Parallels Between BP and J&J

In another life or in the Bizzaro World I might be a successful blogger about the oil industry, which has many parallels with the drug industry, including:
  • Both provide essential services to the public
  • Both suffer dismal reputations among consumers
  • Both engage in research to find new solutions and sources of income
  • Both have very high profit margins and are accused of "gouging" the public
  • Both are highly regulated by government agencies
  • Both have huge lobbying budgets and are accused of "buying" politicians
  • Regulators of both industries are accused of having "cozy" relations with the industries they regulate
  • Both are globally focused
  • Both do a lot of DTC advertising
  • etc., etc.
Thus, if I were an oil industry blogger, I would be writing about issues similar to the ones I write about here on Pharma Marketing Blog.

For the past several weeks the parallels between the drug and oil industry have been brought to the front burner of my mind due to two unfolding stories: the Gulf oil spill caused by BP and the product recall by McNeil (a J&J company).

Of course, the effect of McNeil's product recall on public health pales in comparison with BP's failure. That's an insignificant parrell.

But the causes of both fiascos seem to have been poor decisions by management. That's the first significant parallel I noticed.

BP admitted that mistakes were made by its management just prior to the oil rig disaster and McNeil admitted it made "significant organizational changes in order to augment the quality and operations leadership on the management team and in all McNeil facilities."

McNeil's admission came during testimony yesterday before before the Committee on Oversight and Government Reform in the U.S. House of Representatives. Testifying was Ms. Colleen A. Goggins, Worldwide Chairman, Consumer Group, Johnson & Johnson. Also see JNJBTW blog post "McNeil Consumer Healthcare’s Plans to Assess and Address Quality Issues".

The fact that both company's executives were summoned to testify before Congress is another parallel.

Ms. Googins was sent to testify in place of Bill Weldon, JNJ's CEO, who declined to attend due to medical problems (see "JNJ's CEO Weldon May Send Underling to Congress. The Aching Back Excuse").

I learned today that some BP executives also said they would not testify before Congress due to "medical conditions." According to a NY Times story "Three scheduled witnesses have changed their plans to testify, according to the Coast Guard. Robert Kaluza, a BP official on the rig on the day of the explosion, declined to testify on Thursday by invoking his Fifth Amendment right not to incriminate himself. Another top ranking BP official, Donald Vidrine, and James Mansfield, Transocean’s assistant marine engineer on the Deepwater Horizon, both told the Coast Guard that they had medical conditions" (see story here).

The medical excuses used by both J&J and BP executives is a bizarre parallel that probably has no significance other than the fact that corporate executives at both companies have circled their wagons and refuse to be held publicly responsible.

Perhaps another parallel is that both J&J and BP initially tried to cover up the extent of the problems.  BP originally reported that only 1,000 barrels of oil were leaking per day, whereas now independent estimates place it at 12-19,000 barrels a day. McNeil also publicly admitted much less of a problem with its products early on and only when confronted by the FDA did it expand its recall. BTW, McNeil has been accused of quietly engaging in a "phantom recall" during which its agents went to stores to purchase all of the painkiller Motrin on shelves without notifying FDA. These agents were said to have told store owners to remain silent about the activity (see "J&J ‘Phantom Recall’ Shows Motrin Troubles Go Back to 2008").

FDA is now considering "additional enforcement actions against [Johnson and Johnson] for its pattern of non-compliance which may include seizure, injunction or criminal penalties," according to Joshua Sharfstein, FDA Deputy Commission. He made his remarks during yesterday's testimony (see J&J's Manufacturing Deficiencies Could Draw Criminal Action From FDA).

Federal investigators are also likely to file criminal charges against BP.

What other parallels do you see?

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."

Social Media and Celebrities: A Winning Combination for Pharma Marketers

Attendees at yesterday's session of the Social Media for Pharma Conference were treated to two case studies that combined social media with celebrities.

The first was the "Kaleidoscope Case Study" (aka, "How To Extend The Value And Reach Of Your Organization’s Campaign To Increase Engagement And Program Results") presented by Jim Dayton (@JimDayton), Director of Emerging Media at InTouch Solutions.

According to the FaceBook "Kaleidoscope On Ice" fan page: “Kaleidoscope presented by sanofi-aventis” was a holiday entertainment variety special [presented on Thanksgiving Day, 2009] that featured Olympic skating champions and GRAMMY Award-winning music artists [as well as American Idol singers]. The show featured the historic return to the ice of the legendary Scott Hamilton and Dorothy Hamill who will skate to the music of fellow cancer survivor Olivia Newton-John. The event was in support of women who survived cancer.

This event was promoted in part via Twitter, a campaign that Dayton said was very successful based upon key performance measures -- followers, tweets, etc. Dayton noted that this success was based in part on the active tweeting of the event done by the celebrities who were not paid to tweet but who benefited form the self-promotion.

It's a shame that I did not hear about this event either via Twitter or otherwise. Or at least I don't remember it. Unfortunately for Sanofi, what I do remember is the incident of the woman cancer survivor who laid siege to sanofi-aventis VOICES Facebook Page (read this post: "Patient "Unadvocate" Lays Siege to sanofi-aventis VOICES Facebook Page. Where's S-A's Social Media VOICE?" and listen to this podcast: "What Sanofi-Aventis Learned from Its FaceBook Experience & What the Experts Recommend It Do Now").

The second social media/celebrity case study was "Race with Insulin" presented by Ambre Morley (@ambremorley), Associate Director of Product Communications and Lois Kotkoskie, Director of Promotional Review. Both work for Novo Nordisk. Morley and Kotkoskie made a good tag team, presenting some behind-the-scenes information about how the program was launched with careful regulatory oversight. Their presentation was entitled "How To Use Twitter To Deliver Measurable Results For Your Organization."

You might recall that Race with Insulin is also a campaign that combines a celebrity (racecare driver Charlie Kimball), social media, and real world events (listen to this podcast: "Novo Nordisk's Race With Insulin Campaign: It's Not Just About Twitter"). The twitter account (@racewithinsulin) is famous for being the first branded Twitter account and for posting the first branded tweet, which I labeled "sleazy Twitter spam (see here).

I tried to keep a low profile during both these presentations and did not raise the "fail" sides of these campaigns that I have blogged about in the past. Morley, however, incorporated my comments as part of her presentation to explain how to "Assess Your Promotional Challenges" and to answer the question "Does the reward outweigh the risk?"

During both these presentations, I wondered what was the tactic that actually brought the "rewards?" Was it the social media campaign or was it the celebrities? Could these overall campaigns have been successful without the celebrities? No way! Could they have been successful without the social media component, which most presenters said was just a tactic? Yes, definitely!

The day when real, non-celebrity patients are the celebrities in pharma social media campaigns is the day when pharma breaks away from the mold.

A point I made during Morley's presentation was that although @racewithinsulin has about 1000 followers, Novo Nordisk knows nothing about these followers other than what Morley gleaned from manually reviewing their Twitter profiles. I suggested that Novo Nordisk do what I do: ask followers to fill out a survey. Pharma marketers do this all the time on their web sites and via BRCs. Why don't they do it with their Twitter followers? Either they don't value their Twitter audience enough to learn more about it, or they do not have the resources to do anything with the information.

Inadequate resources was mentioned often at this conference. To move social media beyond merely being a promotional tactic to a strategy to learn more about consumers and patients, pharma has to devote more resouirces to the effort.

OMG! Do I Have ED or "Low T?" Or Both?! Pharma "Symptom Quizzes" Are NOT in the Best Interest of Patient Health!

Just when I resigned myself to the fact that the odds of me having ED are better than 2 in 5 (40% of men over the age of 40 have ED claims Lilly; see "40over40: Lilly's DTC ED Awareness Campaign in the UK"), I now learn that I may also have "Low T."

According to Solvay Pharmaceuticals men who are obese are 2.4 times more likely to have "Low T" than men who are not. If you have high blood pressure, the figure is 1.8 times; and men with high cholesterol are 1.5 times more likely to have "Low T." With all that going against me, I figure my odds of having "Low T" are at least equal to my odds of having ED.

What's "Low T?" you may ask. Good question. Soulful Sepulcher (@soulflsepulcer) called my attention to the blog post "Male Hormone Replacement - Big Pharma and Solvay Pharmaceuticals are at it again mass marketing, popularizing, & main streaming diseases for profit" where I thought I would find the answer. Instead, I found this image of "Low Mr T." Close, but no cigar!

The "T" in "Low T" stands for "testosterone," the male hormone responsible for sex drive/sexual function, muscle mass, and everything else that makes a male a "man."

Of course, Solvay has a quiz you can take to see if you have "Low T." As with other pharmaceutical company health self-assessments, Solvay's quiz is designed to make sure you think you have the condition for which it tests. Even the name -- "Low T Quiz" -- implies the results you will get.

Sure enough, I failed! Now, in addition to questions from Lilly to ask my doctor about ED, I will also have to ask her the following questions about "Low T" suggested by Solvay in its "Doctor Discussion Guide":
  1. I don't feel sick, I just don't feel like myself anymore. Could I have Low T?
  2. Are the symptoms I am experiencing and my other risk factors related to Low T? (Feel free to discuss your results from the Low T Symptoms Quiz.)
  3. Can you order the blood test that measures my total testosterone and the free testosterone in my body?
  4. What medical treatment options are available if I have Low T?
  5. What is the difference between the different testosterone replacement therapies?
  6. If I don't treat my Low T, will it get worse?
  7. Are there any other changes I can make in my diet, fitness and lifestyle to help address Low T?
I assume doctors are being prepped by Solvay reps for the day boatloads of men come into their offices with questions about "Low T," which is a medical condition they may not have heard of in medical school.

Symptom quizzes designed by pharmaceutical marketers in cahoots with sponsored patient advocacy groups are dishonest, IMHO. I do not believe they represent "honest dialogues with the public" nor do I believe that they are in "the best interest of patient health," two principles recently espoused by Bob Perkins, Vice President, Public Policy, AstraZeneca (see "Transparency and Trust in Health Communications"). In fact, they are just the opposite: dishonest and in the best interest of the pharmaceutical company!

Data Mining in the Deep, Dark Social Networks of Patients. Word to Pharma: Caveat Emptor

Yesterday, I posted the following tweet:

PatientsLikeMe blocks "scraper." Is this a trend in SM? Pharma can't mine patient msgs & learn? See http://bit.ly/9lWSIT #fdasm #hcsm

Eventually, that tweet reached the desktop of Jamie Heywood, Co-founder of PatientsLikeMe (PLM), who contacted me to discuss the "richer story" beneath the surface.

But before I get to that, here's how Jamie's partner, Ben Heywood, described what was going on viz-a-viz the "scraper" incident (see here for his full statement):
"Recently, we suspended a user who registered as a patient in the Mood community. This user was not a patient, but rather a computer program that scrapes (i.e. reads and stores) forum information. Our system, which alerts us when an account has looked at too many posts or too many patient profiles within a specified time interval, detected the user. We have verified the account was linked to a major media monitoring company, and we have since sent a cease and desist letter to its executives.

"While this was not a security breach, it was a clear violation of our User Agreement (which expressly forbids this type of activity) and, more significantly, a violation of the community’s trust. Your Account Information (e.g. your names and emails) was NOT in danger of being stolen. It is likely that the forum information that was “scraped” would be sold as part of that company’s Internet monitoring product. In fact, we sell a similar service, PatientsLikeMeListenTM, to our clients so they better understand the voice of the patient."
The important issues for PLM is that the media monitoring company -- probably employed by an unnamed pharmaceutical company -- was not an authentic patient and violated PLM's User Agreement, which states "You may not use any robot, spider, scraper, or other automated means to access the Site or content or services provided on the Site for any purposes."

Recently, I wrote about BzzAgent operatives trolling social media on behalf of pharmaceutical companies (see "Are J&J Agents Trolling for Adverse Events on the Internet?"). One "operative" admitted that he took a survey through BzzAgent for Johnson & Johnson, "which basically was more of a 'contract' where if chosen, I agreed to notify J&J if I became aware of any negative talk about their products."

What this person was doing for J&J was not exactly "scraping" social media patient sites because the monitoring was being done manually by a real person. This may be a neat way of getting around User Agreements of "closed" patient communities like PLM, but it is not nearly as efficient or effective as using software tools (listen the podcast "Aligning Your Message with Patient Needs: How Social Media Can Help" for more insight on that). But, if J&J enlisted the help of thousands of real people to monitor patient communities, it could be pretty effective. BTW, PLM's policy also forbids individuals from using information collected manually or otherwise on PLM "in connection with any commercial endeavors."

Since PLM is using its own "scraper" software to troll its closed communities to create reports for pharma clients (eg, see "PatientsLikeMe Reports High Rate of Adverse Event Reporting Among Its Members"), it has a vested interest in preventing rouge pharma companies from hiring "scraper" agents to mine PLM for the same data it is selling its own pharma clients.

This whole "scraping" incident raises the issue of "Transparency, Openness and Privacy." Anyone can join PLM and claim to be a patient -- we are ALL patients at one time or another. So, when I joined, I was not violating PLM's User Agreement, which also states "To become a member and access the area on this Site reserved for members (the 'Member Area'), PatientsLikeMe requires that you are either (a) a diagnosed patient of the particular community you are joining, (b) a caregiver for a patient eligible to join such community, (c) a health care professional (e.g. doctor, nurse, health researcher, etc.), or (d) a guest as authorized by a PatientsLikeMe member or employee." That includes practically everyone in the known inhabited universe.

Someone "posing as a patient" on PLM is practically an oxymoron (or whatever the term). Therefore, violation of "openness" is not the issue. "Privacy" is also not the issue. PLM members are well aware that whatever they say in PLM's "closed" communities can be revealed to third parties either by PLM itself (de-identified) or by other PLM members (as part of a non-commercial endeavor).

"Transparency" appears to be the major issue here, and one that pharmaceutical companies should be wary of when they hire agents to monitor patient communities. Jamie likened it to a situation in the real world where his church's copper gutters were stolen and the copper resold to people having repairs done on their houses. The end users of the stolen copper may not have known how it was obtained, nor did they probably care. Pharma companies, however, cannot be so blase -- they have a lot more at stake if they accept stolen "copper" and get caught. As Jamie said, you wouldn't want to see that story in the Wall Street Journal (or here on this blog).

The lesson for pharma companies is "caveat emptor" -- when hiring a third party to monitor "closed" patient social networks, be sure they do not violate the policies of these communities and/or do it in an open and transparent way.  For communities like PLM, the only way is to hire PLM to do the scraping for you (ie, see "UCB & PatientsLikeMe: Embracing Social Media, Adverse Events Included!").

[BTW, I'd like to see a pledge not to violate policies of patient social networks as part of every pharma company's social media principles. AstraZeneca, for example, might consider adding it to its "five important principles for online dialogue" (see "Transparency and Trust in Health Communications," posted by Bob Perkins, Vice President, Public Policy, AstraZeneca, on AZ Health Connections Blog).]

PLM community members, BTW, seem to be OK with PLM's sale of information to third parties: "I can live with you selling the information as long as you continue to reinvest in the infrastructure of the site and keep it more than just up to date," said one person in a comment to Ben's post. "Cutting edge is what I have found here and I expect you will still provide this."

You are probably asking yourself "Is John Mack OK with it?" Well, it's not something I would do. But it's a valid business model that provides useful information to clients. As I mention below, however, I think PLM should  also open the door to its proprietary database for the public good -- for free.

Now, let's discuss the "dark" aspect of all this.

"Closed communities" like the member areas of PLM are "dark" to search engine spiders, which are forbidden to troll these areas of PLM and index the content. There are technical ways of doing this, but most search engines agree to abide by requests that certain domains not be indexed.

This is something known as the Dark Net or Deep Web. According to wikipedia, "searching on the Internet today can be compared to dragging a net across the surface of the ocean; a great deal may be caught in the net, but there is a wealth of information that is deep and therefore missed. Most of the Web's information is buried far down on dynamically generated sites, and standard search engines do not find it. Traditional search engines cannot 'see' or retrieve content in the deep Web -- those pages do not exist until they are created dynamically as the result of a specific search. The deep Web is several orders of magnitude larger than the surface Web."

Most pages in forums like those on PLM are dynamically generated. However, it is possible to flip a "switch" that allows the page to be indexed (don't ask me how this works; I only know it's possible because I use such a switch on the Pharma Marketing Network Discussion Forums).

What this all means is that, potentially, much of the best patient-generated information found on social networks is "dark" to pharma companies unless the owners of these communities flip that "switch" or allow pharma marketers access (paid or otherwise). Hopefully, however, these sites might also perform a FREE public service such as what I talked about in this post: "If Patients Know Best, then Patient Social Networks Can Help Capture and Report AEs"

JNJ's CEO Weldon May Send Underling to Congress. The Aching Back Excuse

I just learned that Bill Weldon, JNJ's CEO, who was asked to testify at a May 27 hearing of the House Committee on Oversight and Government Reform about the McNeil manufacturing problems, may send an underling in his place. According to Ed Silverman of Pharmalot "J&J [wrote] back to say Weldon had back surgery today and so he may not be able to travel to DC next week. Instead, J&J is prepared to send Colleen Goggins, who heads the worldwide consumer group. Weldon would still be willing to 'communicate' with the committee after he recovers."

Oh, my aching back! It sure sounds like Weldon is trying to wriggle his way out of appearing before a public hearing to explain why McNeil's manufacturing facilities "may be ‘out of control’ and not following internal standard operating procedures, much less FDA regulations," according to Darrell Issa, a California Republican congressman and member of the Oversight Committee (see letter). Issa has asked committee chair Edolphus Towns to postpone the May 27 hearing.
[If I said that Weldon is "sending in a woman to do a man's job," I may be accused of being a sexist. But I know that women are often taxed with unpleasant tasks at pharma and other companies and that they are not compensated equal to men and are often treated unequal to men on the job  -- see the recent Novartis settlement, for example. I also know that 86% of the members of the Oversight committee are men who may be less inclined to subject Colleen to withering cross examination. Did this figure into JNJ's strategy? What do you think?]
From the statement received by Pharmalot, one could conclude that Weldon may never appear in person before Congress but may "communicate" in some other fashion. He sure has had a problem communicating via social media as I pointed out in my previous post (see "Despite Its Social Media Expertise, J&J Fails to Use It Effectively to Communicate to Consumers"). Now it appears he has a problem communicating in the real world!

I was asked what I would do in JNJ's shoes by Melissa Davies -- a mom and Social Media Practice Lead at Return on Focus, a company that helps companies market their brands. Melissa asked (in a comment to my previous post):
"John, could you share some thoughts on what you would advise JNJ to do as part of a more fully developed social media response strategy? Are you thinking the company should have more Tweets, engage on more sites, etc.? I'm curious what you think the ideal roadmap looks like."
My response:
"For what it's worth, I believe this situation calls for more information and conversation no matter what the channel or the road.

But since we are talking about social media, let's stick to that.

Because the CEO has been targeted, is expected to meet with Congress, and posted a message to JNJBTW, he should lead the discussion. In addition to a formal letter posted to the corporate blog, how about opening up a YouTube channel in which he and McNeil executives talk directly to their audience and provide updates. They should allow comments -- and respond to as many as necessary.

Twitter can work with this to keep people informed about what is going on and link to specific videos.

If the CEO talks to Congress, get the transcript and post it before anyone else does. Ask readers to comment on how well or not so well questions were answered by the CEO and what was missing.

Of course, there needs to be some progress if you are going to give updates. Actions speak louder than words. Social media won't solve the problems.

Right now, I feel that JNJ doesn't have a handle on what's causing the problems. At least that's what I suspect from the reports I have heard. Maybe there are complicated manufacturing issues that involve things JNJ doesn't want to be made public (eg, importation of tainted supplies from China)? Maybe this is a good opportunity to provide a virtual tour of a Good Manufacturing facility with interviews of employees.

I don't know if this is a roadmap or not, but when your company's reputation is at stake, the leaders have to be visible. You can't just say "one of our companies has let you down" and leave it at that. What are going to do about it so that it doesn't happen again? is what people really want to hear from the people who are in charge, not the PR department."
I have a call in to Marc Monseau, Director of Corporate Communications at JNJ. When and if he responds, I will provide an update.

Will 250,000 Morbidly Obese People Sign Allergan's Petition to Congress?

"Be heard!", says Allergan. "The voices of 250,000 can influence the dialogue on the obesity epidemic and help shape policies that can make a real difference in our efforts to reduce the obesity epidemic."

That's the pitch of Allergan's new "social media" "C.H.O.I.C.E." ("Choosing Health over Obesity Inspiring Change through Empowerment") campaign, a core element of which is a petition to Congress to propose "legislation for obesity treatment and weight-loss surgery options like adjustable gastric banding for the morbidly obese."

The petition is really an ad for weight-loss surgery. It states:
"Weight-loss surgery has been proven more effective than diet and exercise alone in people 100 pounds or more overweight – and it's the only treatment proven to be effective long-term ... With less invasive procedures available (like gastric banding), weight-loss surgery has the potential to be a catalyst for change in the health of our citizens and the financial stability of our healthcare system."
Allergan doesn't have to include fair balance in the petition, because it doesn't mention its particular brand of "gastric banding" (ie, LAP-BAND).

This "social media" campaign includes a Facebook page and a Twitter account (@choicecampaign). I joined the "cause" on Facebook and am now following @choicecampaign.

LAP-BAND patients can also enter a contest by submitting videos to the Voice My C.H.O.I.C.E. contest program. Winners will get an all-expenses-paid trip to Washington, DC to be rolled out in front of cameras lobbying Congress for " increased attention" to surgery. Since contestants must already have had the procedure performed, I assume they will be "showcases" for how effective the surgery is.

Allergan's stated goal is to get 250,000 morbidly obese people (defined as being 100 or more pounds overweight) to "sign" its petition. Although I do not qualify as one of the "estimated" 15 million people in the US who are morbidly obese, I signed the petition and checked off the following options:
  • Yes. I would like to receive future email communications from Allergan about the C.H.O.I.C.E. Campaign and the LAP-BAND® System.
  • Yes, Allergan may contact me by mail regarding news and information about the C.H.O.I.C.E. Campaign and the LAP-BAND® System.
  • Yes, Allergan may contact me by phone regarding news and information about the C.H.O.I.C.E. Campaign and the LAP-BAND® System.
This record of my CHOICEs will remind me that I specifically said it was OK for Allergan to call me by phone, which I hope it does. I recall the time another pharma company called me by phone and invited me to participate in a focus group of one about erectile dysfunction, another condition affecting millions of Americans (see "My Sojourn as Market Research Subject for Levitra").

If Allergan calls me and invites me to another focus group -- maybe held at its headquarters in Irvine, California -- I will demur and say I am too overweight to leave my house let alone fit in an airplane coach seat. If they offer first-class, all expenses paid travel, I will have to reconsider. I suppose I could rent a "fat suit" and fool them.

But, seriously Allergan, do you really think you can get 250,000 morbidly obese people to sign your petition? First of all, what's in it for them? Obviously, it's a benefit to Allergan. The petition only asks that Congress pay "increased attention" to the surgery solution. I guess that means money given to somebody because that's what Congress does. Is Allergan suggesting that Congress give obese people "fat vouchers" redeemable to cover certain costs of the surgery. I understand a lot of insurance companies may be reluctant to cover the costs of surgery. Is Allergan interested in getting Congress to force more insurance companies to offer coverage?

Despite the benefits to morbidly obese patients of signing the petition, I doubt that Allergan will motivate 250,000 of them to sign like I did. While 250,000 represents only 1.6% of the "estimated" 15 million morbidly obese people in the US, the C.H.O.I.C.E. campaign is not likely to reach that entire audience. If it were to reach 50% of that audience, 250,000 signatures would be a 3.2% response rate -- which is pretty high for such a campaign.

Many experts are wondering how to measure the effectiveness of social media campaigns like this one. What's the ROI? In this case, the effectiveness can easily be measured by how close Allergan gets to its 250,000 goal. I am not sure what timeframe Allergan has set to achieve that goal, but I hope they issue periodic reports telling me how many people have signed (remember, Allergan, you can call me).

NOTE: Another social media campaign with a publicly disclosed goal is BI's DRIVE4COPD campaign, which has a goal of reaching 1 million to take their "screener" questionnaire. So far, after 2 or 3 months, it looks like BI has reached only 76,109 people (ie, only 7.6% of their goal). BI "estimates" that "24 million Americans may have COPD. About half of those have not been diagnosed." So, a goal to reach 1 million out of 12 million (8% response rate) is even more ambitious than Allergan's "social media" ROI (a 3.2% response rate).

Despite Its Social Media Expertise, J&J Fails to Use It Effectively to Communicate to Consumers

Johnson & Johnson's (JNJ's) has earned accolades from industry pundits for its social media expertise (see Dosie Awards, for example). Yet it's handling of the McNeil Consumer recall of children's medicines seems weak in general and very weak specifically with regard to the use of social media to reach out and engage consumers on the issue.

As reported in the Wall Street Journal, "Some parents say the recall has weakened J&J's reputation for quality. The recall has also prompted a congressional investigation of the company's handling of consumer complaints and the adequacy of the FDA's inspections. The House Committee on Oversight and Government Reform has asked J&J Chief Executive William Weldon to testify at a hearing on May 27" (see "FDA Widens Probe of J&J's McNeil Unit").

The only response from JNJ via social media after issuing notices about the recall back in early May was a 253-word blog post by JNJ CEO Bill Weldon on JNJBTW (see "To All Who Use Our Products -- From Bill Weldon") and a series of Tweets from Marc Monseau, JNJ's Director of Corporate Communication, linking to that letter (see below).

Meanwhile on other blogs like Bnet, Weldon is accused of being clueless (see "Tylenol Recalls: CEO Weldon Is Either Clueless or Lying, and Neither Will Play Before Congress").

Thanks to PharmaGossip for Photoshopped image of Bill Weldon

Social media is often touted by drug industry experts as a tool to be used to "manage the conversation" or, at least, to participate in the conversation. But JNJ is not engaging or participating as much as I think it could or should. To his credit, Monseau has approved and published on JNJBTW blog several negative comments from moms, docs, and former JNJ employees, but Weldon has not responded or continued the dialogue.

NOTE: As Monseau points out in a comment to this post, he has responded to readers in relation JNJBTW posts on this topic (see "McNeil Announces Voluntary Recall"). Edwin Kuffner, MD, Vice President of Medical Affairs at McNeil Consumer Healthcare, has also responded to comments, but mostly to tell consumers to contact their doctors about problems with medications. What I was looking for, I guess, are further posts to JNJBTW keeping readers apprised of progress that J&J is making -- especially from the CEO. The last comment by Monseau on May 4 was "I apologize that we are not able to provide you with more answers at this time. As dr. Kuffner explained, we are continuing to investigate these issues and we have shared as much information with you that we can." Read into that what you want, but the news stories continue and the JNJBTW blog has been silent on these latest stories.

To recap: I feel that the issue deserves more than a single 250-word post by Weldon on a blog. It leads me to believe that Weldon's appearance before Congress will be as engaging and forthright as was Goldman Sach's and the oil industry's.

BTW, after I posted "Trouble in the House that McNeil Built: Why Drug Company Silos are Useful", I was quoted in an AdAge article:
"Deep down I do believe that J&J is keeping its stellar reputation partially due to the fact that it is siloed into many different operating units. It does seem to go out of its way to link the J&J brand to baby products and mom rather than Rx drugs, some of which have nasty side effects and even nastier marketing practices. That's why Marc Monseau always -- I mean always -- prefaces his public statements saying that J&J is not a pharmaceutical company, it's a health company. Imagine a bizarro Oz where the wizard behind the curtain is actually an evil wizard who appears to be doing good things. Of course, I'm not saying that J&J is evil; it's just another drug company" (see "What's Ailing J&J -- and Why Isn't Its Rep Hurting?").

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."

Should Google Allow Pharma an Exception to Its Ban on Redirect URLs? (UPDATED)

Back in April 2009, I suggested that FDA might go after pharma marketers for using paid search redirects in Google Adwords (see "The Next FDA Concern May be the Use of 'Redirect' URLs"). Such ads use visible URLs such as "flaccidmember.com" but, when clicked, lead to viagra.com or cialis.com. Such an is considered to be "unbranded" and beyond FDA regulation. That is, it can say "Stay harder longer with this treatment for erectile dysfuntion" and lead directly to the branded website.

The problem with that strategy is that Google's Adword policy forbids the use of redirect URLs -- for most advertisers. It appears that Google was making an exception for the pharmaceutical industry (see "Redirect URLs in Adwords: Who Knew What When?").

Last week I thought Google may have rescinded this exception. Tyler Ransburgh of What's Your Digital IQ Blog wrote about his problem using a redirect URL in a pharma ad. "I work in pharma," said Tyler, "I have an exception to the rule. Right? Well, I reached out to Google to get an answer on why I am getting caught in this web" (see "Google blocks Pharma paid search redirects")

When Tyler did reach out to Google, here's the reply he got:
"In response to advertiser and user feedback, and in an effort to provide relevant results and a high quality experience for our users, we have made the decision to no longer allow certain exceptions to our display URL policy. Please note that this amendment to our policy applies to all advertisers, regardless of previous exceptions for, or acceptance of, any campaigns. To provide a quality experience for our users and partners, the display URL policy will be strictly enforced."
I'd like to think that my blog posts were part of the "feedback" that Google considered.

Since then we've gotten some feedback indicating that Google has NOT changed its policy regarding pharma's use of URL redirects in Adwords. See this Pharma and SEM Marketing Blog post by SEM Dave Anderson who indirectly received this comment from Google: "Our policy has not changed: pharmaceutical manufacturers continue to have an exception to allow a URL redirect, which is not currently recognized by our automated system." Which seems to directly contradict the comment received by Tyler Ransburgh from a Google Adword support team person who advised Tyler to "be assured that you have reached the appropriate AdWords support team for your AdWords related concern and I’ll be unable to escalate your issue further." Tyler, you see, had asked to speak to this person's supervisor and was rebuffed!

I also received an email from Aaron Stein, someone who claims to be part of Google's PR department. I present the full email message:
Hi John,

This is Aaron Stein from Google PR. I noticed your post this morning and wanted to reach out to you because it is not accurate. If you do a search for cholesterol you'll see that our policy has not changed. I've attached a screenshot to show this as well.

If you wouldn't mind, can you add a correction to your post with the statement below? Happy to chat further about this.

"Our policy has not changed: pharmaceutical manufacturers continue to have an exception to allow a URL redirect, which is not currently recognized by our automated system. All pharmaceutical manufacturers' search ads campaigns continue to run, unchanged, today."

Thanks John, I'll be in touch.

Aaron Stein
Google | Global Communications & Public Affairs

The question, however, is Should Pharma Advertisers Use Redirect URLs in Search Engine Ads? I ask you help to answer this question in a NEW survey, which asks your opinion of this practice. It asks specifically to indicate your level of agreement/disagreement with the following statements about Pharma's use of paid search engine ads:
  • Regardless of search engine rules that may allow pharma advertisers to use redirect URLs ("vanity URLs"), pharma should ONLY use display URLs in ads that ACCURATELY reflect the landing page URLs of the websites being advertised (ie, pharma should obey the rules established for all other advertisers).
  • Pharma advertisers should be allowed an exception to search engine rules regarding redirect URLs because FDA regulations prevent them from displaying a drug brand name in short ads, even when the brand name is only part of the display URL.
  • Redirect URLs should NEVER be used by pharma advertisers because they mislead the consumer into believing that the links will take them to independent disease information websites, not branded drug sites.
Results of this survey may be summarized in Pharma Marketing News. After you answer a few short questions, you will be able to see the summary of all responses to date. No comments or other identifying information is included in the summary.

Your comments are confidential (anonymous) unless you specifically provide your contact information at the end of the survey and allow us to attribute comments to you personally.

Should Pharma Advertisers Use Redirect URLs in Search Engine Ads?

Take the survey Now!

Will FDA Cite this Vyvanse Web Image as Off-Label Promotion?

If an image is worth a thousand words, then this image found on the Vyvanse Web site home page is shouting off-label promotion.

Is it a coincidence that this image, showing a woman ("Fran") with a measuring tape and a dress, evokes weight loss, which is one of the common side effects of Vyvanse and similar stimulant dextroamphetamines?  (Vyvanse is a "prodrug"; it gets converted to stimulant dextroamphetamine in the body). Thanks to "Chad" who pointed this out to me via the "Contact Us" link above.

Other drugs have been promoted off-label for weight loss. Just yesterday I reported that Johnson & Johnson was fined $81.5 million for misbranding and illegally marketing Topamax for weight loss, among other things (see "Trouble in the House that McNeil Built: Why Drug Company Silos are Useful").

Compared to the Topamax off-label case, the Vyvanse off-label imagery is pretty subtle and perhaps only people like me (and "Chad") would even think it was more than a coincidence. Images in direct-to-consumer (DTC) ads, however, are carefully chosen by pharma marketers and the FDA does pay close attention to them as part of the overall message. An example is the shrinking planet Avodart ad that received an FDA letter because the image showed too much shrinkage (see "FDA Warns GSK About Enlarged Avodart Ad Imagery"). Other critics have even pointed out things like the speed of flapping bee's wings in some DTC ads (see "Ruth Day and the Bees Repeat Performance at House DTC Hearing").

These days, the FDA is paying more attention to subtleties in Rx drug promotions. For example, FDA recently sent Novartis warning letters about two unbranded Web sites that it said illegally promoted Gleevec even though the brand name was not mentioned on the sites (see "FDA Warns Novartis Over Gleevec Internet Sites").

Maybe the FDA reads this blog and will take a look at the Vyvanse Web site. If it decides to send Shire a letter, it may not happen for several months, by which time "Fran" may have been replaced by "Frank," a trucker having a late night meal at a truck stop. Pretty stimulating image, eh?

Pharma Marketing Meets Social Media: Can the Two Co-Habitate?

I am taking a short vacation in Miami and will be chairing the Pharmaceutical Marketing Innovation Summit, May 10 - 12, 2010 at the Doral Golf Resort & Spa. I will also be making the following presentation at that conference.

Trouble in the House that McNeil Built: Why Drug Company Silos are Useful

Marc Monseau, head of corporate communications at Johnson & Johnson (J&J or JNJ) and contributor to the JNJBTW Blog, often says that JNJ is not a pharmaceutical company. He likes to think of it as a healthcare company.

But I think of JNJ as a pharmaceutical holding company, by which I mean it holds several separate pharmaceutical companies under its corporate umbrella. Each one a "silo" of sorts.

The advantage of this type of organization is that the Johnson & Johnson name and brand remain untarnished among consumers even when one or more of its "units" breaks the law or fails to protect consumers from tainted products.

One such unit or division is McNeil. There's Ortho-McNeil Pharmaceutical LLC and Ortho-McNeil-Janssen Pharmaceuticals, which markets and sells Rx products such as Topamax. And there's McNeil Consumer Healthcare, which markets and sells over-the-counter products such as children's Tylenol, Motrin, etc.

Both of these J&J/McNeil "units" are in the news these days. Ortho-McNeil Pharmaceutical and Ortho-McNeil-Janssen Pharmaceuticals were fined a total of $81.5 million for misbranding and illegally marketing Topamax (see "J&J to Pay $81 Million, End Federal Cases on Topamax"). Topamax is approved only for treating epilepsy, but BNet author Jim Edwards, points out that the J&J companies "promoted Topamax for such a wild range of conditions [eg, weight loss], based on such thin evidence, that it was impossible not to notice that many of them were off-label" (see here).

Meanwhile, McNeil Consumer Healthcare has been cited AGAIN for bad manufacturing processes. I wrote about this in the past -- see "Social Media Vs. Social Responsibility: J&J Fails Crisis Management 101." McNeil apologized back in January, 2010 and is now apologizing again AFTER FDA issued a report (here and here).

Although news stories mention the J&J name in headlines, when all is said and done, the J&J brand image among consumers will remain unsullied for the most part, IMHO. Which suggests that "silos" works! Other drug companies may not have the same corporate structure as does J&J, but they are just as "siloed" -- by brand! So, consumers remember Vioxx, but often forget that it was marketed by Merck, which lately gets a lot of kudos for Gardasil.

I'm not sure what the point of this is other than that drug company silos can be a useful strategy. Of course, siloing also can lead to failures to communicate (see "Is Your Brand a Digital Genius or a Feeble-Minded Idiot?").

Is Your Brand a Digital Genius or a Feeble-Minded Idiot?

When it comes to digital IQ, some brands are geniuses and some are feeble-minded idiots, according to the "L2 Digital IQ Index" for pharmaceutical brands, a first-of-its kind measurement of the digital competence of 51 pharma brands across eight therapeutic categories.

The index was created by think tank L2 in partnership with media agency PHD Network. They evaluated pharmaceutical brands’ digital presence across four criteria: Platform (40 percent, including site effectiveness and brand translation); Off-Platform Messaging (25 percent, covering digital marketing efforts such as online and mobile advertising); Search Engine Optimization (20 percent, based on visibility on top search engines); and Social Media (15 percent, defined by presence on popular 2.0 platforms). Each brand was scored against more than one hundred qualitative and quantitative data points, and assigned a Digital IQ ranking of Genius, Gifted, Average, Challenged or Feeble (see press release).

The top ten brands on the index are (ta da!):
  1. Viagra (Pfizer)
  2. Nexium (AstraZeneca)
  3. Chantix (Pfizer)
  4. Ortho Tri-Cyclen Lo (Ortho-McNeil Janssen)
  5. Crestor (AstraZeneca)
  6. Tie between Gardasil (Merck) and Yaz (Bayer)
  7. Tie between Symbicort (AstraZeneca) and NuvaRing (Merck)
  8. Lunesta (Sepracor)
What's interesting is that although AstraZeneca emerged as the industry’s digital powerhouse with four brands in the top ten -- Nexium, Crestor, Symbicort and NuvaRing -- it is somewhat of a "digital idiot savant." Two other AZ drugs -- Tropol-XL and Pulmicort -- have a digital IQ in the feeble-minded idiot zone. This digital IQ disparity among brands within the same company seems standard within the drug industry (see chart below).

Pfizer's Viagra and Chantix are digital geniuses whereas Pristiq and Caduet are feeble-minded digital idiots!

How can that be?

The simplest answer is "brand silos." In an interview yesterday, L2 founder and NYU marketing professor Scott Galloway told me that drug companies are "highly siloed by brand. There's almost no sharing of best practices or competencies within the organization." I hope he's just talking about digital marketing! Which is bad enough.

The longer the bar in the chart above, the more "digitally siloed" is the company. AstraZeneca, it appears is not merely a digital powerhouse, it is also a siloed house!