Answers That Won't Matter: Critique of Lilly's Defense of DTC Advertising

The pharmaceutical industry is fighting a losing battle (IMHO) against negative public opinion. The latest weapon to be employed in this battle is a 52-page "booklet" entitled "The Value of Medicine, Improving Health...Improving Life" published by Eli Lilly (find pdf here).

World of DTC Marketing blogger Rich Meyer asks "The real question is will consumers buy it in an era of mistrust and misinformation?" (see Lilly fights back with “The Value of Medicine”). I think the real question is "Will consumers read it in an era of apps and sound bites?"

A 52-page PDF document is a bit much to ask the average consumer to digest even with all the pretty charts and graphs with circles and arrows and paragraphs explaining what each chart is about.

Also, I must say that Lilly engages in some "misinformation" itself, or at least conflicting information (keep reading to see what I mean).

It's all very well to blame the so-called "era of mistrust and misinformation" for pharma's failure to win over the hearts and minds of consumers, but we all know some of the blame falls squarely on pharma's shoulders. It's unfortunate, for example, that this booklet comes out around the same time that AP reported "pharmaceutical companies made up eight of the government's top 10 settlements related to fraud in the last year" (see "Drugmakers top list of DOJ fraud settlements").

But enough about fraud, let's talk about Lilly's defense of DTC (direct-to-consumer) advertising, which is presented in pages 32 to 36 of the booklet.

First, let me say that it's ironic that an industry that spends so much money, time, and effort to produce DTC ads -- including wonderfully creative TV commercials -- to "educate" consumers, relies on pdf files and web sites to defend its products, advertising tactics, and public image. Where's the TV ads? If, as Lilly claims, 30 to 60 second TV ads are so effective in educating consumers about "diseases, about the symptoms that may help their health care provider identify the diseases, and about available therapies to treat these conditions," then why not use TV ads to provide "answers that matter" about "tough questions about access, costs, safety, and ultimately the value that we can bring to patients in preventing and fighting disease" (quoting John C. Lechleiter, PhD, Chief Executive Officer and President, Eli Lilly and Company)?

It can't be that TV ads are too expensive. Lilly claims that the drug industry's spending on DTC advertising (about 65% of which goes to TV) "represents only about 2% of pharmaceutical company sales." BTW, Lilly doesn't mention the $ amount of sales, but it does mention that DTC spending is about $4.4 Bn per year. If you do the math -- something most consumers I regret will not or cannot do -- you get $220 Bn per year for the sales number. I think Lilly is selling itself short here. I find from IMS data that US drug sales in 2009 was more like $300 Bn. Ergo, DTC spending is only 1.4667% of sales. Perhaps Lilly was rounding up -- but it could have rounded down to 1%! Whatever.

Lilly also presents a nice chart to illustrate the point that the pharmaceutical industry "spends less on advertising as a percent of sales than many other industries" (see chart below). Of course, by "less" Lilly really means on a percentage basis. The sporting and athletics goods industry spends MUCH more than pharma on advertising (as a percentage of sales), but not so much more on a dollar basis ($5.6 Bn vs pharma's $4.4 Bn).

According to this chart, pharma advertising spending is 4.2% of sales. How come the discrepancy between this % and the 2% Lilly quoted on the page before the chart? Could it be that this chart includes "advertising" to doctors as well as DTC? Lilly does NOT mention how much the drug industry spends on "marketing" to doctors, but I've seen an estimate of $12 Bn per year for that (see here). But $12 Bn + $4.4 Bn = $16.4 Bn, which is 5.4% of $300 Bn in sales (as reported by IMS) or 7.4% of $220 Bn in sales (as calculated from Lilly's figures).

OK, so the numbers don't jive. I've notice that's often the case when analyzing data about the pharmaceutical industry. I'm used to it. Just another form of "misinformation."

Aside from touting how economical drug companies are regarding advertising, Lilly also claims that "limiting prescription drug promotion may negatively affect patients and health care providers by restricting access to important information about diseases and proper medical treatment. Also, consumers may not as easily receive information about the benefits and risks of prescription medicines."

I can write a whole book in response to that! Let me just say, that in this day and age of Internet technology, which Lilly does not seem to be part of, DTC advertising is an insignificant source of "information about diseases and proper medical treatment" for consumers and physicians alike. Does Lilly really expect us to believe that limiting DTC advertising will negatively affect patients and healthcare providers?

OK. I've spent enough time on this. I assume all of you will download this 52-page booklet and read it from cover to cover. Actually, there are a lot of pictures, so don't worry, you should be able to read the whole thing in about 20-30 minutes or so. Let me know what you think.

Negative Facial Coding Hamstrings Patient Testimonials in DTC Ads

Even though pharmaceutical marketers are NOT exploiting social media to the degree that industry consultants and agencies would like them to, they have learned one important lesson from social media: people trust people like themselves more than they trust company spokespeople or even so-called experts. That may be why you are seeing more and more direct-to-consumer (DTC) ads on TV and in print that feature real patients who offer testimonials to the advertised Rx drug.

Pfizer, for example, is currently running Lipitor and Chantix ads in which real patient users of the drug tell their stories. Previously, Pfizer, like so many other drug companies, employed actors that portrayed physicians or "real" physicians in these ads. That, however, backfired spectacularly when it was discovered that one physician spokesperson -- Dr. Jarvik -- was not actually a practicing physician.

Dan Hill, President of Sensory Logic, Inc., contends that there is a problem with this. Hill was guest on my Pharma Marketing Talk BlogTalkRadio show yesterday -- October 26, 2010 -- where claimed that two-thirds of the ads are "not so good, especially with the would-be testimonials" of real, everyday patients.

Hill bases reached this conclusion by applying "Facial (Action) Coding" techniques to analyze the effectiveness of the ads. If you have ever watched FOX's "Lie to Me" drama series, you may familiar with this technique, which involves analyzes facial expressions to determine the emotional state of a person.

Facial coding was first developed by Dr. Paul Ekman -- who is an adviser for the show "Lie to Me" -- and is featured for 30 pages in Malcolm Gladwell's "Blink." Hill claims that this non-invasive tool -- which breaks down 23 facial expressions (Action Units) into 7 core emotions -- allows him to help clients understand the emotional connection of their market research efforts (for example, what consumer are really feeling about their TV commercials, print ads, websites, as opposed to what they say.)

Hill says the goal of Facial Coding is "Get[ting] the Right Emotions at the Right Time." That sounds like a nice complement to the often-heard axiom of "getting the right message to the right audience at the right time."


Hill offered one example of how the "wrong" emotion exhibited by an actor in a GSK TV ad sent the wrong message to the audience.

At second 17 in the timeline, the test audience -- claims Hill -- had a "fear reaction." There was really no intent by GSK to illicit fear, so Hill was stunned. The verbal comments from the test audience couldn't explain it, so Hill used his facial coding ability to look at the facial activity of the actors. "Lo a behold," said Hill, "at second 17, the male lead showed fear on his face. My suspicion," said Hill, "was that he forgot his line for a nano second." Emotions are so contagious that this flash of fear on the actor's face that the audience "[went] there with him."

With regard to real patient testimonials in TV commercials, Hill says that the actors often look "uneasy, stilted, and don't show the emotions that are meant to be shown." This, Hill claims, hamstrings the commercial so that it is not as effective as it could be.

You Audience Has Left the Building
Another interesting point that Hill made was in regard to the voice-overs (VO) of TV Rx ads. VOs usually occur during the "fair balance" (ie, side effect disclosure) portion of the ad, which may consume 30% of the total running time. Hill said that "the sad truth is that many voice overs kill the commercial. It is the moment when marketers think they are bringing home the message, but instead the audience has left the building." Perhaps the reason why voice overs are used most often during the fair balance portion of the ad is precisely to drive the audience away from the ad once they have already been exposed to the benefit portion.

"A monologue simply does not work for people," said Hill. A Cialis ad was cited by Hill as doing a "very good job with the legalese at the backend of the commercial." The ad keeps switching between the man and the woman delivering the fair balance message. "At least that variation, going from the male to the female and then back to the male, at least make it more noticeable," claims Hill.

One observation in closing is this: current social media lacks the dimension of facial coding and using real patients in social media campaigns retains the advantages of credibility without the disadvantages that Hill pointed out.You can listen to my conversation with Hill using this BogTalkRadio widget:

Listen to internet radio with John Mack on Blog Talk Radio

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.

Pharmaguy's Comedy Improv(e) Club -- An New Idea for "Unconference" Entertainment

The pharmaceutical industry is neither funny nor improvisational, yet those two attributes are precisely what I have depended upon to make Pharma Marketing Blog entertaining as well as informative.

But there are quite a few "funny" people currently or previously associated with the pharmaceutical industry. Kevin Nalts (aka Kevin Nalty), for example, is a former Merck Marketing Director and now makes a living -- I hope -- as a self-proclaimed YouTube comedian (see "Enlightened Stupid Marketer"). I also believe that my Twitter pal Lawrence Sherman (@meducate) dabbles in  the comedic arts.

At ExL's Digital Pharma East I learned that Jason Youner, ExL Conference Director, does standup comedy on the side at a comedy club in Jersey City, NJ (ie, Stockinette Café at 581 Jersey Ave; the 2nd Friday of every month; Jason not only performs, he hosts and produces the show). He was quite funny roasting me during his introduction to my Pharmaguy Social Media Pioneer Award "unceremony" (see "First Pharmaguy Social Media Pioneer Award Given to Janssen's Alex Butler"). At the Pixels & Pills cocktail party, DJ Edgerton (@wiltonbound), CEO of Zemoga, revealed his humorous side by suggesting various kinds of undershirts I should wear when I gave the Hawaiian shirt off my back to Alex Butler.

Perhaps a few of us "comedians" should get together and form the "Pharmaguy Comedy Improv^(e) Club" and volunteer to perform at industry conferences. I am sure it will liven these up considerably. As always, I appreciate your feedback, especially if you wish to join the troupe. Send your email to pharmaguy@epharmapioneers.com

PHARMA Co Patient Opinion Leader Programs

[Below is a blog post that someday SOON may appear on a PHARMA Co Blog such as AZ Health Connections, which recently posted a notice about "AstraZeneca And Doctor Speakers Programs" (read it here). I substituted "patient" for "physician" in the following post to illustrate a point.

In this new social media era, where there is much discussion about pharma participating in patient discussions online, there is a possibility that pharma will hire influential online patients to act as "opinion leaders" just as they have hired physicians to be key opinion leaders (KOLs). Patients have already been hired by pharma companies and their agents to troll patient sites for comments made by patients online (see, for example, "Did J&J Troll Social Media Sites to Ensure Its Motrin "Recall" was a Secret?")].

Beginning soon, news organizations will be publishing a series of stories examining the financial relationships between patients and the pharmaceutical industry. Their focus will be on payments made to patients who serve as “social media moderators” or "opinion leaders" on behalf of companies and their medicines.

PHARMA Co would like to provide our perspective on the issue by having Marie M. – PHARMA Co’s US compliance officer – answer the key questions we’ll be asked by reporters in coming years.

Why does PHARMA Co engage with patients as moderators/opinion leaders?
Marie: PHARMA Co works with online patient opinion leaders (POLs) or moderators to provide other patients online with accurate and balanced information about the use, safety, benefits and risks of our medicines. POLs have the expertise and credibility necessary to educate colleagues to ensure they have the information they need to make informed treatment decisions.

Patients ultimately benefit when they are well informed and knowledgeable about our medicines, treatment options and standards of care.

Why does PHARMA Co pay patients to participate?
Marie: It is appropriate to compensate POLs for the time they dedicate to providing information to other patients about our medicines and who act as moderators of our online discussion boards. Patients who tweet or post information online about our medicines are compensated at a fair market value based on their qualifications and the amount of time they dedicate to the task. We never pay patients in exchange as an incentive to promote our products.

There currently is NO cap on how much each POL can receive from PHARMA Co each year.

How does PHARMA Co ensure laws and industry policies are followed?
Marie: Before a POL can tweet or post information on our behalf online, they must participate in extensive training on our medicines, policies, and the laws and regulations that apply to industry-sponsored presentations. Actually, however, there are NO laws and regulations that apply to industry-sponsored tweets and posts made by patients online. But, be assured, our policies prevent the company from paying POLs in exchange for asking their physicians to prescribe our medicines or as an incentive to promote our products.

How does PHARMA Co select patient opinion leaders?
Marie: There are several criteria that PHARMA Co evaluates when a patient is nominated to be a tweeter or online poster on behalf of the company, including positions within leading online patient social networks, national patient advocacy organizations; membership in special patient opinion leader networks such as WEGO; consistent tweeting and posting records; participation in research trials; and regularly tweets or posts information online.

First Pharmaguy Social Media Pioneer Award Given to Janssen's Alex Butler

I have finally gotten rid of that seriously yellow Hawaiian shirt that has symbolized the Pharmaguy Social Media Pioneer Award and my involvement with pharma's slow march into social media over the past year.  

Alex Butler (see http://bit.ly/AlexButler), Digital Strategy and Social Media Manager at Janssen UK, graciously received the "shirt off my back" at lunch yesterday during the 4th Annual Digital Pharma East conference. That's Alex, the shirt, and my disrobed self pictured on the left. Thanks to Steve Woodruff (@swoodruff) for the photo documenting this historic event.

Kudos for Alex came immediately via Twitter:

@DigitalPharma: Congrats to @Alex__Butler, winner of @pharmaguy's first ever Social Media Pioneer Award! Hope yellow's your color. #digpharm

@pixelandpills: Aaaand the shirt comes off...congrats to @Alex_Butler for his @pharmaguy Digital Pioneer Award win. We think you should frame it. #digpharm

@skoko: Well deserved! Congrats! @Alex__Butler, winner of @pharmaguy's Social Media Pioneer Award /Wish I had seen that shirt come off ;-) #digpharm

@GaryMonk: Well done mate! RT@Alex__Butler: Thnx to @pharmaguy for giving me the famous shirt 2 look after for 1 yr re: social media pioneer award....

@newstream: Congrats! @Alex__Butler, winner of @pharmaguy's Social Media Pioneer Award /Wish I had seen that shirt come off ;-) #digpharm”

As I mentioned in this Pixel & Pills video interview by the lovely Sarah Mclellanny (@sarahmclellanny), I based my choice partially on input from respondents to an online survey. About 65 people participated and the results are shown in the following chart. Each respondent was able to vote for more than one candidate; see the list of ALL the 2010 Pharmaguy Social Media Award candidates here (pdf).

NOTE: ALL candidates will receive the coveted Pharmaguy Social Media Pioneer Lapel Pin (shown on the left).

Aside form the votes and comments that I received via the survey, I also was very much impressed with a presentation Alex made in September at the DigiPharm conference in London. He talked about the launch of Janssen UK's Psoriasis 360 Facebook page (see "Markets as Conversations: Can You Have a Discussion with 'Psoriasis 360' on Facebook?").

When I handed over the Hawaiian shirt to Alex, I stated that another important factor in my decision was that Psoriasis 360 is the first consumer-oriented pharma FaceBook page to allow comments without pre-moderation. All comments are posted first and then reviewed afterward. So far, only a few comments had to be removed -- mostly because of vulgar language or mentions of product names. If a comment includes a product  name, the moderator(s) ask that the comment be resubmitted with the product name removed.

Psoriasis 360, however, may NOT be the FIRST pharma Facebook page that allowed unmoderated comments to be posted. Sanofi-Aventis' VOICES Facebook was probably the first, but only unintentionally! Listen to that story and its aftermath here: "What Sanofi-Aventis Learned from Its FaceBook Experience & What the Experts Recommend It Do Now".

Also, after I made my presentation, Joan Mikardos, Senior Director, Business Innovation, Sanofi-Aventis, reminded me that another S-A Facebook page -- "THE COALITION TO PREVENT DEEP-VEIN THROMBOSIS (DVT)" -- which was launched BEFORE Psoriasis 360, also allows unmoderated posts.

Actually, the DVT Facebook page is technically owned by "The Coalition to Prevent Deep-Vein Thrombosis (DVT)," which is "funded by sanofi-aventis U.S. LLC," as revealed on the Coalition's .org site (see http://www.preventdvt.org/). The "about" page of the site states "In February 2003, more than 60 organizations assembled at the Public Health Leadership Conference on Deep-Vein Thrombosis (DVT) in Washington, D.C. to discuss the urgent need to make DVT a major U.S. public health priority."

Technically, therefore, the DVT Facebook page is not a true S-A site, unless the Coalition is just a front for S-A and not a coalition at all.

Whatever the true provenance of the DVT Facebook page -- a topic I may blog about at some other time -- my award was not a contest to determine who did what first. It is more about people such as S-A's Dennis Urbaniak, who is a bona fide social media pioneer and who received recognition as such in my award "unceremony."

Pay It Forward!
What will happen now? Will another pharma social media pioneer receive another Hawaiian shirt next year?

There WILL be another award, but NOT another shirt. As Alex said in his Pixels & Pills interview, he is now the custodian of the Hawaiian shirt, which he will pass on to the next deserving pioneer a year from now. Just like the Masters green jacket! Meanwhile, keep those nominations coming by taking my survey here.

Proper Care and Handling of the Shirt
Alex and any future Pharmaguy Social Media Pioneer custodians of the Hawaiian shirt award have an obligation to maintain the shirt in its original condition. Here are a few proper care suggestions:

1. Wear the shirt with pride on special occasions such as when attending industry conferences, in-house meetings with your managers, etc. However, avoid wearing the shirt to dinner parties or sporting events where it may suffer irreparable staining or ripping!
2. Do NOT machine wash the shirt! Dry cleaning is recommended.
3. You may mount the shirt for display on your office wall, but do not use any mounting technique that will permanently harm the shirt. To protect it while on display, it is best to frame it behind UV-protective glass.
4. Do NOT allow anyone else to wear the shirt! Not even your significant other who you may wish to appear more sexy "when the time is right."