A Call for Pharma Social Media Transparency Guidelines for Patient Bloggers

"Political strategists agree that the acrimony that has tinged many of the attacks on the news media this year feels different," according to a story in today's New York Times (see "Politicians Are Fighting Mad, at the News Media"). “Everyone has always bashed the media,” said Dana Perino, a Republican consultant who was a White House press secretary under Mr. Bush, “but I do think there’s something larger going on.”

What's going on is this: "the eagerness of many candidates to bypass the mainstream news media in favor of social networking or media outlets that they perceive to be embracing of their political platforms."

I believe the pharmaceutical industry has the same "eagerness" to bypass mainstream news media in favor of social networking. This is evident by the growth in Twitter use by pharma companies to push out news that it used to do via press releases distributed through channels cherished by reporters (eg, prnewswire).

Pharma PR and corporate communications professionals have been courting bloggers with dinner meetings and invites to events that previously only mainstream media journalists were privy to. Johnson & Johnson and Pfizer have lead the way ("Bloggers Dining at Pharma's Table", "Thank You Johnson & Johnson for Dinner", and "Chantix 'Roundtable' Apparently Not Round and Not a Table"). Of course, as a blogger, I have encouraged this.

But influential patients and physicians are becoming more important to pharmaceutical companies than industry bloggers like me. Patient bloggers, for example, are high up on pharma's list of people they'd like to influence. At least some influential patient bloggers have put out the PHARMA WELCOME mat (see "Some Social Media Patient Opinion Leaders Want to be Paid Pharma Professionals").

Many patient bloggers claim that it is important for pharmaceutical companies to "join the discussion." But pharma marketers and PR people -- who control the communications budgets within pharma -- want to "influence the discussion" and not merely "join the discussion" on social networks frequented by patients and physicians.

Within these online communities are "thought leaders" who feel equal to or superior to institutions such as the press, or government agencies. Pharma is poised to exploit these feelings and is probably doing so now as I write this.

The only issue I have with this is that a lot of it may be happening "behind the curtain" (see "Pharma Social Media Behind the Curtain"). Often, neither the pharma company nor the social media patient leader reveals the relationship. New guidelines from the FDA will NOT address this issue because the FDA is concerned only that pharma commercial speech stick to the approved labeling when discussing brand name drugs. FDA cannot, for example, regulate non-branded, disease information that pharma companies may share with patients and physicians. Furthermore, FDA cannot enforce transparency -- it has no authority over patients who are free to do and say what they like without mentioning any relationship they may have with pharma companies.

That's why I say that pharma companies MUST make known their transparency policy with regard to social media. I'm not talking about their policy for how they expect their employees to behave when engaged in social media discussions. I'm talking about policy about how the corporation will behave in relationships with patients and how they will reveal those relationships.

For example, imagine that a pharmaceutical company has invited several influential patient bloggers and social network leaders to a 2-day "conference" at a resort in Orlando, Florida, all expenses paid. The "conference" is all about diabetes and support for diabetes, but not about specific diabetes treatments. It's all about "opening up a dialogue," that sort of thing.

Like a physician author in a medical journal, should patients who receive such largesse from pharma companies be required to reveal that? If the answer is "yes," who requires it? It can't be the government. It must be what I call the pharma company's "social media transparency policy," which might state something like "We require all patients who receive money or goods in kind such as free lunches and airplane tickets and other travel-related expenses to reveal that to their readers and social media followers in an appropriate fashion."

I have revealed my relationships with pharma companies many times, but not every time I write a blog post. What I have done, however, is to update my profile by adding this statement:

"I am not a paid consultant to the pharmaceutical industry, but I occasionally get invited to speak within pharma companies or at industry conferences. For this I receive reimbursement for travel expenses and ask that any speaker fee be donated to a charity. As a publisher, I do accept paid advertising mostly from agencies that work for the pharmaceutical industry."

I think patient bloggers should have something similar in their profiles (or whatever is appropriate for their relationship with the drug industry). Patients who participate in social networks and are considered "leaders" in the community might include the transparency statement in their profiles and/or signature files as well. And pharma companies should encourage this by publishing social media transparency guidelines for their patient blogger/social media partners.

P.S.  Recently, GSK invited eight bloggers to visit its manufacturing facility to "tour the facility and learn about the role that vaccination plays in keeping adults and families healthy" (see "Opening Our Doors--Again").

At least two of the bloggers wrote about their experience (see here and here). At the beginning of each blogger's post was a disclosure. Here's what they said:

"My travel, accommodations and food (except for the bagel and an extremely necessary cup of tea) were covered by GlaxoSmithKline. They did not require me to write about the trip at all, nor did they pay me, review this post or dictate what I have to say. Which is a really impressive release of control for these folks." -- Nutgraf

I don't know who "Nutgraf" is -- life's too short to track down a name when it's not mentioned in the "about me" section of the blog -- but he/she states in her/his "A Note on Integrity":

"I review things – including books, products and advice submissions – in my own time and on my own terms. I need your input to make the advice project a success, and you can rely on me to clearly disclose my policies, protect your privacy and generally deal with you and others in an above-board manner. As for products, books, pitches or anything else of that nature, I’m a big fan of disclosure. I disclose early, loudly and often. I am easily skeezed out and want to be proud of what I do here."

Meanwhile, the other blogger (see profile here, which does not include a blanket disclosure statement as above) states at the beginning of her blog post:

"I went on a trip to Philidelphia to tour the GlaxoSmithKline vaccine plant. My flight, hotel, cab fare and meals were covered expenses. The opinions represented in this post are all mine and were not compensated in any way.This is a VERY long post, and yet I feel strongly about it and would really appreciate if you would take the time to read it in it's entirety." -- Scrutiny by the Masses

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!"

Pharma Social Media Behind the Curtain

Like the Wizard of Oz performing his "magic" behind the curtain, there may be many pharma "wizards" happily managing social media projects behind the scenes and out of public view. All it takes is a new age "Dorothy" to pull back the curtain. That "Dorothy" is Jess Seilheimer (@Jaeselle), who alerted me about the possibilities in a comment to yesterday's post  about Shwen Gwee (see "Happy Pharma Social Media Halloween!"). Shwen leads Digital Strategy and Social Media within the Marketing department at Vertex Pharmaceuticals.

There's a bit of a brouhaha coursing through Twitterdom and the pharma blogosphere about Shwen. Some critics (eg, Rich Meyer, @richmeyer) say that Shwen "has not really done anything of substance yet and works for a company that does not even have any approved drugs yet." I pointed out that "Shwen may actually be working on ... a [social media] project within Vertex but not talking about it."

Today, the WSJ  published an article touting a drug under development at Vertex that may CURE Hepatitis C! (see "New Hepatitis C Drugs May Be Blockbusters"). Surely, Shwen is hard at work "behind the curtain" developing a social media marketing strategy that will launch in concert with the new drug. In fact, as Jess points out, there may be "plenty of initiatives that pre-launch brands focus on in this phase, some of which may not be public knowledge."

Here is what Jess had to say about that and other ways that pharmaceutical companies may be using social media "behind the curtain:"

I'm of the belief that no one should try to validate who "does what" in social media when you're only qualifying it to an approved brand or initiatives in the public domain.

Exhibit A) There are plenty of ways to utilize social media engagement and digital channel in the pre-launch market awareness phase. Initiatives that pre-launch brands focus on in this phase, some of which may not be public knowledge.

- crowd sourcing HCPs input re: R&D initiatives

- utilizing PatientsLikeMe to identify, recruit and communicate with appropriate patients for phase III trial enrollment

- private HCP advisory board networks built through Ozmosis or Within3 social platforms

- 3rd party social sentiment/listening analysis through Buzz Metrics, et al (something that takes months to garner learnings then analyzed/utilized internally to inform target engagement strategies for launch)

- Unbranded disease awareness campaigns development- creating a need for new market entry (again something that may take months to create---tactics which may be teased out on a phased approach

Exhibit B) There are also corporate level initiatives that utilize building policy around a company's POV on how they approach using these channels to optimize their communications.

- these initiatives happen behind the scenes for months

- corporate initiatives are sometimes not publicly published/available for analysis like Roche or AZ

- corporate level investment in internal staff onboarding, education and applicability of using social media as a means to communicate internally with each other.

My point: Having a public brand/corporate supported "patient community" does not equate to "I have done social media', and we should use caution when trying to qualify someone;s knowldeg or within the area. Lastly, let's please consider using appropriate terminology when referring to utilizing social engagement channels for our business/brand objective-- it's not "doing social media".

Al things to take into consideration when proclaiming "people haven't done anything in social media".

They are.
We all are.
You may just not know it.

Happy Pharma Social Media Halloween!

Shwen Gwee recently received the Pharmaguy Social Media Pioneer lapel pin in recognition of his pioneering work as a pharmaceutical social media evangelist.

Just today, Shwen received this mummy on his doorstep from an anonymous source. Needless to say, he's pretty confused. Who would send him such a thing? Perhaps it was an old mummified Web 1.0 pharma pioneer? We may never know.

Shwen leads Digital Strategy and Social Media within the Marketing department at Vertex Pharmaceuticals where I am sure he is playing a major role in educating his colleagues and preparing for the day when his company may launch a social media initiative.

How can someone who has not yet actually been involved in a pharma company social media project receive such a coveted award? Well, first of all, Shwen may actually be working on such a project within Vertex but not talking about it*. More importantly, he is everywhere that social media is discussed within pharmaceutical and healthcare circles.

Like one of the original seven U.S. astronauts, who may not have traveled in space, Shwen is training those who will be there someday and may yet be called to duty himself. So stop trying to scare him, whoever you are!

*Vertex may soon get approval for a blockbuster Hepatitis C "cure" (see "New Hepatitis C Drugs May Be Blockbusters"). Four million Americans may have Hepatitis C and as many as 3 million of them don't know it. This is ripe territory for a social media campaign focused on a population of younger people that includes celebrities.

CORRECTION: Shwen tells me that "most prevalent pop for HCV is baby boomers" like me. Even better I would say. According to Deloitte data, 2009 was the year that social media bloomed for Baby Boomers, with nearly 47% of them actively maintaining a profile on the social web, which is up 15% from 2008 (see "Baby Boomers and Seniors Are Flocking to Facebook").

Answers That Won't Matter: Critique of Lilly's Defense of DTC Advertising

The pharmaceutical industry is fighting a losing battle (IMHO) against negative public opinion. The latest weapon to be employed in this battle is a 52-page "booklet" entitled "The Value of Medicine, Improving Health...Improving Life" published by Eli Lilly (find pdf here).

World of DTC Marketing blogger Rich Meyer asks "The real question is will consumers buy it in an era of mistrust and misinformation?" (see Lilly fights back with “The Value of Medicine”). I think the real question is "Will consumers read it in an era of apps and sound bites?"

A 52-page PDF document is a bit much to ask the average consumer to digest even with all the pretty charts and graphs with circles and arrows and paragraphs explaining what each chart is about.

Also, I must say that Lilly engages in some "misinformation" itself, or at least conflicting information (keep reading to see what I mean).

It's all very well to blame the so-called "era of mistrust and misinformation" for pharma's failure to win over the hearts and minds of consumers, but we all know some of the blame falls squarely on pharma's shoulders. It's unfortunate, for example, that this booklet comes out around the same time that AP reported "pharmaceutical companies made up eight of the government's top 10 settlements related to fraud in the last year" (see "Drugmakers top list of DOJ fraud settlements").

But enough about fraud, let's talk about Lilly's defense of DTC (direct-to-consumer) advertising, which is presented in pages 32 to 36 of the booklet.

First, let me say that it's ironic that an industry that spends so much money, time, and effort to produce DTC ads -- including wonderfully creative TV commercials -- to "educate" consumers, relies on pdf files and web sites to defend its products, advertising tactics, and public image. Where's the TV ads? If, as Lilly claims, 30 to 60 second TV ads are so effective in educating consumers about "diseases, about the symptoms that may help their health care provider identify the diseases, and about available therapies to treat these conditions," then why not use TV ads to provide "answers that matter" about "tough questions about access, costs, safety, and ultimately the value that we can bring to patients in preventing and fighting disease" (quoting John C. Lechleiter, PhD, Chief Executive Officer and President, Eli Lilly and Company)?

It can't be that TV ads are too expensive. Lilly claims that the drug industry's spending on DTC advertising (about 65% of which goes to TV) "represents only about 2% of pharmaceutical company sales." BTW, Lilly doesn't mention the $ amount of sales, but it does mention that DTC spending is about $4.4 Bn per year. If you do the math -- something most consumers I regret will not or cannot do -- you get $220 Bn per year for the sales number. I think Lilly is selling itself short here. I find from IMS data that US drug sales in 2009 was more like $300 Bn. Ergo, DTC spending is only 1.4667% of sales. Perhaps Lilly was rounding up -- but it could have rounded down to 1%! Whatever.

Lilly also presents a nice chart to illustrate the point that the pharmaceutical industry "spends less on advertising as a percent of sales than many other industries" (see chart below). Of course, by "less" Lilly really means on a percentage basis. The sporting and athletics goods industry spends MUCH more than pharma on advertising (as a percentage of sales), but not so much more on a dollar basis ($5.6 Bn vs pharma's $4.4 Bn).

According to this chart, pharma advertising spending is 4.2% of sales. How come the discrepancy between this % and the 2% Lilly quoted on the page before the chart? Could it be that this chart includes "advertising" to doctors as well as DTC? Lilly does NOT mention how much the drug industry spends on "marketing" to doctors, but I've seen an estimate of $12 Bn per year for that (see here). But $12 Bn + $4.4 Bn = $16.4 Bn, which is 5.4% of $300 Bn in sales (as reported by IMS) or 7.4% of $220 Bn in sales (as calculated from Lilly's figures).

OK, so the numbers don't jive. I've notice that's often the case when analyzing data about the pharmaceutical industry. I'm used to it. Just another form of "misinformation."

Aside from touting how economical drug companies are regarding advertising, Lilly also claims that "limiting prescription drug promotion may negatively affect patients and health care providers by restricting access to important information about diseases and proper medical treatment. Also, consumers may not as easily receive information about the benefits and risks of prescription medicines."

I can write a whole book in response to that! Let me just say, that in this day and age of Internet technology, which Lilly does not seem to be part of, DTC advertising is an insignificant source of "information about diseases and proper medical treatment" for consumers and physicians alike. Does Lilly really expect us to believe that limiting DTC advertising will negatively affect patients and healthcare providers?

OK. I've spent enough time on this. I assume all of you will download this 52-page booklet and read it from cover to cover. Actually, there are a lot of pictures, so don't worry, you should be able to read the whole thing in about 20-30 minutes or so. Let me know what you think.

Negative Facial Coding Hamstrings Patient Testimonials in DTC Ads

Even though pharmaceutical marketers are NOT exploiting social media to the degree that industry consultants and agencies would like them to, they have learned one important lesson from social media: people trust people like themselves more than they trust company spokespeople or even so-called experts. That may be why you are seeing more and more direct-to-consumer (DTC) ads on TV and in print that feature real patients who offer testimonials to the advertised Rx drug.

Pfizer, for example, is currently running Lipitor and Chantix ads in which real patient users of the drug tell their stories. Previously, Pfizer, like so many other drug companies, employed actors that portrayed physicians or "real" physicians in these ads. That, however, backfired spectacularly when it was discovered that one physician spokesperson -- Dr. Jarvik -- was not actually a practicing physician.

Dan Hill, President of Sensory Logic, Inc., contends that there is a problem with this. Hill was guest on my Pharma Marketing Talk BlogTalkRadio show yesterday -- October 26, 2010 -- where claimed that two-thirds of the ads are "not so good, especially with the would-be testimonials" of real, everyday patients.

Hill bases reached this conclusion by applying "Facial (Action) Coding" techniques to analyze the effectiveness of the ads. If you have ever watched FOX's "Lie to Me" drama series, you may familiar with this technique, which involves analyzes facial expressions to determine the emotional state of a person.

Facial coding was first developed by Dr. Paul Ekman -- who is an adviser for the show "Lie to Me" -- and is featured for 30 pages in Malcolm Gladwell's "Blink." Hill claims that this non-invasive tool -- which breaks down 23 facial expressions (Action Units) into 7 core emotions -- allows him to help clients understand the emotional connection of their market research efforts (for example, what consumer are really feeling about their TV commercials, print ads, websites, as opposed to what they say.)

Hill says the goal of Facial Coding is "Get[ting] the Right Emotions at the Right Time." That sounds like a nice complement to the often-heard axiom of "getting the right message to the right audience at the right time."


Hill offered one example of how the "wrong" emotion exhibited by an actor in a GSK TV ad sent the wrong message to the audience.

At second 17 in the timeline, the test audience -- claims Hill -- had a "fear reaction." There was really no intent by GSK to illicit fear, so Hill was stunned. The verbal comments from the test audience couldn't explain it, so Hill used his facial coding ability to look at the facial activity of the actors. "Lo a behold," said Hill, "at second 17, the male lead showed fear on his face. My suspicion," said Hill, "was that he forgot his line for a nano second." Emotions are so contagious that this flash of fear on the actor's face that the audience "[went] there with him."

With regard to real patient testimonials in TV commercials, Hill says that the actors often look "uneasy, stilted, and don't show the emotions that are meant to be shown." This, Hill claims, hamstrings the commercial so that it is not as effective as it could be.

You Audience Has Left the Building
Another interesting point that Hill made was in regard to the voice-overs (VO) of TV Rx ads. VOs usually occur during the "fair balance" (ie, side effect disclosure) portion of the ad, which may consume 30% of the total running time. Hill said that "the sad truth is that many voice overs kill the commercial. It is the moment when marketers think they are bringing home the message, but instead the audience has left the building." Perhaps the reason why voice overs are used most often during the fair balance portion of the ad is precisely to drive the audience away from the ad once they have already been exposed to the benefit portion.

"A monologue simply does not work for people," said Hill. A Cialis ad was cited by Hill as doing a "very good job with the legalese at the backend of the commercial." The ad keeps switching between the man and the woman delivering the fair balance message. "At least that variation, going from the male to the female and then back to the male, at least make it more noticeable," claims Hill.

One observation in closing is this: current social media lacks the dimension of facial coding and using real patients in social media campaigns retains the advantages of credibility without the disadvantages that Hill pointed out.You can listen to my conversation with Hill using this BogTalkRadio widget:

Listen to internet radio with John Mack on Blog Talk Radio

A Breast Cancer Patient's Painful, Difficult Therapy Choice: Generic vs. Brand?

Since this is national Breast Cancer Month and I am forced to watch NFL linebackers wear pink shoes and mouth guards, I thought it would be appropriate to discuss an issue that just came up in comments to my post about Sanofi-Aventis, Taxotere, and the disgruntled patient (see "Should Sanofi-Aventis Submit an Adverse Event Report Based on 'Disgruntled Patient's' Comments to VOICES FB Page?" and comments).

An anonymous comment to that blog post opened my eyes about issues facing breast cancer patients beyond what I believe many proponents of the "pink" promotional campaign envisioned. Here's the comment:

"It's not just one disgruntled cancer survivor. There are over a hundred of us. Of course, there's no promise that our hair would grow back. GENERALLY grows back. Well for those of us who battled breast cancer but are forced to look at our bald selves in the mirror every day, "generally" isn't good enough. Yes, we're alive. I'm grateful for that. But again, no promise of how long...and with small children, that's another painful reminder of what I've been through. The thing about S-A and Taxotere is this: there's another drug, Taxol, which doesn't cause this permanent alopecia we're dealing with. But we were never told that there was a choice. And what do you think I would have chosen if I'd had a choice? I'm in my early 40s so dealing with permanent alopecial is especially difficult. I have a job in a senior management position. Hard to earn respect when I look like Ben Franklin. We're not mad that Taxotere caused us to experience permanent alopecia...we're mad that we weren't given the choice of the more hair-friendly medication. And why is that? Our oncologists didn't even know. Don't you think they should be made aware of this fact?"

To which I responded:

"While I am not knowledgeable regarding the benefits vs risks of one treatment vs another, shame on your oncologist for not knowing or caring enough to offer you a choice!"

This gave me an idea of how important hair loss can be to breast cancer patients, something that other commenters to my blog post dismissed by saying things like "you should be happy you are alive," etc. Do many pharmaceutical marketers realize this? My friend Rich Meyer thinks not. "Pharma’s priority is still spreadsheets not patients," says Rich (here). "Patients are leaving pharma marketers behind and pharma marketers act like they still matter."

But is Taxol really better than Taxotere with regard to hair loss? To answer this question, I used Google to search on "taxol vs taxotere" and found some interesting online forums and discussions devoted to the issue. Here's a representative post by "billsgirl" that I found on the community.breastcancer.org/ site:

"I have one more A/C tx 2/22, and have done really well with little se to complain about. Now I must decide which Taxane I should go with. I'm leaning toward taxotere because my onc agrees that the bone marrow issues would be easier for my body to tolerate given my positive experience with the A/C, rather than risk neuropathy.

"Also, what about the hair? I've read some who said their hair started growing back after A/C and through T. I've read some scary stories about permanent hair loss. I'd hate that - I mourned my heai more than my breasts (I know that's odd...)

"I'd love your comments. Anything to help me make my decision."

What "help" did "billsgirl" get? There were several somewhat helpful comments and encouraging posts in this forum, but none really answered the question about which drug is best.

On www.medhelp.org -- a Cleveland Clinic "partner" -- I found a similar question by a patient ("Pam") and an "answer" from a physician.

"This forum is just fantastic!! Thank you Cleveland Clinic and Med Help Int'l. for giving people like me a reliable place to ask questions!!!

"My question is: Can you tell me the difference (if any) between Taxol and Taxotere? Does one work better than the other for particular types of breast cancer? My doctor suggested Taxotere, but didn't really give me a good explanation as to why. Your thoughts will be most appreciated."

Doctor's Answer:

"Dear Pam, Thank you for your complimentary comments regarding this Forum.

"Taxol (paclitaxel) and Taxotere (docetaxel) are both from the same family of medications - the taxanes. Both of these show a high level of activity when used as single agents in metastatic breast cancer.

"In reviews of reported studies, when compared with standard therapies Taxotere looks to be the most active single agent in treatment of metastatic breast cancer.

"There are some differences in the treatment schedules of the 2 medications, and there are some differences in the side effects of these 2 medications. I have listed the side effects of both medications.

"Taxotere: decrease of white blood cells, red blood cells and platelets, flu-like symptoms, fluid retention, numbness and/or tingling to fingers and toes, muscle aches or bone pain for a few days after each treatment, mouth sores, hair loss, decreased appetite.

"Uncommon Side Effects: allergic-type reaction, blood pressure and heart rate changes, nausea and vomiting, diarrhea, skin rash usually occurs on hands and feet, nail changes, menstrual cycle may become irregular or stop permanently, menopausal effects including hot flashes and vaginal dryness. Decreased desire for sex during treatment.

"Taxol: decrease of white blood cells, red blood cells and platelets, allergic-like reaction, blood pressure or heart rate changes during the infusion of the medication, mouth ulcers, numbness and/or tingling to fingers and toes, muscle aches or bone pain for a few days after each treatment, mouth sores, hair loss, diarrhea.

"Uncommon Side Effects: nausea and vomiting, nail changes, menstrual cycle may become irregular or stop permanently, menopausal effects including hot flashes and vaginal dryness. Decreased desire for sex during treatment."

Hair loss is mentioned (buried) as one side effect for both drugs.

So, I am still not sure that Anonymous was correct in her assertion that Taxol does not cause hair loss. But it's clear that her oncologist didn't offer her the kind of comparison that was offered to "Pam" online. Could it be that her oncologist had a conflict of interest? I suggested that in my response to Anonymous:

"It's my understanding that oncologists often make a profit 'reselling' these drugs. Obviously, in that case, they have a vested interest in offering patients the drug that gives them the highest profit. I do not know if Taxotere and Taxol differ in this respect."

What I DO know is this: Taxol is a generic medication and Taxotere is a brand medication. And back in 2007, Sanofi-Aventis, which manufactures and markets Taxotere, received a letter from the FDA warning the company not to make superiority claims for Taxotere vs. Taxol (see here).