What Was Blogworthy in 2006? A Review

What was hot in 2006 for readers of Pharma Marketing Blog? To determine this, I looked at the posts that received the most page views or that generated the most comments from readers and came up with the following review of 2006 highlights.

Failure, Fops, and Pfizer
By far, readers seemed most interested in catastrophic failures of the high and mighty, whether it be the fall of high-profile CEOs (eg, "Another Pharma CEO Bites the Dust!") or highly-anticipated blockbusters (eg, "Pfizer's torcetrapib: Who Knew What, When?" and "torcetrapib: "$800 Million" Failure but Kindler Safe").

Speaking of the high and mighty, readers were VERY interested in "Marketing Executive Salaries."

Pfizer, being the highest of the high and the mightiest of the mighty, is always a good subject for blogging and polling. When I wrote about torcetrapib's failure, it generated quite a bit of discussion on the online Pharma Marketing Discussion Board, where at least one person characterized Pfizer as being arrogant. I wondered how many other people shared this view, so I ran a poll (see "Is Pfizer Arrogant and Superior?") and came up with this:


I suppose Pfizer can live with that.

The post about Dr. Robert Jarvik, inventor of the Jarvik artificial heart and Lipitor "celebrity" spokesperson ("Lipitor's Jarvik: Fop or Flop?"), was inspired by the purple tie he wore in some commercials. I learned that his claim as the inventor of the artificial heart is contested and some readers felt I was being too glib and even "snarky." To see if other readers agreed, I did a poll (see "Snark Meter") and asked readers their opinion. The results are shown below:

I can live with that!

Disease Mongering
"Disease Mongering" was a topic that frequently came up in 2006. The first time was the post "Disease Awareness or Disease Mongering?", which appeared in April. The post "Pharma Tail Wags Patient Dogs", which was the third most viewed page in June, discussed pharmaceutical company support of patient advocacy organizations that failed to disclose this support. The dog wags the tail, however, when these organizations are created de novo by pharmaceutical marketers, which certainly has to be the case with the Restless Leg Syndrome Foundation (for more on that, see "Restless Pharma Marketing"). It's all part and parcel of what critics call "disease mongering." You can hear a Pharma Marketing Talk podcast on this subject here.

Dis Lincoln, Show Beaver
Insomnia posts were only second to erectile dysfunction posts in the number of page views received. Certainly, this topic received the most comments from readers. Back in September, 2005, I predicted that insomnia would be a hot pharma marketing topic (see "Insomnia - the Next DTC Frontier") and I wasn't disappointed. The high point (or low point, depending on your point of view) came in July, 2006, when I posted a critique of the Rozerem ad campaign (see "Rozerem Ads Dis Lincoln, Show Beaver"), which has generated at least 52 comments -- the most for any subject. This post is now a classic and still top-rated in a Google search for "rozerem ad" or "rozerem commercial."

Consumer Mis-Interaction
2006 was the year when pharmaceutical marketers were blitzed by agencies selling them on the merits of Web 2.0, social networking and engaging the consumer/patient. I've written quite a number of posts on topics related to this. In "Question Everything," I question the authenticity of the participants of an online bulletin board sponsored by a pharmaceutical company. This issue -- authentic response by consumers vs. "sock-puppet" marketing (or marketers disguised as consumers) -- comes up often in the comments made to this blog. For example, a comment to a Rozerem ad critique was supposedly written by a "typical woman" who viewed an Abe Lincloln/Beaver Rozerem TV ad and decided right then and there to switch to Rozerem from Ambien. Yeah, and I have a bridge in Brooklyn to sell you! Of course, no one was fooled as the results of a poll showed:


Web 2.0 and the advent of social network marketing is the new wild, wild west of Internet advertising. Isn't it time for the FDA to get its head out of whatever hole it is in and issue some guidance on acceptable pharmaceutical Internet marketing practices? Better yet, the industry should take some steps to define its own guidelines to stave off overly-restrictive FDA guidance based on insufficient knowledge of the technology (for more on this, see "Where's DDMAC's Head At?").

BTW, I had some first-hand dealing with pharmaceutical consumer relations that received a few comments from readers who were not all surprised (see "The Call Center from Hell").


The Adventures of PhRMA Intern
The antics of the Pharmaceutical Research and Manufacturers Association (PhRMA) often came under scrutiny on this blog. This year, the Adventures of PhRMA Intern debuted and delighted many readers. PhRMA Intern has been characterized as a "Strange visitor from an Ivy League school who came to PhRMA with powers and ability far beyond those of Ken Johnson. PhRMA Intern! Who can change the course of mighty news stories, bend the truth at will, and who disguised as Emily Jameson (no relation to Jenna Jameson), mild-mannered intern for a great pharmaceutical trade association, fights a never ending battle for believability, justice for pharmaceutical companies, and the PhRMA way!"

PhRMA Intern's first assignment was to respond to complaints PhRMA received regarding violations of its voluntary guidelines on DTC advertising (see "Adventures of PhRMA Intern!"). From there, she moved on to tackling terrorists on the issue of drug reimportation ("PhRMA Intern Tackles Terrorists") and then to PR agencies ("PhRMA Intern vs. the Pharma PR Agency") on the issue of whether or not "PR marketing" should follow PhRMA's DTC guidelines. She met her match, however, fighting Allergan -- the "we don't need no stinking guidelines" company (see "PhRMA Intern vs. BOTOX!").

I have no doubt that PhRMA Intern may be reincarnated in a new internship -- perhaps at a pharmaceutical company or even at the FDA. Stay tuned!


Breaking the Rules
Speaking of not needing stinking guidelines, there was plenty of opportunity this year to criticize companies that violated their own pledges to abide by PhRMA's DTC Guidelines (see, for example, "Sepracor Sneaks In Lunesta Reminder Ad") or even run Internet ads that violate FDA regulations. For an example of the latter, see "Lunesta, Google, and bAdWords", which broached the topic of violative Google Adwords, which mention the brand name and indication but do not include side effect information or brief summary or any direct link to this information. It turns out that Google may be encouraging pharmaceutical marketers to use these types of ads. I pointed this out in a provocative -- some might even say "snarky" -- post entitled "The Girl from Google." I received a lot of flack in comments to that post, but at least 79% of readers agreed with me that these ads violate FDA regulations (see chart below):
These results are pretty one-sided! It prompted me to submit an official complaint to the FDA. I haven't heard back from that agency yet. Perhaps they are waiting for a summer intern to respond. While we're waiting, enjoy the following video:



Requiem for Pharmaceutical Sales Reps
"Industry PR & Rep Morale" reviewed a survey that showed that the vast majority (85%) of pharmaceutical sales reps believed that public opinion of the industry has decreased. At the time, I thought that getting reps involved in improving public opinion by engaging in public appearances and whatnot was a good move by the industry. I didn't think it would improve the public image of the industry (see "Sales Reps Make Poor Spokespeople"), but I thought the activity would boost rep morale and improve sales force efficiency. The industry, however, has a better, quicker way to improve efficiency -- less reps!

I could go on, but I think this is a pretty good sampling of what was of interest to readers of this blog in 2006. I have every reason to believe that 2007 will be as interesting with lots of issues to discuss.

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Happy New Year!
I wish everyone a happy, prosperous, and productive New Year. Let's just try to keep the bullshit to a minimum, OK?

Revamping the Lunesta Ad Campaign

Regular readers of this blog know how often I have berated Sepracor about its Lunesta ad campaign tactics. Over the months I have made many criticisms of Sepracor's marketing efforts:

• Sepracor's reminder Lunesta ads violate PhRMA DTC Guidelines, to which Sepracor is a signatory (see "Sepracor Sneaks In Lunesta Reminder Ad")
• Worse, Lunesta online advertising violates FDA regulations (see "Lunesta, Google, and bAdWords")
• Despite $200 million or more per year spent on the ad campaign, Lunetsa sales were sleepy (see "Lunesta, a Sleeping Dog")

I wasn't surprised, therefore, when I read in BrandWeek that "Sepracor will 'refresh' its consumer marketing for sleep drug Lunesta in early 2007..." (see "Lunesta To Get Wakeup Effort in New Year").

The article continues: "In a note to investors just before Christmas, Merrill Lynch's Gregg Gilbert wrote that Lunesta's marketing, advertising and promotional materials will be changed early in the new year to reflect positive results from studies of the drug in people with depression, anxiety and menopause. No further details on the campaign were given."

Not only will the ads change, but the Speracor marketing department is also in flux, according to BrandWeek: "...there has been a change in leadership in Sepracor's marketing department. Marketing chief Timothy Healey left the Marlborough, Mass., company recently to take a post at Advanced Magnetics in Cambridge, Mass."

I don't know if that's a step up or down, but Mr. Healey may miss out on a great opportunity; namely, a buyout of Speracor by Pfizer. At least that's the rumor. No replacement for Healey has been named, according to BrandWeek.

The anticipated changes of the Lunesta ad message, in which insomnia is related to serious and prevasive medical conditions like depression and menopause, parallels a similar shift in ads for erectile dysfuntion, which link that condition to the more serious medical problems of diabetes and high blood pressure.

I haven't looked at the data supporting the incidence of insomnia among depressed people and women in menopause, but I suspect the shift is being made primarily because the old message -- you're too worried about your work -- has not worked. At least not well enough to distinguish Lunesta from the market leader Ambien and AmbienCR, which together still command 53% of the insomnia market vs. Lunesta's 13%.

The Numbers Don't Add Up
BTW, I got these market share numbers from BrandWeek, which appears to have gotten them from Merrill Lynch who got them form... I dunno! If we add up the Ambien and Lunesta market share numbers, we get 66%, which leaves 34% to Rozerem and Sonata, the other drugs in the insomnia category. Sonata must be a minor player, so the bulk of that 34% must represent Rozerem's market share according to these numbers.

But there's something clearly wrong here. As I reported in a previous post to this blog, according to Wolters Kluwer, "from March through August 2006, Rozerem sales grew to $38 million, capturing a 1.9 percent market share" (see "Rozerem Ads Innovatively Ineffectual"). I cannot reconcile 1.9% with 34%. Perhaps readers have better numbers for us.

If Lunesta is changing its advertising to help it surpass the 13% market share number, then Rozerem surely should follow suit to break through its pitiful 2-3% market share barrier. I am waiting for that other shoe to drop.

Update on Insomnia Market Share Data
P.S. Jim Edwards, Senior Editor at BrandWeek was kind enough to send me the following information regarding the market share data for various drugs used to treat insomnia. Jim said:

Here's the text of ML's take on insomnia market share:

Lunesta TRx's were 136,173 for an 11.6% share of the sleep agent market (up
10 b.p. wk/wk). Refills accounted for 43% of TRx. Based on $82 per TRx,
Lunesta end-user sales are annualizing at roughly $580.6 million. Rolling
4-week TRx growth for the market was down 70 b.p. to 10.2%.

Lunesta NRx's were 78,011 for a 12.5% share of the sleep agent market (up 10
b.p. wk/wk). Sanofi's Ambien CR NRx share was up 40 b.p. to 17.3%, Ambien
NRx share was down 10 b.p. to 35.9%, King's Sonata NRx share was up 4 b.p.
to 1.92%, Takeda's Rozerem NRx share was up 1 b.p. to 2.57%, temazepam NRx
share was up 10 b.p. to 10.7%, and trazodone NRx share was down 50 b.p. to
15.3%. Rolling 4-week NRx growth for the market was down 50 b.p. to 5.0%
yr/yr (vs. roughly 7.2%-8.0% prior to Lunesta launch)

I used some of this data to create this chart of Market Share based on New Prescriptions (NRx):

The Next Blockbuster - You Decide!

CNN Money reports that "After a rough couple of years dealing with patent expirations and the often frustrating hunt for new products, drug industry executives would love nothing better than an oracle to predict what products in their labs will become the big blockbuster drugs over the next few years." (See "Big Pharma's drug wish list for 2007").

I'd like to try a "wisdom of the crowd" experiment and see if readers of this blog may be the oracle sought by the industry. So, here are the contenders for blockbusters and a bit of information about them. You add your own information and then vote on which ones you think will achieve blockbuster ($1 billion or more in yearly sales) status over the next few years.

• Januvia (Merck) - a recently approved "first-in-class" diabetes drug (enhances the body's ability to produce its own insulin).
• Galvus (Novartis) - an experimental diabetes drug, will compete with Januvia
• MK-0524A (Merck) - experimental drug being tested for its ability to increase HDL (similar to Pfizer's ill-fated torcetrapib)
• Arcoxia (Merck) - experimental anti-inflammatory pain killer drug for arthritis. Available outside US, may be approved next year by FDA.
• Acomplia (Sanofi-Aventis) - generally considered an anti-obesity drug. Available overseas, trying to get approved by the FDA in the US.

So, which of these drugs do you think will become a blockbuster in the next few years. Please take the following poll -- don't cheat and view the results before voting!

Which will be a blockbuster? (choose one or more)
	Acomplia
	Arcoxia
	Galvus
	Januvia
	MK-0524A

Disease Mongering Podcast

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Never heard of Disease Mongering? Read "Disease Awareness or Disease Mongering?".

Guests:

• Neil H. Gray, Managing Partner, Healthcare Trends & Strategies, LLC
• Alex Sugerman-Brozan, Director, Prescription Litigation Access Project
  

Go to the Pharma Marketing Talk Channel Page to listen in.

Background
Disease mongering is a term that was coined by the late journalist Lynn Payer to describe what she saw as the confluence of interests by some doctors, drug companies, patient advocacy groups and media in exaggerating the severity of illness and the ability of drugs to "cure" them. Today's definition includes the accusation that, for example, cardio metabolic syndrome is really a cluster of risk factors for patients with diabetes, hypertension and heart disease. This podcast provides a highly interactive debate incorporating the view points of people from both ends of the spectrum. It also explores the concern that pharma may be loosing credibility with physicians and the general public by "creating" these syndromes.

Some examples of "diseases" that the authors of a PLoS report consider "mongered" include:

• Restless leg syndrome - Prevalence of rare condition exaggerated
• Irritable bowel syndrome - Promoted as a serious illness needing therapy, when usually a mild problem
• Menopause - Too often medicalised as a disorder when really a normal part of life

Some questions addressed in this podcast include:

• What's your viewpoint on this issue? Is it a legitimate issue? Are the diseases mentioned verifiable medical conditions or do they represent fake diseases invented by pharmaceutical marketers? Who's the authority on defining an illness?
  
• Are marketers overstating the prevalence of these and other conditions in order to inflate sales? Isn't there a danger that by doing so, they set themselves up for failure to meet target goals (I'm thinking of the ED market here)? Would this lead to an ever-increasing need to widen the scope of the condition?
  
• How do patient advocacy groups and the media benefit from disease mongering? Is the pharmaceuticfal industry establishing and funding patient advocacy groups for this purpose?
  
• Is "disease awareness" just a euphemism for disease mongering? Is there a danger that legitimate disease awareness will morph into or spill over into disease mongering? How can pharma companies prevent that from happening? Is it necessary to take disease awareness out of marketing like CME was?
  
• Is the pharmaceutical industry losing credibility by promoting treatments for previously unknown conditions for which there are relatively few suferrers? Restless Leg Syndrome comes to mind.

DTC Set to Surpass DTPhysician

The November GAO report on FDA's Oversight of Direct-to-Consumer (DTC) advertising, which I mentioned in yesterday's post (see "Where's DDMAC's Head At?"), includes data from IMS on Rx promotion and R&D spending going back to 1995 (see table; click on it to see the larger, more readable version).

The GAO report states:

The amount that drug companies spend on DTC advertising increased twice as fast as spending on promotion to physicians or on research and development. IMS Health estimated that, from 1997 through 2005, spending on DTC advertising in the United States increased from $1.1 billion to $4.2 billion -- an average annual increase of almost 20 percent. [See "Total U.S. Promotional Spend by Type, 2005."] In contrast, over the same time period, IMS Health estimated that spending on drug promotion to physicians increased by 9 percent annually. Further, PhRMA reported that spending on the research and development of new drugs increased by about 9 percent annually during the same period. While spending on DTC advertising has grown rapidly, companies continue to spend more on promotion to physicians and on research and development.

The DTC estimate includes TV, magazines, newspapers, radio, and outdoor advertising, but not Internet based advertising (for more on that, see "Pharma eMarketing in a Slump"). Physician promotion includes estimated spending on office - and hospital-based promotion to physicians and journal advertising. These estimates do not include other spending, such as drug company spending on meetings and events (eg, CME and advertising at CME events, which could be as much as $1.5 billion), or spending on promotion that targets medical professionals other than physicians, such as nurse practitioners and physicians assistants.

The GAO was careful to point out that more is spent on promotion to physicians than to consumers -- a lot more; 71% more, to be precise ($7.2 vs. 4.2 billion). It emphasized, however, the rate of growth difference; namely, 20 percent average annual growth for DTC spending vs. 9% for DTP (ie, direct-to-physician) spending.

At what point, I thought, would DTC spending surpass DTP spending if those rates of growth continued? I did the calculations and plotted the results and found that, under these assumptions, DTC spending would surpass DTP spending in 20011!

This was interesting, so I looked at the raw data again to see if the 20% vs. 9% numbers were valid assumptions. What I was thinking was that there was practically NO DTC prior to 1997, so any spending would represent a huge percentage increase for years afterward. Maybe it wasn't fair to use the 8-year average of 20% growth. It might be better to look at the last 5 years only, for both DTC and DTP, and redo the calculation.

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Today's show airs live! at 1 PM Eastern US time. The topic is Disease Mongering. Click here for details about the show and instructions for tuning in via your computer or downloading the audio archive afterward.

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Before I get to that, I'd should mention that I could not verify GAO's numbers exactly. I calculated an average of 19.13% rate of increase in DTC spending from 1997 through 2005 (GAO said it was 20% -- actually, 19.6% rounded up) and an 8.25% average increase for DTP (GAO said 9.0%). Rounded down, my numbers were 19% vs. 8%. Using those numbers adds 1 more year to the estimate of when DTC will surpass DTP. I also do not understand how GAO got a total percentage increase in DTC spending from 1997 through 2005 of 296.4%. When I do the math, it comes out to 281.8%. It makes me nervous -- GAO is supposed to be accountants!

Any hoo, if you look at the percent change in DTC and DTP spending year-vs-year, you find there are wide fluctuations, as shown in the following chart:

For example, DTP spending dropped precipitously in 2005 vs. 2004. Wha happened? I leave that up to you as an exercise.

DTC spending seems to be cyclical - rising and falling with the political tide!

So, who knows what the future holds for DTC and DTP spending? Things are in flux with the new Congress (see "Congress vs. Pharma: Trouble Ahead?"). However, let's use recent rates of increase (2000 through 2005; 11.5% for DTC and 5.4% for DTP) as a basis for predicting when DTC spending might overtake DTP spending and see what we get.

What we get is 2015. That is the year that I predict DTC spending will surpass DTP spending ($12.4 billion vs. $12.2 billion, respectively):

So, what's the point of this exercise? Nothing really, except perhaps that the GAO could have included a chart like the above to emphasize further where DTC may be headed in the not too distant future and what the FDA may be up against trying to keep up with it all.

BTW, using my 11.5% growth rate number for DTC and the 6.0% growth rate that GAO reports for R&D spending, I predict DTC spending will outstrip R&D expenditures in 2045, well after many of us are gone and the whole issue is moot to us!