JNJ Attempts YouTube Humor to Promote a DTC Advertising Goal

The goal of every direct-to-consumer (DTC) ad is to get people to visit their doctors and ask about the advertised Rx drug. But are these ads effective?

The drug industry often defends DTC ads, claiming they ARE effective in achieving this goal. Some studies, however, seem to indicate that once people visit their physicians, they do not ask for the advertised drug (read, for example, "Advertisers Don't Know How DTC Works. Say wha?").

But the ads may not even be effective in driving people to see their physicians. Maybe that's why Johnson and Johnson (JNJ) recently promoted a YouTube video it uploaded more that two years ago called "The Appointment." It's an non-branded attempt to use humor. JNJ's corporate Twitter account (@JNJComm) recently posted this tweet:

"Afraid to visit the doctor? Don't be! Watch 'The Appointment' for medicinal laughter - and important info > http://t.co/0PQanPNF @JNJVideo"

On the YouTube page, JNJ introduces the video: "Many people are wary of making a doctors visit. In The Appointment, some extreme humor works to make several important points about why you should visit your doctor and most importantly things you should not be afraid to understand and ask. Enjoy and no, there really isnt a needle that big!"

Here's the video:




A few people do not think the video is funny. One commenter (yes, JNJ accepts comments on its YouTube channel) said:

"I'm not one to start a YouTube spitting contest - I'm just saying that this seems to be a bit (not massively!) insensitive to both the clinicians and the patients who are trying to treat each other better. Your ultimate message in the vid is perfect - it just strikes me as missing the mark in its opening approach."

One commenter even said it was "misguided":

"Wow. I'm sure you meant it to be funny, but I have to say, this is the worst-conceived pitch I've ever seen for being an empowered patient. In addition to the patient looking like something of a simpleton, to me it charicatures doctors in the worst possible way too.. I'm sure y'all meant well, but wow, this is misguided."

To which JNJ replied:

"I understand and respect your point of view. It was supposed to be a lighthearted reminder to those who might not be practicing preventive care. You are already an informed, empowered patient who has dealt with, and become educated about, a life threatening disease. Although it uses caricutures of doctors and patients, the video is aimed at those who might have misconceptions or fears about visiting their doctors for annual check ups and other routine care."

What do you think?

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).

Calling Merck: Help Save the Honey Bee!

The European Parliament has called on the pharmaceutical industry to play a role in finding a solution to halt the rapid decline of the honey bee (see "Can Big Pharma Halt Honey Bee Decline?"). There may even be(e) monetary incentives in the works for any drug company that agrees to develop new medicinal products designed to combat bee diseases.

Merck, which famously uses a honey bee as its Nasonex drug icon (see left) and which is famous for developing vaccines, should be(e) the first to step forward, support this resolution, and announce it is willing to take on the challenge, IMHO. Provided, of course, it gets a major share of those monetary incentives!

Think of the possibilities!

First, Merck would earn the undying love of Europeans facing economic disaster should its honey bee population disappear; did you know that "Albert Einstein once said that without bees, man would live no more than four years"? Thus spoke Hungarian Socialist Csaba Tabajdi, who drafted the resolution.

Whaaa?? A socialist wants to give the capitalist drug industry monetary incentives? This bee problem must really be(e) serious! However, given Europe's current man-made financial crisis, many Europeans may have fewer than 4 years left regardless of the fate of honey bees.

Second, Merck is committed to animal health: "Our Animal Health business is an industry leader and delivered strong revenue growth in 2010 in both companion and production animals, as well as all geographic regions. Merck remains committed to the animal health business and the diversification it brings. We intend to continue to capitalize on growth opportunities in our broad and innovative portfolio" (2010 Annual Report).

Third, imagine the direct-to-consumer (DTC) marketing opportunities should Merck launch a full-bore attack on honey-bee-disease-causing agents that threaten every honey bee, INCLUDING Merck's famous Nasonex icon. I'm thinking that Merck can use that icon to promote its efforts to save the honey bee. It can use Twitter to reach out to Europeans (but, of course, NOT the branded fake @Nasonex_Bee account). I'm also thinking that this non-branded DTC effort would not violate EU restrictions on promoting brand drugs to consumers.

Merck would have an easy time convincing EU parliamentarians to approve laws REQUIRING all flowering-plant farmers to use the Merck anti-honey-bee-disease-causing agent vaccine or whatever. Heck, it could extend the law to require ALL farmers -- even those who grow crops that do NOT require honey bees for pollination -- and even home owners with lawns or other plants, to apply its product. Better yet, the state can take over completely and send out helicopters to spray whole swaths of the countryside!

Of course, you wouldn't want to eliminate COMPLETELY the honey bee scourge! That would not help Merck "continue to capitalize" on its investment, assuming those government subsidies do not cover 100% of the research and development. You must continue to have high sales to recoup those costs!

One fly (or is it a bee?) in the ointment: part of Merck's plan to "diversify" may include developing other agricultural products such as pesticides (see, for example, this Merck EPA Application to Register Pesticide Products).

"Research has shown that pesticides made by the pharmaceutical industry are a cause for the weakening of bees. But instead of asking them to stop producing those pesticides, the European Parliament now asks that same industry to develop medicines against the effects of their pesticides," says Bas Eickhout, Dutch green member of parliament, who presented the house with an alternative resolution asking for a moratorium on the use of harmful pesticides.

Given that 25% of members of the EU Parliament support Eickhout's resolution, I'd say it's time for Merck to send to Brussels its lobbyists left over from its push to get U.S. state legislatures to pass bills requiring ALL children to be vaccinated with Gardasil (see "Gardasil: To Be Mandatory or Not To Be Mandatory -- That is the Question")!

Will Avandia Failure Lead to More Closely Supervised Clinical Studies and Longer Patent Life for New Drugs?

In a BMJ editorial, editor Fiona Godlee contends that Avandia "should not have been licensed and should now be withdrawn." She cites problems that FDA discovered with the RECORD post-marketing study and finds fault with regulatory agencies' oversight of such studies.

Regulators should "should require a higher quality of evidence," Godlee says, "including proof that new drugs are better than existing drugs before being licensed. And if they do ask the manufacturer to undertake post-marketing trials, they must do a better job of overseeing the way these trials are designed and done."

Godlee also called for other reforms, including "far greater transparency from industry and the regulators, including access to raw data and funding for independent trials..."

Holding out a carrot in front of this stick, Godlee suggested that "the patent for new drugs should be extended, from the current 20 years to perhaps 25 or 30."

Personally, I don't think it's a good idea to extend the patent life by up to 50% for "greater transparency" by the drug industry. But Godlee is also calling for "funding for independent trials" as part of the deal. Is she talking about post-marketing trials like RECORD or the clinical trials upon which first approval for marketing is based? Where does the funding come from? I suppose she means that drug companies should somehow pay for "independent trials." That's going to be a problem even bigger than the problem of funding "independent" physician continuing medical education.

No matter how independent the pre-marketing trials are, the data are limited to a small population, which is often not representative of the population at large that will be exposed to the drug once it's on the market. That means additional studies may still be required after the drug is on the market to evaluate the safety among a larger population.

Perhaps having a drug on the market while additional studies are still underway is NOT as big a problem in Europe as it is in the U.S. where direct-to-consumer (DTC) advertising plays a big role in driving millions of consumers to their doctors to demand new medications. As online marketing begins to play a bigger role in marketing to consumers, this effect can be heightened. A recent study by About.com, for example, revealed that online health ads activate consumers as a result of seeing a healthcare (ie, drug) ad online:

• 44 percent researched medication in more detail as a result of seeing a healthcare ad online, up from 36 percent in 2009.
• 35 percent talked to their doctor after seeing an online healthcare ad.

IMHO, a better solution -- in the U.S. anyway -- might be to temporarily prohibit DTC advertising of drugs that require additional studies until those studies prove that the drugs are safe and effective as used in the marketplace. The carrot can still be an extended patent life as Godlee suggests. I have suggested this before -- see "Restrict DTC, but Extend the Patent for New Drugs" -- and the topic may arise again in my upcoming debate with DTC advocate Bob Ehrlich (see "The Great DTC Debate. Round 1: Are Drug Marketers an Endangered Species?").

GSK Kills the FDA Beast! Avandia Lives Another Day. Stay Tuned for DTC.

It seems that the 14 million pages of documents that GSK submitted to the FDA in defense of Avandia has had the intended effect: overwhelming FDA's advisory panel with "science," questionable as it may be.

I'm reminded of the scene in the original King Kong movie that fascinated me as a kid: the scene in which King Kong rips open the jaws of the T Rex and kills it. That's exactly what GSK has done to the FDA -- ripped open its regulatory jaws and rendered it powerless to take Avandia off the market even though it is known that the drug is responsible for the deaths of 400 times more people per year than is Toyota's cars (see "If Drugs Were Like Automobiles").

I have no doubt that the FDA will follow the recommendations of the advisory committee, the majority (17) of whose members voted to keep Avandia on the market albeit with stronger warnings or tighter restrictions on prescribing. Although 10 members voted to take the drug off the market, I don't see that view being taken seriously by the FDA. After all, Avandia's patent will expire within a year and it has received such bad press lately that it is hard to imagine physicians prescribing it. FDA's strategy may be to slap restrictions on Avandia and hope it dies a death of a thousand cuts. That way, the agency can appear to be responsible and science-driven rather than being gung ho anti-industry.

All this leads me to consider how GSK will address the problem of a likely drop off in prescribing by physicians. This is already happening. GSK hopes to solve that problem with a clinical trial that demonstrates that Avandia is as safe (or just as unsafe) as its competitors. It is reported, however, that GSK is having problems recruiting patients for this new study.

Just as BP is hedging its bets on stopping the Gulf oil leak by placing a new cap on the well rather than relying on the success of the relief well option, GSK will roll out a direct-to-consumer (DTC) ad campaign to hedge its bet on the comparison study.

A DTC campiagn can be launched almost immediately and may already be ready to roll. Such a campaign may resemble the Celebrex campaign that Pfizer launched after competitor drug Vioxx was removed from the market and put Celebrex's safety in doubt (see "Celebrex Ad: Let's Dive Deeper").

Keep in mind that DTC campaigns are aimed NOT just at consumers, but also at physicians who are even more likely to watch the evening news on TV than you or I. GSK may also simultaneously launch an equivalent direct-to-physician ad campaign.

The new Avandia advertising campaign will draw upon positive data that GSK cherry picks from its 14 million pages of documents just as the Senate Committee cherry picked negative data.

It was destined that the great Ape would die and so will Avandia. It won't be the FDA gunships that kill Avandia, however. It will be the "beauty" of the marketplace!

Police Lieutenant: Well, Denham, the airplanes got him.

Carl Denham: Oh no, it wasn't the airplanes. It was beauty killed the beast.

How Much Does Pharma Spend on ePromtion? The Mystery Continues - UPDATE

Depending upon what publication reports the data, the TOP 12 pharma companies either spent $287.60 or $168.12 million on "ePromotion" in 2008. The two publications I am talking about are Medical Marketing & Media (MM&M; see "Pharma Report: When Generics Attack") and AdAge (see "Marketing Mix of Leading Pharma Advertisers in 2008"). The "measured media" DTC data reproduced in these publications come from the same source: TNS, which is now part of Kantar Health.

I focus on the 2008 data because I don't have 2009 data from AdAge, but I DO have 2009 data from the May 2010 issue of MM&M, which reported promotional spending in several categories: DTC, detailing, ePromotion, meetings, and journal advertising. Some of the data -- it's not clear which data -- come from SDI's Promotional Audit. 

The 2009 data reported in MM&M covers the TOP 20 pharma companies in terms of "Total Promo Spend" (see chart below, which shows the Detailing, DTC, and ePromotion spend for the 20 companies; not included are the data for meetings and journal advertising; click on the chart for an enlarged view):

What's immediately evident is how LITTLE each company spends on "ePromotion," which -- I assume -- includes only display ads placed on 3rd-party Web sites and specifically not search advertising. This is part of what's called "measured" media spending, which many experts say overstates the actual amount that companies spend on advertising -- because of discounting. Let's not worry about that because discounts probably apply to both types of media.

What % of total measured media spending is devoted to ePromotion? To calculate that I added the spending on DTC, ePromotion, and Journal Ads to get the total measured media spend, which was $4.208 Bn in 2009 according to data reported in MM&M. The total ePromotion spend was $0.3037 Bn, which is 7.2% of the total.

The 7.2% figure is suspect. Measured media data reported in AdAge ("Marketing Mix of Leading Pharma Advertisers in 2008") indicate that Internet display ad spending was 2.4% of total measured media spending in 2008 and 3.1% in 2007. Unless I am missing some data from the MM&M source or made an error in math, I don't see how you can go from 2.4% to 7.4% in one year.

Meanwhile, Melissa Leonhauser, director at SDI, was quoted in MM&M as saying that 2009 pharma ePromotion spending increased 6.6% compared to 2008. Total industry promotional spending increased 2% according to Leonhauser

The other thing I notice from the data reported in MM&M (see chart) is that some companies spend nearly as much or more on DTC as they do on detailing to physicians (eg, Pfizer, BMS, Amgen, BI, and Daiichi-Sankyo). If true, that's pretty amazing. Amazing, because I've seen estimates of physician detail spending of $12 billion industrywide, whereas overall DTC spending is more in the range of $4-5 billion. That yields a Detailing/DTC spending ratio of about 3 to 1. For the biggest spender -- ie, Pfizer -- to have a Detailing/DTC ratio of 1.12 to 1 (based on data reported by MM&M; ie, $1.223 Bn/$1.089 Bn) seems very suspect to me.

I have more suspicions about the data reported in MM&M. In the case of Daiichi-Sankyo, for example, when you add up the columns (ie, different types of promotion) you get $554.50 million, whereas the table has $300.75 million in the Total column.

Let's get back to comparing 2008 ePromotion pharma spending reported in AdAge vs the spending calculated from data reported in MM&M. These numbers are very different for most of the companies on the two lists. Again, I am comparing data for 2008. To do that, I used the % change reported in MM&M to calculate the ePromotion spend for 2008 from the 2009 data. This calculation for Merck, for example, yields $95.5 million whereas AdAge reported that Merck spent only $8.60 on ePromotion (Internet display ads) in 2008 -- a difference of $86.9 million! Anyway, here are the numbers (note:for the AdAge data I merged SP data into Merck and Wyeth data into Pfizer to account for mergers after 2008 and to make a fair comparison to what MM&M reported; 2008 data from MM&M were calculated from % change information published in MM&M):

What can account for the huge differences seen for many companies on this list? There must be a mistake somewhere -- as I said, I may have made a mistake in my math or assumptions. But I know for sure that there is at least one error in the MM&M table -- the data for Daiichi-Sankyo just doesn't add up to the total reported.

UPDATE (6/12/2010):

Bob Harrell commented on my Facebook page: "Are you sure the definition of "ePromotion" in either or both cases is *really just* online display advertising (basically banner ads)? That seems like a very odd and narrow definition to use for ePromotion in pharma - putting aside the question of what can easily be tracked/indexed - and thus a questionable assumption for your comments above."

It's not clear from MM&M Table 4 ("Total Promo Spend, DTC SPend, ePromotional Spend") whether or not the ePromotion numbers refer only to display ads. It is also not clear if the numbers refer to direct-to-consumer ePromotion or ePromotion to physicians, which can include eDetailing, etc, or to BOTH consumers and physicians. Since MM&M put ePromotion and DTC in the same table and had another table (Table 5) devoted to physician promotion, I assumed that the ePromotion numbers in Table 4 referred to consumer ad spending.

The source of the ePromotion numbers reported in MM&M (Table 4) is "SDI's ePromtion Audit," which I now have learned "tracks online promotional activities for physicians" (see "SDI Reports: Pharmaceutical Promotional Spending Indicates Trend Toward Electronic and Online..."). This would explain the inconsistencies I calculated in the table above. It would not explain, however, what the the level of ePromotion to consumers is.

SDI noted an increase of more than 32% in industry spending on ePromotion (to physicians). Kelly Sborlini, Vice President of Market Research Audits at SDI said "we're also seeing a similar shift in pharmaceutical direct-to-consumer advertising. The largest growth area in DTC advertising is on the Internet, whereas spending on consumer magazine print ads is decreasing." I cannot find the numbers that SDI used to support this statement.

Nobody Knows You're a Fake Patient on the Internet!

Last night I had the honor of hosting the #socpharm "Tweetchat" session, standing in for Eileen O'Brien (@EileenObrien; Siren Interactive) who is the founder and regular host of that Twitter discussion stream.

One issue discussed in last night's session was Sara Baker, a "fake" patient created by MedSeek, a health IT company (see Lori Moore's comment to this post).

"Meet Sara Baker," says MedSeek on its website. "ePatients like Sara Baker are the future of eHealth. She uses the Internet to stay connected with friends, check her bank balance and make purchases. She is Web-savvy and expects her healthcare provider to be, too. She has growing expectations of her healthcare providers for 2011 and beyond. And she will be the driving force behind your healthcare organization's ePatient revenue center." [emphasis added]

MedSeek even created a Facebook page/personna (eSaraBaker) for Sara where she posts things like "Just found out my hospital is adding a new online feature starting June 1: Now I’ll be able to log in one time to manage everybody’s appointments, prescriptions, etc. Me, Alex, Brad and Jake… all in one place. How great is that?"

Phil Baumann (@PhilBaumann) first called attention to this marketing ploy that "promises to deliver revenues to healthcare organizations wishing to market to so-called ePatients." Baumann coined the term "fPatient" to distinguish the likes of Sara from real ePatients (see "fPatient – Ethics and Mediocrity in Healthcare Marketing").

The #socpharm discussion of Sara Baker lead to a discussion of the use of "fake" patients on drug.com websites, something I have written about many times here on Pharma Marketing Blog. See, for example, "Alice, 35, is Not a Real Ambien CR Patient." After I wrote that piece, sanofi-aventis added the disclaimer "Not a real patient" to the animation on the site. Since then, however, they have moved away from images of "fPatients" to roosters. Oh well.

The trend today, however, is to solicit and portray real patient stories. See, for example, "Barb" on the Novartis Reclast site. She's featured in a "Dramatic Health Production" video in the "Real Reclast Stories" section of the website (here).

Although Barb is real, there are other "patients" featured on the website who may not be real. Take "Rhoda" for example. There's a written profile of Rhoda, but I can't find her in the "Real Stories" section. Is she real or fake? I can't say for sure one way or the other.

Obviously, actors are used in direct-to-consumer (DTC) Rx drug ads all the time. Sometimes, we are lead to believe that actors playing doctors in TV ads are real doctors or actually rowing when they are not (see "Jarvik: A Modern DTC Tragedy"). On TV we also see actors portraying patients. Sometimes they even speak and say how the drug helped them. Most often, however, these "patients" don't really say anything. They certainly are not identified by name and age as is the case with "Rhoda" and other questionable "patients" on drug.com websites.

Is it ethical for pharma marketers to employ "fpatients?" Is it even necessay? asks Baumann: "Is the deployment of fake profiles in Healthcare Marketing even necessary? Marketing not only has to be effective, it also has to be respectable. Why create a fake social object when so much more social capital can be built by simply being honest and truthful and direct? Why not take advantage of direct interaction and feedback?"

We might have to wait until hell freezes over before pharma marketers are "honest and truthful and direct" let alone before they "take advantage of direct interaction and feedback." Like the Reclast marketers, however, pharma marketers will go on location to videotape a real patient and create a well-crafted, edited video profile that they can feature on their websites and on YouTube for extra-added search engine benefit. You can't get that kind of ROI from "truthful, direct, honest interaction."

Equation Proves that Broadcast DTCA Only a Minor Contributor to Growth in Rx Drug Expenditures

In an equation that Einstein would be proud of, researchers at the National Bureau of Economic Research (NBER) supported by a grant from the Agency for Healthcare Research and Quality have "proved" that "the expansion in broadcast DTCA may be responsible for about 19 percent of the overall growth in prescription drug expenditures over the [period between 1994 and 2005], with over two-thirds of this impact being driven by an increase in demand as a result of the DTCA expansion and the remainder due to higher prices." The researchers based this on an analysis data supplied by IMS fed into this equation:

The equation denotes that the market price (P) is a function of promotion, time until patent expiration and the number of drugs in the therapeutic class. Hey, I'm not going to get into an analysis! Ed Silverman over at Pharmalot already did a great job explaining the research (see here).

I'm just in awe of this equation, which to me looks suspiciously similar to an equation used by Villanova scientists that proved that DTC spending does not impact Rx prices (see here, where you can see a T-shirt with the equation on it).

The authors of the Villanova study concluded that "DTC advertising has no effect on the price of drugs" whereas the authors of the NBER study conclude that "while DTCA is significant, it has not been the primary force driving the growth in overall prescription drug expenditures."