Making Sense of Pharma DTC Spending Trends

ePharma boosters see the latest direct-to-consumer (DTC) advertising spending numbers as a positive sign that the drug industry is finally increasing its allotment to the Internet in its DTC marketing budget. Nielsen data indicate that "spending on Internet ads, which has doubled over the last five years, hit $117.4 million, up 31 percent" (see "Drugmakers boost consumer ad spending 2 pct in '09"). Total DTC spending increased 1.9% in 2009 vs. 2008. All these data do NOT include search engine advertising, which I will get to in a minute.

I am having some problems with the numbers when I compare them to previous reports. For example, the total ad spend in 2009 was reported to be $4.51 Bn. If that is a 1.9% increase over 2008, then ad spending in 2008 must have been $4.42 Bn. But data reported previously by Nielson (see here) says pharma ad spending in 2008 was $4.34 Bn. My notes, however, indicate that the latter was an estimate based on spending for the first 9 months of 2008. So let's forget the latter total and use the former (I adjusted it to $4.425 based on a 1.9% year-over-year increase, which corresponds to Nielsen's latest data; see here).

Working backwards from the year-over-year percent increases reported by Nielsen, I get the following table comparing 2009 to 2008:





All the % Inc/Dec numbers agree with the Nielsen data as reported by AP here. However, the Outdoor spending number for 2008 is suspect. I had to use that number to make sure the total for 2008 more or less agreed with the total based on a 1.9% year-over-year increase. Believe me there are other numbers out there that add up even worse, such as this table I found on World of DTC Marketing:


The totals in this table aren't even close to what was reported in the AP article (Nielsen data). Actually, these are numbers for the first 9 months of each year. But TNS Media Intel's 2009 Internet number of $220.9 million is much larger than Nielsen's 2009 number of $117.4 million. How can these be so different? I'm pretty sure both are reported "measured" media, which does not include search engine ads. TNS/Kantar Media Intelligence told me that it tracks over 3,000 sites throughout the US and Canada, which is a different methodology than that used by Nielsen. So it's important not to compare these apples and oranges! Note: TNS/Kantar Media reports that outdoor pharma ad spending for 2008 was $3,084 million.

In any case, here's what the media mix looks like, 2009 vs. 2008 (using Nielsen data):




According to this, Internet spending (not including search) increased to 2.6% of the overall DTC budget. This is still much less than the 3.6% spent on newspapers! What happens, however, if you add in an estimate for search engine ads? It's been estimated that SE advertising accounts for 40% of online spending. But I'm guessing that pharma pulled back from SE advertising after FDA issued warning letters at the end of March 2009. Let's say SE spending by pharma in the 9 months after that dropped by one-third. According to my back-of-the-napkin calculations, this is how I see TOTAL Internet spending by pharma in 2009 compares with that in 2008:




You can check my math. You will see that in 2008 search equaled 40% of the total Internet spend, whereas in 2009 it is only 33%. This seems believable. If so, then the total Internet spend in 2009 increase only about 18% over 2008, which is a lot less of an increase than 31% and in line with the increase for old media newspaper advertising! Who'd have thunk old media could compete so well with new media?

Use of Patient Testimonials in DTC & Social Media Advertising

This week I was a guest moderator for a graduate class at Johns Hopkins University: “Marketing in a Regulated Environment”.

The students are 90% scientists, working at places like NIH, Amgen, Medimmune, etc. They had a few questions they want me to answer, including these:

"Recently, companies appear to be using more patient testimonials in their DTC advertising. I am thinking in particular of Pfizer’s Chantix commercials. Could you comment on the forces driving the industry in this direction and whether there are any FDA regulatory hurdles or guidances that must be considered in using patient testimonials? As a follow-up, I have not yet noticed any attempt to integrate patient testimonials in DTC advertising with internet social media (e.g. “You can follow Bob’s success with quitting smoking using Chantix on his face book page or receive tweets from him.”). Do you think this will emerge, and if so, what would be the implications? Will Pfizer have its own mini version of The Truman Show?"

and

"There is a growing desire to allow patients who have been on a particular therapy to interact with potential new patients considering their treatment options. What are some of the potential pitfalls that a company may face if they choose to provide a forum for this type of interaction? What do you consider to be some of the competitive advantages this strategy may convey?"

Can you help me answer these questions? Please take this survey:





Use of Patient Testimonials in DTC & Social Media Advertising

sanofi aventis Feels the Social Media Pain. But Is It Authentic?

Simultaneous posts on Pharmalot and Pharma bnet have focused on what seems to be a disgruntled patient who posted photos and comments on sanofi-aventis's (S-A) Facebook page (see "Bald Women Lash Out At Sanofi-Aventis & Taxotere" and "Sanofi's Latest Challenge: Women Who Say Its Chemotherapy Left Them Permanently Bald").

"Ann Adams" posted this message to S-A's Facebook Wall: "Good morning Sanofi, i had your drug Taxotere and as you can see from me photo this is what my scalp looks like 4 years later. Do you have any comment to make?" Her bald head photo appears on S-A's Facebook page as well. See the screen shot below:

I clicked on "Ann Adams" to learn more about her and found her Facebook page that had one message on the Wall: "This is my disfigurment from your drug Taxotere, the drug you kept this adverse side effect secret. Why dont you want to answer my letters and emails?"

I assume this was a message she had also posted on S-A'a page, but I can't find it there.

Did S-A "block" this post?

Ann says: "Its very unpleasant of you Sanofi to have an unhappy customer blocked from your page."

The timelines don't match up. The post on Ann's FB page says it was made 2 hours ago (see screen shot above), but Ann's S-A FB post about being blocked was made 8 hours ago.

Is "Ann" authentic or just a scam perpetrated by a disgruntled S-A employee or a competitor?

On the Internet nobody knows!

UPDATE: See comment to this post, which claims that "Ann Adams" is a real person. That comment cited an article in which "Ann Adams" was quoted.

Sanofi Loses SM Face Over Hair Loss PR Debacle
I also received a note from an anonymous friend who said:

"'Ann Adams' would appear to be a pseudonym for Shirley Ledlie (see Jim Edwards' post from Saturday), given the identical scalp images. I would hypothesize, given the accusations of blocking, that Ledlie's posts were removed and that she subsequently opened up a pseudonymous Facebook account as 'Ann Adams' to repost them...and scold s-a for blocking her in the first place.

"...this is the sort of PR event that any company (especially a company already aware of organized criticism) should have been prepared in advance to respond to...and it represents the degree to which pharma misunderstands social media (as most other industries did 3-5 years ago) in jumping straight into 'push' mode (e.g., FB 'fan' page) without first understanding in depth the conversation that's already going on and the motivations, needs, and behavior patterns of those already engaged in the conversation."

UPDATE TO UPDATE:  
It looks like we may have been "pfooled" by a phony, pfishy sanofi aventis FB page!

See comments to this post. Also, the URL seems "pfishy": http://www.facebook.com/sanofiaventis0 - the final "0" means that "sanofiaventis" was already taken (probably by S-A). Did Shirley Ledlie, aka "Ann Adams", create phony S-A FB page to post her complaints & embarrass S-A?

Pharma Should Leave Unmoderated SM Discussions to 3rd Parties

In comments addressed to the FDA, many drug companies and ad hoc industry groups are suggesting ways drug companies can legally "engage" with patients, physicians, and consumers in online social media discussions (see, for example, "A Pharma 'Social Media Working Group' Submits Comments to FDA").

The hope is that new FDA guidelines (or regulations) will help them do that.

Some drug companies imagine the day when they will be able to host open discussions on their web sites -- even drug.com sites.

The question is, under what terms? Specifically, what conversations will they allow and not allow and how will they deal with posts that are "not allowed?" Every social media site has to have a policy regarding this issue.

Once you allow online conversation, you open yourself up to unsolicited commercial posts (ie, spam), posts from disgruntled employees or people with an axe to grind, posts from competitors and their employees who want to bash your products, anonymous posts from your own employees trying to put your product in a better light than is warranted by the package insert, posts from lawyers trying to get a class-action lawsuit going, well-meaning posts by patients spewing misinformation about your products, etc., etc., etc.

Pharma companies are especially prone to these kinds of posts. Believe me, managing online discussions is no walk in the park with your mandolin. It takes a lot of work and attention.

It would take a lot MORE work if every post submitted first had to be reviewed by your legal/regulatory people before it could be published. Naturally, neither the L/R people nor the SM evangelists within pharma want that burden. Hence, pharmacos suggest that posts to their discussion boards should be UNMODERATED. Of course, they say that this is the only way to allow social media to work as it should - uninhibited, free speech.

What pharma wants to do is to moderate AFTER the fact. That is, remove posts that violate the terms of use. This is how CafePharma works. It has a very active community with very many useful discussions. But the pharma industry is not loving it -- there are many posts from disgruntled employees that criticize the industry. These posts are often X-rated.

Of course, this does not mean that discussions on pharma-owned Web sites would degenerate to the level of CafePharma. But, hey, it could happen!

I moderate every comment submitted to this blog before it is posted. Every day I get comments like this one from "marry": "Blogs are so informative where we get lots of information on any topic. Nice job keep it up!!" First of all, it does not add anything to the conversation. But more important, when you click on "marry" you are likely to end up ion a Web site selling something -- probably counterfeit Viagra pills!

Does the industry want its discussion boards filled with that kind of content? Of course not! But their method of dealing with it leaves a lot to be desired. I imagine one designated employee coming in every morning and reviewing the posts made the previous 24 hours and spending an hour or so deleting the ones that violate the terms or commenting on the off-label ones and keeping them around for awhile so everyone can tell it's off-label (some propose deleting these after 48 hours, some do not indicate any specific time limit).

It's all about the FTE devoted to the job -- the less, the better! Moderation before the fact may require too many FTEs. After the fact, it is much more manageable.

But in social media time, 48, 24 or even 2 hours is a long time! Just ask Ray Kerins, Pfizer's head of corporate communications. While he was busy in traffic court, the Twittersphere buzzed and re-buzzed about whether or not @pfizer_news, which was just launched, was an official Pfizer Twitter account! (see "Pfizer's Social Media Strategy: Piss Off John Mack, Get Hundreds of New Followers!")

To paraphrase Omar Khayyam: "The Moving Finger posts; and, having Tweeted, Moves on: nor all your Piety nor Wit Shall lure it back to cancel half a Line, Nor all your Tears wash out a Word of it."

Merck Says FDA Should Approve the “One-Click Rule”

Merck submitted comments to Docket No. FDA‐2009‐N‐0441 regarding Promotion of FDA‐Regulated Medical Products Using the Internet and Social Media Tools (find it here).

About 75% of Merck’s comments that specifically address FDA’s questions is devoted to an argument in favor of the “one-click rule” as it applies to space-limited digital product ads. For more background on the one-click rule, see "Pharma Prefers '1-Click Rule' for Presenting Fair Balance in Social Media & Other Internet-based Rx Ads."

When FDA issued those infamous 14 notice of violation letters last spring, the drug industry was stunned and immediately pulled back from branded search engine advertising (see "The 14 Letters. Who at the FDA Knew What and When? FDA Intern Wants to Know!"). Apparently, Merck revised its sponsored search ads to the help-seeking format “in March 2009 in response to DDMAC's enforcement letters on sponsored links.”

As a result, across several brands, Merck “observed an increase in click-thru rates with the unbranded, help-seeking format indicating that the format may have attracted more users seeking condition-specific information. However, the number of landing (product) site pages consumed after the click-thru consistently declined. For one brand, the number of page views by the searcher dropped by nearly 50%.”

Merck claims this "decrease in content consumption could indicate a lack of transparency between the advertisement and the linked to content” and “current unbranded, help-seeking sponsored links do not meet the needs of health information seekers using Internet search engines.”

I’m trying to understand Merck’s argument. This is the example “help-seeking” ad it presented in its comments to the FDA:

Merck did some market research to evaluate this and other ad formats, including this product-claim format that Google has made available to drug companies in beta tests (see "Is Google the New FDA?"):

Merck asked its study subjects “How do you feel about having to click on the link to gain access to the product safety information?”

For the Product Claim ad, 78% said they found it very or somewhat acceptable. For the Help-Seeking ad, however, only 34% said it was acceptable. Well, of course it’s not acceptable -- to get to the product information from the Help-Seeking ad, you first have to click through to the product web site. But this doesn’t mean that the Help-Seeking ad did not “meet the needs of health information seekers using Internet search engines.”

I think what Merck really means is that ITS needs are not being met by Help-Seeking ads!

Concluding its comments on the one-click rule for Product Claim ads, Merck says “the use of hyperlinks is an appropriate and effective way to disclose product use and safety information in limited space formats. FDA should adopt standards to be consistent with FTC guidelines and allow hyperlinks to fulfill the regulatory requirements for product use and safety information disclosures in digital media with space limitations, including but not limited to, banner advertising, mobile applications, text messaging and sponsored advertisements in search engines.”

AstraZeneca Urges FDA to Regulate the Whole and Nothing But the Whole SM Conversation

AstraZeneca (AZ) submitted comments to Docket No. FDA‐2009‐N‐0441 regarding Promotion of FDA‐Regulated Medical Products Using the Internet and Social Media Tools (find it here).

Again and again throughout its comments to the FDA, AstraZeneca defends the concept that social media conversations by drug companies are just like real world conversations and should be similarly regulated; ie, FDA should consider the whole conversation, not just one part of it.

"It is our view that the FDA, in developing its guidance, should view such participation in a manner analogous to its existing regulation of in person and telephonic promotional activities," said AZ. "In that case, the FDA examines not just one part of the conversation but the entire conversation as a whole."

"It is similarly appropriate for the agency to view a social media conversation as a whole and not regulate each and every 'post' as if it were, in itself, a promotional piece," said AZ in its comments where it cites FDA's draft guidance on risk communication. AZ quoted this precedent from the FDA guidance: "FDA looks not just at specific risk-related statements, but at the net impression – i.e., the message communicated by all elements of the piece as a whole. The purpose of the evaluation is to determine whether the piece as a whole conveys an accurate and nonmisleading impression of the benefits and risks of the promoted product." [FDA's words]

AZ takes this concept to new heights, however, when it attempts to include all sorts of things in the "conversation": "We recommend a framework that understands that a conversation may include text, video, sounds, and other elements that are appropriate to consider together." These elements, says AZ, can appear together or as near as together as the site or format allows.

AZ cites Twitter as an example: "... on Twitter or another micro-blogging site, a sponsor might use multiple, simultaneous 'posts' to convey information on risks and benefits including using links or other reference marks or symbols."

I once posted several tweets one after the other in an attempt to mimic a particular kind of conversation in the real world, ie, Burma-Shave roadside advertisements. You may be too young to remember this outdoor marketing trick. Typically, six consecutive small signs would be posted along the edge of a highway, spaced for sequential reading by passing motorists. The last sign was the name of the product (ie, "Burma-Shave"; see this wikipedia entry.) Here's an example (imagine each of the following phrases on a separate roadside sign separated by 100 feet or so):

That big blue tube


is like Louise


it gives a thrill


with every squeeze


Burma-Shave!

Each sign is part of the "conversation," but looked at in isolation it makes no sense.

BTW, my Twitter experiment was a disaster. No one strung the tweets together to get the entire message. I looked like a complete idiot who did not know how to use Twitter to communicate!

How Did Pfizer Get So Many Twitter Followers?

Wow! Pfizer's official Twitter account, @pfizer_news ("The official site for Pfizer Inc., where we apply science and our global resources to improve health and well-being at every stage of life.") has over 5,000 followers, making it the MOST followed pharma Twitter account! And just this last December it had less than 1,000 followers (see chart below). How did Pfizer get so many followers so quickly?

 

This chart was created at twittercounter.com where you can find follower and tweet stats for any Twitter account. I compared stats for @pfizer_news with two other pharma-related Twitter accounts having a comparable number of followers (ie, @pharmaguy - me - and @swoodruff - Steve Woodruff).

Something unusual happened around Christmas last year - Pfizer somehow attracted about 3-4,000 NEW Twitter followers in just a few days! Did someone give Pfizer a Christmas present?

[Ha Ha! See comment about Pfizer PR people asking employees to follow. Maybe they sent employees a Christmas card?]

Perhaps Pfizer was spewing out a ton of informative Tweets that just naturally attracted 4,000 new followers. Oh, but wait, that can't be the reason. According to the stats, @pfizer_news has only posted 100 tweets since its launch last fall. It was practically silent around the end of the year in 2009.

More likely is that Pfizer got new followers by doing what it does best -- advertise! Kudos to them. What I want to know is how much did you pay per follower and where did you advertise?