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

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" Januvia - marketed by Merck Onglyza - marketed by Bristol-Myers Squibb/Astrazeneca 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.

Paula Deen and Other Proof that Monetary Rewards Improve Adherence

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?
	Brilliant!
	Dumb!
	It remains to be seen.

Paula Deen Loses 30 lbs. Urges Twitter Fans to Pig Out on Fourth of July!

Paula Deen Loses 30 lbs. Urges Twitter Fans to Pig Out on Fourth of July!

Whilst on the supermarket checkout line, I noticed the cover of the latest, July 9, 2012, People Magazine that featured Paula Deen (see image below). "How I Lost 30 Lbs!" was the headline. Under the banner announcing PAULA'S GET-SLIM RECIPES, the magazine invites us to learn her "secrets": "After diabetes diagnosis, the southern chef finally changed her lifestyle and her pants style. Her secrets will surprise you!"

Deen is really looking good and I cannot wait to discover her "secrets." But, first, I should note that Deen lost those 30 lbs not immediately after she was diagnosed with diabetes over three years ago, but after she signed on with Novo Nordisk to be their diabetes/Victoza spokesperson (see "Paula Deen & Victoza: Brilliant or Dumb?").

Since then Deen and her sons have been creating recipes for "Diabetes Light," a Victoza-branded web site that features "Recipes from Paula with a Dash of Inspiration" (here).

BTW, Novo should get a more recent photo of Deen than the one it currently uses on the "Diabetes Light" website (shown on right). The current one shows a much heavier-looking Deen prior to her recent weight loss.

I wish Deen luck in keeping her weight loss. I know from personal experience that you can lose 25-30 lbs if you change your diet, but quickly gain it back once you regress to your old ways of eating.

Anyway, Paula's "secrets" include these changes in the way she says she eats:

• Fried chicken reduction. Deen says she eats fried chicken only once a month.
• No key lime pie. She says, “You couldn’t pay me to eat that pie.”
• Potato reduction. She has not cut out eating potatoes, but she has cut down on eating them.
• Eating vegetable from her own garden and creating healthy recipes.
• Butter reduction. She has cut her butter consumption in half.
• Eating Greek salads and baked fish.

Meanwhile, however, Deen has been promoting quite a different menu to her 786,000 Twitter followers:

Are y’all ready for Independence Day? Make sure you fix up one of these recipes for the big day! http://ow.ly/bULkY http://ow.ly/i/JuXN

One look at these carbohydrate-rich recipes on PaulaDeen.com and you understand why Novo is not sponsoring Deen's Twitter account:

• Sausage and Potato Salad
• Chilled Grilled Corn and Watermelon Salad
• Lemonade
• Curry Chicken Salad
• Oven Fried Potato Wedges
• Cheesiest Fried Chicken Empanadas with Chili Con Queso Dip
• Bacon Wrapped Grilled Corn on the Cob
• Watermelon Cooler

I suppose I can eat just one Cheesiest Fried Chicken Empanada with a touch of Chili Con Queso Dip, but how am I supposed to eat just a bit of Bacon Wrapped Grilled Corn on the Cob, which calls for 1 Lb of bacon for 8 ears of corn? That's 2 oz. of bacon (300 calories) per cob, not counting the butter I would likely spread on it!

Pharma Celebrity Multiple Personality Disorder (PCMPD)
In my opinion, this demonstrates what I'd like to call "Pharma Multiple Personality Disorder (PCMPD)" where a celebrity promotes one lifestyle under contract with a pharmaceutical company and then promotes the opposite for other business purposes (eg, as a Food Channel chef).

[Thanks to @Paullikeme from patientslike.com for suggesting MPD -- and not Schizophrenia, as I originally suggested -- as the correct DSM-IV diagnosis.]

The fact that Deen has lost 30 lbs is good news for Novo, which received a lot of criticism for its choice of Deen as a diabetes spokesperson. To date, my little poll (below) suggests that a plurality (if 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?
	Brilliant!
	Dumb!
	It remains to be seen.

Meanwhile, I invite you to listen to this conversation with Ambre Morley, Associate Director, Product Communications, Novo Nordisk, about why her company teamed up with celebrity chef Paula Deen as a spokesperson for type 2 diabetes treatment:

Listen to internet radio with Pharmaguy on Blog Talk Radio

Is Deen Positioning Herself as a Potential CHANTIX Spokesperson?
I just picked up a copy of People magazine and learned that "Paula's Next Challenge: [is] Quitting Smoking." She says she "thinks about quitting every day...My husband has quit for over a year now. Maybe one day I'll be ready. I pray that I will," said Deen.

If past experience is any guide, Deen will be "ready to quit" as soon as she closes a deal with Pfizer to be its CHANTIX celebrity spokesperson!

Type 2 Diabetes in Obese Children Proves Difficult to Treat with Drugs Alone

Type 2 Diabetes in Obese Children Proves Difficult to Treat with Drugs Alone

Metformin, "the only pill approved in the U.S. for treatment of children with type 2 diabetes is proving surprisingly ineffective, according to a new study, heightening worries about the fast-growing and largely preventable disease," reports the Wall Street Journal (see here).

The study also included GSK's Avnadia, which is not approved for use in children and has been linked to an increase of heart attacks, curtailing its use in treatment.

699 children between 10 and 17 years old, essentially all of whom were obese and who had been diagnosed with type 2 diabetes for an average of eight months were randomly assigned to one of three treatments: metformin, the mainstay diabetes medicine; metformin plus a lifestyle-intervention program; or metformin plus Avandia.

52% of those on metformin alone had failed, compared with 47% on metformin plus lifestyle change and 39% on the two-drug regimen. Statistically, only the two-drug treatment was considered superior to metformin.

The results prompted other experts to renew calls for societal efforts to combat diabetes and obesity among young people. Here is a chart showing the prevalence of obesity among young people in the U.S.:

Coincidentally (or maybe not), the National Institutes of Health (NIH) sent out a press release today announcing "The Weight of the Nation" documentary series and public awareness campaign focused on obesity in the U.S. HBO, in association with the Institute of Medicine, NIH and the Centers for Disease Control and Prevention, and in partnership with the Michael & Susan Dell Foundation and Kaiser Permanente Foundation, developed four documentaries focused on obesity. The project also includes a three-part HBO Family series for kids, 12 short features, a social media campaign, and a nationwide community-based campaign to mobilize action to move the country to a healthier weight. See the press release here.

Novo Nordisk is Back on Pinterest with Patient Stories

Novo Nordisk is Back on Pinterest with Patient Stories

Novo Nordisk is back on Pinterest! Recall that Novo "de-pinned" all its images a few days after I first discovered them on Pinterest (see "Pharma Pinterest Update: Bayer US Pins, Novo Nordisk Depins!"). Novo now has 3 "boards" and 15 images on the site.

The most interesting "board" is the one devoted to "Patient Stories." The images pinned to this board link to videos that feature narratives spoken by real patients who suffer from various forms of diabetes. Here are the images:

NOTE: Novo is smart to use videos that are viewable on iPhones and iPads. In a previous post I noted that Janssen Uses Digital Storytelling, Animation to "Bring Prescription Medicine Labeling to Life." But Not iPhone or iPad Life!

This, I believe, is a very good use of Pinterest by a pharmaceutical company and I expect others to follow Novo's lead. I am sure, however, that everyone is waiting to see what mischief will befall Novo. So to hurry this process along, I did two things:

• I reported one pin to Pinterest and "complained" that it lead to a "drug site."
• I added a comment to another pin asking Novo if the patient was paid to participate in the video.

I'm a trouble-maker, I know. But someone has to test pharma's use of Pinterest. Let's see if they pass the Pharmaguy Stress Test.

Currently, there is a lot of worry about spammers using Pinterest. Spam pins, for example, link to pages that only contain Google Adwords. Pinterest is trying to deal with this, but many people, like myself are becoming victims of their over zealousness.

Every one of my pins that has a link in the comment section is "blocked" by Pinterest when users click on the link. Pinterest says that the pin has been "reported" as being spam or leading to "objectionable content." All the links are to this blog.

I doubt that Pinterest has bothered to investigate "reports" to determine if they are legitimate or not. They are simply "blocking first and asking questions later." Actually, Pinterest doesn't even tell you that you are being blocked and they certainly haven't asked me any questions about whether or not I am a spammer.

So, I am testing Pinterest by reporting one of Novo's pins.

As I mentioned in the previous post cited above, comments are Pinterest's Achilles heel as far as pharma companies are concerned. It's as easy to make comments on Pinterest as it is on Facebook. We have seen how pharma has run away from Facebook because comments cannot be turned off. Will the same happen with Pinterest?

Meanwhile, you might be interested in taking the following survey. Afterward. you'll be able to view a de-identified summary of results:

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

New Victoza Prescriptions Flatten After Novo Signs Deal with Paula Deen

New Victoza Prescriptions Flatten After Novo Signs Deal with Paula Deen

New prescriptions written per month for Victoza -- diabetes treatment sold by Novo Nordisk -- have leveled off just after Novo signed on celebrity chef Paula Deen as a spokesperson. Prescriptions for the drug were rising steadily for a year and a half prior to that.

The two events may be coincidental (and the flattening may be temporary), but interesting nevertheless because it puts a hole in the theory that the return on celebrity endorsements of pharma products is worth the investment.

The Victoza Rx data comes from a chart I found in the petition filed by Public Citizen with the FDA that asked the agency to withdraw Victoza because of increased risks that patients may developed pancreatitis, serious allergic reactions and kidney failure (find the petition here).

The chart shows a plot of "Number of Prescriptions" of Victoza (liraglutide) versus Byetta (exenatide), a competing drug marketed by Amylin (see below):

It appears that the number of (new) prescriptions written per month has leveled off at about 150,000 -- a number that has not increased since about January 2012 when Novo announced that Deen would be a spokesperson (see "My Bad! Paula Dean Shills for Novo Nordisk, Not Novartis").

In its petition, Public Citizen states "As can be seen by subsequent FDA safety alerts issued for acute pancreatitis, thyroid toxicity, and kidney failure over liraglutide’s first year and a half of marketing, warnings have not succeeded in preventing serious adverse reactions. This is especially unfortunate because diabetics are already at increased risk for pancreatic and kidney toxicity. ... The number of prescriptions for liraglutide has been steadily rising, putting increasing numbers of patients at risk of adverse reactions to this drug. The increase in adverse reactions is seen in the continuing reports in the FDA’s database, making it clear that the FDA’s use of warnings is not sufficient protection."

Public Citizen, however, does not report that based on post-marketing data, BYETTA has also been "associated with acute pancreatitis, including fatal and non-fatal hemorrhagic or necrotizing pancreatitis" according to the safety information that is part of its "package insert."

A couple of questions:

1. Will this new focus on Victoza safety information scare Paula Deen? 
2. Can she discontinue taking Victoza if she felt it was necessary or would her contract with Novo prevent her from doing that (she does take other medications to control her diabetes)?

Paula Deen Does Not Know Her Blood Sugar Numbers

Paula Deen Does Not Know Her Blood Sugar Numbers

Paula Deen, the TV celebrity southern-style chef and spokesperson for Novo Nordisk's diabetes treatment Victoza (see "Novo Nordisk Defends Choice of Paula Deen Over Anthony Bourdain (for example) as Celebrity Chef Spokesperson"), recounted for Prevention Magazine how she learned she had type 2 diabetes. Deen is featured on the cover of the May 2012 issue of Prevention (see cover on left).

When asked "How high was that blood sugar reading?" during a routine doctor visit more than 3 years ago, Deen said "I don't know. They just said it was high." Then her doctor said, "I'm going to start you on some medicine," and wham, bam, thank y'all ma'am, Deen started her secret life as a diabetic.

Furthermore, Deen does not remember her doctor saying anything about lifestyle changes. "Now, she might have," said Deen diplomatically, "but I don't recall coming out of that visit with a lot of literature. She just started me on the drug."

It's hard to believe any doctor worthy of treating a wealthy celebrity would not have given her a bit more education regarding living with diabetes. One important bit of education is "Know Your Blood Sugar Levels." That's the title of a National Institutes of Health National Diabetes Education Program pamphlet (see here). "If you have diabetes," says NIH, "keeping your blood glucose (sugar) numbers in your target range can help you feel good today and stay healthy in the future."

After Novo Nordisk approached her to be a spokesperson, Deen "asked the doctor if I could switch over from the [combo drug]" to Victoza. Of course, her doctor complied because Deen knows best, although she doesn't know her numbers (or choses not to say what they are). Or perhaps the doctor was also "approached" by Novo Nordisk.

Whatever! Deen is now taking not only Victoza but also metformin and "a small dose of Actos." I'm not an expert on diabetes treatments, but because Deen is on multiple drugs and because she hasn't revealed her initial high blood glucose reading, we will never know if Victoza is really helping her control her diabetes.

Deen has the right to keep her blood glucose levels and other medical information confidential. She also has the right not to reveal how much money Novo Nordisk is paying her. "I am being compensated for my time and work," said Deen.

But should pharmaceutical companies be required to reveal how much they pay celebrity spokespeople just as they are now required to reveal how much they pay physicians (celebrities or otherwise)? If Nike reveals that it paid Tiger Woods $105 million, why shouldn't pharma companies reveal how much they pay celebrities (including Phil Mickelson who is a paid ENBREL spokesperson; see here)? What are they hiding?

BTW, there seems to be a pattern of pharmaceutical celebrity spokespeople defending themselves in consumer magazines like Prevention. Mickelson, for example, "opened up" in an interview published in Arthritis Today (see "Phil Mickelson 'Opens Up" to Arthritis Today Magazine"). 

Of course, these magazines also make a lot of money from drug advertising. In fact, there is a nice 2-page ad spread for Victoza featuring Paula Deen in the same issue of Prevention as her less than "tell all" interview. In the ad, Deen is NOT depicted creating her famous bacon, cheeseburger, Krsipy Creme donut sandwich! (See the video of THAT here).

In a recent survey, I asked respondents to say whether they agreed or disagreed with the following statement: "Each pharmaceutical company should be required by law to publicly disclose how much money it pays every celebrity for being a spokesperson." 38% (N=112) said they "strongly agreed, " another 21% said the "somewhat agreed," and 36% said they strongly or somewhat disagreed.

One pharmaceutical company employee respondent made this comment: "What is the point of all this pharma reporting? If I tell you that Paula Deen is making $10M or $1M, what difference does it make? I'm sure she's making a lot of money. But that is driven by her market worth and the specifics of the contract (length of contract, number of events, etc.). There's no realistic way for the public to understand (or care about) that context. So what is the point?"

Full results of the survey will be published in the upcoming April issue of Pharma Marketing News. Subscribe now to get it free!

Sanofi Launches Diabetapedia: "Google" for Diabetes

Sanofi Launches Diabetapedia: "Google" for Diabetes

Laura Kolodjeski (@lkolodjeski), Community Manager for Sanofi US Diabetes, sent me a Twitter DM this morning announcing the launch of Diabetapedia (di-ah-bee-tah-pee-dee-ah), a new site "to help meet educational needs of diabetes community." According to Laura, the goal is to create "a single, comprehensive place where anyone can find and share definitions of diabetes-related terms and phrases." The site's tag line is "Diabetes doesn't define you... so define diabetes."

The name "Diabetapedia" invokes a comparison to "Wikipedia," the online encyclopedia comprised of user-generated content. Diabetapedia does accept contributions from visitors who can use a form on the site to suggest a new term. To use the site, however, you first search for a term as if you were using Google. In fact, the site's home page has the simple look of a "Google" for diabetes site: a single large box for entering a term located under a large logo:

The results of a search also resemble what you would get with Google. It remains to be seen if Diabetapedia will jazz up it's logo and modify it to celebrate certain holidays the way Google does.

The simplicity of the interface also makes the site easy to access from your mobile phone. However, it is NOT optimized for mobile use (eg, the search results, etc., do not line break to enable you to read the entire definition without scrolling side to side).

Of course, there are guidelines. Terms that are appropriate for inclusion in the site include:

• Terms that directly relate to diabetes (e.g. blood glucose meter)
• Diabetes jargon, slang, or abbreviations (e.g. DOC, d-mom, blue Fridays)
• Twitter hashtags that are specific to diabetes discussions (e.g. #dsma, #sweatbetes, #bgnow)
• Diabetes-focused advocacy groups (e.g. The American Diabetes Association, The Diabetes Hands Foundation)

The most important guideline as far as pharmaceutical companies are concerned is: "do not post terms that are specific to brand names of diabetes management products."

Sanofi previews all suggestions and Sanofi promises to contact users if it requires clarification about submissions.

The site currently comes with 119 common diabetes terms and corresponding definitions. "All of the terms include a general definition from the online version of the Merriam-Webster dictionary (when available), a more specific diabetes-related definition, and any alternate uses of the term that might apply. For some," says Laura in her post introducing Diabetapedia (here), "we even included an example of a tweet or a post that demonstrates how the term is commonly used."

I hope to have Laura as a guest on my Pharma Marketing Talk show and get some more details about the site and how Sanofi hopes it will grow. One question I would ask: "Do you plan to release a Diabetapedia mobile application?"

See the questionnaire at the end of this post where you can suggest improvements for Diabetapedia and ask your own questions for Laura to answer.

P.S. Laura points out that Diabetapedia visitors' "Likes and Tweets" "may help create" a program called Diabetes Advocates run by the Diabetes Hands Foundation (DHF). The purpose, says Laura, is to "connect individuals and small organizations that have taken a leadership role in improving the world for people touched by diabetes. In 2012, Sanofi US Diabetes is proud to sponsor the Diabetes Advocates program to help empower its members to have a greater impact by helping them improve their reach and effectiveness."

A discussion of this post on Twitter:

ddwebster: Little disappointed. All definitions from Merriam-Webster RT @pharmaguy: Sanofi Launches Diabetapedia http://t.co/8R3jjYbf #diabetes #hcmktg8:57am, Apr 02 from Visibli

pharmaguy: @ddwebster All? Including "d-mom"? Whatever, good way to start. #diabetes9:00am, Apr 02 from HootSuite

ddwebster: @pharmaguy Yet to find one w/a comprehensive definition. Even A1c doesn't explain ranges, just says a test performed every 2-3 mos#diabetes9:06am, Apr 02 from TweetDeck

pharmaguy: @ddwebster Admit strange to use defns frm MW instead of National Diabetes Information Clearinghouse http://t.co/HO1IMNSX #diabetes9:13am, Apr 02 from HootSuite

ddwebster: @pharmaguy Agreed! I love the idea of the site-find info to be too generic. Pts need more detail-diabetes is complicated9:21am, Apr 02 from TweetDeck

pharmaguy: @ddwebster This could develop into good resource - what happens, however, when it is no longer sponsored by S-A? #diabetes9:32am, Apr 02 from HootSuite

ddwebster: @pharmaguy Yes, that begs a good question. Impressed by efforts by @SanofiDiabetes@Roche_USA in reaching pts in digital space#diabetes9:53am, Apr 02 from TweetDeck

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Diabetes Opinion Leaders Paid by Roche to Curate Content on New Twitter-based Social Media Site

Diabetes Opinion Leaders Paid by Roche to Curate Content on New Twitter-based Social Media Site

Diabetes Nest, according to its "About" statement, "is a Twitter-based diabetes network designed to help people discover the best conversations from the most meaningful voices. The Nest was created by Ignite Health and sponsored by Roche Diabetes Care, makers of ACCU-CHEK® products and services."

Ignite Health, an InVentiv Health agency, maintains the site. Fabio Gratton, chief experience officer at Ignite Health, said:

"Few argue that social media has transformed how patients and their caregivers share healthcare information and find support. But the sheer volume of content can be overwhelming. 

"So we asked ourselves how we could best help the diabetes community find and engage in the most timely, relevant and important conversations. The result is a simple, intuitive, compelling and ultimately self-sustaining diabetes social media community.” Diabetes Nest aggregates, sorts and ranks tweets from a curated list of diabetes experts" (read more here: "Roche Sponsors Diabetes Nest Twitter-Based Social Media Site").

All five of those "diabetes experts" are long-time patient bloggers who are "compensated for their time, effort and invaluable guidance." Caretakers include:

• Amy Tenderich (Diabetes Mine blogger)
• Gina Capone ("gina - your diabetes BFF" blogger)
• Kerri Sparling ("six until me" blogger)
• George Simmons (co-host of DSMA Live on BlogTalkRadio)
• Scott K. Johnson (co-host of DSMA Live on BlogTalkRadio and blogger at Scott's Diabetes)

Roche "has no control or influence over the content or frequency of the Caretakers' tweets."

Roche Diabetes Care has long been wining and dining diabetes bloggers at yearly "Roche Social Media Summits" held in nice places like resorts in Orlando, Florida. When I learned of the first summit held in 2010, I blogged that "Some Social Media Patient Opinion Leaders Want to be Paid Pharma Professionals." Diabetes Nest is, to my knowledge, the first such time that bloggers have been paid to be "consumer opinion leaders" in a manner similar to how pharma often pays physicians to be "key opinion leaders."

At a patient panel discussion during a 2010 conference, Allison Blass (Patient Blogger, Diabetes Activist, Lemonade Life), said "You need to pay some one's full time salary," referring to the desire of some pharma companies to interact with patients in online communities. "The only way to sustain growth and involvement in a [online] community," said Allison, "is to have someone who actually does it [manage social media interactions with patients] as their job... to become the person who is known and loved by the community."

Not that there is anything wrong with being compensated for your time, but pharmaceutical companies have to be careful how they provide compensation. In the case of Diabetes Nest, Roche probably supplies an "unrestricted grant," which is supposed to specify that the grantor (Roche) has no control over the content created by the grantee. The "grantee" in this case is probably Ignite Health, which owns Diabetes Nest (see NOTE below). Ignite Health is an advertising agency that works with pharmaceutical companies.

NOTE: Doing some WHOIS snooping, I learn that the domain diabetesnest.com is registered to "TWTCLK" and the administrative contact is Fabio Gratton, both located at the same address in San Clemente, CA. 

A pharmaceutical company providing unrestricted grants or other funds to an advertising agency in support of a patient site related to a product line is a bit controversial, IMHO, especially if there intends to be a "Chinese" wall between the funding and advertising interests. This kind of thing got pharma companies into trouble with the likes of Senator Grassley when "unrestricted grants" were provided to ad agencies to run independent accredited CME programs for physicians. ACCME, which accredits CME, now requires that CME providers to be independent of ad agencies to avoid conflicts of interest.

Disclosure: Fabio Gratton is a friend of mine and a very nice guy who deserves a lot of credit for his high quality, ethical work with pharmaceutical clients. He has been a frequent guest on my BlogTalk Radio show (eg, listen to "Facebook Timelines for Brands: The Implications for Pharma Companies"). He is not a client of mine, but he could be in the future. Knowing Fabio, I am sure he would welcome a discussion of "conflict of interest" in pharma-sponsored social media. The timing of this post may be a problem for him as he and his wife are expecting their first child any day. He must be very busy. Any way, I hope some day I get to visit him in San Clemente! 

Pharma Social Media Religion Versus Science

Pharma Social Media Religion Versus Science

My goal in attending conferences like CBI's iPharmaCONNECT, which is currently in progress in Philadelphia, is to come away with at least one new topic worthy of discussion. Thanks to yesterday's session on "What Makes a Health App Effective?" presented by Jim Dayton (@JimDayton), Snr Dir Emerging Media at Intouch Solutions, I have a topic I think worthy: Are we getting too much religion (preaching to the faithful) versus science (useful data) at these conferences?

Dayton was reviewing the story and "success" of GoMeals, the iPhone/iPad/Android app developed by Sanofi Aventis that is intended to help people with diabetes count their calories whether at home or eating out at restaurants. I have reviewed this program in a previous post (read "The iPad as a Pharma Marketing Platform").

One piece of data that Dayton presented was the fact that the GoMeals app has been downloaded about 415,000 times since it was launched in November 2009. Of course, it is widely known that nearly 85% of the people who download apps use them maybe once or twice and then never use them again. I did that with GoMeals. I stopped using it when my favorite local restaurants were not included in the database.

Also, like me, maybe many people downloaded the GoMeals app to multiple devices (eg, iPhones and iPads).

Thus, the number of downloads of an app is NOT a useful KPI (Key Performance Indicator), IMHO.

Dayton did mention that GoMeals enjoyed an abandon rate slightly less than the 80-85% average I mentioned above. But he couldn't (or wouldn't) give the audience any hard data regarding that or practically anything else that might be considered a true KPI.

Dayton, of course, is limited in what he can reveal about his client's product. It's obvious, however, that Sanofi considers GoMeals a success because it has continued to update the program and supports it with a web site and a twitter account. All of this requires a certain commitment of resources. But is this commitment justified by relevant data or just because the faithful believe in the program? Do you justify money spent by science or by religion?

Sanofi obviously collects useful data from GoMeals users. For example, the application includes a survey that asks questions such as:

1. Do you or anyone in your household who uses GoMeals have diabetes?
2. How often do you use GoMeals?

Answers to these critical questions would provide some true KPIs. Unfortunately, we don't know what the answers are unless Sanofi chooses to reveal them.

That lead me to ask an unusual question during the panel session yesterday; namely, why doesn't Sanofi reveal these data? The only answer I got was that GoMeals was considered an important part of the marketing plan and therefore that information was proprietary.

I understand that there is a lot of competition among pharma companies in the Type 2 diabetes arena and a lot of this has to do with diets, meals, and menus rather than the benefits of the drugs being marketed (see "Three Companies Compete for Diabetes Market Share Using Recipes Rather Than Product Efficacy"). If competing on helping diabetics with meal planning is the most important part of your marketing plan, then sure, you got to keep this stuff secret.

But how important are mobile apps in pharma's integrated marketing approach? It's got to be a very small part of the pie in terms of resources. If Sanofi revealed what percent of the GoMeals users actually had diabetes, would that be giving too much away?

Why should pharma companies reveal more hard data that can prove (or disprove) the effectiveness of social media and mobile apps? If the SM and mobile evangelists want to convince us that pharma should be doing more in this area, they need to give us some hard data in support of that. If they hide these data and just report "soft," meaningless numbers, I think they are preaching, not teaching.

Charlie Kimball - Novo's Branded Spokesperson - Makes Expensive TV DTC Debut

Charlie Kimball - Novo's Branded Spokesperson - Makes Expensive TV DTC Debut

Charlie Kimball, the Indy racecar driver spokesperson for Novo Nordisk's NovoLog Flexpen, which is used to treat Type 1 diabetes, made his debut as star of his first direct-to-consumer (DTC) TV ad. Not only does the ad feature Novo's product, it also promotes Kimball's Indy team Chip Ganassi Racing. A win-win!

I saw the commercial on the CBS evening News last night. Kimball did a great job.

I couldn't find a version of the commercial on the Internet, but I DID find a video titled "Charlie Kimball and Novo Nordisk" in which Kimball discusses how the commercial was made. One thing that the video demonstrates is why pharma spends so much money on broadcast (ie, TV) DTC. It's not just the loads of money spent on buying airtime on the major networks. It is also the cost of producing the commercial itself. This is what Kimball discusses in the video (embedded below).

Kimball is amazed by all the people involved such as director, assistant director, key grip, not to mention the production crew's four trucks, two motor homes, and catering trailer. All together, 50 people were involved said Kimball.

In the past, Kimball had only been tweeting (see, for example, "Novo Nordisk's Branded (Levemir) Tweet is Sleazy Twitter Spam!" - the #3 Google search result for "sleazy tweet"!) and making personal appearances, which is more of a PR effort than a marketing effort. My guess is that PR costs much less than marketing and employs fewer people compared to marketing's BIG item productions such as TV ads.

So, thank you Charlie and Novo Nordisk for helping America solve it's unemployment problem!

Paula Deen & Victoza: Brilliant or Dumb?

Paula Deen & Victoza: Brilliant or Dumb?

OK. I've written so much about Novo Nordisk's deal with celebrity chef Paula Deen that even I am tempted to say "Enough already! Move one." Well, there is one side of this story that I and others have not yet commented on. That is, what do Novo's troops (ie, sales reps) have to say about it? Specifically, do they think this deal will help them sell Novo's type 2 diabetes drug Victoza -- the drug Deen is a spokesperson for? Or will it hurt sales?

To get answers to those questions, I turned to the Novo Nordisk company board on Cafe Pharma (CP) - the notorious but always entertaining and enlightening pharma sales rep message board. I learned about some other issues that the "troops" discussed, including:

• Heredity vs. Lifestyle as contributing factor
• Is drug treatment the first option recommended when diagnosed with type 2 diabetes?
• The role of the American Diabetes Association (ADA)
• Will Victoza be prescribed off-label for weight loss?

One anonymous commenter,  had this to say:

"This is either the most brilliant marketing strategy ever or the dumbest."

That, of course, remains to be seen.

It's Dumb!
Interestingly, this commenter added some further remarks that offers intriguing insight into the possible strategy of Novo Nordisk's entire diabetes franchise:

"Just think," said this anonymous sales rep, "Paula and her fat fans go from victoza to levemir to novolog. I give her 1 more year and she is on insulin." Not that this rep thinks this is an honorable strategy for Novo to support. "Novo should do the honorable thing here and cancel this deal. Defeat diabetes my ass. They have just done more to cause diabetes than mcd's [McDonald's]. It is like Marlborough Man being a spokesman for Nicorette. Shameful."

Of course, it's possible that this anonymous rep was a rep from a competing pharmaceutical company and not a Novo rep at all. In any case, other commenters had similar things to say, such as:

"Wow. This is a PR disaster. Who were the brains behind this fiasco? Victoza is taking major hits in the media with the whole world now focused on price ($500 a month!) and questions being raised about drug safety and marketing ethics. Novo just bought itself a few million dollars worth of bad publicity. Time to pull the plug to save face."

It's Brilliant!
There were also plenty of posts in defense of the deal:

"Granted, she is still in denial, but she's on Victoza, she's already lost a dress size since starting and it's a Dean family endorsement. Which is even better because it shows it does take a village to help patients with diabetes treat their disease. This is a horrible disease that is difficult to manage. Everyone is playing into Novo's hands with all the press around diabetes and becoming more aware. Novo couldn't pay for all the ads they've gotten over the past week."

"First of all, this whole flap will be short lived. It wont be long before it's been long forgotten. Secondly, PD's hardcore fans couldn't care less about how long she took to reveal her diabetes. If Paula takes Victoza, guess what those hardcore fans are going to ask their doctors to prescribe for them. And there's millions of them too. Most of the critics are selling Novo's management short. Time holds the answer as to what will happen, but my money is on the whole thing being wildly successful.

"the posters who think its ridiculous are the competitors bc they are mad their idiot companies didnt do this first. Its brilliant. Brilliant bc we all know the success rates with Victoza. Our docs rave about it all the time. Theyre not going to write more lantus bc PD was hired by Novo.

"This is brilliant. Do you think Weight Watchers cared when Barkely supposedly trashed their endorsement by saying it was easy money to eat their meals and lose weight? No, it was good TV. This will be for Novo, too. Welcome to big pharma."

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

Someone else pointed out that drug treatment is not the only solution for people with Type 2 diabetes ("T2DM"):

"It is not a 'horrible disease' – it is a disease of gluttony and sedentary lifestyle. T2DM is reversible with implementing healthier eating habits and adding exercise to your daily routine. The alliance with Paula Deen (spelled D-E-E-N) suggests that people can continue to eat what they want and take a drug to make everything all better. Don’t try and spin this alliance as social responsibility – your intentions are purely economic in nature."

You'll Hear More About Heredity and Type 2 Diabetes
The lifestyle change solution POV will be something that Novo and Deen will have to combat as they get deeper into this. In fact, they have already pinpointed "heredity" as the most important factor. This was re-iterated in a comment in response to the above:

"Heredity? Have you ever heard of that? But, what do doctors know? After all, you're an anonymous CP poster, so you know it must only be about gluttony and a sedentary lifestyle. Pick up a textbook some time...you might actually learn something."

In response:

"When diagnosed with t2dm, what are the first instructions a doctor should give to their patients according to the ADA? The answer: diet and lifestyle changes. Why is that? Is the ADA wrong? Are doctors wrong for following the ADA guidelines? Why even bother with this step if heredity is such a controlling factor? Your message to people with diabetes suggests that they can't help themselves without the aid of your pharmaceuticals."

Will the ADA be Caught Up in This?
I'll have to check up on what the ADA has to say about first options. I already know that ADA is part of the deal because the organization has said the Deen family will participate in select diabetes health expos the ADA hosts around the country. It has also been reported that Deen will contribute some of her Novo earnings to the ADA, although no specific monetary amounts were mentioned.

Is Weight Loss a Possible Future Indication for Victoza?
One last point concerns weight loss and whether or not Paula Deen will help sell Victoza for that purpose. CP comments relating to that include:

"She will drop 40 lbs over the next year or less and "bang" we have an unofficial weight loss drug. (no indication necessary) Frankly I think its brilliant, she is probably under contract to eat healthier and exercise....and write a a cookbook with healthier versions of her food. We should look forward to seeing her at the next national POA. May I suggest identifying and adding the weight loss clinic docs in your area to your universe, otherwise you will not get paid Bad press now...millions of dollars later. Laughing all the way to Denmark."

Of course, if Novo or any Novo sales rep were caught mentioning weight loss as a indication, they would be breaking the law and subject the company to hefty fines, as this commenter pointed out:

"glad to hear all the weight loss drug talk. Can't wait to see Novo pay all those off label promotion fines"

Three Companies Compete for Diabetes Market Share Using Recipes Rather Than Product Efficacy

Three Companies Compete for Diabetes Market Share Using Recipes Rather Than Product Efficacy

Whose recipes will reign supreme?!

My Twitter friend, @serious_skeptic, who has Type 1 diabetes, just tweeted: "why the hell would anyone want a recipe from a DRUG company anyway???" during a conversation we were having about celebrity chef Paula Deen and her new relationship with Novo Nordisk (read this for the background).

From reading comments made by other people with diabetes on influential blogs such as DiabetesMine, I get the impression that most do not think Paula Deen was a smart choice as a pharma-paid diabetes treatment spokesperson. Of course, most of these people may come from the "hoity-toity" northeast and LA region of the country that is, according to Novo Mordisk, not representative of the majority.

"and what is this b.s. NYC/LA bias to which Novo refers? I don't live in either & Deen still disgusts me," says @serious_skeptic.

Getting back to the original question about drug company recipes... Novo's deal with Deen propels the company into crowded territory. At least two or three other major pharmaceutical companies tout "diabetes-friendly" recipes, including Merck, which markets Januvia, and Bristol-Myers Squibb/Astrazeneca, which together market Onglyza. With Novo (which markets Victoza), those were the top three Google search results on "diabetes certified recipe" (at least the top 3 PAID results; it's hard to tell these days what are paid and unpaid search results when using Google!):

What these drugs have in common is that they treat type 2 diabetes, NOT type 1. Instead of competing on the effectiveness of their treatments, these companies are competing based on which one offers the best diets. Novo just trumped the competition on that score by signing on a celebrity chef, which none of the others has done at this point.

The emphasis that these drug companies place on DIET rather than efficacy indicates to me that without the diet, these drugs simply would not work very well or work equally well.

Novo Nordisk Defends Choice of Paula Deen Over Anthony Bourdain (for example) as Celebrity Chef Spokesperson

Novo Nordisk Defends Choice of Paula Deen Over Anthony Bourdain (for example) as Celebrity Chef Spokesperson

Yesterday, I spoke with Ambre Morley, Associate Director, Product Communications, Novo Nordisk, who answered my questions about why her company teamed up with celebrity chef Paula Deen as a spokesperson for type 2 diabetes treatment (listen to podcast of the interview here). In case you don't have time to listen to the whole interview, here are my takeaways regarding why Novo Nordisk chose Deen.

I asked: "Why did Novo Nordisk decide to work with Paula Deen as a spokesperson? Did she or her agents approach you?"

Morley claimed that Novo Nordisk was looking for a celebrity chef they could hire to develop diabetes-friendly menus for people with type 2 diabetes. As one commenter said on the Diabetes Mine Blog: "Surely the drug companies could choose spokesmen who are role models for their community."

Why, for example, did Novo Nordisk choose Paula Deen, noted for her fatty, calorie-rich recipes, versus Mario Batali or Anthony Bourdain, both of whom are celebrity chefs with shows on TV (although not necessarily better "role models")?

"We wanted to take really good recipes and change them -- have them certified by dietitians. That's how it started. We then started to look for chefs that could help us promote this campaign. Honestly, Paula Deen popped into my head," said Morley. "How cool would it be," said Morley, "to challenge Paula to change some of her famously tasty, and butter-rich, and really unhealthy recipes?" Probably not much of a challenge if you throw her sons -- Bobbly and Jamie -- into the deal. The sons have broken with their mama and have their own Food Channel show titled "Not My Mamma's Meals." Paula tries to promote her sons every chance she gets. On the Today Show, for example, she tried to do it at the end of the interview but Al Roker cut her off (see it here). No biggie! Her sons are part of the deal with Novo Nordisk.

So, Morley et al called Deen; Deen did not call Novo Nordisk. Morley said that she had "no idea" that Deen had diabetes (she has people who can validate this story, she said), which I suppose is possible considering how secretive Deen was for three years about her condition while all the time promoting her "unhealthy" recipes.

Chef Anthony Bourdain, who has never been a fan of Ms. Deen‘s, told Eater.com: “When your signature dish is hamburger in between a doughnut, and you’ve been cheerfully selling this stuff knowing all along that you’ve got Type 2 diabetes ... it’s in bad taste, if nothing else” (see here).

Aside from getting a package deal with Deen and her sons, why else did Novo Nordisk choose her as a spokesperson?

Morley did not want to choose a chef based in food-snobby New York or Los Angeles, which are the haunts of Bourdain and Batali. "I can't say that a chef in New York -- even a chef with diabetes -- who has a hoity-toity fancy restaurant would have the same impact on people as Paula Deen would. It came down to: Who would the greatest number of people look at and say that person was like me?"

Regarding the incidence of type 2 diabetes, Morley went on to say that "there's a huge difference between New York and LA and the rest of the country." Reality in the northeastern part of the country is different than in the South, for example. "In the Southeast and in Middle America," said Morley, "when people are diagnosed with diabetes, they don't run out and shout and tell the world that they have it," said Morley. True that! But most people down South also are not TV celebrities and role models for millions of people. I have to agree with Bourdain. Deen exhibited "bad taste" (I would say "deception") by keeping her diabetes secret while hawking "unhealthy" recipes to millions.

Morley claims that a lot of criticism of Deen is unfounded and she implied that the criticism demonstrated a NY-LA bias and that other celebrities would not be subject to the same kind of personal attacks endured by Deen. I would have to disagree, because I for one have often criticized the use of celebrities by pharmaceutical companies. See, for example, my posts about Phil Mickelson (eg, "Amgen Blows Its Marketing Budget on Phil Mickelson Campaign").

My Bad! Paula Dean Shills for Novo Nordisk, Not Novartis

My Bad! Paula Dean Shills for Novo Nordisk, Not Novartis

[Alternative title for this post: "Paula Deen and Diabetes Prevention: A Recipe for Disaster!"]

Last week I reported on a story that celebrity southern-style chef Paula Deen has type 2 diabetes and that she is a spokesperson for Novartis's diabetes franchise (see "Sanofi vs Novartis: Paul Sorvino vs. Paula Deen").

It turns out that the source of this information confused Novartis with Novo Nordisk, another pharmaceutical company famous for using celebs to shill for its diabetes treatments (see, for example, "Novo Nordisk's Branded (Levemir) Tweet is Sleazy Twitter Spam!").

"The rumors that Novartis has signed a multi-million dollar spokesperson deal with Paula Deen for a diabetes treatment are not true," a Novartis rep told CBSNews.com. "Novartis is not working with Ms. Deen."

It's official! Deen is now shilling for Novo Nordisk (see "Paula Deen Now Novo Nordisk Diabetes Paid Spokesperson" and Novo's press release). Yes, she's being paid for her new role with the drugmaker, Deen says. "Talking about money is garish. It's tacky. But, of course, I'm been compensated for my time. That's the way our world works."

Ha! Ha! Talking about money is "garish"! That's rich! Only people with lots of money can say that! Senator Grassley should investigate the money that pharmaceutical companies pay celebrities such as Paula Deen and push to have these payments made public just like pharma payments to physicians must be made public.

Deen uses Novo Nordisk's Victoza, a once-daily, non-insulin injection that may improve blood sugar levels in adults with type 2 diabetes when used along with diet and exercise. [my emphasis]

It appears that Deen will NOT change her lifestyle -- ie, eating habits -- much to encourage PREVENTION of type 2 diabetes.

"Type 2 diabetes is like 'Russian roulette' when it comes to whom it's going to strike, Deen says. 'It's about heredity. It's about age, lifestyle, race. I'm the only one in my family who has it. My grandmother cooked and ate like I ate, and she didn't have it.'

"Deen says she's not going to change the focus of her cooking shows because of diabetes. 'I suspect I'll stick to my roots but will say a little louder, Eat this in moderation.'"

Eat this Paula Deen donut-bacon-hamburger sandwich in "moderation:"



Novo Nordisk appears to be abandoning life style changes it has supported in the past or maybe it's just exhibiting a form of PR-Marketing schizophrenia.

Just this past November on World Diabetes Day, for example, the company issued a press release in which it announced that it was a partner in the World Diabetes Day campaign and that it "has planned or co-sponsored a variety of activities throughout the world...[all of which] are focused on increasing awareness and improving knowledge of diabetes and its prevention" (see "Dramatic increase in diabetes prevalence calls for action").

The two activities just do not fit together! The first (sponsoring World Diabetes Day) is a matter of public relations and the second (Paula Deen) is marketing's turf -- never the twain shall meet.

Novo and Paula have launched a new Website whose very name hints at the new emphasis: "Diabetes in a new light!™" (www.diabetesinanewlight.com/). Apparently, Novo Nordisk is more interested in helping people live with type 2 diabetes by treating it than it is in helping 26 million Americans prevent it.

IMHO, this shows that pharmaceutical companies are not very trustworthy when it comes to their public stance on disease prevention.

Sanofi vs Novartis: Paul Sorvino vs. Paula Deen

Sanofi vs Novartis: Paul Sorvino vs. Paula Deen

It is rumored that celebrity southern-style chef Paula Deen will soon announce that she has diabetes (surprise) and that she is a spokesperson for Novartis's diabetes franchise (see "Rumors Say Paula Deen Has Diabetes, Will Work for Novartis"). She will compete with Paul Sorvino and daughter who are currently the diabetes spokespeople for Sanofi (see "Diabetes Costars").

How Novartis plans to position Deen as a spokesperson for diabetes awareness should really be interesting. She's not much of a proponent for healthy lifestyle changes, which PhRMA recommends should be part of every direct-to-consumer advertising campaign.

According to the article cited above, "Deen has faced withering criticism for the high amounts of fat, salt and sugar in her dishes. When Deen’s cookbook for kids, 'Lunch-Box Set,' was published in 2009, Barbara Walters asked her, 'You tell kids to have cheesecake for breakfast. You tell them to have chocolate cake and meatloaf for lunch. And french fries. Doesn’t it bother you that you’re adding to this?'"

In 2009, I took a road trip down south with my son (see photos here). A highlight was when we had lunch  at "The Lady & Sons" — the restaurant Deen owns in Savannah, Ga. We ate the "fried chicken, ribs, cheesy meatloaf and sweet potatoes" for which the restaurant is famous. Here's the scene that day outside the restaurant (TIP: you may not have to wait for a table if you are willing to eat upstairs in the bar; of course, you have to be thin enough to fit on the stools, which may not work for most of these people waiting on line):

While it's a good idea to have an overweight person as a diabetes spokesperson, it's quite another to have an UNAPOLOGETIC overweight person who recommends cheesecake for kids' breakfasts! It's sort of like having a "vulture capitalist" claim he creates jobs!


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UPDATE:
"The rumors that Novartis has signed a multi-million dollar spokesperson deal with Paula Deen for a diabetes treatment are not true," a Novartis rep told CBSNews.com. "Novartis is not working with Ms. Deen."  See "Novartis rep: There's no deal with Paula Deen."
**********

[See "My Bad! Paula Dean Shills for Novo Nordisk, Not Novartis" for a followup to this post.]