Can You Read This "Fair Balance" on Race With Insulin Twitter Page, or Is It Just Me Having Problems?

The "Race with Insulin" branded Twitter account is old news (listen to this podcast "Novo Nordisk's Race With Insulin Campaign: It's Not Just About Twitter").

Celebrity racecar driver and Levemir spokesperson Charlie Kimball is still posting interesting and informative tweets such as "Heading to bed. Just used my Levemir® FlexPen®. For Levemir® (insulin detemir [rDNA origin]) prescribing Info: http://tinyurl.com/28dp52d" and Novo Nordisk is making the rounds at industry conferences describing how they were able to do this while staying within FDA regulatory boundaries.

I am not going to complain about "sleazy spam tweets" and wonder what value such tweets are to patients. Instead, I'd like to point out how UNREADBALE the "fair balance" (safety) information is on the Race With Insulin Twitter page, which you can find here. I've reproduced that part of the page on the left. 

I challenge you to read this either using this image or viewing the original statement on the Race With Insulin Twitter page. It's impossible!


Novo Nordisk should realize that many people with diabetes are older and may have vision problems made worse by diabetes. For the sake of these patients, shouldn't Novo make this safety information more readable?


I also think the FDA should take an interest in this and issue Novo Nordisk a "warning letter" as it has done in other cases where fair balance information is not as prominent as benefit information.


To be fair, however, the Twitter page shows no "benefit" statements at all! It just mentions the medical condition and the brand name. Technically, therefore, while the safety information is required by the FDA, it's probably OK with the FDA that it is unreadable because there is no benefit statements to compare it with. What a dilemma!


This is a case where the pharma company should go beyond what is merely required by the regulators and provide a useful service to the patients who are using their products. What do you think?

Aged Female "Ka-Boomers" Shun Social Media, Favor Email

A recent "She Says" survey, conducted by Pink Tank, a division of GSW Worldwide specializing in women and health, and Meredith Research Solutions, has been cited to show that "women are highly cynical about pharmaceutical marketing efforts, with 56% of those surveyed believing that pharmaceutical marketing does more harm than good" (see "'Ka-Boomers' blow up more perceptions of pharma advertising").

That's nothing new to me and not the most important piece of information I got from this study, which you can find here.

The most important insight I received from this survey is that these women -- whose MEDIAN age is 53.1 years! -- shun social media and favor email for spreading interesting health news via the Internet (see chart below).

Click on the chart to enlarge.

Sorry if this chart is difficult to read, but the "pink tank" pdf survey summary is so muted with feminine colors that it is very difficult to read with my baby-boomer eyes! I had to darken the image in PhotoShop considerably to get even this barely readable version. I guess the report is not meant to be read by the half of the survey respondents who are over 53.1 years old!

Whatever! The point is that only 4% of these baby boomer women (MEDIAN age = 53.1 years) use social media to discuss and share interesting health information with their peers. Only 1% (a rounding error) use Twitter for that purpose. Meanwhile, 34% of these women use good old, antiquated Email!

As reported in MedAd Blog, "Based on the survey results, Ms. Goffe-Wagner [senior VP and brand manager for Pink Tank] says there are some tactics pharmaceutical companies should be following when evaluating their marketing. 'When the brand is all about itself, women feel, as one put it in the survey, that it's patient before pocketbook,' [sic? should this read 'pocketbook before patient'?] Ms. Goffe-Wagner says. 'That’s the lens they are looking at; they are looking at what you say, and what you do, to see whether they feel that you’re just all about growing sales of your brand, or whether you’re really about improving health and the lives of women."

Another tactic that pharmaceutical companies should be following is to use Email to reach these women rather than social media.

BTW, I would be interested in seeing how women in different age groups feel about the issues studied in this survey. For example, women between the ages of 18 and 44 years may be more likely to use social media and 46.6% of them are using at least one prescription drug according to the survey.

Is Pharma Blocking or Supporting iPad Use by Sales Reps?

"Has anyone had any luck getting the iPad to connect to J&J email system," asks an anonymous sales rep on the J&J IT board of CafePharma. "My iPhone connects perfectly and I believe that the iPad should work just the same way. However, even with exactly the same settings it isn't working for me..."

"I called helpdesk," said another poster, "he said iPads, Android, and a few other things are blocked at a device family level from activesynching. Didn't say why."

On the Eisai Pharmaceuticals discussion board, another anonymous poster said "I heard that we are getting new ipads for e-detailing. Great now we have 2 systems for inventory and 2 systems for account management. I better be able to dowload some games and it better have a decent battery. Prob nope on the last 2 requests."

In response was this post: "Who wants an Eisai neutered iPAD? You know they will block all downloads. No apps, movies, or music. Screw that!"

On the other hand, it seems that Genentech is providing iPads to its sales force: "iPads will be overnighted to the entire sales force next Tuesday," said an anonymous poster to the Genentech board on June 8, 2010.

According to Quang Pham, CEO, LathianHealth - an eDetailing company - iPads definitely have a place in the future of eDetailing. He was speaking at a MedAdNews webinar on sales force effectiveness today. Pham did mention, however, that many eDetailing programs currently use Adobe Flash, which is not supported by iPad. Yet the low price point for iPads is a great incentive for pharma to goose its eDetailing vendors to develop programs specifically for the iPad.

In the same webinar, David Kerr, SVP Business Development at PDI, Inc. (a company that provides outsourced sales and marketing services) wondered whether the iPad was robust enough to be thrown around in a sales rep's bag. I use the iPad Case (see photo) to protect my iPad and have taken it everywhere in my backpack without any worries.

DTC Marketing Mix: Radio & Outdoor Ad Spend Soars, Internet Not So Much.

As reported by Nielsen Monitor Plus and reported in the June, 2010, issue of DTC Perspectives, direct-to-consumer (DTC) advertising spend by the pharma industry increased by nearly 2% in 2009 versus 2008 (see trend chart below).

 As reported by DTC Perspectives, radio and outdoor "see largest increases in 2009 DTC promotion" (112% and 55%, respectively), whereas Internet spending (display ads only) saw a 31% increase. About 2.6% (a meager $117 MM) of pharma's DTC ad spend budget in 2009 was devoted to Internet display ads (4.4% if you include search advertising, which is estimated to be about 40% of the total Internet spend). The following chart compares the 2009 mix with the 2008 mix.

Not much of a change.

Take Your Medicine, Win the Lottery! Void Where Prohibited.

New England Healthcare Institute (NEHI), a nonprofit research organization with ties to the pharmaceutical industry, health insurers and academia, estimates that one third to one half of all patients in the U.S. do not take their medications as prescribed by their doctors. [Actually, regarding that percentage, NEHI may be quoting the World Health Organization, which may be getting its figures from the pharmaceutical industry, which may just be making them up.]

"Adherence" is the technical term used by the pharma industry for "following doctor's orders" about taking medication. NEHI suggests many reasons for the poor "adherence" behavior of Americans, including:

• cost
• side effects
• the challenge of managing multiple prescriptions (polypharmacy)
• patients’ understanding of their disease
• forgetfulness
• cultural and belief systems
• imperfect drug regimens
• patients’ ability to navigate the health care system
• cognitive impairments
• a reduced sense of urgency due to asymptomatic conditions

"In general," says NEHI, "adherence rates are lower among patients with chronic conditions than among those with acute conditions." NEHI estimates poor adherence poses an increased risk of hospitalizations due to poor health outcomes, resulting in significant excess costs that are passed along to everyone via higher insurance/co-pay rates. "Since a full 75 percent of U.S. health care spending goes to the treatment of chronic disease, poor medication adherence presents a serious roadblock to efforts to improve health care efficiency and affordability."

Not to mention the roadblock to increased pharma industry profits!

There have been many strategies to overcome poor adherence. Drug companies, for example, have incentive programs that include coupons for the partial or total re-imbursement of copayments.

A new strategy embraced by pharmaceutical companies, pharmacies and insurers, reported today in the New York Times, is a lottery whereby patients can win cash for taking their medication! "In a Philadelphia program people prescribed warfarin, an anti-blood-clot medication, can win $10 or $100 each day they take the drug," reported the NYT (see "Cash Helps the Medicine Go Down"). The program uses a computerized pillbox to record if patients took the medicine and whether they won that day.

First of all, no computerized pillbox can actually know if patients swallowed the pill or merely threw it down the drain, which they might do if non-adherence was due primarily to bad side effects. For more about electronic pill boxes, see, "Can an In-home Electronic Pillbox Solve Our Medication Error Problem?"

You can, however, place an electronic collar around patients' necks and detect if specially-designed pills were actually swallowed. As if that will ever happen! (See "Invasive Compliance: A Bitter Pill to Swallow.")

Aside from gaming the system by throwing the pill down the drain, the lottery idea is intriguing. It is well-suited to the American psyche, which now expects bad behavior to be rewarded (as in getting great refinancing deals and government subsidies when you decide not to make your monthly mortgage payments). You can also look at this as rewarding good behavior, except I suspect that those patients who prudently have taken their medication all along are not included in such incentive programs.

I am waiting for such a program to be offered to the millions of men who suffer from erectile dysfunction and who "forget" to take their daily dose of Cialis! When that happens, I'll be the first to sign up!

How Much Does Pharma Spend on ePromtion? The Mystery Continues - UPDATE

Depending upon what publication reports the data, the TOP 12 pharma companies either spent $287.60 or $168.12 million on "ePromotion" in 2008. The two publications I am talking about are Medical Marketing & Media (MM&M; see "Pharma Report: When Generics Attack") and AdAge (see "Marketing Mix of Leading Pharma Advertisers in 2008"). The "measured media" DTC data reproduced in these publications come from the same source: TNS, which is now part of Kantar Health.

I focus on the 2008 data because I don't have 2009 data from AdAge, but I DO have 2009 data from the May 2010 issue of MM&M, which reported promotional spending in several categories: DTC, detailing, ePromotion, meetings, and journal advertising. Some of the data -- it's not clear which data -- come from SDI's Promotional Audit. 

The 2009 data reported in MM&M covers the TOP 20 pharma companies in terms of "Total Promo Spend" (see chart below, which shows the Detailing, DTC, and ePromotion spend for the 20 companies; not included are the data for meetings and journal advertising; click on the chart for an enlarged view):

What's immediately evident is how LITTLE each company spends on "ePromotion," which -- I assume -- includes only display ads placed on 3rd-party Web sites and specifically not search advertising. This is part of what's called "measured" media spending, which many experts say overstates the actual amount that companies spend on advertising -- because of discounting. Let's not worry about that because discounts probably apply to both types of media.

What % of total measured media spending is devoted to ePromotion? To calculate that I added the spending on DTC, ePromotion, and Journal Ads to get the total measured media spend, which was $4.208 Bn in 2009 according to data reported in MM&M. The total ePromotion spend was $0.3037 Bn, which is 7.2% of the total.

The 7.2% figure is suspect. Measured media data reported in AdAge ("Marketing Mix of Leading Pharma Advertisers in 2008") indicate that Internet display ad spending was 2.4% of total measured media spending in 2008 and 3.1% in 2007. Unless I am missing some data from the MM&M source or made an error in math, I don't see how you can go from 2.4% to 7.4% in one year.

Meanwhile, Melissa Leonhauser, director at SDI, was quoted in MM&M as saying that 2009 pharma ePromotion spending increased 6.6% compared to 2008. Total industry promotional spending increased 2% according to Leonhauser

The other thing I notice from the data reported in MM&M (see chart) is that some companies spend nearly as much or more on DTC as they do on detailing to physicians (eg, Pfizer, BMS, Amgen, BI, and Daiichi-Sankyo). If true, that's pretty amazing. Amazing, because I've seen estimates of physician detail spending of $12 billion industrywide, whereas overall DTC spending is more in the range of $4-5 billion. That yields a Detailing/DTC spending ratio of about 3 to 1. For the biggest spender -- ie, Pfizer -- to have a Detailing/DTC ratio of 1.12 to 1 (based on data reported by MM&M; ie, $1.223 Bn/$1.089 Bn) seems very suspect to me.

I have more suspicions about the data reported in MM&M. In the case of Daiichi-Sankyo, for example, when you add up the columns (ie, different types of promotion) you get $554.50 million, whereas the table has $300.75 million in the Total column.

Let's get back to comparing 2008 ePromotion pharma spending reported in AdAge vs the spending calculated from data reported in MM&M. These numbers are very different for most of the companies on the two lists. Again, I am comparing data for 2008. To do that, I used the % change reported in MM&M to calculate the ePromotion spend for 2008 from the 2009 data. This calculation for Merck, for example, yields $95.5 million whereas AdAge reported that Merck spent only $8.60 on ePromotion (Internet display ads) in 2008 -- a difference of $86.9 million! Anyway, here are the numbers (note:for the AdAge data I merged SP data into Merck and Wyeth data into Pfizer to account for mergers after 2008 and to make a fair comparison to what MM&M reported; 2008 data from MM&M were calculated from % change information published in MM&M):

What can account for the huge differences seen for many companies on this list? There must be a mistake somewhere -- as I said, I may have made a mistake in my math or assumptions. But I know for sure that there is at least one error in the MM&M table -- the data for Daiichi-Sankyo just doesn't add up to the total reported.

UPDATE (6/12/2010):

Bob Harrell commented on my Facebook page: "Are you sure the definition of "ePromotion" in either or both cases is *really just* online display advertising (basically banner ads)? That seems like a very odd and narrow definition to use for ePromotion in pharma - putting aside the question of what can easily be tracked/indexed - and thus a questionable assumption for your comments above."

It's not clear from MM&M Table 4 ("Total Promo Spend, DTC SPend, ePromotional Spend") whether or not the ePromotion numbers refer only to display ads. It is also not clear if the numbers refer to direct-to-consumer ePromotion or ePromotion to physicians, which can include eDetailing, etc, or to BOTH consumers and physicians. Since MM&M put ePromotion and DTC in the same table and had another table (Table 5) devoted to physician promotion, I assumed that the ePromotion numbers in Table 4 referred to consumer ad spending.

The source of the ePromotion numbers reported in MM&M (Table 4) is "SDI's ePromtion Audit," which I now have learned "tracks online promotional activities for physicians" (see "SDI Reports: Pharmaceutical Promotional Spending Indicates Trend Toward Electronic and Online..."). This would explain the inconsistencies I calculated in the table above. It would not explain, however, what the the level of ePromotion to consumers is.

SDI noted an increase of more than 32% in industry spending on ePromotion (to physicians). Kelly Sborlini, Vice President of Market Research Audits at SDI said "we're also seeing a similar shift in pharmaceutical direct-to-consumer advertising. The largest growth area in DTC advertising is on the Internet, whereas spending on consumer magazine print ads is decreasing." I cannot find the numbers that SDI used to support this statement.

Kellogg Engages in Serial Advertising Misbehavior

"Leading cereal maker Kellogg Company has agreed to new advertising restrictions to resolve a Federal Trade Commission (FTC) investigation into questionable immunity-related claims for Rice Krispies cereal," said FTC in a press release (see "FTC Investigation of Rice Krispies Ad Claims"). "This is the second time in the last year that the FTC has taken action against the company."

What's disturbing is the fact that Kellog went ahead with its questionable Rice Krispies campaign while being investigated by the FTC for other "cereal" health claims:

"We are concerned that while Kellogg was developing its questionable Rice Krispies campaign last year, it was simultaneously negotiating with the FTC to resolve earlier allegations that the company had deceptively marketed Frosted Mini-Wheats as improving children’s attentiveness," said FTC Commissioner Julie Brill and Chairman Jon Leibowitz in a concurring statement. "What is particularly disconcerting to us," said Brill and Leibowitz, "is that at the same time that Kellogg was making promises to the Commission regarding Frosted Mini-Wheats, the company was preparing to make problematic claims about Rice Krispies."

This makes Kellogg a "serial" misbehaving "cereal" advertiser, if you get my drift.

This is another example of "a trusted, long-established company with a presence in millions of American homes" (FTC Commissioner's words) that makes products we put into the mouths of our children "[shirking] its responsibility to do the right thing" (FTC Commissioner's words). The other company is Johnson & Johnson (see "Parallels Between BP and J&J").