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Social Media Marketing

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The Blog Ate My Job!

I just received this comment via my "Contact Us" form:
"John, while the information you post online is informative and I am glad someone is bring (sic) things to public attention it is also can be estremely (sic) opnionated (sic) and unjust. Please realize that the actions you take in your writing can and has cost people their jobs. I work for an ad agency. I try my best to ensure my contributions are not to just sell drugs but to educate consumers. Pharma is about money but its also about making people better. When ads come out they are a result of multiple hands touching a piece from agency, to brand teams to mlr. When you decide to callout an ad you are impacting all those people. So please think about that when writing your blog. And look at what guidelines fda has set and where they still need to go. Rather then being a tatle (sic) tale be a solution maker."
I'm guessing this has something to do with the post I made earlier today about "Retro Replax" ads (here).

The person who wrote chose to remain anonymous, so I will I will just refer to him/her as "Anon."

Anon claims that my writing "can and has cost people their jobs" and I assume he/she means his/her job because the subject line of the message was "lost my job."

First of all, it seems pretty unlikely that someone would be fired within hours after an "opnionated" and "unjust" blog post was made. Who can be so cruel to fire someone on the spot like that, especially someone who is just one of the "multiple hands" responsible for creating and approving ads?

I wonder if Anon also complained to Deborah Dick-Rath over at MM&M. She wrote her critical piece about the Replax print ad way before I did. She really ripped into the creative team: "And while the Relpax creative team put in a valiant effort, in the end, they were defeated by too many typefaces, too much copy, too many messages and a somewhat unfortunate choice in art direction."

I suppose she gets a free pass because she started out with praise, faint though it was.

Maybe this doesn't have anything to do with Replax at all. I just can't recall, however, any recent critical posts I have made that may have gotten Anon fired.

Anyway, I assume Anon will be able to collect a couple of years of unemployment insurance, unless Congress refuses to extend that benefit. When I was laid off many years ago during the dotcom bust, I only received 26 weeks of unemployment insurance - damn George Bush and those Republicans!

Retro Relpax Web Site Features Woman Mopping the Floor. Inspirational? Not!

The "DDR on DTC" column in the August 2012 issue of MM&M magazine ripped into a print ad that showed a woman migraine sufferer being able to mop the floor after taking the Pfizer anti-migraine headache drug Replax.

"DTC ads used to be over-aspirational," said the author, Deborah Dick-Rath, "we saw relieved arthritis sufferers running marathons or playing Frisbee. With Relpax, the insight seems to be that sufferers just aspire to do such everyday activities as mopping the floor...We hope that Relpax is a success for Pfizer and that migraine sufferers find relief. We also hope they get (strictly aspirationally) excused from swabbing the deck" (see "DDR on DTC: Relpax").

Here's the ad that DDR reviewed:

This is probably the result of Pfizer's conservative view of what modern women aspire to at 11:00 Am in the morning (note the clock).

I couldn't find this ad in a recent issue of People Magazine, which is the publication in which DDR found the above ad. Instead I found this much more politically correct, although still not too inspirational, ad:

In this version, two hours after taking Replax, the migraine sufferer is able to go out and do whatever her business is -- probably commuting to work given that the clock is showing 8;00 AM (or is it PM?).

Perhaps Pfizer read DDR's column and revised the print ad campaign, at least as far as image is concerned. Surprisingly, however, the Replax.com Web site still portrays the woman mopping the floor:

It appears that it takes longer to swap out a Web image that a print ad image.

Pfizer is asking Replax.com visitors to tell their "stories" by submitting photos or video. "Tell us about your experience with migraines by submitting a story," says the promo page (here). "Your story can include a photo or video. If chosen, your submission could be featured on RELPAX.com."

I don't imagine a single submitted photo or video will feature a woman mopping the floor. Do you?

You can tell that pharma marketers are getting desperate when they have to beg consumers to submit stories to compensate for the fact that their image of the modern consumer dates back to the 1950's.

Lipitor U.S. Sales Tank 70% in 2012 vs 2011!

According to Drugs.com, Lipitor U.S. sales in Q2 of 2012 were only 30% of what they were in Q2 2011 ($579 million vs. $1,949 million, respectively (see chart below; Source: http://www.drugs.com/stats/lipitor).

Meanwhile, sales of Crestor (a competitor anti-cholesterol drug) increased only somewhat during the same period (see chart below; Source: http://www.drugs.com/stats/crestor).

I conclude that most of the loss of Lipitor sales was due to direct competition from generic versions of Lipitor now currently available, which is further proof that Pfizer's "innovative" attempts to stem the generic Lipitor tide has failed (see also "Pfizer Throws In the Lipitor Marketing Towel").

BI to Launch Beta Version of its Syrum FaceBook Game on September 13, 2012

John Pugh, Director of Digital for Boehringer Ingelheim GmbH (BI), announced that BI will release a BETA version of the FaceBook game SYRUM at a PSFK conference in London on September 13, 2012.

I have been anxiously awaiting the launch of this game after I first heard about it 10 months ago at a pharma industry conference (see "Pharma & Fun, Not Oxymoronic? Here Comes Gamification!" and "BI's Facebook Game Syrum to be Launched 'When It's Ready'"). At least BI is speedier than the FDA in delivering on long-awaited promises!

I have not heard of the PSFK conferences until now. According to its website, PSFK "conferences offer a diverse program of speakers with backgrounds in art, technology, design, marketing, and media, creating an environment where disparate ideas can come together in new ways to fuel work that changes the world for the better. We set an agenda that allows participants to meet and discuss with one another, together sharing and building upon the ideas brought forth from the stage."

I am a bit surprised, however, that Pugh/BI did not choose to launch SYRUM at a pharma industry conference such as DigiPharm Europe, which will take place less than a fortnight later, also in London. Over the past year, Pugh has been making the rounds at such industry conferences promoting SYRUM. I'm not one to speculate (ha ha), but is Pugh getting ready to move on to greener pastures in another, more "innovative" industry? To be fair, it's important for pharma company employees to make connections with like-minded people in other industries to get new ideas that may be applied to pharma.

In any case, here's some of what Pugh revealed to PSFK (read the full interview here):
“We are taking a Silicon Valley approach,” said Pugh, “where we know we have got a really good game that’s stable but we’ll launch a beta version. We really want to make it so that we get lots of feedback from the people who are playing.”

“We’re offering rewards and prizes for people to give feedback so that we can really create the duration of the game, and develop it, and have more of a crowdsourced collaborative effort to develop the future stages of it, so the game will grow and evolve, as more people play it. This is a very unique offering from a highly regulated industry.”
"Crowdsourcing" seems to be all the rage now in the pharmaceutical industry. See, for example, "Crowd Sourced Creative Commons Drug Information" (free subscription required).

Meanwhile, here's a first glimpse of actual SYRUM game screens - previously, we've only been able to see the opening screen with the message "coming soon."

Certifying Prescription Grade Smartphone Medical Apps

An article in yesterday's NYT focused on what I call "Prescription Grade Smartphone Medical Apps." The article said the idea of such apps "excites some people in the health care industry, who see them as a starting point for even more sophisticated applications that might otherwise never be built" (read the article here).

"But unlike a 99-cent game, apps dealing directly with medical care cannot be introduced to the public with bugs that will be fixed later. The industry is still grappling with how to ensure quality and safety." I have written about this issue before, although for apps created by the pharma industry and not "Prescription Grade" apps. See, for example:
Lee H. Perlman, managing director of Happtique, a subsidiary of the business arm of the Greater New York Hospital Association, says "he believes that doctors will soon prescribe both clinically tested apps and more modest apps, like those that track physical activity or remind patients to take their pills. The company has established its own set of guidelines to determine the quality of health care-related apps, and helps doctors integrate them into their medical practice."

Happtique, in July 2012, released a draft of standards that it will be using to certify medical, health, and fitness apps under Happtique’s App Certification Program. The purpose of the program is to help users identify apps that meet high operability, privacy, and security standards and are based on reliable content. You can find the Happtique certification draft standards attached to this post.

The Happtique Certification Standards include these categories:
  • App Operability Standards
  • App Privacy Standards
  • App Security Standards
  • App Content Standards
My interest at the moment is in the App Content (C1) and Security (S6) Standards because these are most relevant to my concerns about the credibility of some recent pharma apps.

Content Standard C1 states: "The app is based on one or more credible information sources such as an accepted protocol, published guidelines, evidence-based practice, peer-reviewed journal, etc.

Performance Requirements for Standard C1
  • C1.01 If the app is based on content from a recognized source (e.g., guidelines from a public or private entity), documentation (e.g., link to journal article, medical textbook citation) about the information source is provided.
  • C1.02 If the app is based on content other than from a recognized source, documentation about how the content was formulated is provided, including information regarding its relevancy and reliability
I have seen pharma apps that do not comply with C1.01 (e.g., read "Be Aware of What's Behind a Pharma Mobile App: Disclaimers Only Tell Part of the Story").

But more troubling than the lack of documentation regarding content, is the accuracy of the apps software. Happtique Certification Security Standards address some of my concerns.

Security Standard S6 states: "The app owner has a mechanism to notify end users about apps that are banned or recalled by the app owner or any regulatory entity (e.g., FDA, FTC, FCC)."

Performance Requirements for Standard S6
  • S6.01 In the event that an app is banned or recalled, a mechanism or process is in place to notify all users about the ban or recall and render the app inoperable.
  • S6.02 In the event that the app constitutes a medical device (e.g., 510(k)) or is regulated by the FDA in any other capacity, the app owner has a policy and a mechanism in place to comply with any and all applicable rules and regulations for purposes of handling all aspects of a product notification or recall, including all corrections and removals.
Unfortunately, I do not find a standard for addressing the problem of "buggy" medical app software, which I discussed in a previous post to Pharma Marketing Blog (see "The Problem with Unregulated "Calculator" Apps for Physicians"). Specifically, shouldn't there be some certification standard that specifies how the app software was tested for accuracy? I think so.



Public's Confidence in Science Remains Steady Over 38 Years, But Not So for Medicine

Michael Ritchie, Postdoctoral Fellow at Pfizer, recently posted to the Think Science Blog that he was NOT surprised that the American public "lost significant trust in the institutions of education, the executive branch of the federal government, organized religion, congress, banks/financial institutions and the press" over the period from 1973 through 2010. He cited results of a study conducted by the University of Chicago, National Opinion Research Center.

"In contrast," Richie said, "the American public’s trust in the scientific community remained virtually unchanged over this period" (see "Perspectives from a Postdoc: The Public’s Trust of Science").

Ritchie may have been using "Science community" as a surrogate for the pharmaceutical industry, which wasn't a specific category included in the study. What Ritchie didn't mention, however, is that public confidence (which is what the study actually measured, not "trust") decreased more or less "significantly" with regard to "Medicine" and "Major companies," two other -- perhaps more relevant -- surrogates for the pharmaceutical industry.

I plotted the data for Medicine, Science, Organized Religion, Major Companies, and the Press in the following chart. You can find the complete set of data here.

What do you think is the better indicator in this study for the trend in public confidence in the pharmaceutical industry? Science? Medicine? or "Major Companies?"

BTW, if you look at the public's confidence in Congress and the Executive branch of government, you will see that it bounces up and down according to the political atmosphere and whether or not we are war. It's hard to say if there was a significant decrease over the years.

The $400 Million bapi Drug Failure: Are Patient Advocates the Scapegoat?

"Few people in pharma or the investment community were surprised at bapineuzumab's failure, as most odds makers put its chances for success at approximately 25 percent," said Daniel R. Hoffman, Ph.D., in a post to the Philadelphia Inquirer Check Up blog (see "Choosing between baldfaced political lies and Pharma's half-truths").

Bapineuzumab is an experimental drug for the treatment of Alzheimer's Disease (see "Pfizer and Janssen Halt Alzheimer Drug Development: Why Not Try Gamification?").

"But why do pharmas advance poor prospects to expensive, Phase 3 testing and throw half a billion dollars of shareholder money out the window in the process?"

The former head of Pfizer's R&D, John LaMattina, offered the following as a possible answer:

“Perhaps the answer lies the fact that there were groups of stakeholders who desperately wanted bapi to advance. AD [Alzheimer's Disease] patient advocacy groups would top the list. These people, who are doing their utmost to help find any treatment for this disease, would have been outraged had bapi been dropped at phase 2. Furthermore, their concerns would have been supported by leading experts in the field. Back in 2008, many of the leading experts in AD strongly believed in the science behind bapi and they would have been quite negative about ending the bapi program. Finally, dropping bapi would have caused public relations damage. Imagine the headlines: ‘Big Rich Pharma Companies Dump Promising Drug For AD. Patients, Scientists Crushed.’"

LaMattina says that he "had no part in the bapi discussions," but he suspects that Wyeth/J&J "knew that bapi had less than a 50-50 chance to succeed" and he agrees that it was a $400 million dollar gamble.

Obviously, LaMattina is just speculating on the role that Alzheimer patient advocates may have had on the decision to proceed with the phase 3 trials of bapi. But I seriously doubt that the "deciders" were worried about bad publicity if they refused to take the gamble. Drug companies, after all, pay corporate communications professionals big bucks to favorably "spin" bad news.

"Patient advocacy groups can exert some effect," said Hoffman, "but basically they stand several rungs down the influence ladder from the greed, ego and similar motives of senior executives. The area where patient advocacy groups scream the loudest concerns the exorbitant pricing of drugs for their respective therapeutic areas. Yet pharmas seldom let these plaintive cries influence their inexorable price increases. Certainly the patient groups didn't deter pharma's industry-wide strategy of pricing as many new products as possible at the vastly higher level of biologicals and, for some, even into the orphan drug stratosphere."

True that!

Dr. Hoffman complains of "half-truths and misdirecting statements that pharma's cheerleaders now communicate regularly" when referring to LaMattina's analysis. LaMattina, said Hoffman, "didn't place even a smidgeon of responsibility at the feet of fiduciary officers and senior R&D people who receive bonuses based upon the number of compounds they advance to Phase 3. Nor did he state that C-suite people uniformly believe they look better to shareholders by throwing a Hail Mary pass against a stacked secondary, rather than limiting their losses by punting the ball."

Football: Another reference to games! See my post cited above.

Obviously, drug development is a risky business - high risk vs. high reward. These days, however, the rewards are less "stratospheric" than they used to be.

Instead of looking for scapegoats -- whether they be patient advocates or C-suite football quarterback wanabees -- we should talk about the broken pharma business model and how to change it to be less risky. A guest Forbes post by Christopher Bowe, the US Healthcare Analyst at Informa Scrip, addresses this issue in his analyis of the bapi failure:

"To save itself - and save more patients - the industry should take two vital steps: develop a more flexible approach to drug approval and patent exclusivity and change its business model to encourage more scientific collaboration among companies," said Bowe. "The first change is relatively closer to our grasp; the second requires a sea change in the industry" (see "Big Pharma Failures Light the Way to Change").

On that note, I invite you to read this Pharma Marketing News article: "Crowd Sourced Creative Commons Drug Information" (subscription required) and/or this Pharma Marketing Blog post: "OMG, LCOI! Open Source Pharma: Creative Commons Coming To Pharma."

An open crowd-sourced approach to pharmaceutical research is not a hairbrained idea. An article in today's Wall Street Journal describes how the U.S. military is using crowdsourcing to design a new amphibious vehicle for the Marines (see "Tapping Crowds for Military Design"; subscription required). "The Defense Advanced Research Projects Agency, known as Darpa, is preparing to assess whether crowdsourcing, a freewheeling collaborative method sometimes used to develop software, can be an effective means of designing military equipment."

IMHO, if the military can handle open source data sharing without revealing secrets, so can the pharmaceutical industry.

Lilly Overtakes Pfizer as Biggest DTC Advertising Spender!

According to cegedim Strategic Data, Lilly overtook Pfizer in total direct-to-consumer (DTC) spending in April, 2012. The chart below shows the top 10 DTC spenders between July 2011 and April 2012.

Pfizer spent nearly $900 million in DTC advertising in 2011. $220 million of that was for Lipitor. I predicted that Lipitor would hold the "Key to DTC Ad Spending in 2012" (see here) and this chart proves it.

Lilly's Cymbalta and Cialis were the #2 and #3 highest in DTC ad spending in 2011. It looks like they will be #1 and #2 in 2012.

Fake vs. Real Pharma Twitter Followers

Piotr Wrzosinski (@pwrzosin), IPM Digital Marketing at Roche and a member of my Pharma Twitter Pioneer Group (see here), recently posted this to Twitter today:

"0% of my followers are fake. How many fake followers do you have..? http://sttsp.pl/ahaf @StatusPeople #FollowerSpam"

Goodie! Another social media metric I can use to compare pharma Twitter accounts. I quickly followed the link to StatusPeople Web site where I was invited to "Find out how many fake followers your friends have."

Before looking at my "friends" data, however, I looked at my own and found out that 73% of my nearly 12,000 Twitter followers were neither "fake" ("spam" accounts that "tend to have few or no followers and few or no tweets, but [which] tend to follow a lot of other accounts.") nor "inactive." This was quite better than most pharma Twitter accounts as can be seen in the following chart (click for an enlarged view):

I do not have 0% fakes like Piotr; six percent (6%) of my followers may be fakes. This is the lowest percentage among the 16 pharma Twitter accounts I measured. @Abbottnews had the highest percent of "fake" followers: 18%. Fouteen percent (14%) of followers of Roche, Novartis, Pfizer GSK(U.S.) are "fakes" or suspected spam accounts.

Why is it important to know how many fake and inactive followers a Twitter account has?
"There are two reasons," says StatusPeople. "First it's important for you to be sure when you communicate on Twitter that you are communicating with real and active followers. Because the more active your follower base the more likely they are to share your content.
The second reason is there are a growing number of Fakers out there. People who buy followers in a vain attempt to build legitimacy. "'Look at me I have 20,000 followers, I must know my...' They are essentially trying to game the system and it's important for you to be able to spot them, and steer clear of them. Because ultimately if you're willing to lie about how many friends you have you are not a very trustworthy individual."
Well, Pfizer has over 31,000 followers. Way back in 2010, I asked "How Did Pfizer Get So Many Twitter Followers?" (see here). I suggested that Pfizer sent out a memo to all their more than 100,000 employees worldwide telling them to follow @pfizer_news. I was kidding, of course. But I suspected something was up because Pfizer_news somehow attracted about 3-4,000 NEW Twitter followers in just a few days (see chart below)!

Did Pfizer "attempt to build legitimacy" by "gaming the system?"

One caveat: StatusPeople contends that its tool provides "very accurate insight into how many inactive and fake" followers a Twitter account has, but ONLY if there are fewer than 10,000 followers. "If you're very 'popular' the tool will still provide good insight but may better reflect your current follower activity rather than your whole follower base."

Only 6 out of my sample of 16 pharma Twitter accounts have fewer than 10,000 followers (Phrma, SanofiUS, Diabetes_Sanofi, BoehringerUS, BMSnews, and Abbottnews).

If you want to learn how many fake followers you have, go here.

How Johnson & Johnson Uses Twitter for Patient Support: A-plus for Effort, D-minus for Sharing

Every day, I get a synopsis of tweets and newsfeeds from selected pharma companies that I am following (see "News Direct from the Pharma Industry"). Lately, I've been noticing a number of tweets from Johnson and Johnson (@JNJComm) that are direct responses to complaints from consumers about its products. In some cases, complainants have had an extended conversation with JNJ.

However, you won't find these conversations if you look at the @JNJComm Twitter timeline here but you can find them in the PMN Forum archives here. More on this later. Right now I'd like to focus on one of these conversations.

@hiltmon (Hilton Lipschitz) complained about an Acuvue contact lens problem in a tweet posted to @JNJComm. @hiltmon said: "@JNJComm, could you please fwd this to Acuvue team: See the hole in the lens (top right), happened twice now. Thanks. pic.twitter.com/50ML8IrT" The link leads to this photo:

Whether or not this could be classified as a legitimate "adverse event," is a matter for debate, but JNJ responded as if it were: "thanks for alerting use. Please call us at 800-843-2020. It's important that we fully understand what occurred. Thanks! ^DE" Here's a screen shot of the full exchange:

I am not sure what "^DE" means. It appears that JNJComm uses it only at the end of responses to these sorts of complaints. I assume it allows some kind of tracking or followup. [Actually, it indicates the author - in this case Devon Eyer; see UPDATE at the end of this post.] In any case, the end result was one happy (I assume) customer.

I cannot find a legitimate Acuvue Twitter account, although the brand does have a Facebook page. After a quick scan through the Acuvue FB page, I can find no consumer complaints or conversations like the above. It's all good brand "conversations" over there on the Acuvue FB page :-)

The above Twitter conversation might be considered a "brand conversation," which is what brand marketers would like to see (although they would like positive rather than negative conversations about their products). So, JNJ corporate communications people are having these brand support conversations via Twitter, but the brand people -- who presumably manage the FB page -- do not. That's telling in respect to the question I asked in a previous post: "Who's Your Social Media Daddy?"

This conversation is somewhat hidden from most of the nearly 20,000 @JNJComm followers. As I mentioned above, it does not appear in @JNJComm's Twitter timeline because each tweet begins with "@". That makes it a personal conversation in Twitter. Unless you access @JNJComm's Twitter RSS feed as I do, you won't see these tweets. That's unfortunate, IMHO, because it means that the power of social media (e.g., sharing content with followers) is sidestepped. In this case, other consumers may not learn about important safety and other information about Acuvue lenses. Public health would be better served if everyone could learn from the conversation (e.g., the batch number of the faulty lenses).

Of course, it also means that these conversations may not be picked up by the media -- presumably the main audience for @JNJComm and other pharma corporate Twitter accounts -- or by regulators who may like more information about faulty medical products.

UPDATE: ^DE indicates that the @JNJComm posts were written by Devon Eyer, Director, Corporate Communications, Social Media at Johnson & Johnson (see her LinkedIn profile here).

I have included Devon in my list of contenders for the 3rd Annual Pharmaguy Social Media Award. You can learn more about this award here and/or vote for your favorite here.

New Pharma Business Model: Prizes, Not Patents, for Innovative Drugs

A BMJ articled titled "Pharmaceutical research and development: what do we get for all that money?" was roundly criticized by Rich Meyer of World of DTC Marketing blog and Derek Lowe of In the Pipeline blog. Both have both ripped into the central premise of the BMJ article; specifically critiquing these statements made by the authors: (1) the "widely touted innovation crisis in pharmaceuticals is a myth" and (2) for every dollar pharmaceutical companies spend on "basic research, $19 goes toward promotion and marketing."

Meyer (here) tackles #2 using data from Lilly (ie, see this chart embedded below), whereas Derek tackles #1 (here).

Everyone fools around with the numbers to reach their desired pre-ordained conclusions. I have blogged about this many times. First, I wrote about differing estimates of pharma's expenditures on total marketing, not just direct-to-consumer (DTC) spending, which was used to create the above chart of dollars spent on advertising vs. sales. I've also compared this to how much the industry spends on research (see, for example, "Promotion vs. R&Deja vu all over again!").

My conclusion: The drug industry spends approximately the same on marketing as it does on research. So, can't we all agree to that and just get along?

If you actually read the BMJ article, you might be surprised to learn that the authors' goal seems to be to promote a NEW business model for the pharmaceutical industry:

"We should consider new ways of rewarding [drug industry] innovation directly, such as through the large cash prizes envisioned in US Senate Bill 1137, rather than through the high prices generated by patent protection," said the authors.

I was intrigued to learn that a US Senate Bill has been proposed -- although long tabled -- that actually seriously proposed getting rid of patent protection for new drugs as an incentive for innovation. Here's how the BMJ authors describe what SB 1137 proposes:

"The bill proposes the collection of several billion dollars a year from all federal and non-federal health reimbursement and insurance programmes, and a committee would award prizes in proportion to how well new drugs fulfilled unmet clinical needs and constituted real therapeutic gains. Without patents new drugs are immediately open to generic competition, lowering prices, while at the same time innovators are rewarded quickly to innovate again."

The authors assure us that the approach advocated by SB 1137 "would save countries billions in healthcare costs and produce real gains in people’s health."

Maybe so, but I seriously doubt that prizes awarded by a government committee (ie, "Board of Trustees for the Fund for Medical Innovation Prizes") would be more effective than the profit motive or less prone to corruption than the industry's cozy relationship with the FDA (ie, drug industry "users fees" directly cover the majority of FDA's drug approval expenses).

SB 1137 also calls for 5 percent of the prize rewards fund (ie, 5% of about $80 BILLION or about $4 billion -- the approximate amount pharma spends each year on DTC advertising) to be distributed to those who "provide open access to knowledge, data, materials, and technologies." The bill claims that such "new open source business models... will induce greater access to useful knowledge, data, materials, and technologies."

That's interesting because I recently talked to people at Lilly -- not the same people who created the above chart -- about an "open access" project they are launching for innovative pharma research (see "Crowd Sourced Creative Commons Drug Information").

Who's Your Social Media Daddy? A Panel Discussion

That is one of the questions/topics to be discussed by a panel of experts I will be moderating at the next PharmaForce conference in Princeton, NJ, on October 30, 2012. Actually, the real question to be considered is "Who Owns Your Social Media Initiatives?"

Pharma Marketing News is a Media Partner for this event and is helping promote it through advertising. The panel I volunteered to moderate is titled "Effectively Building Your Social Business" (see here). I am not getting paid to do this, but I hope to learn a lot from the experience, especially from meeting and working with the expert panelists.

Not all the panelists have been chosen as yet. I and the conference organizers are interested in finding pharma panelists who can give their POVs regarding the following discussion bullet points:
  • Tap into social media data to reveal customer behavior
  • Understand the power of influence and influence mapping
  • How to best balance the risk and rewards of social
  • Who owns your social media initiatives
  • Determine the desired outcomes of your social media strategy
  • Align social media activities to your multichannel marketing strategy
I'll be contacting a few qualified people from my contacts, including my list of Pharma Twitter Pioneers (here) and candidates for the 3rd Annual Pharmaguy Social Media Pioneer Award (here). If you are interested in being a panel member or know someone you'd like to recommend, please let me know by filling out the following form.

NOTE: I am looking specifically for pharma people. There is no compensation for participation on panels except for the 45 minutes of fame and notoriety involved (I probably will write up a summary of the panel discussion afterward).

Create your free online surveys with SurveyMonkey, the world's leading questionnaire tool.

Is Type 2 Diabetes Drug Marketing Responsible for Misdiagnosis of Type 1 Diabetics?

A Wall Street Journal article documents several cases of people being misdiagnosed by general practitioners as having Type 2 diabetes when they actually have Type 1 diabetes, "a substantially different condition" (see "Wrong Call: The Trouble Diagnosing Diabetes"). According to the article:

"An incorrect diagnosis usually occurs in the offices of primary-care doctors, many of whom haven't received adequate education in medical school about rising rates of Type 1 in adults and how to diagnose it. 'It is not on their radar because they see so much diabetes and it is by far mostly Type 2,' said Irl B. Hirsch, professor of medicine at the University of Washington Medical Center in Seattle."

As I continued reading, I couldn't help but wonder if the current competition among drug companies to sell Type 2 diabetes drugs has something to do with this. Fierce marketing of these drugs - see box below - may be contributing to emphasizing Type 2 diabetes on GP's "radar screens."

The Three Type 2 Diabetes Drug "Amigos"
  1. Januvia - marketed by Merck
  2. Onglyza - marketed by Bristol-Myers Squibb/Astrazeneca
  3. Victoza - marketed by Novo Nordisk
See "Three Companies Compete for Diabetes Market Share"

In each case cited in the article, misdiagnosed patients were taking oral drugs, none of which were mentioned by name, and none of which are effective or approved by the FDA for treating Type 1 diabetes. "For six years, Mr. Jones [a patient] treated what had been diagnosed as Type 2 diabetes. He changed his diet and took three oral medications daily." It's likely that at least one of those drugs was one of the "Three Type 2 Diabetes Drug 'Amigos'" mentioned above.

Of course, many GPs would probably misdiagnose patients as having Type 2 diabetes when they actually have Type 1 diabetes even without being bombarded with marketing for Type 2 treatments. But having multiple pills available to prescribe makes it easier, in my opinion, to avoid taking the patient down the path to a possible Type 1 diagnosis.

The ultimate responsibility for misdiagnosis, however, must rest with the physician and not the pharmaceutical marketer, unless of course, the marketer offers physicians inducements (ie, money or non-monetary rewards) for prescribing products.

On that note, I also read a story in today's WSJ about Pfizer and other drug companies bribing doctors to prescribe their drugs. Pfizer settled with the DOJ -- admitting nothing -- but paid $60.2 Million to "Resolve U.S. Allegations That It Used Illegal Payoffs to Win Business Overseas."

Of course, such things do NOT happen here in the U.S.

Pfizer and Janssen Halt Alzheimer Drug Development: Why Not Try Gamification?

"In the wake of another negative trial with the anti-amyloid biologic drug bapineuzumab, Pfizer and Janssen said they were halting development of the product for mild to moderate Alzheimer's disease," reports medpage today (here).

Pfizer may have had high hopes for this drug because it already launched a multichannel marketing/PR campaign centered around "getting old" (see "Pfizer's Social Media Initiatives are Getting Old") and this drug in particular (see "Can Pharma Cure Alzheimer's Disease? A Pfizer Pre-Launch Multichannel Marketing Case Study").

I'm not sure what other Alzheimer products Pfizer is currently working on, but maybe it's time for it think out of the box. Perhaps it should look into gamification as an alternative strategy.

You might ask, "Are you serious John? Just yesterday you pooh-poohed gamification as an alternative to ADHD drugs" (see "Cure by Gamification: Science or Wishful Thinking?").

True that. I still believe that games will never be approved by the FDA for treatment of a medical condition and doctors won't prescribe them even if they were approved. But that doesn't mean games cannot be effective in the treatment of Alzheimers Disease by slowing its progression, which has been the goal of clinical trials of drugs like bapineuzumab.

There is actually some SCIENCE published in a peer-reviewed medical journal (JAMA's Archives of Neurology) that purports to have found a link between “brain-stimulating activities” and levels of protein -- ie, β-amyloid -- thought to cause Alzheimer’s disease (see "Brain Games May Help Thwart Alzheimer’s: Study"). The authors of the study state:

"We report a direct association between cognitive activity and [11C]PiB uptake, suggesting that lifestyle factors found in individuals with high cognitive engagement may prevent or slow deposition of β-amyloid, perhaps influencing the onset and progression of AD."

At least one patient support group supports the idea that games might be helpful in thwarting Alzheimer's Disease (see this LivingStrong web site page: "BRAIN GAMES FOR ALZHEIMER'S").

For anecdotal evidence, I have been solving 2-3 crossword puzzles per day (as recommended by LivingStrong) for a couple of years and am happy to say that I have not been diagnosed with Alzheimer's -- yet. Unfortunately, I did not have a brain scan before starting nor do I have a control group so as to scientifically prove or disprove that I am not slowly developing the disease.

Nevertheless, I still think it's unlikely that any drug company would get into the business of "drug gamification" -- ie, developing games approved by the FDA for treatment of medical conditions. For one thing, it's much more expensive getting games approved by the FDA than it is to develop the games themselves -- an economic reversal of the typical pharma drug development model.

As a consequence, it would be very easy for competitors to develop therapeutic games of their own and get them approved by the FDA, which is likely to consider such games as medical devices (they are not consumed by patients). I believe that the way FDA approves medical devices makes it easier for competitors to get similar games approved without having to finance new clinical trials. "Me too" game developers can use existing clinical data paid for by the "innovator" company as evidence of safety and efficacy.

Then there would be "over the counter" competition from games that do not have to be approved by the FDA as long as they are not marketed as being effective in treating a disease like Alzheimer's (the marketers, however, can say things like "helps improve cognitive ability").

Hey, I'm sorry to break your bubble -- ie, hype -- about the potential of gamification for the pharmaceutical industry in so far as treatment modality goes. It's not that games may not be effective in the treatment of certain medical conditions -- they could be. My point is that it is unlikely that traditional pharma companies will develop games for that purpose for the reasons cited above and in previous posts. That's my opinion and I'm sticking to it!

Cure by Gamification: Science or Wishful Thinking?

Last week, I wrote about a video game -- Akili, meaning "wisdom" in Swahili -- that the developers plan to submit to the FDA for approval in the hope that "clinicians will turn to before prescribing medicines for ADHD" (see "The Next New Drug: An FDA-Approved Video Game").

"We would aim to have efficacy and tolerability that outstrips any of the drugs," said Dr. Martucci, an associate at PureTech Ventures, which formed the start-up company that is developing the game.

I expressed strong doubts that the FDA would ever approve a game to treat a medical condition. Even if the FDA did approve such a game, I doubt insurers and other payers would pay for it. I also doubted that physicians would prescribe it.

This morning, James Ellis (@digital_pharma), a "digital strategist" at closerlook tweeted:

"Gamification is laughable, says @pharmaguy? I'd rather listen to what science says. bit.ly/NjIo9G"

In his blog post ("Who’s Scared of Gamification? (Besides pharma, I mean)"), Ellis says:
"But last week, Pharma Guy decided to stomp all over the idea of gamification like it was irritating pest. A game that helps kids with ADHD train their brain to not need Ritalin? Laughable! Now, I’m not picking a fight with John Mack (oh, wait. Yes I am), but he seemed to take actual joy in pointing at it and calling it names."

Let's start with the "laughable" crack. I certainly did not call this game or even the idea of developing FDA-approved games "laughable." And I did not call it a "name" other than what it's called by its developers! I also did not "stomp all over the idea of gamification" -- my post was simply about one particular game and not a critique of gamification. If you want that, Ellis, I suggest you read "A Drug is Developed:" Easier than Launching an Educational Facebook Game about Drug Development?

As for the science, I have no idea what Ellis is referring to in this case. There certainly is NO SCIENCE -- ie, clinical trials -- that I know of that proves a video game can treat ADHD. And certainly no scientific data that has been submitted to the FDA. Nor does Ellis offer ANY science in support of his thesis, which is nothing more than wishful thinking.

In the end, Ellis makes this wise crack: "maybe Pharma Guy thinks washing one’s hands before an operation is lunacy."

I have no idea where that came from! Maybe Ellis thinks wishful thinking -- ie, that science WILL one day prove Akili helps kids with ADHD so they will "not need" ritalin -- is enough for the pharma industry to go out and hire "digital strategists" to develop games. Now that's "lunacy!"

Does Generic Competition Stifle Branded Pharma Innovation?

Sure, use of generic drugs saves payers -- U.S. Gov't, insurances companies, and patients -- money. But does generic competition harm the innovation of new and improved drugs?

According to a report published by the Generic Pharmaceutical Association (GPhA), the answer is no. Let's look at some of the data.

First, the GPha claims that generic prescription drugs in the U.S. saved about $193 billion in 2011 alone and over $1 TRILLION in the last 10 years (see "Generic Savings in U.S." for a copy of the report and top figure in the infographic shown here; click here for a full-size view of the infographic).

Given that there is just one prescription drug pie to share, that must mean that the branded pharma industry's slice has decreased somewhat proportionately, even though the whole pie may has grown over the years (by what %?).

But GPha does not discuss THAT in its report. Instead, it focuses on "innovation" and the defense of the 1984 Drug Price Competition and Patent Term Restoration Act (Hatch-Waxman), which had the dual objectives of incentivizing the development of new brand drugs (the patent term restoration part) and facilitating the approval of generics to lower consumer costs (the drug price competition part).

The Hatch-Waxman Act has recently come under attack as being too favorable to the generic drug industry. An article in the November 2011 issue of Health Affairs, for example, argued that "generic usage has increased so markedly that the incentive to develop new drugs has been harmed" (said GPhA). From the abstract of that article:

"Generic drug usage and challenges to brand-name drugs’ patents have increased markedly, resulting in greatly increased cost savings but also potentially reduced incentives for innovators. Congress should review whether Hatch-Waxman is achieving its intended purpose of balancing incentives for generics and innovation" (see "Evolving Brand-Name And Generic Drug Competition May Warrant A Revision Of The Hatch-Waxman Act").

As evidence that this is not true, GPha presented new drug approval data from the FDA. The data it presented was similar to the middle chart in the infographic shown here. The GPhA chart only went back 10 years to 2002, whereas the chart shown here goes back to 1994. Although the trend in new drug approvals by the FDA is downward between 1994 and 2011, in recent years (ie, since about 2002), it is trending upward.

Drug approvals by FDA may not be the best indicator of innovation, however. Consequently, I added to the infographic another chart from the FDA that also shows the number of NDAs (new drug applications) filed with the FDA in the last 10 years.

I notice that the number of approvals seems to be directly related to the number of NDAs filed. The FDA often argues that it is not its fault if less drugs are approved in any given year -- it's the fault of fewer NDAs being filed (ie, lack of innovation by the drug industry).

In any case, the GPhA argument seems to have merit. So much so that the branded drug industry -- i.e., its trade association, PhRMA -- chose not to dispute the evidence, but made lemonade from GPhA's lemons.

PhRMA pats itself on the back, saying that "without the development of new medicines by innovator companies, there would be neither the new medicines essential to progress against diseases nor generic copies." Here's more from PhRMA on that:
"[GPhA's report] documents one of the many benefits achieved by new medicines developed by biopharmaceutical research companies. Cost savings attributable to generic drugs represent one stage of the prescription drug lifecycle. Such savings are possible because innovator biopharmaceutical research companies – the most research-intensive sector in the U.S. economy – produce medical advances through pioneering scientific work and long-term, expensive investments. Over time, these innovative new medicines lead to generic copies that patients use at low cost for many years" (see "PhRMA Statement on Prescription Drug Costs").
What do you think?

Does generic drug competition harm the innovation of new drugs?


Paula Deen and Other Proof that Monetary Rewards Improve Adherence

Last month it was reported that celebrity chef and paid spokesperson for Novo Nordisk had lost 30 pounds in the six months since she signed on to help promote Novo's diabetes drug, Victoza (see "Paula Deen Loses 30 lbs. Urges Twitter Fans to Pig Out on Fourth of July!"). This was good for Deen and redemption for Novo Nordisk, which was criticized by me and others for choosing Deen -- who is notorious for her high fat, high calories recipes -- as a type 2 diabetes spokesperson (see see, for example, "Paula Deen & Victoza: Brilliant or Dumb?").

So how did Deen lose all that weight? On the ABC food show “The Chew” Deen said: “It’s really about moderation. I’ve said it for so long but I really started to practice that." She also started working out with weights and walking.

Well, I doubt "so long" goes back to before she started collecting money from Novo Nordisk in December, 2011, or thereabouts. I also don't put any stock into her statement: “It took me a couple of years to get to this point" (see "What’s the Secret to Paula Deen’s Weight Loss?"). The fact is, she lost the weight AFTER being signed on as a spokesperson.

Which proves that money is the best incentive for adhering to a healthy lifestyle. If, like Deen, I was paid a substantial amount of money to lose 30 lbs in six months, I have no doubt I could do it. In fact, I have lost 30 pounds in less than 6 months without any monetary rewards. But that's another story; ie, I have since gained back those 30 lbs :-(.

Even rewards as low as $1 or $2 per week can induce ordinary folks like you and me to lose weight. This was demonstrated by a UConn study in which patients who lost "at least a pound in a given week would draw from a prize bowl. The prize bowl contained 500 cards, 250 of which were prizes. Most of the prizes were valued at around $1, and some were of greater value, offering a chance at larger prizes such as an iPod or fitness equipment. The average cost per draw was approximately $2" (see "UConn Researchers Find Incentives Effective for Weight Loss"). Participants in the study also received "supportive counseling," which, I'm sure, Deen also is getting (free of charge?).

Anyhoo, at the end of the 12-week UConn study, the results showed an average weight loss of 6 percent of body weight in the group receiving awards, compared to an average body weight loss of 3.5 percent in the counseling-only group.

Let's do some math. A 6% weight loss for the reward group computes to about 11 lbs for an overweight 180-lb woman. That's over a period of 3 months. In six months, it would be 22 lbs -- pretty close to what Deen lost.

In the UConn study, participants were not guaranteed a reward if they lost weight and the reward was not commensurate with the amount of weight lost -- such a reward system might be unethical and cause people to starve themselves for money. Hopefully, that will not happen with Paula Deen. And hopefully, she, like me, will not gain back her weight when her deal with Novo Nordisk is finished.

My little poll (below) suggests that a plurality (not a majority) of people believe the Novo Nordisk deal with Paula Deen was a "Dumb" idea from a marketing perspective. Many people who were unsure may now think it wasn't such a dumb idea after all. What do you think?

From a marketing perspective, is the Novo Nordisk deal with Paula Deen Brilliant or Dumb?
It remains to be seen.


Phil Disclosure: Mickelson is a Serial Undisclosed Celebrity Endorser

Today, while reading an article about 5 Guys Burgers ("All in the Family") in the August 2012 issue of Forbes Magazine, I came across a reference to Phil Mickelson. In 2010, Mickelson gave a glowing, unprompted endorsement of Five Guys Burgers during a press conference at The Players Championship.

"What I’ve done the last five days, go to Five Guys Burgers. That place is so good. I can’t stop going there. This will be my sixth day in a row. I grew up on In-n-Out. I thought that was the best burger until I had Five Guys. That is hands down the best burger I’ve ever had" (see story here).

A few days later, fellow golfer Stewart Cink, a big fan of In-N-Out, directed this tweet at AP golf writer Doug Ferguson: “Keep in mind, PM owns SoCal rights to FiveGuys. Biased argument?”

[Keep in mind that Cink may shill for In-N-Out - his Twitter profile shows him eating an In-N-Out burger and fires.]

Cink was correct - Mickelson was biased. As reported on CNBC, Gaylord Sports Management, which represents Mickelson, confirmed that Mickelson was in fact part of a group that has purchased the rights for Five Guys franchises in Orange County.

A few months later, during the 2010 PGA Championship, Mickelson again made an "unsolicited" endorsement. This time, it was for ENBREL, the Amgen/Pfizer drug inicated for the treatment of psoriatic arthritis.

The subtitle to a NowPublic article titled "Phil Mickelson Arthritis: Will Play At PGA Whistling Straights", stated "Phil Mickelson Has Psoriatic Arthritis - Uses Enbrel To Help Manage Condition." The article (here) includes this quote from Mickelson: "I have no aches and pains. My back feels great. I feel stronger and more flexible than I've ever been."

At the time, I asked "Is Phil Mickelson Shilling for Enbrel?"

Well, the jury is out on whether or not Mickelson was a paid ENBREL celebrity endorser at the time he made that statement. But in a manner similar to his Five Guys Burgers outing by social media, it was later revealed that Mickelson was indeed a paid celebrity spokesperson for ENBREL (see "Phil Mickelson 'Opens Up' to Arthritis Today Magazine"). The Arthritis Today article claims that Mickelson "entered into a partnership with Amgen-Pfizer, an Arthritis Foundation sponsor, in November, 2010." Also see "Amgen Blows Its Marketing Budget on Phil Mickelson Campaign" for the Amgen press release announcing the deal.

As soon as Phil became a PAID spokesperson for ENBREL, he could not say these things because he became an extension of the brand and subject to FDA regulations. But at the time he said the above, I suspect he was giving his future benefactors a freebie! We don't know how long the negotiations were going on before the deal was signed, but this story could have been arranged to seal the deal.

BTW, my sons think Five Guys Burgers are "epic." They ate at a Five Guys joint every week while at Penn State. Of course, they are not paid by Five Guys nor do they own a Five Guys franchise.

So, I'm not saying that Mickelson lied when he said a Five Guys burger was "the best burger I’ve ever had" nor when he said he feels "stronger and more flexible than I've ever been" after taking ENBREL.

My concern is a celebrity who promotes a drug having dangerous side effects without revealing that he may have a financial interest in the product. When Mickelson first made his statements about ENBREL he may or may not have technically signed a contract, but it was obviously meant to get the work -- a demonstration of what he could do. Now that he is featured on ENBREL TV ads, everyone knows he is a paid spokesperson. I have no problem with that, especially that now his commercial speech is regulated by the FDA and he can no longer make outlandish statements.

UPDATE (8/16/2012): In a personal communication, a reader said: "I had to laugh when several times I thought I noticed Phil dropping a right hand wedge into his bag during the TV commercial. But look closely, it's true..." Phil is left-handed, so I guess the director of the commercial used his own clubs as props!

The U.S. Pharma Industry Recession (or Depression?) Continues

Is the Pharma Industry in a Recession?
Not sure
Not yet, but soon
Maybe not, but it's hurting!

Last week, while at a New Jersey networking event, I met many people who used to be employed in the pharmaceutical industry but who are now "in transition," which is one of those "Awkward Euphemisms" for out of work and looking for a job (see "Days of Live Pharma Reps are Numbered: M&A's and Outsourcing - the 'Bain/Bane"' of the U.S. Pharma Industry").

I've written about the pharma industry "recession" back in March, 2008 (see "Is the Pharma Industry in a Recession?") when I started a little poll asking readers whether or not they thought the industry was in a recession. By May, 2008, only about 276 people responded to the poll and 68% of them believed that the pharmaceutical industry was in a recession at that time.

I've kept the poll going and as of today over 2,500 responses have been collected. 85% of respondents agree that the industry is in a "recession." Unfortunately, I did not include "DEPRESSION" as a choice. I'm sure a good portion of respondents would have chosen that rather than "recession." You can take the poll yourself and/or view the current results (right, above).

Obviously, the pharmaceutical industry has shed a lot of jobs between 2008 and today. Pharmalot reports, for example, that according to Challenger Gray & Christmas, 18,264, jobs were lost between January and July 2011 vs 8,958 that were tallied during the same period this year (see here).

In 2008, I suspect most pharma jobs that disappeared were in sales and marketing. Since then, however, research and development has been hit hard by layoffs due to mergers and acquisitions and outsourcing research overseas. That's why I met only out of work scientists at the NJ networking event.

The Next New Drug: An FDA-Approved Video Game

Imagine my surprise when I read this in today's Wall Street Journal: "Akili Interactive Labs Inc. of Boston, formed by start-up-creating firm PureTech Ventures, and San Francisco company Brain Plasticity Inc. are seeking Food and Drug Administration approval for a video game treatment they hope clinicians will turn to before prescribing medicines for ADHD" (read the story here).

I've been writing a lot about "gamification" and the pharma industry (see "Pharma & Fun, Not Oxymoronic? Here Comes Gamification!" and "Gamification, Then and Now", for example), but never from the perspective of games designed to compete with drugs such as Novartis' Ritalin, a stimulate indicated for the treatment of ADHD.

Akili -- meaning "wisdom" in Swahili -- is the name of the video game that Akili Interactive Labs hopes will be the first ever video game "treatment" approved by the FDA. The game is designed to run on smartphones and iPads. The company also hopes clinicians will recommend the game to patients before prescribing medicines for ADHD.

Fat chance!

First, fat chance that the FDA will actually approve a video game as an effective treatment for a medical condition. Second, fat chance that even if approved, health insurers/patients will pay for a game treatment after being conditioned all these years to think only of drugs as treatments. Third, fat chance that physicians will prescribe the game to their patients. That would require overturning the entire drug-physician industrial complex!

Nevertheless, Akili co-founder Eddie Martucci said "his company's research shows that people want choices other than today's powerful medicines. 'We would aim to have efficacy and tolerability that outstrips any of the drugs.'"

Wow! Are these guys anti-drug industry? NOPE! Senior Partner, Chairman of PureTech Ventures is Dr. Ben Shapiro who was previously Executive Vice President, Worldwide Licensing and External Research for Merck. Another Senior Partner at PureTech is Dr. John LaMattina, who was previously President, Pfizer Global Research and Development and Senior Vice President, at Pfizer Inc.

LaMattina, who also writes the Drug Truths Blog at Forbes, was once enthusiastic about torcetrapib, a drug that Pfizer hoped would replace LIPITOR. "We believe this is the most important new development in cardiovascular medicine in years," said LaMittina. That was before Pfizer halted development of torcetrapib and after it spent more than $800 million on its development (read "torcetrapib: $800 Million Failure but Kindler Safe"). Hopefully, Akili isn't costing nearly as much to develop as a new drug.

With such experienced drug industry veterans as partners, Akili might have a chance of making it to the FDA. Unless, of course, clinical trials reveal dangerous side effects.

It's not likely such side effects will be similar to those that torcetrapib caused; i.e., death. Some video game critics, however, fear that "electronic media might improve visual attention but impair the ability to sustain attention on a hard or boring task," notes the WSJ article. "The latter type is what teachers need from students, according to ... Douglas A. Gentile, a developmental psychologist at Iowa State University." What teachers DON'T need, however, is for students to claim that playing video games during school is part of their medical treatment!

It's interesting to speculate how FDA-approved video games would be marketed, assuming any will actually be approved by the FDA. Akili, for example, might splurge on exhibits at medical meetings and lure physicians into its booth to play the game. And maybe it would hire physicians to be "consultants" and "speakers" to promote the game to their peers. I'm betting that direct-to-consumer (DTC) TV ads would be out of the question -- much too expensive for a product unlikely to reach "blockbuster" levels of sales.

I do, however, envision that DTC social media could be very cost-effective for marketing FDA-approved video game treatments.

Pharma Support of CME at Lowest Level Ever Recorded!

According to data maintained by the Accreditation Council for Continuing Medical Information (ACCME), in 2011 the percent of accredited CME revenue attributed to the pharmaceutical/medical device industry (i.e., grants, advertising, and exhibit fees) was 33.2% of total revenue received from all sources.

This is the lowest percentage attributed to commercial sources since ACCME began reporting these data in 1998 when the percent was 34.0%.

Refer to the infographic on left (find a full size view on my Pinterest page here).

These data refer to CME offered primarily to national or international audiences of physicians and other health care professionals by provider directly accredited by ACCME. It does not include data from state-accredited providers.

For the first time, the 2011 ACCME Annual Report Data features separate data sets about the CME delivered by ACCME-accredited providers and by state-accredited providers, offering an overview of the CME system at both the national and state levels.

Whereas the total commercial support for direct ACCME-accredited providers was $1.033 billion ($736 million in grants and $296 million in advertising and exhibit fees) in 2011, state-accredited providers received only $28.5 million from the drug industry ($16 million in grants and $12.6 million in advertising and exhibit fees).

As the last chart in the infographic shows, the trend in the percent of physicians opting for online CME continues to decrease. About the same number of physicians participated in ACCME-accredit CME programs in 2011 as in 2010 (approx. 11.4 million), but a lower percentage (37.8%) participated in online CME (not including live sessions and search learning). That compares to 40.1% in 2010 and a peak of 41.9% in 2009.

Why are fewer physicians participating in online CME activities? There were 25,000 online CME activities offered by ACCME-accredited providers in 2011 vs. 23,300 in 2012. The decline, therefore, cannot be attributed to fewer available activities.

UPDATE: Hat Tip to Mario Nacinovich (@nacinovich), Managing Partner, AXON, for pointing out to me that the CME numbers I quoted above should be bolstered after implementation of the FDA opioid safety plan (see "Drugmakers must pay for opioid continuing medical education programs for physicians").

The FDA Blueprint for Prescriber Education for Extended-Release and Long-Acting Opioid Analgesics (find it attached to above article) calls for "education for prescribers of these medications, which will be provided through accredited continuing education (CE) activities supported by independent educational grants from ER/LA opioid analgesic companies." Unfortunately, the training is voluntary and won't begin until March 2013. The grants may or may not impact the 2012 ACCME data and reverse some of the trends noted above.

War on Counterfeit/Illegal Drugs Hobbled by Same Demons as Real War

Pfizer Intelligence Uncovers $200 of Counterfeit Viagra In Manila Raid!

"Armed with a tip from pharmaceutical company Pfizer Inc., several dozen government investigators carried out a series of rapid fire raids one day last month on what were supposed to be the key suppliers of counterfeit drugs in the city [Manila]," reports the Wall Street Journal (read the story here).

"The net result of the raids, touted beforehand as likely to be one of the largest counterfeit drug busts in the city this year, was $200 worth of fake Viagra, Pfizer's erectile-dysfunction drug."

This intelligence gaffe reminds me of the Bush-era Iraqi weapons of mass destruction intelligence gaffe that propelled us to war in Iraq. I'm wondering if the "war on counterfeit drugs" is similarly based on faulty intelligence?

Another similarity between these two types of war is the unbridled optimism expressed by those in charge. "I think we are making a dent in the problem, but it's a slow process," said Scott Davis, senior director for global security in the Asia Pacific for Pfizer and a former special agent for U.S. Customs. Smells or sounds like victory, but it's no where near actual victory.

Here's yet another analogy: the war on counterfeit (or illegal) drugs seems to be as hobbled by rampant corruption of officials as is the war in Afganistan (or Iraq). In the case of the Manila raid, an owner of a couple of the target warehouses "bragged that he knew the NBI's [the Philippine's National Bureau of Investigation; i.e., the country's FBI] lead investigator on the counterfeit drug case and the deputy director who authorized the raid." After the raid turned up practically nothing, "the owner and the government agents walked a block away to lunch at Maxim's Tea House, a Chinese restaurant, according to people close to the investigation." That lunch probably cost more than $200!

It was interesting that the raiders found what they thought was counterfeit Cialis -- an ED drug marketed by Eli Lilly. Unfortunately, they did not have a search warrant for that illegal product, so no one was arrested.

It appears that Pfizer and Lilly did not share their intelligence data in this case, otherwise the NBI could have had a more inclusive search warrant.

This begs the question: Is the drug industry working together as allies in the war on counterfeit/illegal drugs? Are they sharing intelligence? Or is this also "proprietary" information that each company wants to keep close to its vest?

Days of Live Pharma Reps are Numbered: M&A's and Outsourcing - the "Bain/Bane" of the U.S. Pharma Industry

Last night, my sons and I attended a NJ BioPharma Networking Group (NJBPNG) meetup at the Princeton Sports Bar and Grille. NJBPNG is an ad hoc LikedIn group, which you can join (here).

This group is mostly comprised of senior pharmaceutical executives in the research side of the drug industry (click on infographic on the right for more NJBPNG demographics).

It was a good night out with my sons, but not so upbeat for most of the people I met there, many of whom are out of work -- including PhDs, organic chemists, and project  managers.

When meeting new people I usually ask "What do you do?" The most frequent answer I received last night was "I'm in transition," which is one of those "Awkward Euphemisms" for out of work and looking for a job (see other euphemisms listed by Michael Spiro, a professional recruiter, on his blog here).

When I asked "Why?", the response was either mergers and acquisitions or outsourcing, which, I note, was the specialty of Bain Capital in its glory years. Sorry, I just had to throw in a Romney reference and relate "Bain" to "Bane" (i.e., the super-villain nemesis of Batman).

Seriously, outsourcing in the pharmaceutical industry is on the rise. Clinical research is being outsourced to countries like India, and China. Basic research is also being outsourced to startup companies and academia and maybe even overseas.

I also met a few people who are doing very well, thank you. One was the owner of a sales outsourcing agency that specializes in non-personal pharma sales and marketing; i.e., sales calls done by phone via a call center.

"This year has been my best year ever," said this person. He's been doing this for several years. In fact, his prediction for the future of live sales reps is dire: "they will disappear."

Frankly, I had hoped that my son -- a recent Penn State Smeal College of Business graduate -- would make some connections at the meetup that could help him find a job. He doesn't have any pharmaceutical experience, which is what a young recruiter attendee was looking for. Perhaps my son should become a recruiter -- if you aren't qualified for a job, maybe the next best thing is finding a qualified person.

But we learned of one job that my son IS qualified for: one of those people on the phone at the call center mentioned above. It turns out that this is a low-paying, entry-level job paying about $20 per hour. You don't have to be a nurse or former pharma sales rep. In fact, such people are over qualified for this sort of non-personal sales and marketing.

Just like young, entry-level commercial airline pilots bunk together in small apartment nearby airport hubs, young call center employees relocate near the call center and share low-rent apartments. Sounds like Penn State to me!

What advice should I give my son? Should he apply for a job at the call center?

Meet “Ceyockey,” an Astrazeneca Pharma Wikipedian

The most visible and most accessed example of crowd-sourced “creative commons” information is Wikipedia where “wikipedians” – i.e., people who write and edit the pages for Wikipedia – create drug information pages such as the one about rosuvastatin (“marketed by AstraZeneca as Crestor”).

“Nearly 75% of US physicians going online for professional purposes are visiting Wikipedia for medical information according to Manhattan Research,” says Eileen O'Brien, Director, Search & Innovation at Siren Interactive. “And 36% of US consumers searched for health info on Wikipedia according to Rodale's DTC Study. This is because Wikipedia dominates the search results for health. As Wikipedia plays such a key role, I think it's essential that pharma help to provide accurate information.” O'Brien made her comment in response to the this survey: Should Pharma Edit Wikipedia Articles? You can take the survey here -- afterward you will be able to see a summary of the results to date.

There may in fact be several “wikipedians” responsible for a single page of drug information on Wikipedia. The rosuvastatin page, for example, was edited by over 175 people as of 21 July 2012. The top three “editors” were:
  1. “Ceyockey” (who made 35 edits),
  2. “Jfdwolff” (who made 29 edits), and
  3. “MALvis” (who made 23 edits).
The person who is number 4 on the list with 15 edits is "anon."

Who are these “wikipedians” and what credentials do they have as credible sources of drug information? We may never know who "anon" is, but we have some information about identified contributors.

“Jfdwolff” is a a "Dutch doctor living and working in the United Kingdom." “MALvis” is a US physician, "specializing in preventive, non-invasive and invasive cardiology and internal medicine in San Antonio." Both seem to be well-qualified to write about rosuvastatin, but their Wikipedia profiles tell us nothing about possible conflicts of interest (COI).

“Ceyockey,”  however, does have a COI. He is Courtland Yockey, an “informatics scientist” who lives in Delaware and works for a “top-10 multi-national pharmaceutical company,” according to his profile on Wikipedia.

Yockey has nothing to hide. You can find his Wikipedia profile here,  his LinkedIn page here, his Twitter account  here, and his Facebook page here.

According to his LinkedIn page, the pharmaceutical company that Yockey works for is Astrazeneca, which markets rosuvastatin as CRESTOR.

“I believe that my editing of Wikipedia is generally beneficial,” says Yockey in his Wikipedia profile, “and I have no regrets or concerns about anything that I have or will create or revise here, which is why I am willing to provide my real name.”

Whether or not it is “beneficial” for individual pharma company employees such as Yockey to be editing Wikipedia information about their own company’s products is difficult to know for certain. Transparency, however, is crucial for judging credibility of drug information on Wikipedia. Yockey addressed transparency head on in a straight-forward fashion, although he failed to state unambiguously  in his Wikipedia profile that he works for “Astrazeneca.”

Did Astrazeneca empower Yockey or give him permission to edit Wikipedia pages about AZ drugs? That is, is Yockey an "official" Wikipedia spokesperson appointed by Astrazeneca to perform all Wikipedia article edits on behalf of the company? I doubt it. Yockey's profile specifies that he works on edits from home.

Official pharma employee Wikipedia editors and related issues were discussed during a recent Pharma Marketing Talk podcast titled “Pharma Wikipedians: The Pros and Cons of Pharma Employees Editing Wikipedia Articles” (listen here).

It's possible to determine the exact edits Yockey has made to the Wikipedia rosuvastatin page, but I do not have the time or resources to find that needle in a haystack of thousands of edits Yockey has made to Wikipedia articles over the years. Wikipedia is not user-friendly enough to allow ordinary citizens to ferret out that kind of information, IMHO. For all I know, Yockey could have written or edited the section titled "Debate and criticisms."

Another problem with Wikipedia drug information pages is that they are not consumer-friendly -- i.e., not written at a level that is understandable by non-physicians. The Wikipedia rosuvastatin page, for example, says "as with all statins, there is a concern of rhabdomyolysis, a severe undesired side effect." Unfortunately, the article does not explain what rhabdomyolysis is in layperson terms.