Physicians Prefer Gated Social Media Communities

Research sponsored by Pfizer and published last month in the Journal of Medical Internet Research, found that over 70% of physicians surveyed (N=485) are either "current users" (52%) or "likely/very likely" users (19%) of "restricted online communities" (such as Sermo). In this case, "use" means sharing medical information and staying up to date professionally. The following chart is a remake of Figure 2 from that study (find it here).

Wikipedia is the next closest "social media" site used by these docs (186 oncologists and 299 primary care physicians) -- only 25% of surveyed physicians said they are current users of Wikipedia. As for YouTube, 23% of surveyed docs said they were current users.

This survey was conducted in March 2011.

According to Manhattan Research’s Taking the Pulse® v11.0 study (May 2011), only about a third of all “digital” physicians (24% of all physicians) are using gated physician peer communities like Sermo, Medscape, DrConnect, PhysicianConnect, Ozmosis, etc.

Some experts, such as Bruce Grant, SVP of Strategic Services at Digitas Health, in the past have cited other, conflicting data that suggests physicians interested in using online peer-to-peer social communities outnumber by 2 to 1 physicians who are actually using them (see "Physician Participation in Peer-to-Peer Social Media Sites"; use discount code P2Pfree).

52% or 24%, whatever! The number of physicians using gated social media communities for professional purposes far exceeds the number of physicians using "open" communities such as Twitter or Facebook. Only 7% of surveyed physicians say they use Twitter in order to share medical information and stay up to date and 36% of said they either were not aware of Twitter (3%) or said they would never use Twitter (33%) for such purposes (another 50% said they were unlikely or not sure if they would use it)!

Meanwhile, the use of Twitter by patients/consumers seems to be on the rise. Twitter reports that tweets about health are up 51 percent this year (see "Twitter Courts Healthcare – But Cautiously").

It doesn't seem likely that physicians and their patients will ever communicate using social media. They just don't seem like birds willing to flock together on social media.

Sermo Physicians Use Telephone, Eschew Social Media, to Communicate with Patients

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.

You can read more about this survey as well as download a white paper summarizing all the results here: New Survey: Physicians Ask Pharma, Help Me, Help My Patients

Will Drug Samples Soon Be a Thing of the Past?

We all know that the number of pharmaceutical sales representatives have declined significantly since the high point in 2007 when approximately 105,000 members of this species were alive and well in the U.S.

Sales rep visits that included samples have dropped even faster. According to Cegedim Strategic Data (SD), the number of detailer visits that included samples has decreased 35% from 116 million in 2007 to 76 million in 2011 (see " Spending on Drug Samples Continues to Decline").

There are lots of reasons why sales rep visits that include drug samples is declining. For one thing, many physicians are refusing samples because they think they promote more expensive treatments. However, it's more likely due to cutbacks to the sales force. "If we're seeing a decline in samples at this point, today one of the major drivers is the drop in the overall number of sales calls being delivered," Jerry Maynor, director of marketing and business development for CSD's U.S. division. eSampling, where physicians can order samples without the sales rep, is a very minor activity that does not account for the trend (only 5% of doctors want to receive samples by mail only).

What percent of total details include samples? That gets complicated because numbers are all over the place. In 2008, there were 92.93 million details according to data reported here. But CSD says 106 million details in 2008 included samples. Of course, that's a mathematical impossibility. I will have to track down more compatible numbers.

How much do drug companies spend on samples? That's a number in dispute, depending on how you calculate the value of samples (ie, retail value of samples vs. Average Wholesale Price; see here). By CSD's estimate, in 2007, drugmakers spent nearly $8.4 billion on samples. That figure fell to about $6.3 billion in 2011, the most recent data available.

The Definition of Insane Pharma Marketing

It may have been Einstein who defined insanity as doing the same thing over and over again and expecting different results. When I analyze a recent survey of pharmaceutical marketing executives, I believe that definition fits them to a T!

The headlines read: "Pharma execs expect to increase use of doctor-focused social media" (here), but when you dig down into the data, you discover that there's practically nothing many of these guys don't think they will spend more money on when it comes to communicating with physicians -- except, that is, print journal advertising.

The data I speak of comes from a Booz & Co survey of 156 senior industry executives from Europe and the U.S. You can find that survey attached to this post. Below is the relevant chart of the data:

First of all, 156 is not a significant N and the error here must be at least ±20 percentage points error. Thus, the 58% of execs who say pharma will increase spending on "MD-oriented Social Media" could actually be 38% (ie, less than a majority). Secondly, these data are probably skewed in favor of executives working in the EU. Booz only says "All survey participants work in either the United States or one of the big five European Union countries, and they represent a diverse range of pharmaceutical companies."

Whatever! These VPs (15%), directors (52%), and managers (20%), most of whom are responsible for a product portfolio (46%) or a specific brand (33%), are an optimistic bunch. Practically speaking, except for the case of print advertising, NONE of these guys think spending will decrease in the next two years for any "communication vehicle!" This despite the belief of many of them (43%) that the sales-force time for their products will decrease.

Obviously, to believe otherwise is to question your existence on this planet!

Strangely, however, 68% of the execs agree or strongly agree that "the current commercial pharmaceutical model is broken and needs significant repair." And practically 0% believe the model is NOT broken!

Isn't part of that model exactly what they say will see increased spending in the next two years? I mean, most of the "channels" in the chart above are part of the current "model," no? There's nothing new there.

In other words, these guys think the model is broken, but they are going to spend more on the model in the next two years! That's the definition of insane pharma marketing!

China Enjoys a Burst of Pharma Marketing Spending While U.S. & Japan See a Decrease

Cegedim Strategic Data (CSD) reports a decline of 3.4% in worldwide audited pharmaceutical marketing investments for 2011 (see "Pharma Marketing Global Spend Dipped 3.4% in 2011"). In China, however, pharma spending on sales rep detailing physicians increased by 23% in 2011 compared to 2010. That activity represents about 81% of the total pharma marketing spend in China compared to 60% globally.

"This is typical of emerging markets," noted Christopher Wooden Vice President for CSD Global Promotion Audits.

Another type of marketing spend that is "typical" for emerging markets is meetings where physicians are invited to listen to key opinion leaders or specific promotions. In China, meeting spending was up 43% in 2011 vs. 2010. That represents 17% of the total marketing spend in China. Sampling, on the other hand, represents only 1% of the marketing spend, whereas in in the U.S. 21% of pharma's marketing spend is on samples. Note that CSD costs samples according to Average Wholesaler Cost rather than retail value.

Japan, on the other hand, saw a "surge" in pharma marketing spend in 2010 over 2009, but there was a "pull back" in 2011 with a 12.5% drop overall. Detailing was down 12% and spending on meetings, which accounts for almost 30% of the marketing mix, was down 11% to $7.4 Bn.

Using my math, that means that total pharma marketing spend in Japan in 2011 was about $24.7 Bn (7.4/.3) compared to $29.2 Bn in the US.

In the U.S., pharma marketing spend was down by about 4% overall, with detailing dipping 6% in 2011 compared to 2010 (see "2011 U.S. Pharma Company Promotion Spending" and chart below).

How the Placebo Effect & Marketing Can Improve Health & Increase Pharma Profits

Big pharmaceutical companies are drastically cutting back on research and development. The economics just do not support the model that has been the driving force of the drug industry over the past 15 years.

According to a Forbes analysis reported by Matthew Herper, "The average drug developed by a major pharmaceutical company costs at least $4 billion, and it can be as much as $11 billion" (see "The Truly Staggering Cost Of Inventing New Drugs").

Some pundits suggest that lowering the cost of performing clinical trials will help get more drugs to market faster. Andrew von Eschenbach, former FDA Commissioner and now employed as chairman of conservative think tank Manhattan Institute's Project FDA initiative, suggested that instead of the FDA asking pharma companies to complete "laborious clinical trials proving efficacy, after proof of concept and safety testing, the product could be approved for marketing with every eligible patient entered in a registry so the company and the FDA can establish efficacy through post-market studies" (see here).

However, Herper points out that the "main expense is failure. AstraZeneca (AZ) does badly by this measure because it has had so few new drugs hit the market." AZ spent about $59 billion on R&D between 1997 and 2011, but only managed to get 5 new drugs approved. According to simple arithmetic, that means each of these 5 drugs cost about $11.8 billion to develop.

That's an interesting number. A very similar number came up during last night's 60 Minutes segment on "Treating Depression: Is there a placebo effect?" (see it here). It turns out that antidepressants sales in the U.S. bring in $11.3 billion a year to pharmaceutical companies that sell them -- including AstraZeneca!

Could it be that the drug industry is merely "breaking even" in the anti-depressant market?

I suspect they are probably making a pretty good profit -- but that profit may be diminishing as more and more anti-depressants go off patent. In fact, it has been suggested that 60 Minutes dared to air this expose -- four years after the research was first published -- because the "news" can no longer harm the drug companies that CBS depends upon for advertising -- most of the drugs mentioned are off patent (see “You’re telling me this now?” Why the news is suddenly critical of statins and antidepressants).

I did a blog post about antidepressants and the placebo effect two years ago in January 2010 (read "A Common Goal of Research and Marketing: Fool the Doctor"). In that post, it was noted that clinical evidence suggests these drugs are not any more effective than a placebo in patients with less severe depression. But drug company marketing to physicians does not mention this. Thus, physicians are led to believe that the drugs ARE effective for all patients with depression.

As pointed out in the 60 Minutes piece, "a clinician who cares, who takes the time, who listens to you, who asks questions about your condition and pays attention to what you say, that's the kind of care that can help facilitate a placebo effect." That goes double if the clinician actually believes what he or she is prescribing is a drug with proven efficacy.

Consequently, marketing to physicians along with direct marketing to consumers can play a huge role in "facilitating" a placebo effect. Which leads me to this idea: pharmaceutical companies should be in the business of developing placebos rather than dangerous, ineffective chemical compounds. There would be no need for expensive clinical trials and it would be easy for FDA to adopt von Eschenbach's idea to approve these new "drugs" before they are proven effective. It will be up to marketing to make them effective by facilitating the placebo effect!

Of course, to be successful, this new approach to drug development must be done surreptitiously and the FDA must conspire with the drug industry (not too much of a stretch there). After all, if everyone knows that the drug industry is manufacturing placebos, the game is up -- doctors will know that they are prescribing placebos and so would patients. That knowledge will render the placebo ineffective. This is a case where a knowledgeable patient is at a disadvantage.

It should be noted, however, that many physicians in some countries knowingly prescribe placebos. Results of a survey published in the British Medical Journal (BMJ) indicate that "about half of the surveyed internists and rheumatologists reported prescribing placebo treatments on a regular basis. Furthermore," say the researchers, "physicians who use placebo treatments most commonly describe them to patients as a potentially beneficial medicine or treatment not typically used for their condition; only rarely do they explicitly describe them as placebos" (read this).

Lilly Sales Reps Learn Marketing Lessons From Disney's Animal Keepers

Lilly sales representatives are learning about customer service by observing Disney Animal Kingdom workers as they "[greet] families at the gate and [answer] questions around the attractions," according to an article in today's Wall Street Journal (read "Drug Sales Reps Soften Pitches").

"Lilly's most recent national sales meeting, held at Disney's business training institute in Florida in February, was devoted to customer service, not product training," said the WSJ.

"Increasing physician satisfaction, it turns out, is a much better way to promote a pharmaceutical agent than simply telling them to write more prescriptions or what the benefits" are, said David Ricks, president of Lilly's global business unit.

I'm not sure it was necessary for Lilly to bring its sales reps to a Disney resort in order to learn about the "new service model," which I have been writing about for the last few years in collaboration with Kantar Health (a client). You can read the latest installment, "Stakeholder Effectiveness: Maximizing the Value of Your Interactions with Multiple Stakeholders" (here - use discount code '101701stake'), which ranks the top 15 pharmaceutical companies on how well their sales reps provide services desired by physicians. Also, you can read the first article in the series, "Reinventing the Sales Model: Moving from Sales to Service" (pdf).

Each year Kantar Health asks physicians in the U.S. and Europe if they have started to notice a move toward a “service model” experience, where other services are emphasized beyond sales reps detailing physicians, such as patient education and information and internet-based services. They quantify this using what is called a TRI*M™ index. The lower the TRI*M, the better service provided and the higher the ranking. The 2009 through 2011 U.S. Primary Care Physician rankings are shown in the following chart (click on it for an enlarged view).

Lilly improved its rank somewhat in the last two but is still not among the "Top Tier" companies such as Pfizer, Merck, and GSK. Hopefully, Disney's animal trainers will help improve Lilly's TRI*M index in 2012.

Some Interesting Numbers Regarding US Sales Reps & Budget

As reported in the WSJ (op cit), "the industry has slashed 33,000 sales jobs in the U.S. from its peak five years ago, when 105,000 representatives flooded the zone. Most recently, AstraZeneca PLC said it would cut its U.S. sales staff by 24%, or 1,150 jobs. The industry spent $14.5 billion on marketing in the U.S. in 2010, down about 15% from five years ago, according to Cegedim Strategic Data."

Are Pharma Reps Important to Docs or Not?

Back in March, 2011, I reviewed a PhRMA sponsored survey of physicians the results of which PhRMA claimed shows that "nearly eight out of 10 physicians view pharmaceutical research companies and their sales representatives as useful sources of information on prescription medicines" (see "New PhRMA Survey of Physicians: Are Sales Reps as "Useful" as PhRMA Wants Us to Believe?"). If you look at a chart of the relevant data (see below), however, you see that the 80% mentioned by PhRMA includes 53% of physicians who find sales reps only "somewhat useful." Only 26% of physicians surveyed found reps "very useful."

Yesterday, I came across the Wolters Kluwer Health Point-of-Care survey of physicians, part of which looked at where physicians receive information to make decisions about diagnoses, treatment and ongoing patient care (see press release and executive summary here). This study asked physicians: "How often do you use the following sources to gain information used to diagnose, treat and care for patients?" The results are shown in the following chart:

The trends are comparable (eg, prof'l journals are rank near the top and sales reps rank near the bottom in both surveys), but you can't group the Wolters Kluwer categories "frequently" and "occasionally" together as well as you can group together PhRMA's "very useful" and "somewhat useful" categories. Because of the way PhRMA designed it's study -- using categories that can easily be combined -- they were able to spin the results favorably, whereas no such spin of the data is possible in the Wolters Kluwer survey.

So, looking at ALL the data, IMHO, the best that can be said in answer to my question is that most physicians find pharma sales reps among the least important sources of information they use to help them diagnose, treat and care for their patients.

P.S. (27-MAR-2012) I just came across another study attempting to answer the question "Do physicians find sales reps useful?" The study comes from Cegedim Strategic Data (CSD), a provider of integrated healthcare market research. CSD analyzed physician-reported diary entries of recent sales calls. Results from over 30 countries showed that overall 93.8% of physicians worldwide, both GPs and specialists, "find sales representative calls useful and of value to their practice, based on over 5.6 million product detailing mentions" (find more details here).

I believe CSD's methodology asks physicians to evaluate recent sales calls. This technique eliminates physicians who did not receive any sales calls, which skews the data to favor physicians who like sales reps to begin with. The CSD study does not compare usefulness of reps compared to other sources of information.

In any case, it's amazing how many studies are out there and how difficult it is to get a straight answer to a simple question.

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

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

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

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

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

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

Emergency physicians may accept educational gifts that are not of substantial value ($100 or less). Examples include:

• Occasional modest meals in an office, clinic, or hospital setting that accompany an educational presentation 
• Evidence-based clinical care guidelines or pocket handbooks 
• Anatomical models designed for patient education 
• Informational materials to facilitate patient understanding of a disease or treatment

This sounds familiar. The PhRMA Code on Interactions with Healthcare Professionals says essentially the same thing. Code #11 states "It is appropriate for companies, where permitted by law, to offer items designed primarily for the education of patients or healthcare professionals if the items are not of substantial value ($100 or less) and do not have value to healthcare professionals outside of his or her professional responsibilities. For example, an anatomical model for use in an examination room is intended for the education of the patients and is therefore appropriate..."

The ACEP policy, however, cites examples of gifts that should NOT be accepted. These include:

• Meals provided for physicians or their family members, staff, or guests (other than modest meals accompanying educational presentations, as noted above)
• Personal or recreational items, such as tickets to theatrical or sporting events
• Direct subsidy of any expenses (such as registration, travel, lodging, meals) incurred in attending CME events or other educational or professional meetings (All industry support for such activities should be provided directly to the activity provider to offset program costs or to a general fund for continuing education programs.)
• Cash or cash equivalents such as gift certificates or vouchers
• Gifts offered in exchange for prescribing or using a product
• Medical equipment, such as stethoscopes or otoscopes
• Payment for token consultant or advisory arrangements
• Medical products for the personal use of the physician, the physician's staff, or family members

Again, PhRMA takes a similar stance. Code #3 states: "To ensure the appropriate focus on education and informational exchange and to avoid the appearance of impropriety, companies should not provide any entertainment or recreational items, such as tickets to the theater or sporting events, sporting equipment, or leisure or vacation trips, to any healthcare professional who is not a salaried employee of the company."

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

Of course, the drug industry is free to promote drugs to emergency and other physicians. There's nothing in the ACEP policy that limits access to physicians for promotional purposes. In fact, the policy states:

"The College also recognizes that emergency physicians should be free to interact with industry representatives if they choose, and that physicians may receive useful information about particular products from industry representatives. Emergency physicians may receive compensation at fair market value from pharmaceutical and biomedical device companies for legitimate professional services rendered, including participation in research and service as faculty in continuing education programs."

What PhRMA and Dr. Rubin should have focused on is the role of "promotion" in general and not the free gifts to physicians straw man. Rubin, for example, says that "Research and promotion are merely 2 sides of the same coin," which is a more rational point of view that deserves a bit more analysis.

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

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

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

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

Some other information physicians want from pharma companies include:

• Drug pipeline information. 
• New information about product—not interested in being detailed, however. 
• Focus on topics like re-imbursement, patient education materials, etc.

So there's a lot more to "promotion" than detailing physicians after gaining access made possible by free gifts!

P.S. I finally did get a copy of Dr. Rubin's Op-Ed piece from ACEP. Thanks very much. The Annals of Emergency Medicine will publish a "rebuttal" to Dr. Rubin in the next few weeks. Meanwhile, here's my rebuttal:

After reading just the first three paragraphs of Dr. Rubin's op-ed, I am bowled over by his cherry picking of "the best evidence" (eg, 3 citations of the same author). Dr. Rubin also said that "the best evidence" indicates that ACEP's policies are "likely to lead to worse outcomes for patients." He did not cite any references to "the best evidence." 

Dr. Rubin's naivete regarding the FDA approval process is breathtaking. According to Dr. Rubin,  the FDA drug approval is "restrictive"; ergo "this means that we would expect that newer drugs would be better than older drugs. Because this is so [my emphasis], actions that lead to increased sales of newer drugs [eg, free gifts for physicians] would be expected to improve patient health." Whaaa? Dr. Rubin offered no proof -- eg, clinical outcomes -- that this is so. That did not stop him, however, from criticizing studies that find fault with pharma advertising because they too offered no real proof; ie, "clinical outcomes."

It doesn't take a PhD in economics to rebut Dr, Rubin's shoddy analysis. Even so, I can't wait to see the rebuttal to be published in the Annals of Emergency Medicine!

Physician Bailout: On Average, Pharma Pays Every US Physician Over $750 Per Year

The pharmaceutical industry has been very generous in making payments to physicians. Last year (2010), for example, a mere dozen pharmaceutical companies paid $760 million to physicians and other health care providers for consulting, speaking, research and expenses, according to ProPublica's "Dollars for Docs" project. ProPublica has taken "translucent" -- ie, difficult to analyze -- data reported by pharmaceutical companies and created a single database that makes comparisons simple (see here).

The database contains information about payments made to about 500,000 doctors. That's about half of ALL doctors in the US (including Peurto Rico). That works out to about $1,520 per doctor (or about $760 per EVERY doctor in the US), on average.

Of course, some doctors were paid MUCH more than this -- eg, pain specialist Gerald M. Sacks raked in $270,825 from Pfizer, Johnson & Johnson, Lilly and Cephalon in 2010, up from $225,575 in 2009. And some doctors received only $50 for lunch. At least 20 doctors, however, received "meals worth $2000 or more from Pfizer between July 2009 and March of this year," said ProPublica reporter Charles Ornstein.

According to the ProPublica database, Pfizer paid my doctor -- Catherine Spratt-Turner -- $388 for meals and $1,500 for speaking in 2010. This worries me because she wants me to come in and discuss my high cholesterol. Apparently, generic pravastatin is not doing the job and I suspect she wants to switch me to another anti-cholesterol medication. Will she suggest Pfizer's LIPITOR? I'll let you know when I see her. Previously, she was hot to get me on AstraZeneca's CRESTOR, which I resisted because of its published side effects. BTW, Spratt-Turner did NOT get any money from AZ last year.

This is exactly what worries some physicians who receive payments from pharmaceutical companies. As more and more searchable data becomes easily available to the public, they fear that patients will rebel and resist their advice if it appears that payments are influencing that advice. Oh, well! Welcome to the social media age!

The table above shows physician payments made by some pharma companies compared to sales. Surprisingly, Lilly spent about 2 times as much as did Pfizer despite having only about half Pfizer's sales volume. Perhaps Pfizer is more efficient than Lilly in targeting influential physicians? Nah! Viagra sales don't need much physician goosing to prescribe, whereas Lilly's Cialis needs as much help as money can buy. [I suspect, however, from the fees paid to pain docs like Dr Sacks, that Lilly is more concerned with promoting Cymbalta for pain.]

Overall, it appears that pharma companies tend to spread payments among physicians such that there is a more or less direct correlation between the number of physicians in a state and the amount of payments made to physicians in that state (see chart below).

Of course, $760 (or $1,520) per every physician is not going to improve a physician's lifestyle very much (although I am sure YOU and I would be happy to have an extra thou to spend every year!).

No, this money is central to what I call pharma's "prescribing recovery act" designed to grease the drug prescribing economy.

[This post originally appeared in Pharma Marketing Blog. 

Make sure you are reading the source to get the latest comments.]

Point-of-Care Pharma Marketing: When Is It Appropriate?

In the world of smartphone apps for physicians, Epocrates plays a leading role. The Epocrates iPhone app is free (with a $99 PREMIUM upgrade option) to physicians -- and anyone else -- who can use the app to find information on drug dosing, interactions and insurance coverage while seeing a patient. According to a New York Times article (see here), 70% of Epocrates' revenue comes from pharma point-of-care advertising; ie, messages from pharma advertisers that pop up as "DocAlerts" when the app is used to look up drugs, etc.

Some docs complain about the messaging, claiming they don't have time for that "nonsense." A few reviews on the iPhone app store suggest this is a common complaint:

"why must I be badgered with your alerts?"

"Paid for 'premium' subscription, getting nagging pharma clinical alerts that are rarely useful. Alerts don't go away unless you tap through them. If this is the case, should be free app."

According to the NYT article, "Epocrates is betting that the 320,000 physicians who use its apps, much like those who use Google and other advertising-supported data services, will tolerate some marketing to get the information they want at no charge." However, unlike Google, ads delivered directly to doctors while delivering care can have a much greater influence over their prescribing. If you are of the opinion that advertised drugs are usually more expensive and sometimes less safe than generics, then pharma paid DocAlerts (ads) are not in the best interests of patients and payors.

For pharmaceutical manufacturers, Drug information apps such as offered by ePocrates and ePrescribing may offer a new channel to influence physician prescribing at the point of care. “The beauty of the work we do with Epocrates is that we literally put ourselves in the palm of their hand,” said Dr. Freda Lewis Hall, chief medical officer at Pfizer.

Being in the doc's palm is one thing, but interrupting his/her workflow is another. When is it appropriate to "interrupt" physicians with commercial messages at the point of care? There are several more or less disruptive ways to provide messages in apps at the point of care, including:

• Ads appear via a splash screen when doc turns on PDA, smartphone, or iPad. The message not related to any prescribing transaction.
• Specific targeted messages are "triggered" by doc's drug lookup choice, demographic, and/or prescribing history and designed to influence doc's prescribing decision.
• Non-targeted messages delivered before, during, or after the prescribing process.

Which do you think is most appropriate and why? Please take a few minutes to respond to my "Point-of-Care Pharma Marketing" survey (click here). After finishing the survey, you will be able to see a summary review of the results to date. No open-ended results that may contain personal information of respondents will be shown. Also, at the end of the survey, you will find links to these FREE Pharma Marketing News articles:

1. ePrescribing: What Role Should Pharma Play?
2. Ready or Not: Gearing Up for the Expansion of ePrescribing

Thanks!

[This post originally appeared in Pharma Marketing Blog. 

Make sure you are reading the source to get the latest comments.]

Academic Physicians Promulgate "Principles of Conservative Prescribing" to Limit Patient Exposure to Drug Risks

A shift toward more conservative medication-prescribing practices would serve patients better and counterbalance prescribing pressures from the drug industry, according to a review article published Online First today by Archives of Internal Medicine, one of the JAMA/Archives journals. The article is part of the journal’s Less Is More series.

The authors argue that physicians -- especially young physicians, "who lack historical knowledge of past drug harms and withdrawals from the market" -- should resist the urge to prescribe the "latest and greatest" drugs, a tendency, say the authors, that is "congruent with the messages and interests of the pharmaceutical industry."

The proposed "Principles of Conservative Prescribing" address practically every tactic the pharmaceutical industry uses to increase prescriptions including, Direct-to-Consumer (DTC) advertising, sales rep distribution of peer-reviewed literature to physicians (which the FDA allows), off-label promotion of drugs (which is illegal, but often done by pharmaceutical companies who are sometimes caught doing it!), pharma-sponsored CME or education from "'experts' with conflicts of interest," using surrogate endpoints rather than outcomes to measure clinical trial success, etc.

With regard to DTC advertising, for example, the authors obviously believe that "with the growth of direct-to-consumer advertising, clinicians are under greater pressure from their patients to prescribe advertised drugs." The authors warn physicians not to take the "path of least resistance." To which I have two comments: (1) the path of least resistance is also the path to profits, whereas the other path leads to bankruptcy, and (2) the authors obviously have not heard that DTC advertising has been proved NOT to influence physician prescribing (see "Advertisers Don't Know How DTC Works. Say wha?").

Here's the abstract that summarizes all the principles:

Judicious prescribing is a prerequisite for safe and appropriate medication use. Based on evidence and lessons from recent studies demonstrating problems with widely prescribed medications, we offer a series of principles as a prescription for more cautious and conservative prescribing. These principles urge clinicians to (1) think beyond drugs (consider nondrug therapy, treatable underlying causes, and prevention); (2) practice more strategic prescribing (defer nonurgent drug treatment; avoid unwarranted drug switching; be circumspect about unproven drug uses; and start treatment with only 1 new drug at a time); (3) maintain heightened vigilance regarding adverse effects (suspect drug reactions; be aware of withdrawal syndromes; and educate patients to anticipate reactions); (4) exercise caution and skepticism regarding new drugs (seek out unbiased information; wait until drugs have sufficient time on the market; be skeptical about surrogate rather than true clinical outcomes; avoid stretching indications; avoid seduction by elegant molecular pharmacology; beware of selective drug trial reporting); (5) work with patients for a shared agenda (do not automatically accede to drug requests; consider nonadherence before adding drugs to regimen; avoid restarting previously unsuccessful drug treatment; discontinue treatment with unneeded medications; and respect patients’ reservations about drugs); and (6) consider long-term, broader impacts (weigh long-term outcomes, and recognize that improved systems may outweigh marginal benefits of new drugs). [Arch Intern Med. 2011;10.1001/archinternmed.2011.256.]

I doubt if a young physician just starting private practice could build a financially successful practice based on these principles, which are specifically designed as tricks for new dogs. These physicians have to compete with the old dogs out there who have been weaned by the drug industry to expect the industry to pay for everything in return for which they will prescribe their drugs -- especially new, unproven in the real world drugs.

The authors, in fact, recommend that physicians obey the "7-year rule" when prescribing; ie, "wait 7 years before using a new drug." Wholly cow! The authors cite a couple of studies purporting to show that "it often takes 5 to 10 years to identify significant adverse effects."

Adverse effects figure large in the Principles. I would go so far as to say that adverse drug effects form the principles' principal target! Maybe it is just a coincidence that recently I came across news reports that adverse drug events are one of the leading causes of death in the U.S. and other developed countries around the world.

At one point, the authors ask "Could 'fibromyalgia' pain be statin-induced myopathy?" [authors' quotes, not mine, around fibromyalgia]. This prompted my own question: Is it just a coincidence that Pfizer, which produces Lipitor, the #1 selling statin, is also aggressively marketing Lyrica for the treatment of fibromyalgia pain? Coincidentally, a few days ago the FDA recommended changes in the Zocor (another statin drug) label (see "FDA approves redesigned labels for some Merck drugs"). The mind boggles!

The authors advise physicians not to ignore any problem that develops while a patient is taking a medication, "no matter how unusual or unlikely a symptom a patient reports... always consider that it might be drug related."

I am sure the drug industry will have something to say about that!

[This post originally appeared in Pharma Marketing Blog. Make sure you are reading the source to get the latest comments.]

Pharma Tracks Docs at Medical Meetings Using RFID Technology

Although the pharmaceutical industry is dragging its feet implementing RFID (Radio Frequency Identification) technology to keep track of drug supplies, some companies are currently using the technology to track physicians' movements at scientific conferences.

"Dr. Wes" (Westby G. Fisher, MD, FACC) called this "Physician Tag and Release" (see "The Implications of Physician Tag and Release"). The photo on the left shows the back of Dr. Wes's badge at the recent American College of Cardiology Conference held 2-5 April 2011 in New Orleans, LA.

The technology is also being used at the Heart Rhythm Society conference going on right now. Propublica and USA Today co-published a story about how doctors are being bombarded with pitches for drugs and medical devices at this conference (see "Financial Ties Bind Medical Societies To Drug and Device Makers").

RFID tracking is a disturbing aspect of industry-sponsorship because it may give exhibitors access to the identity of any physician who enters (or merely passes by?) sponsor booths at medical meetings even if the docs do not talk to reps or give their permission to collect such information.

"Many physicians were unaware that exhibitors had paid to receive real-time data about who visited their booths, including names, job titles and how much time they spent," says Propublica.

The Heart Rhythm Society claims that exhibitors are not getting doctors’ personal information, but here's what the American College of Cardiology says about how its exhibitors benefit from RFID technology (see "Using Technology to Better Understand ACC Meeting Attendees"):

"The second way in which RFID technology is utilized is in the Exposition. Exhibitors were able to rent RFID readers from the vendor. They are able to use the data in much the same way as the ACC – to evaluate how effectively their work stations are structured and to improve their offerings to attendees. In addition, they are given access to limited information about the visitors to their booths. The information they are given is the same information that was available on meeting attendees badges in print (name/city/state/institution). No contact information is provided. ACC’s intention was not to create a revenue source by offering attendee data to exhibitors (in fact, only five out of more than 300 exhibiting companies decided to invest in RFID in their booths), but rather to provide exhibitors another resource by which to understand the traffic flow in their booths and to better align their displays with attendees’ needs."

Instead of "opting in" for tracking at scientific meetings, doctors must "opt out" from the use of tracking technology when registering for scientific meetings.

The practice "disturbs" Dr. Wes who says:

"It is no secret that these societies make a significant portion of their operating revenues from industry sponsors at these meetings. By instituting tracking, the value of their membership's privacy has taken a back seat to the income generated from tracking revenues."

and

"At the risk of sounding like a conspiracy theorist, it is not too hard to imagine one's credentials being called into question in court because a doctor did not demonstrate enough time in CME activities at the scientific sessions to quality for credit or because these data implicate a doctor in a purchasing agreement between a vendor and hospital system simply because a doctor visited a display booth."

Dr. Wes also imagines a scenario where RFID data collected at medical meetings can be combined with a doctor's prescribing information without their permission. That's a double whammy for physicians who wish to keep their prescribing habits private. The Supreme Court is deliberating that issue (see "Supreme Court to Decide Fate of State Laws that Prohibit Use of Rx Records by Pharma").

Pharma Even More Digitally Feeble When it Comes to Healthcare Providers!

"More than 60 percent of brands’ HCP digital efforts result in Challenged or Feeble Digital IQs," according a new Digital IQ INDEX® ranking created by think tank L2 in partnership with Vue Group. The results are shown in the following chart:

This is in stark contrast to the May 2010 Digital IQ Index™ for Pharmaceuticals that analyzed direct-to-consumer (DTC) digital efforts. That analysis found that 31 percent of brands were digitally "Challenged"o r Feeble" (see "Is Your Brand a Digital Genius or a Feeble-Minded Idiot?").

The report also concludes that "most brands are not purchasing HCP-targeted search terms, investing in mobile, engaging in email marketing, or investing in display advertising on physician portal sites." For more information, including a table of IQ scores for 70 brands, download the report here.

The report laments the limited investment and adoption of digital technology to reach physicians and provide them product information on-demand and on their own schedule. For a A Lilly case study on reaching physicians via the Web, see this Pharma marketing News article: "Pharma TeleWeb e-Detailing" (use code 'TWEB' to download it free).

GSK's U.S. Sales Reps "Europeanized": No Longer Rewarded for Ability to Push Prescriptions

According to the Financial Times, "GlaxoSmithKline will this month scrap payments to its US-based commercial staff based on individual sales targets, as it attempts to draw a line under past aggressive marketing practices that have incurred substantial fines" (see here).

GSK’s sales "reps" will no longer receive commissions "based on their ability to push prescriptions. They will instead be paid based on their scientific knowledge, feedback from customers and the performance of their business unit."

An anonymous poster to CafePharma described what the "new" sales model will look like:

You will be judged on 3 categories. Product Knowledge, Customer Value, and Business Acumen. Each one of these will be split into 2 parts. Preparation and implementation. Basically, 6 categories to be subjectively assigned expertise levels by your manager. Hope you have a good relationship... This is how you will get your "cut" of your region's take of bonus dollars.

Oh yeah... you are also no longer referred to as pharmaceutical sales reps... from now on you are called "Customer Facing Staff". No joke...

GSK recently revealed a $3.5bn charge to settle product liability lawsuits and regulatory fines linked to past sales practices (see story here), which may have prompted this change as well as changes in funding physician continuing medical education (CME): GSK will now restrict funding CME courses to a small number of non-profit institutions.

This seems to be a radical shift in the evolution of the pharma sales model that has been followed by companies like Kantar Health. I've written on this subject in several Pharma Marketing News articles over the past year or so. See this recent article: "The Changing Pharma Commercial Model in 2010 and Beyond" (use discount code '95MDK' to download it free).

I also note that in order for a pharma company to reward its sales reps based on prescription volume of physicians they have detailed (the "old" model), the company has to have access to the prescription writing data of individual physicians. It's not a coincidence perhaps that the Supreme Court will soon determine if states have the right to prevent access to that data by pharma companies (see "Supreme Court to Decide Fate of State Laws that Prohibit Use of Rx Records by Pharma"). GSK may be sensing that the decision will go against them and they can take the "high" voluntary road now instead of taking the "low" legally-forced road tomorrow.

Although this model may be new in the U.S., it's not so new in Europe where pharma companies never had access to individual physician prescribing behavior. In Europe -- as I understand it -- pharma companies can only see how prescriptions change among a block of physicians in a certain geographical area more or less equivalent to a zip code in the U.S. Thus, basing sales rep commissions upon "district" performance in the U.S. is similar to how it's done in the EU. From the anonymous post made to CafePharma cited above, it looks like U.S. reps are not going to be happy to be "Europeanized."

Detailing by Telephone Accounts for Nearly Half of "New Media" Promotion to Physicians

*** PODCAST: Pharma TeleWeb e-Detailing - A CASE STUDY: Lilly's Experience in Europe Recorded LIVE Feb 23, 2011, 2 PM Eastern US. ***

It's always been difficult to get a handle on the amount of money pharmaceutical companies spend on promotion to physicians and especially how much of the total spend is focused on "e" channels such as Web advertising and Internet detailing. Several different companies offer estimates that vary depending upon exactly what they include when totaling up the numbers.

But no matter what the source and how the numbers differ, my analysis is always the same: spending in the "e" space is a tiny fraction (less than 5%) of total promotional spend and has remained in that range every since I can remember!

Today, I received a summary of a report from SK&A, a market research company, titled "U.S. Pharma Company Promotional Spending Trends in New Media" (see here). Of interest to me were the sections on "New-Media Average Monthly Expenditures, 2006 to 2010" and "Promotional Expenditures by New-Media Channel, Oct. 2009 to Sept. 2010." Again, the numbers show that pharma spends very little on ePromotions or "New Media" promotions or whatever you want to call it.

According to this report, "Pharmaceutical companies are finding novel ways to promote their products to physicians and other prescribers, namely through new media channels such as internet detailing, tele-detailing, e-meetings and web advertising." It's interesting that the telephone (as in "tele-detailing"/"Telephone Detailing") has been included as a "new media" channel. And here I thought the telephone was invented over 100 years ago!

SK&A says that "tele-detailing" accounts for 49% of the new media channel physician promotional spend, whereas "Internet Detailing" is only 35% and Web advertising is a meager 1% (see chart below).

According to the report, which is based on an "ongoing survey panel of 2,455 physicians and other healthcare practitioners," the total U.S. "New Media" channel promotion spend by pharma focused on physicians was $327 million during the 1-year period between October 2009 and September 2010. That includes $160 million for "Telephone Detailing."

The report claims that "In the U.S., promotional spending [aimed at the HCP audience] totaled $24 billion between October 2009 and September 2010." Thus, "New Media" spending represents ONLY 1.4% of the total spent on promotion to physicians by pharma companies. If we eliminate the $160 million spent on telephone detailing, that percentage drops to 0.7%!

But I bet the $24 billion includes the retail cost of samples, which could account for as much as $18 billion a year (see here). If so, then only $6 billion was spent on non-sample promotion to physicians and 2.8% of that went to "true" new media (ie, not telephone detailing).

But "New Media" promotional spending is increasing by leaps and bounds according to the report, which states "[monthly] promotional spending in new media has increased significantly from about $5 million in January 2006 to about $26 million by September 2010" (see chart below).

Again, telephone detailing is included in the "new media" category. It could be that ALL of this "significant" increase is due to docs receiving more telephone calls from sales reps!

FOLLOW UP: November 23, 2010. Rich Meyer over at World of DTC Marketing Blog clarified how "Telephone Detailing" works and why it may have been included under "new media" in the SK&A report.

"There are many types of electronic detailing including detailing by phone," said Meyer. "Phone allows physicians to hear a detail on demand along with an interactive presentation via the Web."

See Meyer's complete post: "Detailing by phone: What do physicians think?"

A Breast Cancer Patient's Painful, Difficult Therapy Choice: Generic vs. Brand?

Since this is national Breast Cancer Month and I am forced to watch NFL linebackers wear pink shoes and mouth guards, I thought it would be appropriate to discuss an issue that just came up in comments to my post about Sanofi-Aventis, Taxotere, and the disgruntled patient (see "Should Sanofi-Aventis Submit an Adverse Event Report Based on 'Disgruntled Patient's' Comments to VOICES FB Page?" and comments).

An anonymous comment to that blog post opened my eyes about issues facing breast cancer patients beyond what I believe many proponents of the "pink" promotional campaign envisioned. Here's the comment:

"It's not just one disgruntled cancer survivor. There are over a hundred of us. Of course, there's no promise that our hair would grow back. GENERALLY grows back. Well for those of us who battled breast cancer but are forced to look at our bald selves in the mirror every day, "generally" isn't good enough. Yes, we're alive. I'm grateful for that. But again, no promise of how long...and with small children, that's another painful reminder of what I've been through. The thing about S-A and Taxotere is this: there's another drug, Taxol, which doesn't cause this permanent alopecia we're dealing with. But we were never told that there was a choice. And what do you think I would have chosen if I'd had a choice? I'm in my early 40s so dealing with permanent alopecial is especially difficult. I have a job in a senior management position. Hard to earn respect when I look like Ben Franklin. We're not mad that Taxotere caused us to experience permanent alopecia...we're mad that we weren't given the choice of the more hair-friendly medication. And why is that? Our oncologists didn't even know. Don't you think they should be made aware of this fact?"

To which I responded:

"While I am not knowledgeable regarding the benefits vs risks of one treatment vs another, shame on your oncologist for not knowing or caring enough to offer you a choice!"

This gave me an idea of how important hair loss can be to breast cancer patients, something that other commenters to my blog post dismissed by saying things like "you should be happy you are alive," etc. Do many pharmaceutical marketers realize this? My friend Rich Meyer thinks not. "Pharma’s priority is still spreadsheets not patients," says Rich (here). "Patients are leaving pharma marketers behind and pharma marketers act like they still matter."

But is Taxol really better than Taxotere with regard to hair loss? To answer this question, I used Google to search on "taxol vs taxotere" and found some interesting online forums and discussions devoted to the issue. Here's a representative post by "billsgirl" that I found on the community.breastcancer.org/ site:

"I have one more A/C tx 2/22, and have done really well with little se to complain about. Now I must decide which Taxane I should go with. I'm leaning toward taxotere because my onc agrees that the bone marrow issues would be easier for my body to tolerate given my positive experience with the A/C, rather than risk neuropathy.

"Also, what about the hair? I've read some who said their hair started growing back after A/C and through T. I've read some scary stories about permanent hair loss. I'd hate that - I mourned my heai more than my breasts (I know that's odd...)

"I'd love your comments. Anything to help me make my decision."

What "help" did "billsgirl" get? There were several somewhat helpful comments and encouraging posts in this forum, but none really answered the question about which drug is best.

On www.medhelp.org -- a Cleveland Clinic "partner" -- I found a similar question by a patient ("Pam") and an "answer" from a physician.

"This forum is just fantastic!! Thank you Cleveland Clinic and Med Help Int'l. for giving people like me a reliable place to ask questions!!!

"My question is: Can you tell me the difference (if any) between Taxol and Taxotere? Does one work better than the other for particular types of breast cancer? My doctor suggested Taxotere, but didn't really give me a good explanation as to why. Your thoughts will be most appreciated."

Doctor's Answer:

"Dear Pam, Thank you for your complimentary comments regarding this Forum.

"Taxol (paclitaxel) and Taxotere (docetaxel) are both from the same family of medications - the taxanes. Both of these show a high level of activity when used as single agents in metastatic breast cancer.

"In reviews of reported studies, when compared with standard therapies Taxotere looks to be the most active single agent in treatment of metastatic breast cancer.

"There are some differences in the treatment schedules of the 2 medications, and there are some differences in the side effects of these 2 medications. I have listed the side effects of both medications.

"Taxotere: decrease of white blood cells, red blood cells and platelets, flu-like symptoms, fluid retention, numbness and/or tingling to fingers and toes, muscle aches or bone pain for a few days after each treatment, mouth sores, hair loss, decreased appetite.

"Uncommon Side Effects: allergic-type reaction, blood pressure and heart rate changes, nausea and vomiting, diarrhea, skin rash usually occurs on hands and feet, nail changes, menstrual cycle may become irregular or stop permanently, menopausal effects including hot flashes and vaginal dryness. Decreased desire for sex during treatment.

"Taxol: decrease of white blood cells, red blood cells and platelets, allergic-like reaction, blood pressure or heart rate changes during the infusion of the medication, mouth ulcers, numbness and/or tingling to fingers and toes, muscle aches or bone pain for a few days after each treatment, mouth sores, hair loss, diarrhea.

"Uncommon Side Effects: nausea and vomiting, nail changes, menstrual cycle may become irregular or stop permanently, menopausal effects including hot flashes and vaginal dryness. Decreased desire for sex during treatment."

Hair loss is mentioned (buried) as one side effect for both drugs.

So, I am still not sure that Anonymous was correct in her assertion that Taxol does not cause hair loss. But it's clear that her oncologist didn't offer her the kind of comparison that was offered to "Pam" online. Could it be that her oncologist had a conflict of interest? I suggested that in my response to Anonymous:

"It's my understanding that oncologists often make a profit 'reselling' these drugs. Obviously, in that case, they have a vested interest in offering patients the drug that gives them the highest profit. I do not know if Taxotere and Taxol differ in this respect."

What I DO know is this: Taxol is a generic medication and Taxotere is a brand medication. And back in 2007, Sanofi-Aventis, which manufactures and markets Taxotere, received a letter from the FDA warning the company not to make superiority claims for Taxotere vs. Taxol (see here).

Social Media's OK Corral: Docs vs. Patients

The O.K. Corral was a site in Tombstone, Arizona Territory where a gunfight took place on October 26, 1881. In that fight, the Earp brothers and "Doc" Holliday killed some cowboys who refused to disarm.

I mention this as a analogy to what I foresee happening in the health social media realm where the conversation is not as friendly or beneficial as some pharma social media pundits would have us believe. If pharma marketers are not careful, they may find themselves in the middle of the crossfire.

I am talking about the crossfire between physicians and patients, especially with regard as to which "stakeholder" group will be more credible as hired "opinion leaders."

You probably already know all about physician KOLs ("key opinion leaders") and how pharma hires KOLs to influence doctors. I predict that in order to be effective in social media that are inhabited by patients, pharma will hire respected patients to follow the discussion and to point their followers to "key" information, which includes key Rx-related information or information that supports the benefits of Rx products (see "Some Social Media Patient Opinion Leaders Want to be Paid Pharma Professionals" and "PHARMA Co Patient Opinion Leader Programs").

This will lead to the inevitable conflict with physicians who may have different ideas as to what "key" patient information should be.

At two recent industry conferences, I witnessed what I think is the opening salvo between the two opposing camps. First, at a multi-channel pharma marketing conference that I chaired in Princeton, NJ, a physical wall was erected between a physician panel on one side of the room and a patient panel on the other side. Both were supposed to talk about what they wanted from the pharmaceutical industry. As I reported, the patients essentially wanted money and were quite forthright about it. The physicians, on the other hand, were too sophisticated to ask for money directly -- they already are getting plenty of money from pharma. They asked for technology or rather free technology such as iPhone apps.

But the conversation that hinted at the coming Social Media OK Corral Docs vs Patients struggle occurred during a patient panel at the Digital Pharma East conference (ie, "A Panel of ePatients Discuss Key Issues that Affect their Lives, Relationships and Treatment").

Part of the discussion revolved around how the "value proposition" of patient online communities was the vast amount of information available from patients that is "more accurate" than information that patients typically get from healthcare providers/physicians. That, in itself, is not surprising or dangerous. But another statement made by a patient panel member sets the stage for the coming gunfight. That statement concerned patient evaluation of specific brands. The patient said that her physician was of the opinion that all branded Rx drugs for treating her condition were essentially the same. She begged to differ and pushed for her favorite brand.

It seems that patients are more in tune with pharma's direct-to-consumer (DTC) advertising premise: one brand of insulin or ACE inhibitor is better than another brand. Usually, it's the advertised brand that's better than a competitor brand or the unadvertised generic brand.

Since Rx DTC advertising has ingrained the belief in consumers and patients that one brand of Rx is better than another, it benefits pharma marketers to use online patient opinion leaders such as those on the above-mentioned panel to influence other patients online. Once they do that, marketers are again placing themselves in the middle of the patient and his or her physician just as they have been accused of doing with mass media DTC advertising.

There is a wall between physicians and patients not only at industry conferences, but also within online communities. Patients have their communities and physicians have theirs. Unless the two stakeholders can meet online and have a dialogue, someday there will be a gunfight. Pharma marketers will continue to arm both sides. Maybe they'll get caught in the crossfire, maybe not. Time will tell.

One Pharma Company's Social Media Policy: Threaten Physicians Who Complain About Your Drug Online

According to an article in today's Wall Street Journal (see here), URL Pharma's general counsel sent letters to several physicians who criticized the company's new treatment for gout in an online message board for rheumatologists sponsored by the American College of Rheumatology. The drug in question is Colcrys, which is equivalent to generic colchicine, a drug that cost pennies and has been around for so long that its use "predated the Food and Drug Administration and therefore didn't require the agency's vetting."

When Colcrys came on the market, a number of physicians voiced their displeasure online. Some doctors had advocated use of colchicine. "In response, URL Pharma's general counsel sent letters to several of the critics asking them to 'clarify the record' and saying there were 'potential risks and liability' associated with using unapproved versions."

"'These are shake-down letters to silence' critics, said John Goldman, an Atlanta rheumatologist. In his postings, he had criticized URL Pharma for conducting limited research and for its pricing of Colcrys. URL Pharma says it reached out to physicians to educate them about its clinical trials and help them prescribe the drug appropriately, not to quash criticism."

"We were trying to alert this small group of misinformed physicians to the fact that they were being led into medical malpractice liability," the company said in a statement.

URL's action may not be indicative of how the pharma industry as a whole "engages" with physicians who use social media, but it raises an important issue regarding pharma's participation in closed social networks such as the rheumatology discussion board in question. Obviously, URL physician employees or physicians hired by URL or an agency of URL were "lurking" on the board monitoring discussions. This is probably a common practice of many pharma companies. Should these agents identify themselves to the community?

In other cases, pharma companies have been transparent about their monitoring of physician communities. Pfizer, for example, has a deal with Sermo that allows their physicians to join the Sermo physician community. These physicians are clearly identified with a special logo, I believe. They obviously can "lurk" and not be seen unless they post a message, but Sermo and Pfizer were quite open about it to the Sermo community (see "Pfizer has a Gold Mine in Sermo!").





BTW, URL Pharma should have read this post I made over a year ago: "Social Media: Ask Permission to Join the Conversation First or You Just Might Get Your Ass Kicked!"

Also see How Should Pharma Engage in Patient/Physician Social Networks? Survey Results.