This blog post seemed to capture a sense of thefrustration many marketers are experiencing aspharma slowly adapts to new methods of inter-acting with their customers—doctors andpatients. The post is reprinted here with permis-sion, and we suspect you’re going to have a lot tosay about Richman’s view. Send us an email athealth@chronicle.org

By Jonathan RichmanSpecial to THE CHRONICLE OF

HEALTHCARE MARKETING

IFIGURE THIS ARTICLE IS THE ONE that’llget the most comments ever. It’s goingto be the one that probably outrages

you the most or makes you think that I’vecompletely lost it (which perhaps I have).

Here’s why I’m writing this. I’ve got-ten really tired of all the discussion aboutsocial media in pharma and healthcare.I’ve grown bored with all the debates onwhy these industries should use socialmedia, and this is despite the fact that Ifind myself writing and talking about it all

the time. So, in an effort to move thedebate along to something different, Idecided to come up with a list of 10 otherdigital marketing initiatives that pharmacompanies could try that make basic socialmedia programs look like child’s play.

I’m fairly sure that no company isready to take these on, but they shouldstart getting ready. Some of these justmight be the next big marketing channelor idea that’ll vault some company ahead

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Healthcarelikely morereceptive toprivate sector� IMS exec says long-standing ideologicalbarriers coming downBy Ian J.S. Mooreof THE CHRONICLE OF HEALTHCARE MARKETING

GOVERNMENT EFFORTS TO CON-strain and control annualincreases in healthcare costs—

and the debate on how to accomplish asustainable system—will transformCanadian healthcare in the years aheadand will likely result in making the sys-tem more receptive to the private sec-tor, says an official with IMS Health.

“The long-standing ideologicalbarriers between the two sectors arecoming down,” John Pye, editor ofHealth Edition and principal author ofthe report PharmaFocus 2013 told arecent update meeting for the compa-ny’s clients in Toronto.

“This creates tremendous oppor-tunities for the pharmaceutical industryto develop closer relationships withgovernments and management.”

The current worldwide economictumble is going to leave an indeliblemark on our governments and howthey manage healthcare, he said.

“Canada is in the top tier in terms

Take your brand to new heights with North America’s Health & Lifestyle Agency. Call Kevin Brady at 416-960-3830.

Toronto New YorkVancouverMontreal San Francisco www.andersonddb.com

M a r k e t i n g

10 digital marketing ideas pharmacompanies will never try (but should)� Pharma blogger challenges industry to put a clamp on all the talk, and jump in

Turn to Private sector, page 10

Turn to 10 ideas, page 9

REPORT ON PATIENT-CENTERED MARKETING: Expect new rules and guidelines as regulators recognize impact of strategy • 4

MY TURN: Leave decisions regarding choice of therapies to doctors and their patients • 14

INNOVATION REVIEWS: Is it ethnographic research, or just getting a cultural perspective? • 8

• June 30, 2009 • • www.pharmacongress.info

D o l l a r s f o r d i a b e t e s

Members of the Juvenile Diabetes Research Foundation Canada (JDRF) opened the TSX on June 12 to salute the 21stannual Toronto Ride for Diabetes Research campaign. The 2009 ride takes place on Sept. 25 at Nathan Phillips Square, where1,500 corporate teams will help the JDRF reach their goal of raising $2.5-million in Toronto. (CNW Group/TSX Group)

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Can you blame them? HOFFMANN-LAROCHE doesn’t want to be a drugcompany anymore. The Swiss drug-maker, which earlier this year fullyacquired its biotech subsidiary Genentech, says it will leave the USdrugmakers’ lobby, PhRMA, and will affiliate with the BiotechIndustry Organization. The Star-Ledger newspaper of New Jerseyreports Roche boss Severin Schwan turned down a personal appealfrom AstraZeneca kingpin David Brennan, this year’s PhRMA chair,to remain in the drugmakers’ group. Concurrently, Roche’s UK unitwon’t be renewing its membership in the Association of the BritishPharmaceutical Industry, reports London`s Financial Times. The com-pany had been suspended from ABPI last year following charges ofimproper marketing practices on obesity Rx orlistat (Xenical.) �Roche announced it would withdraw systemic acne Tx isotretinoin(Accutane) from the US market, citing generic competition. And, per-haps there might have been another factor. “In addition,” the compa-ny added, in a statement, “Roche has been faced with high costs frompersonal-injury lawsuits that the company continues to defend vigor-ously.” Roche faces 5,000 outstanding claims pertaining to the Rx,which went off-patent stateside seven years ago.

First, no Accutane. Now, NO TCHOTCHKES. This is shaping up as theworst meeting ever for dermatologists attending the summer AmericanAcademy of Dermatology chinwag in Boston. The confab’s venue isthe Hynes Convention Center in Boston—where new laws pertainingto Rx marketing are set to come in on July 1. Henceforth,Massachusetts will say “nyet” to common promotional items such aslogo-bearing pens and coffee mugs, and the state will also protect itsphysicians from hospitality offered by drugmakers at congresses andsymposia. Drug reps will still be able to provide meals in a doctor’soffice.

DRUG REPS are so last-century, but drugmakers can’t seem to getenough MSLs. PharmaForce International says the number ofMedical Science Liaisons employed by 12 stateside Big Pharmacompanies grew to nearly 2,000 last year, a 48 per cent increasein just five years. Between 2006 and 2008, however, the US drug-biz was sending pink-slips to 16,000 bag-carriers, shrinking theindustry field force by 15 per cent. � Just when drug reps seemto be entering the endangered species list, here comesHollywood to makes things worse. Remember the

not-quite bestselling book by formerPfizer detailer Jamie Reidy, entitled“Hard Sell: The Evolution of a ViagraSalesman”? Actually, we’d forgotten it,

too, until we learned A-list actors Jake Gyllenhaal and Anne Hathawayhave been signed to star in the film version, set to begin lensing anyday now, as they say in *Variety.* Both appeared in the Oscar-winninghorse opera “Brokeback Mountain.” Reidy’s original title was deemeda bit too stiff for cineplex marquees, so the movie will be called “Loveand Other Drugs.” That’s okay with the author, whose real ambition,like all reps everywhere, is to direct.

New data adds further evidence to the theory that drug reps are a dis-appearing life-form. SK&A, a California-based consultancy, findsaccess to physician offices is rapidly becoming scarce. Between June2008 and the end of last year, the percentage of US doctors who insiston reps having a pre-arranged appointment rose to 38.5 per cent, from31.4 per cent. During the same six-month period the percentage of“no see” practices increased to 23.6 per cent, from 22.3 per cent.SK&A’s Physician Access survey was based on telephone interviewswith 227,000 medical practices. The consultants say their surveyresponse rate was 94 per cent. There is some regional disparity in thefindings. Doctors in the southern states are more receptive to drop-ins, and those in the west are less welcoming.

One question concerning DTC ADVERTISING that has never beendefinitively answered is: Does it work? New research from theUniversity of North Carolina, which examined the effect on promo-tion of IBS Tx tegaserod (Zelnorm, Novartis), provides the incom-plete answer of We`re not sure.` The US unit of Novartis invested US$127 million promoting Zelnorm to MDs, and US$122 million inDTC. A spike in doctor-visits followed, with an additional 1 millionnew patients turning up with IBS symptoms, within three months of

the campaign. Four-hundred thousand new IBS diagnoses weremade. However, the effect of the promotion was short-lived,and levels quickly returned to normal. Researcher Dr. SpencerDorn says he concludes most of the new diagnoses wereattributable to the heavy promotion to professionals. In the

end, none of it mattered all that much:Zelnorm was withdrawn from the US mar-ket in March 2007, following reports ofside-effects.

The Chronicle of Healthcare Marketing June 30, 2009 · 3

Anti-Diabetic Agent / InsulinResistance Reducing Agent 05-20

Pioglitazone (supplied aspioglitazone hydrochloride)(Actos, TakedaPharmaceuticals NorthAmerica Inc.) Comments:Manufacturer name change;TAB(15mg, 30mg, 45mg)ORL

H+, K+-ATPase Inhibitor 06-03Lansoprazole (Apo-Lansoprazole, Apotex Inc.)Comments: CDR(15mg,30mg)ORL

Non-Peptidic ProteaseInhibitor 06-03

Tipranavir (Aptivus,Boehringer Ingelheim (Canada)Limited) Comments: Updateto the Product Monograph -addition of 48/96 week data;CAP(250mg)ORL

Beta-Adrenergic ReceptorBlocking Agent 06-03

Atenolol (Atenolol, Pro DocLtée) Comments: New manu-facturer and product name;TAB(25mg)ORL

Antiretroviral Agent 05-20Emtricitabine (Emtriva, GileadSciences Canada Inc.)Turn to NOCs page 12

N O C s o f N o t e : June 2009

Significant TPP approvals

of Rxs for human use

O u t t h e r eWhat’s happening in drug marketing

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The US FDA has already scolded USpharmas for their search advertisements onGoogle and Yahoo, and, prompted bycomplaints from the public, Health Canadais expected to issue a new advisory reiterat-ing its own regulations for direct-to-con-sumer advertising early this summer..

“They’re not happy with the currentstate of affairs,” Ray Chepesiuk, PAABcommissioner, reports. “It’s not the factthat the [Schedule D] ads are out there, it’sthat they don’t have fair balance-risk infor-mation.”

The problem, according to theCommish, is that some pharma advertiserstake a second kick at the can by submittingtheir DTCA efforts for Schedule D productsto Advertising Standards Canada forapproval, if they are turned down by thePAAB.

“With DTC ads [advertisers] can go toASC or they can come here,” he notes.“We told them to put fair balance in, sothey chose to go to ASC and ASC didn’trequire fair balance.

“It’s a black eye on the industry.They’re correcting ads—and there aremore ads coming—and they don’t knowwhat the hell they’re doing over there.”

Chepesiuk believes Health Canada isthe original source of the problem, havinggiving ASC permission to review andapprove DTCA campaigns a few years ago,but failing to enforce their own HealthCanada regulations.

“It gives self-regulation a black eye,”he says. “And anybody knows that whenpoliticians start asking questions aboutself-regulation and the more often HealthCanada has to intervene, they’re going towrite regulations like Bill C-51 and they’regoing to write more regulations.”

Kevin Brady, captain at AndersonDDB Health and Lifestyle, Toronto, says

the new media have multiplied so rapidly inrecent years, iPhone applications are nowavailable for diabetics to access informa-tion on the symptoms, diagnosis, and careof the disease, as easily as one looks for arestaurant’s location and phone number.

“You can even link your glucose mon-itor to the iPhone and track your glucosereading,” he reports.

“It’s changing so quickly and thedynamics are good. It’s an exciting newfrontier. The question is controlling it, so itdoesn’t get out of hand.”

Patient-centric marketing is gettingmore promo dollars because pharmas aredisappointed with the results of theirdirect-to-consumer advertising, accordingto Mark McElwain, vee-pee, the WellnessGroup at Allard-Johnson Communicat-ions, Toronto.

“My general feeling has been that thetide is running away from mass advertisingto consumers,” he says, referring to areport of a substantial drop in DTCA phar-ma advertising in the US last year.

“Mass spending on consumers may beless effective than trying to speak topatients, people who have been prescribedthe medicine. They are open to differentrules and regulations than consumers, andcompanies can say more to them, makingsure they take the meds correctly, whichincreases the odds they will keep on taking

them into thefuture.”

Adherence toprescribed medica-tions is the main rea-son for pharmas’ en-thusiasm for patient-centric programs, ag-rees James Cran,founder and headhoncho at Anti body,Toronto, becausemost new medicat-ions take a long timebefore they can gaina listing on provincialformularies and pri-vate carrier plans.

“In the old daysif we got threepatients and lost two,we didn’t really carebecause all the mar-kets like hypertension,high cholesterol, anderectile dysfunctionwere very new disor-ders and growingbeyond belief.”

No surprise,then, that when apharma gets a newpatient using one of

its newer agents, the marketing emphasis ison recruiting physicians, nurses, pharma-cists and other healthcare pros to helpenrol this newest patient in a program pro-claiming the health benefits of adherence.

When it comes to devising a cam-paign, Cran believes a mix of media is thepreferable strategy. “Patients do still likegetting things sent to their home,” he saysof direct mail. “When they see the enve-lope with the program name, they openthem.”

“But we’re also finding that olderfolks are just as web savvy as others. Thebenefit of the web is that it is much morecost-effective.”

FOCUS MUST BE ON THE PATIENTSMore competition from rivals and heavierpressure from payers looking to restrictaccess to medications are two principal rea-sons for pharmas shifting their marketingfocus from the healthcare professional topatients, says Don Swainson, managingpartner at Cameron Stewart IntegratedStrategy, Mississauga, Ont.

“The patients are core, and should becore to the thinking when companies aredesigning programs and services instead ofconcentrating so much on the representa-tive-doctor dialogue.

“And physicians themselves are saying‘We’re not seeing enough value from hav-ing all their representatives bombard ouroffices.’”

Will the shift from pro to patientmove market share? The answer is “yes”and “no” so far, according to Swainson. Ifpatient-centric marketing is defined asattempts to find the most efficient channelto sales, the answer is affirmative. If effortsare defined as DTC advertising, the answeris negative.

“It’s still about your interaction withthe physician, but really centering yourpromotional efforts on how to help thepatient.”

Crucial to marketing success, he adds,is the initial step of making it easier for thephysician to introduce a new medication tothe patient. Providing sophisticated ser-vices oriented to the patient will help toadd new patient starts as well as maintainadherence to scripts.

One service option, he says, isAdvanced Speech Recognition (ASR), soft-ware programming, that uses pre-recordedprofessional voices in automated telephonecalls to patients.

“When individuals are enrolled in theprogram they have to agree to receive thesecalls, which have a message that has beenapproved by the company and has gonethrough PAAB,” Swainson explains.

In one program, 82 per cent ofpatients in a group which had been tele-phoned at two-month intervals about theirtreatment regimen with a statin were stilltaking the medication after six months,compared to only 18 per cent of those whohad not been contacted via the ASR sys-tem, Swainson said.

4 · June 30, 2009 The Chronicle of HealthcareMarketing

This SPECIAL REPORT was compiledby Ian J.S. Moore, a frequent contribu-tor to THE CHRONICLE OF HEALTHCAREMARKETING

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IN AN ENVIRONMENT

where diabetics can nowuse their iPods to getinformation about theirdisease, where US phar-

mas are now owners and oper-ators of web sites and socialmedia outlets devoted to dis-ease states, and Schedule Dproducts (vaccines, biologics)in Canada are routinely circum-venting the PAAB approvalprocess, new rules and regula-tions governing patient-cen-tered marketing (a.k.a. CRM orcustomer relationship mar-keting to some) are inevitable.

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Chris McEvenue, partner atCPC Healthcare Communications,Toronto, notes a distinction be-tween marketing environments.One is disease state awareness, anunbranded environment, which isappealing to patients and is mostbeneficial to brand leaders becauseopportunities for convertingunaware patients to a specificproduct are greater.

The second is the area wherefollow-up is necessary to ensurecompliance or dosage administra-tion—as in cases of hyperten-

sion, ADHD, and plaque psoria-sis treated with a biologic agent.

“There are many [disease]categories where the outcome isconfounded by poor adherenceto therapy, and often it’s a matterof the patient not being aware of

the potential negative effects ofnot maintaining therapy.”

Measuring outcomes isessential to abandoning programswith poor results, because there isno ‘one size fits all,’ he adds.Some programs concentrate as

much on the caregiver as thepatient.

SHOULD CREATE A RESPONSE“It needs to be approached witha very good understanding of thecondition and the reasons whyyou’ve not been successful so farin getting the outcomes in patientactivity you wanted.”

“The world of the physicianand the world of the consumerare colliding at light speed,” saysRick Smith, prexy of the health-care division at Torre, Lazure,McCann, Toronto. “Withoutads for both, your client isn’t

going to be able to communicateto your patients, so all strategiesshould include everybodyinvolved in the mix.”

Smith agrees with othersthat reliance on but one mediumis not good strategy.

“Pick -ing onemedium isnot usually awise idea.Phys icianswant to bekept up tospeed oncritical, newinformation,and peopleare going tolook upeverythingfrom themildestmedical con-dition, andthey wantinformationto describewhat’s goingon to aphysician.

“Thisisn’t justonline, it’sin any com-municationform youwant tomake. Itshould berelevant,and shouldcreate aresponse.”

PaulWhitehead,the mainman atInformationDisplaySystems,Toronto, isanothermedia mixer.

“Any one medium can besuccessful,” he says, “but themore you can integrate them andoffer patients more options, thebetter for everybody, patient,physician and provid er.”

His company concentrateson point-of-care items such asproprietary brochure display sys-tems, a poster network and mag-azines, such as the Can adianMedical Associat ion’s CanadianHealth Magazine, and more re-cently narrow-cast television net-work for doctors’ offices.

“If the patient is proactiveand wants information, there’s nobetter place than the doctor’soffice for the mind set and thecredibility, the doctor being there.

Print materials are still effec-tive contenders in the media mix,he adds, referring to the firm’sresearch showing brochures and

6 · June 30, 2009 The Chronicle of Healthcare Marketing

Picking 1 medium to encourage compliance is usually not a wise ideacontinued from page 4

Turn to Patients, page 12

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The Chronicle of Healthcare Marketing June 30, 2009 · 7

T h e n e w i n f l u e n c e r s

Pharma needs to get a handle on social media� Newspaper editor says implications of movement to social media will impact how businesses are organized

By Ian J.S. Mooreof THE CHRONICLE OFHEALTHCARE MARKETING

PHARMA AND JUST ABOUT

every other business orga-nization in the world today

function in an environmentwhere all media, including news-papers, radio, and television,should be considered socialmedia, and the implications areprofound in terms of how busi-ness is organized and operated,says a Toronto newspaper editor.

“I don’t think any media isreally the same anymore in anyway, any media that you look at,”Mathew Ingram, communitieseditor for The Globe and Mailnewspaper told a spring meetingof the Ontario PharmaceuticalMarketing Association.

“It’s effectively becomingsocial, whether it wants to or not.”

According to Ingram, tradi-tional media are viewed as a one-way channel—much like a mega-phone—but social media is acrowd with every individual try-ing to do something.

“Once you get past all thegoofy companies with the stupidnames and bizarre business mod-els, it’s just people trying to con-nect with other people who areinterested in the same things thatthey’re interested in,” he said.

Some sociologists have cate-gorized this interest as ambientawareness, or a network of weaklinks. Interestingly, research hasshown these links are better thanstrong ones for exposing an indi-vidual to new ideas.

They’re also thrashing tradi-tional media when it comes toreaders or site visitors. The NewYork Times has a daily readershipof two million, and its web siteattracts another 650,000 so-calledvisitors. But Facebook, the socialnetworking site, has more than6.5 million visitors each day andthe numbers are growing at 100per cent year over year. At lastcount, Twitter was growing at1,300 per cent year over year.

STORM FORMS AROUND ISSUEBlogs also have many readers, 350million on a regular basis, accord-ing to Ingram, and companieswould do well to avoid being thesubject of a blog “storm” whichcan form quickly around an issue.

“You don’t necessarily wantto find either yourself or yourorganization in the middle of oneof these storms, but it’s probablygoing to happen to some of you,”Ingram remarked, referring toone storm launched by “MotrinMoms” against a particularMcNeil consumer ad campaign.

Social media are not theexclusive domain of teenagers and

twenty-somethings, he added, asthe Obama election team demon-strated effectively when it intro-duced the candidate’s BriefingBook, incorporating the views ofpotential voters in policy decisions.

Individuals and groupsincluding business firms would dowell to pay attention to socialmedia conversations and also par-ticipate in the conversationsthrough blogging, Twitter, RSS keyand other searches, he suggested.

“You should have one ofeverything,” he advised. “Try andcorrect the information whensomeone’s got something wrongand try and do it politely and incontext wherever the conversa-tion is occurring.

“The best way to understandthe social media is to become apart of it. So, dive in.”

“If you build it, they won’tnecessarily come, unless you workit,” Alon Marcovici, vee-pee digi-

tal media and research, CTV-Rogers Olympic consortium, saidabout social media sites. “Youwon’t automatically be in the Top10 online overnight.”

He outlined network plans tomake extensive use of social mediain its preparations for and cover-age of the 2010 Olympics. CTVwill “embrace” YouTube as a dis-tribution channel and encourageuser participation, allowing view-ers to comment on figure skating

judging and results from othercompetitions, as well as enablingviewers to create their own high-light reels from various events.

The network also plans tointegrate user-generated contentinto site content, he added, andintends to “wigidize” the contentfor broad distribution.

“We use Twitter to trackwhat people are saying aboutCTV Olympics,” Marcovici said,

º

Turn to Social media, page 8

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8 · June 30, 2009 The Chronicle of Healthcare Marketing

THE CHRONICLE OF HEALTHCAREMARKETING presents the second instalment in afeature series intended to critically assess newtools, technologies, and tactics available to thepharma marketer from a range of Canadian andinternational suppliers. In this issue, AndrewSenior looks at ethnographic research.

By Andrew SeniorSpecial to THE CHRONICLEOF HEALTHCARE MARKETING

THE DYNAMIC FOR DECISION-MAKINGin prescription drugs is changing withpower and influence shifting away

from physicians and toward other stake-holders. Nurse practitioners, pharmacists,and naturopaths are being granted the rightsto prescribe drugs. The various bodiesresponsible for reimbursement are taking onstronger roles and patients are becomingmore knowledgeable and empowered.

The pharmaceutical marketer is facedwith a new challenge. Not only doeshe/she need to differentiate and grow theirbrand, they must do it in a marketplace ofchanging customers.

Historically, the prescriber was king,and the patient an afterthought. Now mar-keters need to consider the patient moreseriously, and to do that requires a good

understanding of their needs and motiva-tions. In the past we have gathered data andinformation though patient focus groups,surveys, patient advocacy groups, andthrough physician feedback. Unfortunately,these forms of research rarely yield greatinsights into patient needs and the motiva-tions behind their actions. The reason mightbe that what people say does not alwaysreflect what they do, and we have been bas-ing decisions on what they say.

Perhaps this is why almost every

patient compliance program has failed toimprove compliance. Patients said they“forget to take their meds”, so we sent themreminders, emails, or had telemarketers callthem. What has been missing are trueinsights into patient behavior. A patientwith overactive bladder does not “forget”their meds. They simply do not take them ifthey are going to be at home where they canquickly get to a washroom. On the otherhand, if they know they are going to be outin public, the fear of embarrassment moti-vates them to take their medication.

An innovative way to obtain patientinsight is through ethnographic research.Historically it has been used to study edu-cation systems, consumer behavior, andother areas where human behavior isimportant. Surprisingly it is just now mov-ing into pharmaceutical marketing.

Ethnographic research (or ethnography)relies heavily on observation, participation,and interaction with the subject. Insights aredeveloped by spending an extended period oftime—sometimes a day or two—with thesubject in their environment: home, sociallife, the clinic setting, work, etc. The ethnog-rapher records observations and descrip-tions, and also finds out the motivationsbehind the subject’s actions to better under-stand why they act in a certain way.

OBSERVE BEHAVIOR IN NATURAL SETTINGThere are three principles to ethnographicresearch which give it an advantage over tra-ditional market research in understandingthe nature of human behavior. First, behav-ior is observed in a natural setting. Any arti-ficial setting such as interviews cannot pre-cisely replicate what is done in this setting.

Second, the ethnographer learns how

and why people act in a certain way. Inessence it is gaining an understanding ofcultural perspectives. In the healthcare set-ting a group of patients with a particulardisease may develop their own culture andhence behave differently than those with-out it. Finally the research method isexploratory, and open. It is more useful atidentifying issues rather than testing ahypothesis. However, the nature ofethnography allows it to both learn and testas the research proceeds. (See .A Synthesisof Ethnographic Research, by MichaelGenzuk, PhD, of University of SouthernCalifornia, Center for Multilingual,Multicultural Research.)

GEARSHIFTING INC is one of thefirst organizations to bring ethnographicresearch to the pharmaceutical industry.The company, started by Mehbs Remtulla,former CEO, EURO RSCG LIFE, helpsclients develop innovative solutions toeveryday challenges. The starting point isgaining insights through ethnographicresearch and includes assembling a groupof lateral thinkers (client, key stakeholders,and even a few from outside the industry),to turn those insights into innovative initia-tives. To date, their work has involvedpatients, physicians and even payers, inCanada, US, and Europe.

For a European client developing adrug for diabetes the insights identified ledto a solution that may completely changethe way diabetes is treated. The conceptpromises to offer more integrated andcohesive care than the current treatmentmodel provides, with improved patientoutcomes expected. Payers are on-boardwith the promise of listing the drug if themodel works. The ultimate outcome, basedon one insight gathered from ethnograph-ic research, could improve access to targetphysicians, generate a readily available poolof patients for clinical research, create atrue industry-customer partnership, reducethe time to formulary listing and provide acompetitive listing advantage.

Most understand that the role ofpatients is changing and most would agreethey have limited insights into the needs andmotivations of patients. A better understand-ing of this customer group may well leadpharma marketers to stronger positioning,innovative strategies, and/or more effectivetactics. If your brand requires patient-specif-ic strategies or tactics, ethnographic researchcould help you invest your promotional dol-lars efficiently and effectively.

A r e v i e w o f i n n o v a t i o n s i n p h a r m a c e u t i c a l m a r k e t i n g

Pharma needs to understand patient motivations� A better understanding of this customer group may well lead the pharma marketer to more effective tactics

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“and we are struggling as many of youmay be in terms of how we react. How do we react with a human voice?”

The network is feeling its way in this digital universe, he admitted, and has severalother considerations to ponder. How should blogs and social conversations be monitoredand to what level? What if nobody builds content?

“We really are cognizant of not putting in too many barriers for people to comment,because there are place they can go where there are no barriers,” he said.

“While no man is an island, every man is his own medium. Every one of you can beout there and be as destructive or as productive as you want with your own brand.”

Social media offer pharma great opportunities to humanize the industry, according toNatalie Bourré, prexy of Marketing 4 Health, Inc. of Richmond Hill, Ont.

“If we don’t get involved, we’re really missing out on an opportunity to learn aboutour markets, to engage with our consumers,” she said. “And also to put discussions intocontext, because patients are providing their own personal experiences and their ownpersonal contexts.”

Social media: Fewer barriers improves commentary—continued from page 7

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The Chronicle of Healthcare Marketing June 30, 2009 · 9

of everyone else. And I almostforgot, it’s what your customersare demanding.

Before I begin, know that Iunderstand the regulatory realitiesof pharma and healthcare market-ing. I lived them for 12 years. So,I’m not suggesting anyone runout and do exactly what I spellout here. I know it’s not that sim-ple. However, I offer these tohelp stretch your thinking and tochallenge you to figure out a wayto do something that preservesthe spirit of the ideas here, butdoesn’t get you fired. If you needhelp, just give us a call. So, herethey are, in no particular order.1. Create a game for the Wii

Fit that helps your patientsmanage their disease and begina proper exercise and fitnessregimen. I just wrote aboutthis (http://tiny.cc/YjZhZ)More details on why this is agood idea in my post.

2. Get rid of your brand web-site. No one is really visitingyour site anyway. It’s likely notdriving anyone to get a pre-scription and it’s almost cer-tainly not getting anyone tostay on your treatment.Instead, take all the moneyyou were going to spend onyour site and create great con-tent that you syndicate out tocredible third-party sites. Theinformation can includebranded and unbranded infor-mation, but it would now belocated where patients (anddoctors) are likely to find itand pay attention. It’ll be onthe health sites they trust at atime when they’re researchingtheir condition.

3. Add ratings and reviews toyour brand site. Don’t wantto get rid of your website?Okay, how about adding rat-ings and reviews to your site.Every other industry has real-ized that this is critical tobuilding trust with visitorsbecause it shows authenticity.It turns out that simply havingreviews can increase traffic,conversion rate, and averageorder value (see more detail athttp://tiny.cc/NFn7x). Inaddition, negative reviewsaren’t an issue so long as therearen’t only negative reviews.Your products are alreadybeing reviewed on sites likeiGuard, so why not bring thisonto your site and build somecredibility with your patients?

4. Install Google Friend Con -nect. Wonder who your realfriends are? Install this tooland see. Visitors can join yoursite, which in turn adds yoursite to their Google profile asone of their “friend” sites.They can comment on the siteand quickly and easily shareyour site with friends. A simpleway to add a little social media

to your site without going toofar. Not sure what FriendConnect is? There’s a videofrom Google explaining it(http://tiny.cc/h9wlD).

5. Allow patients to share theirhistory with Google Health (orMicrosoft HealthVault). Yes,more Google. I’m sure youknow about Google Health(http://tiny.cc/8Sp1A), but didyou know that you can becomea partner and allow patients toexport their prescription histo-ry directly from your site intotheir Google Health record?Why not make it easy for your

patients? Oh, what’s that yousay, you don’t let people tracktheir prescription history andsymptom improvement onyour site? Hmmm. Nevermindthis one.

6. Add features to your sitethat allow patients to tracktheir condition and comparewith others. If number fivedidn’t appeal because youdon’t have any tracking func-tionality on your site, here’syour chance. The best in classhealthcare sites feature tools tohelp people manage their dis-ease. The best of the best (in

my opinion) is Patients LikeMe (http://tiny.cc/0wqCp).They feature an array of toolsthat let you track yourprogress, medications taken,and side effects. What’s evenmore important is that you cancompare yourself to others tosee if you are doing better orworse and see which treat-ments seem to be working bestfor the community. You’ve gotto give people a reason tocome to your site and you dothis by adding value beyondyour product messages.

7. Hire five “community man-

agers” to help fix your onlinereputation. Let’s be honest, nobrand manager has time tomonitor what’s going ononline with their brand. Theycan’t keep track of everythingthat’s happening and every-thing people are saying (or canthey?)(http://tiny.cc/Ubzih).Nevermind the monitoring,how about actually respondingto some of the comments?What about correcting the bla-tantly inaccurate information?It’s certainly your right to dothis, but corporate policies

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10 · June 30, 2009 The Chronicle of Healthcare Marketing

of how much of our collectivewealth we dedicate to health-care—eighth among 30 OECDcountries.”

Pye noted that healthcarespending is expected to amountto 10.7 per cent of the country’sGDP for 2008, with 30 per centof the total coming from privatesources like insurance plans andhousehold out-of-pocketexpenses.

After interest payments,provincial and territorial govern-ments spent $332-billion in 2007-2008 on all their various pro-

grams, and health programsaccounted for 35.6 per cent, butthis percentage will be affectedby the expected drop in tax rev-enues under the current econom-ic conditions.

“For healthcare, belt tighten-ing and creating new revenuestreams are the only options,”Pye said.

Among the revenue options,he said, governments will have todefine core services in the publicsystem and introduce selectivefees for service. A dedicatedhealth tax or healthcare savingsplan, or allowing consumers to

buy “add ons” as Alberta is doingin long-term care are other possi-bilities.

“The other option is to allowthe private sector to providemore and ensure more services toconsumers who are willing to payfor it.”

SHORTER HOURS FOR DOCSThings are tight now and willbecome even tighter in the hospi-tal sector, Pye predicted.Governments are already workingto restructure their hospitals andmanage costs, principally by limit-ing budget increases. Regionalhealth units are being revamped to

better co-ordinate services toimprove business practices.

“Shared service organiza-tions are expanded and activity-based funding is being consid-ered and experimented with toprovide more equitable fundingfor the distribution of money,”he said.

Community care is anotherarea of healthcare that will under-go significant changes during thenext five years, and “the pharma-ceutical industry will have atremendous role to play,’ Pyepredicted, noting that more long-term care facilities are under con-

struction with the private sectorplaying an important role.

Home care, a proven cost-efficient policy, is also expectedto become prevalent, helpedalong by new technologies liketelemonitoring.

The aging physician popula-tion and an influx of femalephysicians (who now form amajority of med students) areother factors that will affect thenational healthcare system in theyears ahead, he noted.

New physicians are expectedto work shorter hours and havesmaller case loads. Receptive tonew technologies, they will useinnovative approaches in theirpractices, which he predictedwould likely be within the team-based care model.

Pye anticipates that pharmapolicy will be redefined withinthe next few years, as govern-ments attempt to control risingexpenditures in this area, forecastby the Canadian Institute forHealth Information (CIHI) tohave been slightly fewer that $30-billion for medications last year.Prescription drug sales accountedfor $25-billion of this total.

FEDS MOST CONCERNED WITHSAFETY OF MEDSPye reported that sales of pre-scription drugs have doubledsince 2001 and the annualincrease in spending has beenhigher in this segment than theincrease in overall healthcarespending each year since 1999.

“According to CIHI, 2008-2009 is expected to be the first yearthat the annual increase in provin-cial/territorial drug spending wasin line with that of healthcare over-all, 5.8 per cent for drugs and 5.9per cent healthcare,” he said.

“It’s the same situation for2009-2010 based on the currentbudgets.”

The federal government isdetermined to adhere to its coreresponsibility—principally prod-uct safety—and this is the reasonwhy nothing has been done con-cerning the much-discussed pro-gram called the NationalPharmaceuticals Strategy.

“This is why the feds haveinvested in the drug safety andeffectiveness network to the tuneof some $31-million over fouryears,” Pye said, “but there is nomovement from Ottawa to splitthe cost of a $5-billion cata-strophic drug plan as proposedby the provinces.”

It is the provinces, henoted, who are taking the policylead, particularly Ontario onpricing and Alberta on itsExpensive Drugs for RareDiseases program. And allprovinces are moving to enactlegislation for income-baseddrug plan coverage.

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The Chronicle of Healthcare Marketing June 30, 2009 · 11

make this impossible. Howabout hiring someone (or afew someones) who areempowered to go online,search out this misinformationand correct it? They also canengage in discussions and helpimprove people’s overall per-ception of you. You can givethem a set (approved) script ofthings they can and can’t say toguide where they get involvedif you’re really worried aboutthe legal implications.

8. Create a portal allowingphysicians to get every pieceof clinical information relatedto your product and its indica-tion in one place. Now,wouldn’t that be useful? Moreand more doctors are usingthe Internet to research condi-tions and medical challenges(no duh?!?), but it’s still prettyhard to find everything youneed and it involves a lot offishing around. Sites likePubMed don’t offer a greatsearch interface (just compareit to Google) making it hard tofind what you need. Howabout instead automatingsome searches and adding afeed on your physician brandsite that allows them to see theabsolute latest clinical dataabout your disease state?Technically speaking, this is apretty simple exercise, but willyour regulatory team allow it?

9. Kick people out of your CRMprogram. While that might

sound a bit Machiavellian onthe surface, it’s for everyone’sbenefit. Consider that yourprogram probably has thou-sands of people in it that willnever change their behavior,try the product, or be persis-tent with it. They just won’trespond to your program.Don’t feel bad, they probablywouldn’t respond to anything.The problem with allowingthese people to enter and stayin your program is that inorder to allow this you have totake money and resourcesfrom those who actuallywould benefit from some-thing. If you only allow accessto those you know you canhelp, then you can concentratemore resources on them,which will allow you to createmore robust support systemsand programs. You don’t haveto completely forget the oth-ers if it makes you feel better,but you have to send them avery “lite” version of yourprogram so you can focuswhere you’re going to make animpact. Don’t think it’s possi-ble to figure out which peopleyou can and need to help?Merck does. They created“‘The Adherence Estimator,’an elegantly researched toolfor predicting which patientswill display poor compli-ance—by focusing on justthree core issues: commitmentto treatment, concerns overtherapy, and cost

(http://tiny.cc/LWr54). Now,that’s handy.

10. Implement OpenID onyour website wherever yourequire registration.(ht tp ://t iny .cc/5BV9C) .Don’t know what OpenID is?You will. It continues to growas people have grown tired ofhaving a different user nameand password on hundreds ofdifferent sites. Instead, theycan now have a single, vali-dated user name and pass-word that gets them onto anysite that supports OpenID.Why should you care about

this as a pharma company?Simple. Remember that mostpeople don’t really trust youthat much. Giving visitors away to engage with you thatdoesn’t immediately requirethem to give you personalinformation (yes, an emailaddress counts as personal)probably will increase thechances that they actually doengage with you. As you buildtrust over time and they real-ize that what you are provid-ing is valuable, then they’llstart to volunteer more per-sonal information in order to

get even more useful contentor tools from you.

SO, WHO’S going to be first toimplement any one of these? Ifyou know of a pharma or health-care company that’s doing any ofthese, I’d love to hear about it.Also, if there’s anything I missed,feel free to send a comment..

Jonathan Richman is director of busi-ness development for Bridge Worldwide,an interactive and relationship market-ing agency based in Cincinnati (1-513-297-1060). He is the author of thehealthcare industry blog, Dose of Digital(h t tp ://www.do s e o fd i g i t a l . c om) .

10 big ideas on digital marketing pharma will never try, but shouldcontinued from page 9

BM S i s i n t h e n e i g h b o r h o o d

Over 300 BMS employees across Canada took part in the 2nd annual Bristol-MyersSquibb Canada Community Action Day by volunteering with various organizations. In Montreal,the organizations included Moisson Montreal, a food bank; Heritage Laurentien, an environmentalprotection organization; and the West Island Cancer Wellness Center. In the photo, from left toright: BMS Canada employees Vicky Esposito, Jean Bellavance, Lucille Frappier (retiree), JoAnnTarzi, Litsa Kouroumalis and her son, Michael-John Sakellaropoulos, Marie-France Miljours,Philippe Toupin, and Margaret Jackson. (CNW Group/Bristol-Myers Squibb Canada)

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12 · June 30, 2009 The Chronicle of Healthcare Marketing

Comments: Manufacturer name change; CAP(200mg)ORL

Antipsychotic Agent 05-07Haloperidol (supplied as Haloperidol Decanoate)(Haloperidol Decanoate Injection, Hospira HealthcareCorporation) Comments: Manufacturer name change;LIQ(50mg/ml, 100mg/ml)IM

Antiviral Agent 05-20Adefovir Dipivoxil (Hepsera, Gilead Sciences Canada Inc.)Comments: Manufacturer name change; TAB(10mg)ORL

Topical Corticosteroid with Antibacterial - AntifungalAgent 06-03

Flumethasone Pivalate / Clioquinol (Locacorten VioformEardrops, Paladin Labs Inc.) Comments: Manufacturername change; DPS(0.02%/1%)OT

Antimetabolite / Antirheumatic Agent 06-03Methotrexate (Methotrexate Injection BP, AccordHealthcare Inc.) Comments: SOL(25mg/ml)IAR, IM, INT,IV

Prostaglandin 06-05Alprostadil (Muse, Paladin Labs Inc.) Comments:Manufacturer name change; SUP(125mcg, 250mcg, 500mcg,1000mcg)URH

Calcium Channel Blocking Agent 05-07Nimodipine (Nimotop, Bayer Inc.) Comments: Newdosage form: 30 mg/tab; TAB(30mg)ORL

Opioid Analgesic 05-07Oxycodone hydrochloride (Oxycodone, Pro Doc Ltée)Comments: New manufacturer and product name;TAB(5mg, 10mg, 20mg)ORL

Antibiotic 06-05Erythromycin (supplied as erythromycin ethylsuccinate) /sulfisoxazole (supplied as sulfisoxazole acetyl) (Pediazole,Amdipharm Limited) Comments: Manufacturer namechange; PSU(200mg/5ml / 600mg/5ml)ORL

Androgen 05-08Testosterone undecanoate (pms-Testosterone,Pharmascience Inc.) Comments: Product name change;CAP(40mg)ORL

Opioid analgesic 05-22Fentanyl (Ran-Fentanyl Mat, Ranbaxy PharmaceuticalsCanada Inc.) Comments: New formulation;PATCH[25mcg/hour (4.2mg/patch), 50mcg/hour (8.4mg/patch),75mcg/hour (12.6mg/patch), 100mcg/hour (16.8mg/patch)]TRD

Opioid Analgesic 06-03Fentanyl (Sandoz Fentanyl MTX Patch, Sandoz CanadaInc.) Comments: PATCH(12mcg/h, 25mcg/h, 37mcg/h,50mcg/h, 75mcg/h, 100mcg/h)TRD

Antipsychotic Agent 06-04Quetiapine (supplied as quetiapine fumarate) (SandozQuetiapine, Sandoz Canada Inc.) Comments: New indica-tion; TAB(25mg, 100mg, 200mg, 300mg)ORL

Calcimimetic Agent 06-05Cinacalcet (supplied as cinacalcet hydrochloride) (Sensipar,Amgen Canada Inc.) Comments: New Indications: Forthe reduction of hypercalcemia in patients with parathyroidcarcinoma and for the reduction of clinically significanthypercalcemia, as defined by relevant treatment guidelines.In patients with primary HPT for whom parathyroidecto-my is not clinically appropriate or is contraindicated;TAB(30mg, 60mg, 90mg)ORL

Psychotropic Agent 05-27Quetiapine (supplied as quetiapine fumarate) (Seroquel XR,AstraZeneca Canada Inc.) Comments: New indication:Major depressive disorder; TER(50mg, 150mg, 200mg,300mg, 400mg)ORL

Antiepileptic Agent 05-06Gabapentin (Sig-Gabapentin, Sigmacon Lifesciences Inc.)Comments: New manufacturer and product name;CAP(100mg, 300mg, 400mg)ORL

Oral Anticoagulant 06-03Acenocoumarol (Sintrom, Paladin Labs Inc.) Comments:Manufacturer name change; TAB(1mg, 4mg)ORL

Antibiotic 05-07Ceftriaxone (supplied as ceftriaxone sodium) (StragenCeftriaxone, Stragen Inc.) Comments: PWSO(250mg/vial,500mg/vial, 1g/vial, 2g/vial)IM, IV; PWSO(10g/vial)IV

Selective Norepinephrine Reuptake Inhibitor forAttention- Deficit/Hyperactivity Disorder (ADHD) 05-25

Atomoxetine (supplied as atomoxetine hydrochloride)(Strattera, Eli Lilly Canada Inc.) Comments: Revision tothe Dosage and Administration section and other revisionsto the Product Monograph; CAP(10mg, 18mg, 25mg, 40mg,60mg, 80mg, 100mg)ORL

Endothelin Receptor Antagonist 06-05Bosentan (supplied as bosentan monohydrate) (Tracleer,Actelion Pharmaceuticals LTD.) Comments: To extendthe currently approved indication to include the treatmentof pulmonary arterial hypertension in patients with WHOfunctional class II; TAB(62.5mg, 125mg)ORL

Antiretroviral Agent 05-20Emtricitabine / tenofovir disoproxil fumarate (Truvada,Gilead Sciences Canada Inc.) Comments: Manufacturername change; TAB(200mg / 300mg)ORL

Antiretroviral Agent 05-20Tenofovir disoproxil fumarate (Viread, Gilead SciencesCanada Inc.) Comments: Manufacturer name change;TAB(300mg)ORL

Human Growth Hormone 04-20

Somatropin (Omnitrope, Sandoz Canada Inc.) Comments:PWSO(5.8mg/vial)SC; SOL(5mg/cartridge, 10mg/cartridge)SC

Immunomodulator 06-08Interferon beta-1a (Rebif, EMD Serono CanadaIncorporated) Comments: Updated Product Monograph;SOL(8.8mcg/0.2ml, 22mcg/0.5ml, 44mcg/0.5ml)SC

Cardioprotective Agent 05-28Dexrazoxane (Zinecard, Pfizer Canada Inc.) Comments:New dosing regimen: The ZINECARD dose should bereduced by 50% in patients with creatinine clearance values< 40 ml/min. In patients with moderate to severe renaldysfunction, the recommended dosage ratio ofZINECARD: doxorubicin is 5:1; PWSO(250mg/vial,500mg/vial)IV

Luteinizing Hormone / Releasing Hormone (LHRH)Analog 05-22

Goserelin (supplied as goserelin acetate) (Zoladex, ZoladexLA, AstraZeneca Canada Inc.) Comments: Update to theClinical Trials section and revisions to the ProductMonograph; IMP(3.6mg, 10.8mg)SC

Antineoplastic Agent for Bladder Instillation 06-01

Bacillus Calmette-Guerin (BCG) Strain TICE (OncoTICE,Schering-Plough Canada Inc.) Comments: Manufacturername change; PWSO(800000000unit/vial)ITV

N O C s o f N o t e :June 2009

Significant TPP approvals of Rxs for human use—continued from page 3

posters are more popular than ever amongpatients.

Among the media options, the socialmedia offer pharmas some outstandingopportunities, but many challenges, too,according to Kim Bercovitz, medical soci-ologist and prexy of The Research DoctorInc. in Thorn hill, Ont.

INTERNET PROMPTS QUESTIONS“Patients don’t know one web site fromanother and they also don’t know whichweb site is credible and which isn’t. Andthey’re using the Internet to self-diagnoseand to confirm or question the doctor’sconclusion about the illness.”

She noted that a Pew InternetProject last year revealed that 59 per centof newly diagnosed patients reported theInternet prompted them to ask physiciansnew questions or to seek second opin-ions.

Natalie Bourre, president of Mark -

eting 4 Health Inc., Richmond Hill, Ont.,confirms that older age groups are Internetusers.

Bourre is preparing a white paper onthe use of social media in the industryand notes that research by others hasshown that 51 per cent of those olderthan 60 are regularly online, and as manyas one in five have visited a social net-working site.

And for Canadian of all ages, lookingfor medical and health information is thefourth most popular Internet informationactivity: almost 70 per cent say they dooccasionally, compared to 38 per cent wholist job searches.

IMS figures for 2008 indicate the pro-motional spend of Canadian pharmasdropped by 13 per cent last year, withdeclines of 7.38 per cent in detailing costsand 28.9 per cent in journal advertising.There are no figures on how muchCanadian or US pharmas allocated to websites or social media.

“The intelligence I’m getting from theUS is that pharma is moving somewhatmore slowly with this [web site and socialmedia] process than the public at large,”says Debbie Locke, director of marketingat IMS Health, Mississauga, Ont. “I thinkthat’s because they have to be so mindfulof what they can and cannot say on thesesites.

“I had heard of the J&J site,(www.Childrenwithdiabetes.com) andI’ve heard of the one AstraZeneca isdoing, (a branded YouTube channel forSymbicort), but I think they’re approach-ing it as people sharing their experiences,and they’re keeping control over the con-tent.

These sites, she notes, and any othersthat may be developed by US pharmas canbe easily accessed by Canadians.

CAN’T APPEAL TO EVERYBODYNeil Follett, founder and managing direc-tor of Brightworks Interactive Marketing,

Toronto, believes industry and agenciesshould temper their enthusiasm for newerdigital and electronic gadgets and themedia they generate.

During his last visit for a check-up henoticed his doctor still had a printed vol-ume of the CPS in his office

“There’s a lot of noise around newapplications such as the iPhone, but 2009 isnot the year where iPhone applications aregoing to replace direct mail,” he says.“iPhone applications [downloads] have justreached the one billion mark, but my takeon the current situation is that the market-ing mix now has a capital M, because it’s atrue mix.”

And the stress of creating a successfulmarketing mélange is evident.

“It’s not just ‘We’re going to do a DMdrop, we’re going to get new detail aids in,and we’re going to do a Slim Jim,’” Folletttold THE CHRONICLE OF HEALTHCAREMARKETING. “And you’re not going to doiPhone apps to appeal to everybody.”

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The Chronicle of Healthcare Marketing June 30, 2009 · 13

between the development of adrug and the approval of its use

in Canada is left out of the equation.

LONG APPROVAL TIMES DEPRIVE EVERYONEThe longer it takes for a new medication to be approved for use the more patients whomight be helped by the drug must go without, even when people with identical condi-tions in other countries are being prescribed the drug and benefiting from it. HealthCanada, recognizing this, is working on meeting a goal of approving or barring a drugwithin 300 days of its submission, or 180 days if the drug is considered a high priority.Advocating for patient safety, a number of critics—including the CCPA—believe thatfaster approval will increase the number of patients who have serious reactions to newdrugs, resulting in injury or death.

But by stressing the number of fatal adverse drug reactions, the criticism misses thewider issue. What too many critics of the pharmaceutical industry neglect to address isthat patients taking experimental or newly released drugs are usually suffering from dis-eases that greatly hamper their quality of life and can be fatal. All medications carry somerisk, however small. They are prescribed because they also confer great benefits. Whetherthe risks for a particular patient outweigh the benefits is a difficult judgment that is dif-ferent in every case. It is precisely because this decision is so personal that it should beleft to patients and their doctors.

In order to make the right decision, though, doctors must be equipped with up-to-date and accurate information about the side effects associated with any drug, and theymust share this information with their patients. In this respect, the CCPA paper is exact-ly right.

One way to mitigate the risk is to follow the US example of imposing penalties—through litigation—on manufacturers who don’t disclose the risks of their products. Thisdynamic is largely absent in Canada.

The solution is not to ask the government to play a heavy-handed role and decide onbehalf of patients and doctors what treatments should be available to Canadians. Nobodyhas as much on the line when choosing a treatment plan as patients themselves. The bestway to ensure good outcomes combined with access to drugs is to make available as manyoptions as possible, coupled with current and comprehensive information about the risks,known and unknown, of each treatment.

It is time to change Health Canada’s focus from delaying access to drugs to boostingaccess to information to help Canadians, with their doctors, make the best choices possi-ble about their medical care.

Rebecca Walberg is director of health policy at the Frontier Center for Public Policy,based in Calgary

ISOTECHNIKA PHARMA, the EdmontonRx developer, named Jonathan RossGoodman as board chair. He is thefounder and prexy of Paladin Labs, theMontreal specialty drugmaker. Iso andPal recently inked a joint venture tobring to market antipsoriatic Tx candi-date voclosporin. Goodman replacesDonald Schurman, who ankled. ClemensKaiser, Iso’s chief marketing officer, alsoresigned. � Paladin picked a peck ofproducts currently marketed in Canadaby Wyeth, including warhorse OTC anal-gesics ASA (Anacin) and benzocaine(Anbesol.) Financial terms were not dis-closed. Sales for the acquired brandscame to $4 million last year.

Ontario added a once-monthly formula-tion of risedronate (Actonel) to theprovince`s formulary, reports P&GPHARMACEUTICALS CANADA. SaysP&G boss Andy McClenaghan:Osteoporosis affects almost two millionCanadians. Treating osteoporosis`andthe related fractures costs our healthcaresystem billions of dollars every year, notto mention the impact it can have onpatients and their families.”

NUVO RESEARCH, theMississauga, Ont. maker oftopical Txs, out-licensed itsNSAIDs, marketed asPennsaid and PennsaidPlus, to Mallinckrodt. Theproduct is approved inCanada, but has enduredlong delays in gaining FDA

approval. Nuvo, once known asDimethead Research, will receive an up-front, non-refundable payment of US$10million, and may get a US$15 millionmilestone payment on Pennsaid’sapproval by US regulators, which willincrease to US$20 million if certainlabeling criteria are agreed to by the G-men. Says Nuvo supremo Dan Chicoine:“[Mallinckrodt] is aggressively addingresources to maximize the value of thePennsaid/Pennsaid Plus franchise andpursue its strategy of becoming a globalpresence in the treatment of pain.”

MERCK will ankle from its three-year-oldR&D and licensing agreements for painTx candidates with Vancouver`s privatelyheld Neuromed, the companies announ-ced. Says Neuromed kingpin ChristopherGallen: “The molecules generated in ourcollaboration, while effective in diseasemodels, did not demonstrate the profileneeded to enter the next phase of testing,including human clinical trials.``

The CANADIAN MEDICALASSOCIATION tapped Paul-EmileCloutier as CEO and Secretary-

General, effective next month.He joined the CMA joined theCMA in 2002 and worked inthe advocacy, communications

and public affairs offices.Barbara Drew, who hasbeen the association`s act-ing secretary general and

CEO since Octo ber 2008,announced her retirement.

U p h e r eWhat’s happening in the world of drug marketing

Leave therapy decisions to patients and their MDs—continued from page 14

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The Premier’s summer musical

TO FIND ONE’S SELF IN ONTARIO DURING THE EARLYsummer of 2009 is to be transported back to smalltown Iowa in the year 1912. That was the place and

time depicted by Broadway legend Meredith Willson in hisTony award winning stage hit, The Music Man.

In Mr. Willson’s extravaganza, the townsfolk of RiverCity are at odds; to paraphrase the familiar lyrics of theshow-tune, “They got trouble.” The municipal authorities,led by Mayor George Shinn, are unable to contend with thethreat to civic order represented by the opening of a newpool hall. In their fear, incompetence, and lack of sophisti-cation, they become prey to a travelling con-artist, Prof.Harold Hill, who convinces the hick-town politicians thatthe answer to all their problems lies in establishing a boys’band. The professor, of course, has an ulterior motive. Heintends to exploit the River Citians’ uninformed enthusi-asm, by taking their money and delivering nothing.

The whole world loves The Music Man: whether we’rediscussing the original 1957 stage version, the 1962 screenadaptation, or the Broadway and UK revivals, whichoccurred in 2000, and 2008, respectively. However, no oneis as fond of the enduring musical as is Ontario PremierDalton McGuinty. The Premier enjoys The Music Man somuch that he has taken an extraordinary step toward fur-ther popularizing the play throughout his province.

As his personal contribution to the lively arts, PremierMcGuinty has created, and performs in, his own updated2009 version of The Music Man, in a summer stock produc-tion for Ontario audiences. He has also cast several members

of his cabinet in key roles in this entertainment, and placedthe spotlight on a deserved selection of talented behind-the-scenes personnel. Bravo, and take a bow, Mr. Premier!

Mr. McGuinty has cleverly revised the script to makeit more meaningful to contemporary audiences, and, in aminor adjustment, has transplanted the setting from small-town Iowa, to the Ontario Parliament. To make thingsmore topical, his crisis has nothing to do with a pool hall,but rather, with healthcare.

Indeed, he’s got trouble, right here, right here. His healthminister, a Buddy Hackett lookalike whose mother got himhis job, can’t seem to deliver services to patients, and thisminister’s idea of how to solve the crisis is to glue posters tothe wall in the Buffalo, NY air terminal, inviting any physi-cians who may be passing through to relocate to Ontario.*

Personally taking on the role of the bumbling MayorShinn, Mr. McGuinty provides a convincing portrayal of asitting duck waiting for the arrival of the conniving HaroldHill character, who offers a solution to the healthcare cri-sis. In this revised version of the musical, it isn’t a boys’band, but something even more preposterous: electronichealth records!

The political leaders, not understanding a thing aboutelectronic health records, or much else, either, seize on theopportunity to be seen as doing something useful, andagree to set up a public agency to undertake the project,which, in a moment of inspired comedy, they decide to callE-health Ontario.

Mr. McGuinty, employing grand theatrical gestures,writes out a cheque on the provincial treasury for $25 mil-lion, and hands it to the health minister, who in turn hands

it with a flourish to Prof. Hill, represented byan Ethel Merman lookalike who is the execu-tive director of the agency. The characters cel-ebrate their achievement by singing the show-stopping “E-health Ontario” song, which isperformed to the tune of “Gary, Indiana,”from Willson’s original score. The lyrics havebeen revised as follows:

E-health Ontario!What a wonderful name, The ‘E’ stand for electronic; that’s our game.E-health Ontario, all your health records on a

card,Pork for all us insiders, so, come on, let’s spread

the lard —E-health Ontario, E-health Ontario, E-health

Ontario,Let me say it once again.E-health Ontario, E-health Ontario, E-health

Ontario,Now let’s go out, and hire all our frien’s.

_________________________________* (This part is absolutely true; no one except the healthminister could possibly have made this poster idea up.)

This rousing number brings down the curtain onAct I.

Act II begins with an ensemble of E-health Ontarioconsultants and contractors who form a barbershop quartet,submitting invoices to the province for duties such asmunching on pastries during bull sessions, reading the news-paper, and chatting with each other on the telephone. MayorMcGuinty appears on stage momentarily to inquire aboutwhat is taking place. “Oh, we’re busy creating electronichealth records,” the group exclaims. “Excellent! Carry onthen,” says the Mayor, as he confusedly strides off-stage.

The plot thickens, as some of the townsfolk seem tocotton on to the idea that their mayor is being hornswag-gled, or perhaps hoodwinked.

“This is crazy. Why do we need to spend all thismoney, if all we need is electronic health records?”, cries acast member. “There are dozens of suppliers who will pro-vide solutions for next to nothing! Why don`t we just ridealong with a successful existing program, join forces withGoogle and the Cleveland Clinic, or Microsoft and theMayo Clinic, and spend the 25 million bucks on patientcare? Can’t you see that River City is being conned?”

The community’s anxiety eventually penetrates MayorMcGuinty’s fog of obliviousness, and he calls a town-hallmeeting in the high school gym, to determine what to do withE-health Ontario. Wringing his hands, he asks, “Where’s thee-health records? Where’s the e-health records?”

Ethel Merman, fearing that her ruse has been ex -posed, is about to be led away in handcuffs by the townconstable. Just then the cast convenes to perform therousing closing number:

Twenty-three genomes led the big paradeWith a hundred and ten DNA samples close at hand.They were encoded on smart, smart cards that were stacked in feet and yardsand contained your ev’ry DNA strand.

Twenty-three genomes on a plastic plateWith a hundred and ten molecular cures right behindThere were plenty of chromosomes Just like subdivision homesThere were cytoplasms of ev’ry shape and kind.

Encores abound. Theatrical critics across the prov incecan only agree that Dalton McGuinty owns the role of May-or Shinn, and that, by offering this musical spectacle to theprovince’s taxpayers, he is the most successful impressariothe province has seen since Garth Drabinsky and MyronGottlieb—pending the result of Garth and Myron’sSupreme Court appeal, of course.

Premier McGuinty’s version of The Music Man passesthe ultimate test of any stage performance, which is thataudiences are guaranteed to leave the theatre singing the hittune, “We got trouble.”

Leave decisions on therapies to doctors and their patientsBy Rebecca Walberg, Special to THE CHRONICLE OF HEALTHCARE MARKETING

WHILE A STUDY RELEASED IN APRIL BY THE CANADIAN CENTRE FOR POLICY ALTERNATIVES (CCPA)correctly identifies a number of administrative problems involved in drug monitoring, arguing thatCanada allows new drugs onto the market too soon, its emphasis on the hazards associated with

innovative drugs leads it to advocate for an unduly restrictive approach to pharmaceuticals.CCPA’s conclusions are wrong because it forgot to include two stakeholders in their analysis: patients and

their doctors. Both safety and good medical outcomes are maximized if patients and their doctors have asmany treatments options as possible, as well as comprehensive information about the risks and benefits of allindicated drugs.

Drug companies, of course, are not disinterested actors in pharmaceutical policy, since their incomedepends upon consumption of their product. But governments are equally biased, since every province subsi-dizes out-patient prescriptions for those in need, and pays directly for drugs prescribed and administered inhospital.

The stakeholders least biased and best positioned to make informed and appropriate decisions aboutwhen to use drugs and which ones to use are patients together with their doctors. Needless to say, it ispatients who stand to lose or gain the most when choosing a course of treatment. Patients are not wellserved by an adversarial relationship between those who develop and sell drugs and those who regulatethem.

When a new drug is submitted to Health Canada for approval, its manufacturer must satisfy the govern-ment that the drug is safe and effective. The interval between submission and approval is, on average, almosttwo years long in Canada. In the US, UK, and Sweden, it takes slightly over one year to accomplish the samething. When investigators take longer to authorize the use of a drug, the possibility that dangerous side effectswill be discovered before the drug hits the market increases.Too often, however, the downside of lengthy delays

THE CHRONICLE OF HEALTHCARE MARKETING welcomes contributions fromreaders. In particular, we’d like to know what’s going on at your company, or organi-zation, and you are especially welcome to keep us informed about new develop-ments, new appointments, and new practices at your shop.

If you’re submitting an article, opinion piece, press release, or letter to the edi-tor for consideration, please bear in mind that we select material for publicationfrom a large volume of submitted material, and that we may not be able to publishyour submission in a specific issue (or at all) due to space constraints and other con-siderations.

Our policies are: All material submitted to THE CHRONICLE becomes the prop-erty of Chronicle Information Resources Ltd., and is subject to the company’s usualeditorial procedures; We will not consider for publication any material that has beensimultaneously sent to other publications; Only original material or information willbe considered; Payment at our established freelance rates will be offered upon publi-cation for feature articles and for the following departments:What Lies Ahead: Original articles of approximately 500 to 700 words dealing with trends

that shape the healthcare industry; andMy Turn: Opinion pieces of approximately 500 to 700 words, offering original commentary on

issues facing the healthcare industry.Please refer inquiries to: Editor, The Chronicle of Healthcare Marketing,

555 Burnhamthorpe Rd., Suite 306, Toronto, Ont. M9C 2Y3 Canada.Fax 416.352.6199, E-mail: health@chronicle.org

Published seven times annually by theproprietor, Chronicle Infor mationResources Ltd., from offices at 555Burnhamthorpe Rd., Suite 306, Tor -onto, Ont. M9C 2Y3 Canada. Tele -

phone: 416.916.2476; Fax 416.352.6199. E-mail: health@chroni cle.org

Contents © Chronicle Information Resources Ltd., 2009, exceptwhere noted. All rights reserved worldwide. The Publisher prohibitsreproduction in any form, including print, broadcast, and electronic,without written permission. Printed in Canada.Subscriptions: $59.95 per year in Canada, $74.95 per year in all othercountries. Combined rate including Chronicle MONDAY and ChronicleMIDWEEK newsletters: $240 per year in Canada, $360 per year in all othercountries. Single copies: $7.95 per issue (plus 5% GST).

Canada Post Canadian Publications Mail Sales Product Agreement Number40016917. Please forward all correspondence on circulation matters to:Circulation Manager, The Chronicle of Healthcare Marketing, 555Burnhamthorpe Rd., Suite 306, Toronto, Ont. M9C 2Y3 Canada. E-mail:circulation@chronicle.ca

ISSN 1209-0654

June 30, 2009 • Published with Chronicle MONDAY and Chronicle MIDWEEK

Turn to Leave decisions, page 13 * SRx is a sample

EDITORIAL DIRECTORR. Allan RyanASSISTANT EDITOR

Lynn Bradshaw

SALES & MARKETING

Henry RobertsPRODUCTION & CIRCULATIONCathy Dusome

COMPTROLLERRose Arciero

PUBLISHER

Mitchell Shannon

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* SRx is a sample prescription captured at all retail pharmacies and reported within 24 hours.

SmartTechnology programs offer an accurate, relevant and timely measure of new patient starts.

Once a SmartTechnologyproduct is redeemed at any retail pharmacy, itbecomes a legal sampleprescription (SRx*).

This SRx data is reported by thepharmacy to STI in Real-Time, and thenprovided within 24 hours to a customer.

Every SmartTechnology programincludes specific redemptioninformation by pharmacy andterritory along with important patient age/gender demographic information.

All SmartTechnologyprograms supply anearlier and more relevant indicator of actual sales (SRx is non-projected).

Sales Representative physician distributionscan be captured within CRM systems.Once each distribution is linked to anSRx redemption, it identifies high and low prescribing physicians in Real-Time.

Ultimately, SmartTechnology programs allow business decisions to be made sooner at an individual physician level,more quickly driving top line sales for your brand.

V i s i t S R X r e a l t i m e R O I . c a o r c a l l 9 0 2 . 4 5 0 . 5 5 0 0

Watch a sample become a new patient ...right before your eyes.

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Liberating brandsliberating@jsai.comliberating@jsai.com

NCZAS 6455 11x16 ad v01.indd 1 4/1/09 3:22:31 PM

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