At the recent Prescription Access Litigation Annual Dinner, (where we announced our first Annual Blockbuster Awards), we featured a pharmaceutically-oriented version of the classic Abbott and Costello comedy sketch, “Who’s On First?” (Original here).
While we make no pretensions of being even remotely as funny as the original, we offer here for your amusement,
Who’s on Pharma, Featuring Mark Etting & Aaron Dee.
(Aaron Dee, a journalist, is interviewing Mark Etting, head of public relations for GloboMegaCostaPharma)
Aaron Dee: Since you’re the head of public relations for GloboMegaCostaPharma, can you give the names of the people in your company who can tell me what I need to know about the pharmaceutical industry?
Mark Etting: I certainly can.
AD: Ok, the first thing I want to know is who can tell me how much the industry spends on research.
MA: No, he can’t.
AD: Who can’t?
MA: That’s right.
MA: You asked if Who could tell you how much we spend on research.
AD: So who can?
MA: No, he can’t. I already told you that.
AD: Who can’t?
MA: Yes. Didn’t we already cover that?
AD: I mean the person’s name who can tell me how much you spend on research.
MA: The person who can tell you how much we spend on research?
MA: I Don’t Know.
AD: What do you mean you don’t know? I thought you said you knew all the people who could give me this information.
MA: I do. And the answer is, I Don’t Know.
AD: Listen, either you do know or you don’t.
MA: I do! And the person you want to ask is I Don’t Know!
AD: What do you mean, I don’t know?
MA: That’s the person’s name.
AD: The person who supposedly knows how much you spend on research is named I Don’t Know.
AD: I guess that figures. So who can tell me how much, say, CVS, pays for your wonder drug Scamafleeceomendacin?
MA: Trade Secret.
AD: What do you mean, trade secret? How can it be a trade secret?
MA: I don’t know, I wasn’t there when her parents named her!
AD: Named who?
MA: No, not Who. Trade Secret!
AD: What, now you’re telling me that the person who can tell me that is a trade secret too?
MA: That’s what it says on her business cards.
AD: On who’s business cards?
MA: Why do you keep bringing Who into it? Can’t you leave Who out of it?
AD: OK fine, let’s move on. I heard that your company was under a criminal investigation, but it got resolved and now you have a strict compliance program. So now I want know the name of your director of corporate compliance.
MA: I Can’t Remember.
AD: What do you mean, you can’t remember? This just happened a few months ago!
MA: I know – and it was a big announcement. All the mucky-mucks were there. They brought him in to whip the company into shape, top to bottom. And the CEO got up to introduce him, and said, “Ladies and Gentlemen, I Can’t Remember!”
AD: That’s amazing. He can’t remember who he hired?
MA: No, of course he can. He introduced the Vice President of compliance that day too .
AD: Really? Tell me that person’s name.
MA: I Plead the Fifth.
AD: What do you mean? I’m a reporter, not a prosecutor! Why would you plead the fifth?
MA: You’re not making any sense.
AD: I’M not making any sense? I just want to know the name of your VP of compliance.
MA: And I told you – The CEO got up that day to introduce the VP, and said “Ladies and Gentlemen, I Plead the Fifth,” and pointed right at him.
AD: Right at who?
MA: Oh, for crying out loud, Who wasn’t even there that day! He was on paternity leave!
AD: Never mind. Tell me the name of your director of marketing.
MA: You Need It.
AD: Yes, I need it, or I wouldn’t be asking.
MA: No, her name, the director of marketing — You Need It.
AD: I already told you that! What do you want me to do, get on my knees and beg?
MA: Hey, leave our Director of Government Subsidies out of it.
AD: Look, I’ve seen your ads – the ones that show people frolicking through fields of flowers, having sex in antique bathtubs, lifting station wagons. They make it seem like everyone should be on your drugs. I want to know the name of the person behind those ads.
MA: Well, that’s her – You Need It. And she’s got a Ph.D. in consumer psychology.
AD: Listen, you’ve done nothing but stonewall the entire interview. I try to get information from you, and you just try to confuse me. As far as I’m concerned, you can go to hell.
MA: Oh, that’s our Director of Charitable Programs. You want to interview him?
And if this has given you a craving to see the much-better, real deal original, here it is:
Last month, the House Energy and Commerce Committee announced that it would be looking into the use of celebrities in drug advertisements, and in particular into the appearance of Doctor Jarvik in Pfizer’s ads for Lipitor. We posted “Should you trust Dr. Jarvik on Lipitor?” discussing this investigation. It was revealed back then that Dr. Jarvik has never had a license to practice medicine, is not a cardiologist and thus has never written a prescription.
The New York Times ran an article today, ““Drug Ads Raise Questions for Heart Pioneer” describing the dust-up, and providing some additional damning details that don’t exactly improve the credibility of Dr. Jarvik or Pfizer.
Here’s some of the juicier excerpts:
The ads depict Dr. Jarvik rowing on a lake. But…
And, for that matter, what qualifies him to pose as a rowing enthusiast? As it turns out, Dr. Jarvik, 61, does not actually practice the sport. The ad agency hired a stunt double for the sculling scenes.
“He’s about as much an outdoorsman as Woody Allen,” said a longtime collaborator, Dr. O. H. Frazier of the Texas Heart Institute. “He can’t row.”
Rep. John Dingell (D-MI), who is leading the investigation, said:
“It seems that Pfizer’s No. 1 priority is to sell lots of Lipitor, by whatever means necessary, including misleading the American people,” Mr. Dingell said.
Lipitor, the world’s single best-selling drug, is Pfizer’s biggest product, generating sales of $12.7 billion last year. But as it has come under competition from cheaper generic alternatives, Pfizer has used the Jarvik campaign, introduced in early 2006, to help protect its Lipitor franchise.
Pfizer spent $258 million from January 2006 to September 2007 advertising Lipitor, according to TNS Media Intelligence. Much of that went for the Jarvik campaign.
Spending $258 million to get $12.7 billion is a pretty good return on investment. Of course, that number doesn’t include the other promotional spending to drive up Lipitor prescriptions, such as the cost of pharmaceutical “salespeople” and free “samples.” Assume for the sake of argument that Pfizer spent as much on those types of promotion as they did on ads, for a total of a strictly-hypothetical $516 million. That’d be a return of 2,460%. Not bad at all. (Of course, not all of the spending on Lipitor in 2007 can be attributed to the marketing, but the returns are still pretty handsome.)
Despite the efforts by industry and government to curb drug advertising, spending on consumer drug ads increased more than 300 percent from 1997 to 2007, when it reached about $4.8 billion.
There are various estimates for how much in additional sales you get for each dollar you spend in consumer drug ads. They range from $1.50 to $4.20. Pretty good returns no matter how you slice it.
And back to the row about the rowing…
A newsletter published by the Lake Washington Rowing Club in Seattle describes how one of its rowers was a stunt double in the ad for Dr. Jarvik. The sculler, a professional photographer and rowing enthusiast named Dennis Williams, was picked partly for his size and partly because, like Dr. Jarvik, he has a receding hairline, according to the newsletter, which said a crew filmed the commercial for three days at Lake Crescent, near Port Angeles, Wash.
In the ad, Mr. Williams was shown as a solitary sculler navigating an unspoiled lake. Through deft editing, he appeared to be Dr. Jarvik. But, in fact, the frames that actually included Dr. Jarvik were shot in a rowing apparatus on a platform, according to the newsletter.
So Jarvik’s not a licensed MD, not a rower. Does he really even take Lipitor? Is that really his receding hairline, or it’s a hair-double’s? (Of course if you were going to have a “hair-double,” you’d go for the full head of flowing locks, right?)
In conclusion, we have the world’s best-selling drug owing a likely-good-sized-chunk of its success to the appearance of a man whose credibility, at this point, is highly questionable. I’d suggest that, rather than shying away from featuring “doctors” in drug ads who aren’t really doctors, perhaps drug companies should embrace it. In the style of “I’m not a doctor, but I play one on TV.”
Certainly, there are many actors and other non-medical celebrities who play doctors who probably have more credibility with many viewers than real doctors. I offer here a few suggestions:
Zach Braff, who plays Dr. John Dorian on the hit comedy “Scrubs.”
Katherine Heigl, who plays Dr. Izzy on Grey’s Anatomy. (But she also starred earlier in her career in “Side Effects,” an independent film poking fun at drug company salespeople, so perhaps not… Incidentally, I appear in Money Talks: Profits before Patient Safety, a documentary about the drug industry that Kathleen Slattery-Moshkau, the director of Side Effects did as a nonfiction counterpart to her comedy feature. So if we’re playing “Six Degrees of Katherine Heigl” that means there’s just two degrees between me and Dr. Izzy. We’re practically cousins. Katherine, how come you never call?)
Dr. Teeth, bandleader of the “Electric Mayhem,” a regular staple on the Muppets in the late 70s. With the kids who grew up with the Muppet Show rapidly approaching and entering their 40s, he might be perfect.
Dr. J, aka Julius Erving, legendary basketball player
Dr. Nick, intrepid medical provider to the denizens of The Simpsons, known for his distinct “Hi Everybody!” greeting, demonstrating his solid bedside manner and approachability.
Dr. John, famed New Orleans musician.
I could go on like this all day. Other suggestions of famous doctors, medical or otherwise, that Big Pharma should recruit for drug ads? Post a comment with them…
Our friends over at PostScript, the blog of the Prescription Project, got in to the holiday spirit last week with a Christmas Carol about the joys of drug sales people pitching their drugs to Doctors, with the aid of data and information sold to them by the American Medical Association (AMA). Here it is. Enjoy!
Here in PostScript country, we’re up to the shins in snow and to the gills with yuletide spirit, so we thought we’d turn all that merriment toward something else that’s on our minds…
A Data-Mining Carol
[to the tune of Jingle Bells]
Dashing through the wards, with a briefcase in his hand,
The rep signs in and waits, then shakes the doctor’s hand
But this is no plain pitch,
He knows just what to say,
Because he knows just how much Doc wrote
Of Seroquel last May
Data sells, the reps can tell
How well their free lunch pays
But docs don’t know how much is shown
On a rep’s handheld display, hey
Prescriptions filled, providers billed,
The rep calls it a day,
Oh how tough his job would be
Without the AMA!
Very funny parody song/ad for a new drug called “Paracetamoxyfrusebendroneomycin.” The lyrics make various references to the UK’s National Health Service, the jokes about it which are mostly lost on us here in the U.S. However, the rest is more or less universal.
And then, another by the same group of British lads, the Amateur Transplants. This one appears to be inspired by the great Tom Lehrer’s song about the Periodic Table of Elements, sung to the tune of Gilbert & Sullvan’s “Modern Major General”
A new song called Pillagers by New Jersey rappers Sudden Death pokes fun at the pharmaceutical industry. The song spoofs the constant barrage of advertisements for new drugs and contains a mock ad for a fictional product called Liquiplox. The song quickly became a number one hit on the nationally syndicated Dr. Demento Show.
Hardyston, NJ, July 21, 2007 –(PR.com)– A new song by New Jersey rap group Sudden Death takes aim and fires at drug companies and their seemingly endless barrage of new products. The song, called Pillagers, tells the story of a man who is taking about two dozen pills for things from flatulence to soft eyeballs and who has been told by his doctor that he must now take another pill for his mood swings. Meanwhile at the drug company the board of directors is brainstorming about new products they can sell to keep their stock price up because the projected $7 trillion in sales of their new product isn’t enough. The result is Liquiplox.
Liquiplox, much to the man’s relief, isn’t a pill. It’s a “liquid solution that relaxes the lining of your throat making it easier to take pills.” Of course this great product comes with a host of side effects which are told in rap form.
“Side effects include headache, runny nose, drowsiness and a rash/ a sugar high, bloating, and an absence of cash/ vomiting, abdominal cramps and diarrhea/ and an overwhelming urge to buy a couch from Ikea.”
“I really had fun with the side effects,” says Tom Rockwell, author of the song and Sudden Death’s front man. “A lot of the things that are said are things that I’ve actually said to the television while mocking some of the drug commercials that I’ve seen.”
“Liquiplox isn’t for everyone. People without health insurance or who otherwise may be unable to pay should not take Liquiplox,” the song says. “Do not stop taking any of your other medications without consulting your doctor as this may cause an unsafe drop in our profit margins.”
The ubiquitous “Luna Moth” ads have become the archetype of current drug ads, lulling the critical faculties of viewers into a slumber, and making even the deepest sleeper wonder if they should Ask Their Doctor about Lunesta.
Lunesta’s sales growth has been hampered by Ambien going generic (reports of sleep-eating, sleep-walking, and sleep-driving notwithstanding) and by competition from the latest entry into the prescription sleep drug market, Rozerem. So what does the forward-thinking company do in the face of lagging sales? Why, raise the price, of course! Yes, Ed Silverman at Pharmalot reports that Sepracor has raised the price of Lunesta 9%, on top of an earlier 9% price hike in November.
DTC television advertising that identifies a product by name should clearly state the health conditions for which the medicine is approved and the major risks associated with the medicine being advertised.
Sepracor continues to run so-called “reminder ads” for Lunesta, those brief spots which say the name of the drug but nothing else about it. Such ads are designed to increase name recognition, much in the same way that lawn signs and bumper stickers do for electoral candidates. Since they don’t say anything about what the drug is used for, under FDA regulations, they aren’t required to list the major side effects and other information we see in full drug ads.
What has PhRMA done about such violations, which they have been repeatedly informed of? N o one knows, since their report on the first year of the Guiding Principles and “comments” they received from consumers named no names and was widely considered to be a whitewash.
(Speaking of Ambien’s now-famous side effects: As is the case so often on matters of importance, perhaps the most thoughtful commentary on sleep drugs and their risks is, of course, from the Simpsons:)
GlaxoSmithKline has been nothing but forthright when it comes to the side effects of its new Over-the-Counter weight loss drug, alli (which earned the “With Allies Like This, Who Needs Enemas?” Award from PAL earlier this week) – they’ve admitted that it causes loose stools, fecal urgency and flatulence with oily spotting. And how could they not? Can you imagine consumers’ reactions if they didn’t know about these side effects until they occurred?
These side effects have caused many to wonder why on earth GlaxoSmithKline is even bothering to market this drug Over-the-Counter. It likely has much to do with the potential approval of sanofi aventis’ Acomplia (chemical name rimonabant, or Zimulti, as it likely will be called in the US), a much-awaited prescription weight loss drug that is already approved in Europe but is awaiting approval here in the U.S. (In fact, an FDA advisory board will vote on this drug tomorrow). If Acomplia/Zimulti is approved, it will further cut into the sales of prescription only Xenical. alli is the half-strength over-the-counter version of Xenical, and Xenical sales have been steadily falling over the past few years, due in no small measure to the disgusting side effects.
A video distributed by GlaxoSmithKline as part of its $150 million promotion of alli describes what GSK euphemistically calls “treatment effects.” John Mack over at Pharma Marketing Blog rightly calls this Orwellian style “Newspeak.” And the video seems to suggest that these “treatment effects” are a helpful guide to knowing when you eat too much fat. Helpful guide, indeed! As GSK advises, carry a change of clothes for the first few weeks on alli! It also seems to imply that these wonderful “treatment effects” are some kind of sign that the drug is working.
This smacks of Puritanism in that one on alli who “sins” by eating too much fat will be “punished” through oily spotting and uncontrollable diarrhea. Watch the video below and judge for yourself.
Prescription Access Litigation gives latest Bitter Pill Award to GlaxoSmithKline
Drugmaker gets the ‘With Allies Like This, Who Needs Enemas?’ Award for
Irresponsibly Selling a Formerly Prescription-Only Weight Loss Drug Over-the-Counter
BOSTON, MA – Prescription Access Litigation (PAL) today announced that its latest Bitter Pill Award is being given to GlaxoSmithKline, for the impending marketing of “alli,” (pronounced AL-eye, chemical name orlistat) an Over-the-Counter weight loss drug. Alli is being launched on June 15. PAL gave GSK the ‘With Allies Like This, Who Needs Enemas?’ Award for
Irresponsibly Selling a Formerly Prescription-Only Weight Loss Drug Over-the-Counter.
Alli is an Over-the-Counter (OTC) version of a previously prescription-only drug, Xenical. PAL believes that, by aggressively marketing alli and eliminating the need for a doctor’s supervision, GSK will cause this drug to be used inappropriately and even abused. PAL is particularly concerned that the drug will be used by teenagers and people with eating disorders. Since anyone can walk into a pharmacy and buy this drug, there are no controls in place to prevent this.
Alli is the most recent example of a drug to shift from requiring a doctor’s prescription to being available to anyone who walks into a pharmacy. While there are prescription drugs with long safety records that can be used Over-the-Counter by patients appropriately without a doctor’s supervision, alli is not one of them. Rather, the switch to OTC appears geared towards increasing the sales of a drug that has minimal effectiveness, disgusting and possibly dangerous side effects and uncertain risks. Prescription sales of Xenical have been steadily declining over the past 5 years, down from $202 million in 2000 to $86.6 million in 2005, according to IMS Health. A recent Zogby/UPI poll found that 29% of Americans said they would likely try an over-the-counter weight-loss pill.
“It is extremely irresponsible for GSK to sell alli as an Over-the-Counter drug,” said Alex Sugerman-Brozan, director of Prescription Access Litigation, “Anyone – including teenagers and people with eating disorders – will be able to walk into a pharmacy and buy this drug.”
Prescription Access Litigation, a national coalition of over 130 consumer advocacy organizations that criticizes Direct-to-Consumer Advertising of prescription drugs, has given out the Bitter Pill Awards: Exposing Drug Company Manipulation of Consumers (http://www.bitterpillawards.org) since 2005. The awards are intended to call attention to particularly insidious examples of irresponsible or manipulative drug advertising.
Alli works to block the absorption of fat by the body. The additional weight loss that results is quite minimal, with two studies showing that patients who took orlistat, the active ingredient of alli, for four years, only lost 2.8% more weight than patients taking a placebo. Alli has a number of unpleasant and disgusting side effects associated with it, including diarrhea, oily spotting, oily stools, flatulence with discharge, and fecal urgency. A book being sold by GSK as a marketing tie-in, Are you Losing It?, advises people taking alli to wear dark clothing and keep a change of clothes handy until they know how the drug will affect them. The drug also blocks the absorption of fat-soluble vitamins, including Vitamins A, D, E and K, putting patients at risk of vitamin deficiencies. Finally, even the modest additional weight loss only remains as long as patients keep taking the drug.
GSK has done an extensive pre-sales marketing campaign, emphasizing the importance of a low-fat diet and exercise. Notwithstanding this campaign and slogans like “there are no miracle diets,” making alli Over-the-Counter ensures that such “recommendations” are nothing more than that – recommendations that millions of consumers are likely to ignore (as they already do) and take the drug anyway, with potentially harmful consequences.
“A slick marketing campaign about changing eating habits is no substitute for requiring the prescription and supervision of a doctor,” added Sugerman-Brozan, “This is not aspirin – it is a drug with serious and potentially dangerous side effects and risks, and shouldn’t be available Over-the-Counter.”
Drug companies have often sought to switch prescription drugs to Over-the-Counter in an effort to increase sales or compete against generic versions of the prescription version of the drug. When a drug has a long and established record of safety, has a low potential for abuse, and can be used appropriately by consumers without a doctor’s supervision, it can and should be made available Over-the-Counter. But alli, which meets none of these criteria, should not. For all these reasons, Prescription Access Litigation awards GlaxoSmith Kline it first Bitter Pill Award of 2007, the ‘With Allies Like This, Who Needs Enemas?’ Award, for Irresponsibly Selling a Formerly Prescription-Only Weight Loss Drug Over-the-Counter.