specific situation."
On the other hand, Bruce Wilson, a medical writer from Quebec, Canada suggests undue influence:
"I have often overheard physicians talking to each other at meeting symposia. On one occasion a physician asked his colleague whether he would use the drug of the symposium sponsor or the competing drug? His answer, 'It depends on who feeds me best.'

"Disgusting but true."
Would the drug industry spend $1 to $1.6 billion per year on an activity that has no positive return on investment? If it was Google, my answer would be "yes."

Tuesday, October 10, 2006

Snark Meter

In the course of writing this blog, I have come across many comments from people. Most -- I am happy to say -- are positive.

One comment, however, referred to my post on the Rozerem DTC ad campaign ("Rozerem Ads Dis Lincoln, Show Beaver") as "snarky." Since then, I have seen the word used critically against other bloggers, including Peter Rost, "Pharma's Black Knight."

When I first saw the word, I wasn't sure what it meant, but it didn't sound good. So, I "Googled" it. Here are a few definitions I've come up with:
adj. Slang., -ier, -iest.

1. Rudely sarcastic or disrespectful; snide.
2. Irritable or short-tempered; irascible.

[From dialectal snark, to nag, from snark, snork, to snore, snort, from Dutch and Low German snorken, of imitative origin.]
I think this definition doesn't quite fit me. I mean, c'mon, accusing Rozerem of dissing Lincoln and showing beaver isn't disrespectful, is it? I think that the Rozerem ad itself is disrespectful to Lincoln, if not beavers everywhere! Still, I didn't accuse the ad creators of being "snarky."

If you really want to see some snarky blogging of the worst sort, take a look at Drugwonks. Here are a few recent topics from that snarky blog:

"North Korea, Drug Counterfeiting and Senator Vitter" -- Now that's rudely disrespectful. How else can you describe an attempt to put a US Senator in the same bucket as North Korea?

"A new treatment for a rare lymphoma: Circle of Cancer Cynics Ready to Pounce"

"Ben 'Dr. Doolittle' Bernanke"

"IOM's Silly Drug Safety Study"

And on and on it goes.

Here's another definition of snarky:
Snarky. def. adj. cranky yet vaguely amusing. See also: curmudgeony, cantankerous, impertinent, impudent, audacious, insolent, fresh. Used in context: "His comment was so idiotic, I had no choice but to respond with a snarky comment."
This is closer because I do think I am "vaguely amusing" -- at least I try to be. The sentence above can be turned into a good mission statement for this blog:
Some activities of pharmaceutical advertisers and marketers are so idiotic, I have no choice but to respond with a snarky [vaguely amusing] analysis.
Yet another definition with a bit of history:
The adjective snarky is first recorded in 1906. It is from dialectal British snark, meaning 'to nag, find fault with', which is probably the same word as snark, snork, meaning 'to snort, snore'. (The likely connection is the derisive snorting sound of someone who is always finding fault.) Most dictionaries label snarky as "Chiefly British Slang." But for the last five or more years, it has become increasingly common in American publications, maybe ones infiltrated by British or Canadian writers and journalists.
Now I understand! It's one of those British slang words (not that there's anything wrong with that). I like to use British slang just as well as the next American. Recently, I've picked up on "brilliant," which is a word Brits use when they get their way in negotiations.

I must admit that I do always find faults. Perhaps if more people looked for faults we wouldn't be faced with as many disasters such as the two fatal Shuttle events or the withdrawal of Vioxx from the market.

I think that my fault finding has also helped pharmaceutical marketers. For example, I found fault with the Rozerem marketing people who were not up to snuff when it came to search engine optimization (see "Rozerem Beaver Buzz"). Since then, I've noticed that if you search for "Rozerem commercial" on Google, my post about Lincoln and the beaver is no longer at the top of the list -- the Rozerem product web site is! How about that!

Tell Me What You Think

Which best describes this Blog (check all that apply):
Rudely sarcastic
Cranky yet vaguely amusing

Monday, October 09, 2006

Pharma Support for CME Slows

2005 marks the third consecutive year of decreased growth in commercial support of continuing medical education (CME) by the pharmaceutical industry, according to the 2005 annual report of the Accreditation Council for Continuing Medical Education (ACCME), which collects this data from accredited CME providers.

In previous years, pharma support for CME had grown at a double-digit rate (the average from 1999 through 2003 was 22.1%). In the last two years the growth rate has averaged only 8.2% (see chart).

Not since the market bust of 2000-2001 has pharma support slowed, and not as dramatically as in the last two years.

Commercial support comes from grants ($1.12 billion) plus advertising and exhibit fees ($236 million).

The total income of CME providers in 2005 was $2.25 million vs. $2.05 million in 2004. Pharma commercial support contributed 61.8% of that in 2004 and 60.0% in 2005 or 52.2% and 49.6%, respectively, just considering grants and not advertising or exhibit fees.

Less Support for Schools of Medicine
Medical schools are competing with commercial CME providers (MECCs) in this arena and pharma has cut back on the absolute amount of commercial support for CME provided by medical schools while increasing support of MECCs.

In 2004, pharma support for medical school based CME was at an all time high of $249 million. In 2005, that dropped to $239 million. Pharma contributions to physician societies for CME has remained flat at about $168 million.

Pharma support for commercial CME providers on the other hand has increased from $704 million in 2004 to $738 million in 2005.

This could be in reaction to calls from the medical community that medical schools stop accepting "free gifts" from pharmaceutical companies and that grants for CME from pharma be contributed to a general fund rather than to individual physicians (see "Gifts That Keep on Giving"). We could be witnessing payback by the pharma industry.

Education vs Lunch
Last week I posted some estimates of the amount of money the pharmaceutical industry spends on providing free lunches to physicians (see "Free Lunch for Physicians: Newsweek Misleads"). Based on 2004 data, I estimated that the industry spends $1.1 billion on its free lunch program for physicians. Using data about the total budget for sales reps in 2005 of $11 billion -- a number supplied by a commenter to the above post -- I estimate that the free lunch program cost the industry $1.65 billion in 2005 (this assumes that the percentage of a rep's budget spent on lunch has remained constant at 15%). This is about $500 million more than the industry spends on CME.

It's good to see where the priorities are.

Friday, October 06, 2006

Free Lunch for Physicians: Newsweek Misleads

According to a Newsweek online article, "A growing number of doctors and medical centers are shutting the door on freebies from big drug companies" (see "Saying No to Big Pharma").

Newsweek quoted IMS Health data for 2004 and claimed that pharmaceutical companies spent about $7.3 billion on "free lunches and pens" for physicians that year. Here's the exact quote:
"Drug companies spent another $27.7 billion on promotion, including $15.9 billion on free drug samples and $7.3 billion on sales-rep contacts (free lunches and pens), $4 billion on direct-to-consumer advertising and $500,000 on journal advertising..."
The $7.3 billion figure is likely to be repeated in many blogs and other critical pieces (for example, see the recent post on this topic in PharmaGossip). The problem is that Newsweek is purposely misleading its readers and I'd like to set the record straight.

Newsweek has mislead its readers (and some bloggers) by parenthetically qualifying "sales-rep contacts" to mean "free lunches and pens." This implies that $7.3 billion was spent
only on free lunches and pens for physicians, which is patently impossible! And this is from someone who is not a big fan of this type of promotion to physicians as any regular reader of this blog can attest (see, for example, "Gifts That Keep on Giving").

$7.3 billion works out to about $11,000
per physician! That assumes each physician in the US received the same piece of the total pie as it were. If you apply the 80/20 rule of physician marketing, which states that 80% of promotional spending goes to the top 20% of prescribers, then each high prescriber would receive $43,000 worth of free lunches and pens.

$11,000 or $43,000: no one could eat that much lunch or use that many pens! Unless, that is, each physician and his/her staff of four were treated to 250 lunches per year.

So, how much is actually spent on free lunches for physicians?

A while back I quoted a figure that suggested that each of the 90,000 or so pharma sales reps has a monthly physician lunch budget of $2,000 (see "Free lunch for patients! Why not?"). That works out to only about $2.2 billion for pharma's physician free lunch program. Eli Lilly claims the real monthly budget per rep is only about one-quarter to one-third that amount. Let's compromise and use $1.1 billion as the best estimate. That's 15% of the total sales rep promotional budget (not including samples), which is not an unreasonable amount.

Other Freebies
Of course, the $7.3 billion is what the industry spends on
all sales rep activity, not including cost of dispensing samples. Newsweek is being grammatically incorrect -- but politically correct -- by parenthetically qualifying "sales-rep contacts" to mean "free lunches and pens." Sales-rep contact includes other expenses like wages, bonuses, car, rep expenses, and most importantly, sales aids and other promotional items/expenses. The latter may include physician "freebies" like compensation to attend conferences, consulting fees, ghost writing services, etc.

These other "freebies" are what really influences physicians to prescribe the drugs of the gift givers.

In a recent Pharma Marketing News online poll, respondents were asked to rank various "gifts" to physicians in terms potential conflict of interest. The results are summarized in the chart (left). You can also access an interactive summary of the results or read opinions of experts in the article: "Free Gifts to Physicians: What's the Big Deal?"

It's a shame to frame this topic as "free lunch and pens" when the issue is much more complex than that. Lunches and pens involve little conflict of interest compared to payment for "consulting" and other "freebies" according to poll cited above. It is obviously convenient for Newsweek not to do any fact checking and to mislead readers to believe that $7.3 billion is spent on free lunch and pens for physicians. It makes for good proselytizing, but not good reporting.

While we're on the subject of free lunches for physicians, feel free to participate in the following poll:

Should pharma companies stop serving free lunches to physicians?

Wednesday, October 04, 2006

Imprecise DTC Benefit Messages

Bob Ehrlich, who writes a weekly DTC Perspectives e-mail newsletter, recently wrote:
"When drug ads warn about risks and side effects they use words that are open to interpretation such as rare, possible, may, higher chance, etc. These words have different meanings to each consumer. The imprecision in side effect language is dangerous. Usually consumers will magnify the risks of serious side effects and this may cause them to avoid drug treatment."
While reading this, I did a little mental exercise in which I substituted "benefit" for "risk" and came to similar conclusions regarding vague benefit statements in DTC ads: consumers may magnify minor benefits and this may cause them to ask for drugs that they don't need. Benefit statements may also be "imprecise" and thus dangerous.

The most infamous example I can think of regarding dangerous, imprecise benefit statements in DTC ads is the current Rozerem ad campaign. I've discussed this campaign in many previous posts to this blog. You can find them here:
First if all, there is not much of any benefit statement at all in the Rozerem print ads (see area "B" in image below): only about 5% of the print ad area is devoted to a benefit statement, which includes this: "Your doctor can explain why Rozerem is so different." That's not very precise! In fact, I am sure a focus group of consumers would give it much more positive weight than it deserves: "Oh! It's different. Not just 'different,' but SO different! Sounds good!"

Ehrlich laments that advertisers are being hampered by FDA rules that do "not allow marketers to state risk from post marketing experience because it is anecdotal." I wonder what kind of evidence Takeda has to support its "so different" claims? Could it also be anecdotal? I don't think any kind of anecdotal experience has a place in advertising prescription drugs, although it seems that the FDA has no problem with celebrities citing their anecdotal benefits in ads.

Not many people would argue that the graphic images in DTC ads convey mainly perceptions of benefits -- you don't see any photos, for example, of people suffering side effects.

In Rozerem print ads, the graphic occupies about 81% of the ad area (see area "A" in image above). It must convey a very important message if the advertisers allocated all that space to it. But what is the message? It seems that only the ad agency that created the ad can interpret the true meaning of Abe and Beaver (for more on this, see the "Interpreting Rozerem DTC" section of the post "Odds & Ends & Interpretations").

Here's what Richard Meyer had to say over at World of DTC Markleting: "This is clearly what happens when creative people get too damn creative and lose sight of the key message. When people see commercials they should not have to think about what is being said it should be upfront so that that light can go on in their head but here we have a man in his kitchen with 'Honest Abe' and a beaver and 'your dreams miss you!'...if this is good DTC then the pharma industry is in deep shit."

Ehrlich ends his piece with: "If I might die or become permanently disabled from a drug reaction, I deserve more than vague words." He was speaking about words used in the risk statements of DTC ads. I agree.

The same can be said, of course, for "vague" words and/or graphics used to convey benefit information in DTC ads. Rozerem is just an extreme case produced by a slick advertising agency that -- as one commenter put it -- is "toying" with us rather than being forthright.

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