Up Yours, Rush Limbaugh, Say Women Lawmakers!

In Virginia, state Senator Janet Howell reacted to a bill that requires women to get an ultrasound before an abortion with an amendment requiring doctors to perform a rectal exam and stress test before prescribing impotence pills.

I'm pretty sure Rush Limbaugh would not like to have a rectal exam every time he went in to refill his Viagra prescription!

Peter O’Toole, a Pfizer spokesman, said by phone that the company doesn’t comment on specific legislation.



HT: Pharmalot ("Want Viagra? See A Sex Therapist And Notary First!")

Also see "Women Lawmakers Turn the Tables on Men Who Take Viagra".

Viagra Website Goes Dark!

No, Viagra.com hasn't been the target of "distributed denial of service" attacks by "unknown hackers," nor has Amazon pulled the site from its servers following political pressure from Senator Joe Lieberman, who chairs the Senate Homeland Security Committee. And Lieberman did NOT call for organizations hosting Viagra.com to terminate their relationship with the website.

All that's not likely to happen because here in America we value the freedom of information and believe the first amendment applies to corporate speech as well as to individual speech.

But Viagra.com has moved to the dark side and has become the first Rx drug site to use a black background, as far as I am aware (see screen shot below).

Several weeks ago, I noticed a similarly dark Viagra print ad in a magazine (see "Be a Macho Man! Ask Your Doctor for Viagra!"). The Viagra.com web site continues the "macho" theme as well.

Man, I'd love to be like one of these guys! Own a private plane and even know enough to work on its engine as well as not panic when my OLD car's water temperature gauge goes into the red zone while I'm driving  through the desert! Who knew such guys had ED (erectile dysfunction)?

ED guys don't have to ask mechanics for help on the road, but they DO have to ask their physicians for help getting an erection (ie, a prescription for Viagra). That's the best advice Viagra.com can offer!

P.S. Delving a bit deeper into the Viagra.com Web site, I find that "ED is More Common Than You Think" in the "Common Questions" section. There, Pfizer claims that "MORE THAN HALF OF MEN OVER 40 HAVE SOME DEGREE OF ED." I've often taken issue with this statement, so I researched the source that Pfizer cites for this: The Massachusetts Aging Men Study, which found that 52% of respondents claimed they had some degree of ED. Another analysis of this study concluded "Men who worked in blue-collar occupations were one and a half times more likely to develop ED compared to men in white-collar occupations" (see here). So why aren't blue-collar men depicted in Viagra ads instead of professional-looking guys and guys who own their own private planes? I doubt many blue-collar types are able to afford their own private airplane these days. What kind of world does Pfizer think we live in????

Be a Macho Man! Ask Your Doctor for Viagra!

I came across this Viagra print ad in this week's Time magazine.

"You may be a man of FEW WORDS," proclaims the large headline of the ad, "but you know when to make them count. When there's something worth saying, you say it."

I will try and be a man of few words as I critique this ad; you tell me if they are worth anything.

This ad is a bit unusual in several respects, the most important of which is that it is "dark." The ad's dominant color scheme is black and dark green, which is more reminiscent of ads I've seen for men's deodorants in Playboy magazine, which I read for the interviews.

The ad also prominently features an African-American male. I suppose not enough men of color are speaking up and asking their doctors about Viagra.

It's a fact that a higher proportion of blacks in the U.S. -- but NOT worldwide --  have high blood pressure than whiles (41% of blacks have high blood pressure, as compared to 27% of whites; see here). One complication of high blood pressure is erectile dysfunction. The connection between high blood pressure and ED used to be the focus of ED awareness ads way back when certain lawmakers were critical of daytime DTC ads in the category (see "Deconstructing Frist on DTC"). I guess that wasn't enough to convince blacks to be a "man" and ask their doctors about Viagra. A more dramatic appeal to "machismo" such as in this ad seems necessary.

To keep this to as few words as possible, I will not talk about how often I have noticed that the men in many of these erectile dysfunction ads seem a lot younger than warranted by the incidence of ED in men under 40 (in the UK, Lilly targets men OVER 40 in its "40over40 ED Awareness Campaign"). Pfizer covers its ass on  this point by using these few words: "so, if you're like millions of men who have some degree of erectile dysfunction..." [my emphasis].

Here's something worth saying: what man among us has NOT had some degree of ED at one time or another (see, for example, "You Must Score Better than 84% on Viagra's Sexual Health Quiz to NOT Have Signs of ED")? We can ALL relate to that and also to the closing machismo statement, just before the VIAGRA logo:  "THIS IS THE AGE OF TAKING ACTION."

At the beginning of the "fair balance" portion of the ad -- the part that contains MANY words -- Pfizer qualifies the "age of action" call to action by saying that "with every age comes responsibility." This is another machismo axiom. "Dude," Pfizer seems to say, "you are responsible for your actions. If you suffer any of the following side effects, that's your responsibility. We warned you!"

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

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

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

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

What concerns the FDA about these products? FDA states:

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

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

Nope.

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

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

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

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

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

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

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

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

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

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

A Snarky Look at Sneaky Marketing Tactics Pharma Hasn't Avoided

My friend Jonathan Richman (@jonmrich) often sees the pharma marketing glass half full, whereas I often see it half empty. It's just the way we are wired. The goal, however, is the same -- improve pharma marketing.

Jonathan likes lists. In a recent article entitled "10 sneaky marketing tactics you need to avoid" published on iMedia Connection, Jonathan lists some dubious marketing tactics that companies should avoid. After just a cursory reading of his list, it is obvious to me that pharmaceutical marketers have not been very good at avoiding most of these and other sneaky tactics.

#1 Sneaky Tactic Pharma Has Not Avoided: "AstroTurfing"

"Simply put," says Richman, "AstroTurfing is when a company or group creates a campaign designed to look like a grassroots consumer movement when, in fact, it's completely artificial."

Some time ago, I pointed out one instance of "astroturfing" in the pharma realm: the RLS Foundation. The Restless Leg Syndrome (RLS) Foundation -- a US patient organization -- has very close ties to GSK -- a UK-based company that markets ReQuip for treatment of (RLS). In fact, I believe that the RLS Foundation was established by GSK. Here are some interesting factoids that support my thesis (see "Restless Pharma Marketing", for more details):

• GSK is a Gold Corporate Sponsor of the RLS Foundation, which means GSK has given the foundation a good chunk of change;
• at least one member of the Foundation's Medical Advisory Board has financial ties to a pharmaceutical company (GSK) with a treatment for RLS;
• the PR activity of the organization seems to have picked up right when that company's drug (ReQuip) hit the market;
• the first RLS Foundation Science Award went to Ronald L. Krall, MD, Senior VP of Worldwide Development at GSK;
• Dr. Richard Allen, a member of the RLS Foundation's Medical Advisory Board, had the "pleasure" of "collaborating" with GSK to do studies supporting the data on the prevalence of RLS in the US and in Europe;
• the color scheme of the RLS Foundation's Web site matches that of the Requip product site.

#2 Sneaky Tactic Pharma Has Not Avoided: Spam and violation of privacy rights

Jonathan calls this "Lucky guess (aka, we were 'smart' enough to acquire your email address, so we're sending you stuff)." This falls under the heading of contacting someone without their permission. This actually happened to me when I participated in a focus group for erectile dysfunction. I received a phone call from the agency doing the research because I requested information from the Levitra Web site -- I did not give my phone number, but gave my address so they could send me the information. The researchers were "smart enough" to obtain my phone number from my address and bingo! "Lucky guess!" Read all about my experience in the Pharma Marketing Blog post "Market Research: Privacy Matters."

#3 Sneaky Tactic Pharma Has Not Avoided: Anonymous tidying (aka, we fix what we don't like and hope you don't find out)"

"If you try to cover up your identity online, people will find out. Always," says Richman.

Oh boy! Where to start here? You can find some good examples of this sneaky tactic in my "Web 2.0 Pharma Marketing Tricks for Dummies" (click here and use code 'free68' to get it FREE). In there you'll find out how pharma marketers or their agents pose as consumers on social networks, alter Wikipedia entries about drug information, and lots more sneaky stuff.

#4 Sneaky Tactic Pharma Has Not Avoided: A little off the top (aka, we reject reality and substitute our own stylized version)

Pharma marketers routinely do this by overestimating the number of people who MAY have the medical condition that the drug is approved to treat. Sometimes, it is claimed, pharma marketers create diseases where none really exists. This is called "disease mongering." You can read about that in this Pharma Marketing News article: "Disease Mongering: When Is the Line Crossed?" I also have documented this "sneaky tactic" a number of times here on Pharma Marketing Blog. See, for example, "40over40: Lilly's DTC ED Awareness Campaign in the UK" and, more recently, "Danica Patrick: NASCAR Driver, Super Model, Superbowl Lingerie Ad Model, & COPD Spokesperson All Rolled Into one!"

I am not going to address the remaining 6 "sneaky tactics" on Richman's list; I need to take my morning shower, especially after revisiting all these sneaky tactics. Some of the tactics probably don't apply to pharma because they are used to promote consumer products in ways that pharma has not yet mastered. Or it is impossible to know if these tactics have actually been employed. Also, there are many other "sneaky tactics" that Richman doesn't mention, but which are employed by pharma marketers (see "Dummies").