Social Media Can't Fix This Limitation of Disease Awareness Campaigns

At the Digipharm EU conference last week, I presented an update on expected FDA guidance regarding pharma's use of the Internet. The last slide of my presentation (find it here) was my take on what effect this guidance would have on EU-based pharmaceutical marketers. The last bullet point stated:

"When all is said and done by the FDA, we may realize that social media really fits BETTER with the European way of pharma marketing, which focuses on disease awareness and direct-to-patient response only upon request by the patient."

I've expressed that view several times here on Pharma Marketing Blog (see, for example, "Some Pharma Marketers Can't See the Unbranded SM Forest for the Branded SM Tree").

Also, I have noticed that almost ALL pharma social media campaigns are unbranded, disease awareness/support campaigns sponsored by EU-based companies that are used to focusing on this type of communication because of EU laws that forbid branded advertising.

Recently, however, such campaigns have come under attack because they may be pushing more patients into treatment unnecessarily. Such was the point made in a recent LA Times article regarding breast cancer awareness campaigns (see here). That article, which reminded us that October is National Breast Cancer Awareness Month, pointed out that disease awareness campaigns lead to more screening and "the more we screen, the more women we subject to surgery, chemotherapy and radiation for cancers that never would have harmed them. A New England Journal of Medicine article," said the LA Times, "estimated that for every life saved by a screening mammogram, five to 15 other women needlessly became diagnosed and treated."

To top it all off, according to the National Breast Cancer Coalition in Washington, D.C., 117 women in the U.S. died of breast cancer every day in 1991; today that number is 110.

The founding sponsor of National Breast Cancer Awareness Month is AstraZeneca, which responded to the LA Times article by saying "If it's not broken, I don't think we should try and fix it." AZ cited data available from the National Cancer Institute, which suggested that "the mortality rate for women with breast cancer was 32.6 percent [in 1991]. That had fallen to 22.8 percent in 2007..." (see "National Breast Cancer Awareness Month as relevant as ever").

Aside from the issue of effectiveness of disease awareness campaigns, there's the issue of patient empowerment, which we often hear in conjunction with these campaigns. "Some critics," notes the LA Times article, "object to messages that emphasize the need for women to 'take charge' of their breast health because they imply that women are at fault if they get the disease, says Angela Wall, communications manager for Breast Cancer Action, a San Francisco-based advocacy group."

Of course, an issue I've often mentioned in this blog is pharma's tendency to make it seem that more people may have the disease du jour than is warranted by the data (see, for example, "OMG! Do I Have ED or 'Low T?' Or Both?! Pharma 'Symptom Quizzes' Are NOT in the Best Interest of Patient Health!" and "You Must Score Better than 84% on Viagra's Sexual Health Quiz to NOT Have Signs of ED.").

Still, a disease awareness campaign, if done right, can benefit from a social media component. First, these campaigns are usually not on FDA's regulatory radar. Second, consumers and patients are more likely to engage with social media campaigns than with branded campaigns. You can motivate more people to walk 10 miles for breast cancer awareness than for Zoladex, which is AZ's FDA-approved drug for use against breast cancer.

Markets as Conversations: Can You Have a Discussion with "Psoriasis 360" on Facebook?

Alex Butler, Digital Strategy and Social Media Manager at Janssen and candidate for the Pharmaguy Social Media Pioneer Award, just informed me by email that he and his team have launched the Psoriasis 360 Facebook page, which is part of a larger disease-awareness campaign.

Alex wrote:

"The Psoriasis 360 campaign has been developed by Janssen as part of an ongoing commitment to improving the lives of patients through the provision of useful and relevant information about psoriasis. We know that people who live with psoriasis don’t always get the help and support they need to manage their condition. Many people are not aware how severe their psoriasis is, the impact that this has on their life and how to speak to their doctor about managing the condition.

"This information forms the core of the content on the psoriasis 360 website. We would like people to join our community on Facebook and share their experiences with ourselves and others. They can also connect with us and follow the latest psoriasis and 360 community news on twitter. Shortly there will also be a YouTube channel that has been set up with the primary goal of YouTube itself in mind-letting people touched by the condition broadcast themselves and share their stories with others, helping people to live better with psoriasis.

"We believe strongly that people should be able to share their views in an open a manner as possible for a regulated industry and the commenting policy reflects this attitude."

I think this pharma social media site is the first to publish ALL comments BEFORE they are reviewed. Janssen, however, reserves the right to remove any comments "if they directly talk about medication or could be offensive to people."

It also appears that Janssen will allow links to third-party videos and other information: "Janssen are (sic) not responsible for third-party materials appearing on the Psoriasis 360, including but not limited to linked third-party videos, linked third-party sites, and third-party advertisements," says the comment policy. "Janssen does not control or endorse this third-party content and makes no representations regarding its accuracy."

Of course, this leaves the door open for Janssen and/or their agency partners to post all kinds of links to information that Janssen MAY endorse and be responsible for under other circumstances.

But let's not put the cart before the horse and start criticizing this policy before we see more "conversations" on the site.

Speaking of "conversations," I will be interviewing Doc Searls, one of the authors of the Cluetrain Manifesto, about the relevance of the Manifesto for the pharmaceutical industry in today's social media world.

According to the ClueTrain Manifesto "A powerful global conversation has begun. Through the Internet, people are discovering and inventing new ways to share relevant knowledge with blinding speed. As a direct result, markets are getting smarter—and getting smarter faster than most companies."

The first 6 theses of the Manifesto state:

1. Markets are conversations.
2. Markets consist of human beings, not demographic sectors.
3. Conversations among human beings sound human. They are conducted in a human voice.
4. Whether delivering information, opinions, perspectives, dissenting arguments or humorous asides, the human voice is typically open, natural, uncontrived.
5. People recognize each other as such from the sound of this voice.
6. The Internet is enabling conversations among human beings that were simply not possible in the era of mass media.

I'm most interested, however, in latter theses that are relevant to the growing list of pharmaceutical Facebook pages; namely "The ideal, according to the manifesto," as reported in wikipedia, "is for the networked marketplace to be connected to the networked intranet so that full communication can exist between those within the marketplace and those within the company itself (thesis 53.) Achieving this level of communication is hindered by the imposition of ‘command and control’ structures (thesis 54-58) but, ultimately, organizations will need to allow this level of communication to exist as the new marketplace will no longer respond to the mass-media ‘voice’ of the organization (theses 59-71)."

What I notice on the "Psoriasis 360" FB Wall as well as other pharma FB Walls is that often the response to comments come from unidentified, branded accounts that may or may not be real "human beings." On Psoriasis 360, the responses come from "Psoriasis 360." It's a closed loop that does not bring me to any real human being.

Therefore, I made this post today to the Psoriasis 360 FB Wall:

"Good luck on your new FB page. A piece of advice I'd like to see implemented is for the Janssen people who are responsible for this FB page AND for the ppl who are part of the psoriasis team at Janssen to perhaps identify themselves and/or post their photos to the site. I know this is sometimes a problem because of pri...vacy issues, but eventually the general public would like to know who they are talking to. Having replies come from REAL identifiable ppl may help generate discussion better than having replies come from 'Psoriasis 360.' What do you think?"

Until pharma can break down the "command and control" structure within its marketing organization and allow voices from real people within the organization to respond to consumers, it will never achieve the vision of the ClueTrain Manifesto.

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The Relevance of the Cluetrain Manifesto in a Social Media WorldWhat's Still Not "Conversational" in Today's Markets?


A conversation with Doc Searls, Senior Editor of Linux Journal and co-author of The Cluetrain Manifesto, about the relevance of the Manifesto for the pharmaceutical industry in today's social media world. Doc will preview the keynote presentation he plans to make at the upcoming Digital Pharma East conference. (See guest bio.)



Airs LIVE on: Thursday, October 7, 2010 * 2 PM Eastern USA

Go to this Pharma Marketing Talk Segment Page to listen to the LIVE show via streaming audio on the Web or to listen to the podcast archive afterward.

How FDA Warnings & DTC Advertising Increase Sales of Sexual Enhancement Dietary Supplements

Here's an example of how the Internet and direct-to-consumer (DTC) advertising empowers consumers.

For several years now the FDA has been issuing warnings to consumers about "dietary supplements" that claim to enhance sexual performance or treat erectile dysfunction. According to the FDA, although it has issued "many alerts about these types of supplements over the past several years, ... their number seems to be growing" (see "FDA Consumer Corner: Cautions about Sexual Enhancement Products").

Using the Internet, FDA now has a much more direct line of communication to consumers. And consumers use the Internet to buy dietary supplements. This concerns drug companies and the FDA.

What concerns the FDA about these products? FDA states:

"FDA has found that many of these supposedly 'all natural' products actually contain ingredients that aren't on the label, and these ingredients could lead to serious and even fatal effects."

Is FDA talking about rat poison? That's what Pfizer says MAY be in such products sold over the Internet (see "Was a Rat Harmed in the Filming of This Pfizer Commercial?" and "Unsafe Drugs: Is It Counterfeiters or the Supply Chain That's the Problem?").

Nope.

FDA isn't saying that these products contain dangerous ingredients like rat poison. It is claiming that they contain dangerous ingredients such as the ACTIVE ingredients of VIAGRA, CIALIS, and LEVITRA -- all FDA-approved Rx drugs.

"An FDA investigation of a number of these sexual enhancement supplements found that a third of them actually contained the same or similar ingredients to the class of prescription drugs that includes Viagra (sildenafil citrate), Cialis (tadalafil) and Levitra (vardenafil HCl)."

Hmmm... so if I buy one of these products, the chances are 1 in 3 that I will get the same active ingredient as found in Viagra/Cialis/Levitra?

OK, I know that these active ingredients can be dangerous even when sold as Viagra, Cialis, or Levitra (is Levitra still on the market?). But the TV commercials make these products sound pretty safe to me. In fact, the commercials tell me exactly what I should be concerned about: e.g., "Don't take Cialis if your take prescription drugs that contain nitrates, such as nitroglycerin."

Thanks FDA for alerting me to the fact that these dietary supplements may contain active ingredients that you have approved for human use in Rx drugs and thanks DTC advertising for educating me about the risks.

Excuse me while I search online for the best selling Sexual Enhancement Dietary Supplement.

In fact, I found a handy side-by-side comparison easily via Google search on "Sexual Enhancement Dietary Supplement" (see below). Unfortunately, I had to black out the rating symbols that appear on the original chart (which I found on JournalScopereviews.com, here) because Consumers Union (CU) lawyers informed me that the "rating symbols ... are confusingly similar or identical to Consumer Reports' trademarked icons and Ratings symbols. When consumers see your (sic) chart, they will not know if there is some connection between Consumers Union and the creator of these ratings. Obviously, there is not. The confusion this can engender is all the more pronounced given that Consumer Reports does write about dietary supplements, and has recently published information relating to sexual enhancement dietary supplements in particular. Needless to say, our views do not necessarily mirror yours, or those of the originator of the chart. This makes it still more crucial that all such confusion be avoided. To that end, therefore, we ask that you remove this chart from your blogs and refrain from using these particular Rating symbols in the future. Using some other shape or design will help ensure there is no confusion as to the source of the ratings."

BTW, I look forward to seeing CR's report on sexual enhancement dietary supplements. I wonder if the report includes the FDA warnings?

The CU lawyers also wanted to know how to find the original chart. It seems they are not as adept at using Google as am I!

Anyway, here's the blacked out version of the chart:

Lilly vs. AstraZeneca on Covering the Medicare "Doughnut Hole" Gap

Two pharma companies have responded very differently to recent stories in the press about pharma's "deal" with democrats to help cover the gap ("doughnut hole") in Medicare drug coverage. Whereas Lilly hemmed and hawed and skirted the issue and mainly defended high drug prices (see "Why Price Controls Are Not The Right Answer" and my comments here: "LillyPad Launches Specious Rocket Attack Against Drug Price Control Straw Man" and ), AstaZeneca seized the moment to support the coverage and explain how else it is helping senior citizens pay for their prescription drugs (see "Our Fair Share: Closing the Coverage Gap").

[For background, see "Medicare "Doughnut Hole" to Cost Pharma Less Than 1% of US Sales."]

Just on the basis of the two blog post titles, I have to give AZ kudos for its positive stance vs. Lilly's negative stance. It's interesting that the negative commentary comes from a drug company that is US-based, whereas the positive stance comes from a UK-based drug company. Lilly also seems to be directing its comments to lawmakers and not senior citizens, which seems to be who AZ is talking to.

Pharma Brands Benefit from "Mack Attacks" Say Attendees at DigiPharma EU

Last week I attended the DigiPharm EU conference in London and had a great time meeting old friends and people I have only interacted with through social media such as Twitter and FaceBook. Several EU pharma people presented at the conference, including candidates for the Pharmaguy Social Media Pioneer Award. I'll have more to say about these people and their presentations later, but right now I'd like to focus on me.

First of all, I gained 2 lbs! It was the English comfort food I was exposed to at a couple of tweetups and during the buffet lunch at the conference. Food such as bangers and mash, roasted pork belly, and Shepherds pie. And the drinking!

I blame it all on Alexandra Fulford (@pharmaguapa) and Sam Walmsley (@sammielw), two English women who are my new best friends on FaceBook.

Alexandra coined her Twitter handle after some Spanish guy said she was "muy guapa," which means "very pretty." Of course, I immediately said I was going to reserve "pharmaguapo" -- handsome pharmaguy -- as a new twitter handle.

I don't think anyone in Spain would say I was "muy guapo," but Miguel A. Tovar (@blogaceutics), who is a native of Barcelona, was happy to see me and I him.

Alexandra likes to cook and gave me some Aromat Savoury Seasoning, which I smuggled back to the US. I used it last night to season my roasted chicken and salad. Alexandra, meanwhile, cooks Bangers and Mash for her lunch! I look forward to having Alexandra on my BlogTalkRadio show as a guest and learn more about her pharma-related expertise. We'll also talk about cooking.

Sam Walmsley and I shared an interesting Q&A session at the DigiPharm conference. Sam is the head of digital & social media at Chandler Chicco Companies, an advertising agency. One question Sam came up with was "Did a 'Mack Attack' help your brand?"

I didn't have to explain what a "Mack Attack" was because I had just finished my presentation (find it here), which included a reference to my famous attack against Novo Nordisk's Levemir-branded tweet (see "Novo Nordisk's Branded (Levemir) Tweet is Sleazy Twitter Spam!"). I don't know if that attack helped Levemir sales, but I am sure it helped drive traffic to the @RaceWithInsulin Twitter account and Ambre Morley (@ambremorley), Associate Director of Product Communications at Novo Nordisk always favorably refers to me in her presentations.

Surprisingly, practically everyone agreed that a "Mack Attack" helps brands. Judith von Gordon, Head of External Communications at Boehringer Ingelheim, commented that BI experienced a "Mack Attack" in relation to its COPD Youtube channel (see "Danica Patrick: NASCAR Driver, Super Model, Superbowl Lingerie Ad Model, & COPD Spokesperson All Rolled Into one!").

"The 'Mack Attack' helped us internally tremendously," said von Gordon. "Our US colleagues cried 'fire' and as a consequence I had three US lawyers [contact me] complaining about what headquarters in Europe was doing." It turns out that the US lawyers were "terrified that the FDA would see the Mack Attack."

von Gordon said BI learned from this experience. "The [Mack Attack] helped us define our position," said von Gordon, "what can we do, how far can we go. More importantly, we learned we can contact John and have a debate on his website (see "Pharma on Twitter: Boehringer Ingelheim")."

I was very happy to hear von Gordon's comments and hope that all the pharma "victims" of a "Mack Attack" agree with her. But you don't have to be a Mack Attack victim to be a guest on my Pharma Marketing Talk show or a candidate for the Pharmaguy Social Media Pioneer Award. Just send a message to pharmaguapo@pharma-mkting.com and ask if you qualify!

I am Off to London to Meet Some EU ePharma Pioneers at the DigiPharm 2010 Conference!

I leave tonight to attend and speak at the 2nd annual DigiPharm Europe 2010 conference in London. I am looking forward to meeting a few people I learned about after I launched The Pharmaguy Social Media Pioneer Award nomination process. These include Alex Butler, Digital Strategy and Social Media Manager at Janssen-Cilag; Kai Gait, Digital Commerce Marketing Manager at GlaxoSmithKline; Gary Monk, Product Manager - Concerta XL, Janssen Cilag;

My presentation is scheduled for Thursday, September 30: "New Rules for New Media: A Funny Think Happened While Waiting for FDA Guidance" (see below). I will also be moderating an "unconference" discussion entitled "UTurn." I am interested in learning more about that when I get there.

If you are at the conference, please say hello!

I am not a real road warrior and may not have all my tools with me to allow me to blog a lot while I am attending the conference. But I will try an update this blog at least once or twice during the week and for sure send out tweets from the conference. Follow me on Twitter: @Pharmaguy.

New Rules for New Media: A Funny Think Happened While Waiting for FDA Guidance

View more presentations from Pharma Marketing Network.

Avandia and Janet Woodcock, the Next FDA Commissioner

By now you all know about FDA's decision to put restrictions on how physicians prescribe Avandia in the US (see "FDA will significantly restrict the use of the diabetes drug Avandia"). European regulators, however, chose to completely ban the sale of Avandia.

Why the difference in approach between two regulatory agencies whose decisions were announced simultaneously in what has been described as "an unusual degree of coordination" (see WSJ article "FDA Restrictions on Avandia Will Lead to 'Minimal' Sales")?

The WSJ tells us the answer: "By keeping the drug on the market with restrictions, FDA Commissioner Margaret Hamburg gave a nod to a powerful internal faction led by drug chief Janet Woodcock, who maintained for years that the evidence against Avandia wasn't conclusive," noted the Wall Street Journal. "Dr. Woodcock noted the divisions Thursday, saying FDA scientists couldn't agree on how to weigh the evidence of Avandia's risk, resulting in 'different conclusions.'"

IMHO, it looks like Janet Woodcock is keeping on the good side of the drug industry, which is now donating large sums of money to the GOP in the hopes of defeating Obama in the 2012 presidential elections. If that happens, it is unlikely that Margaret Hamburg will remain on as FDA Commissioner and the one person remaining who has the backing of the drug industry is Janet Woodcock.

I learned about pharma's support of Woodcock during and after the 2008 elections, when I hosted a survey that tried to determine who among the likely candidates at the time would be nominated by Obama as the next FDA Commissioner (see "Meet the Person Likely to be the Next FDA Commissioner").

[It's interesting to note that several of the candidates for FDA Commissioner in 2008 have been involved in the controversy over Avandia and were mentioned in the Wall Street Journal article; namely, Janet Woodcock, Dr. Steven Nissen, former FDA Commissioner David Kessler, and current FDA Deputy Commissioner Joshua Sharfstein.]

While Hamburg was hardly mentioned as a contender for commissioner in 2008, Janet Woodcock was and she received 11% of the votes from US respondents overall in my survey. However, Woodcock received 56% of the vote of respondents who said they were employed by pharmaceutical companies (see chart below, click for enlarged view).

David Kessler -- not known as a friend of the drug industry -- also received a majority of pharma respondents' votes, which is something I am at a loss to explain.

Of course, this survey of over 450 people should not be considered "scientific." Similarly, according to Woodcock, the meta data results upon which Avandia's cardiovascular risk was pegged are also not scientifically "robust or consistent." "We still feel there's considerable uncertainty about the magnitude and existence" of the risk," said Woodcock.

It's clear that if Janet Woodcock were FDA Commissioner, the fate of Avandia would have been very different. But there's still hope! The fact that Avandia remains on the market means that the reports of its demise may be a bit premature. First, GSK, which markets Avandia, can still supply the FDA with data from its RECORD study that proves the cardiovascular risk of Avandia is not substantial. Second, FDA's actions can be reversed if there is a new regime at FDA after the 2012 elections. The person most likely to head such a new regime is Janet Woodcock.