Scott Hensley in his Wall Street Journal blog of May 28, reported on a study critiquing media health stories. This study surprised me. A group of reviewers rated 500 media stories on health and graded them as unsatisfactory on some major areas. The study subjectively grade print and broadcast stories on a number of areas of communication.

The media failed to do a good job in several key areas, according to the authors. The study from healthnewsreview.org, said “journalists fail to usually discuss costs, the quality of the evidence, the existence of alternative options, and the absolute magnitude of benefits and harms.” All these areas were rated as below 50% satisfactory. Discussing cost was rated at only 23%, quantifying benefit rated 28%, discussing evidence rated 35% and existence of alternatives only 38%.

Anyone on the drug industry side would probably think that the media loves to discuss high drug costs, recalled drugs, risk issues and poor clinical evidence. Maybe they chose 500 stories I never read, but I think journalists often over state the negative in drug stories and are highly cynical in covering the drug companies.

I guess the interpretation depends on one’s perspective. It is true that on stories that cover drugs in clinical development that the media may overhype the benefit. “New drug allows you to eat whatever you want. Stay tuned for news at 11.” That kind of story does exist and can mislead consumers. On the other hand, stories on drug withdrawal get overhyped as well, full of “death in your medicine cabinet” stories.

It may be that media stories do a poor job discussing cost because the price has not yet been established when the story is reported. Quality of evidence and risk/benefit profile may be beyond their expertise to report on. The media cannot provide all the detail the authors want to see because print or broadcast stories need to be short and punchy. I guess that is why we depend on doctors to sort these things out for us. No consumer should expect full disclosure and objectivity from the media, drug companies, insurance companies, employers, advocacy groups, government agencies or physicians. Unfortunately, everyone in the health arena has a different perspective. We would like one objective source for consumers but that is not reality.

So I give the media the benefit of recognizing that they play a useful role in education, albeit incomplete. Consumers must work to gain a balanced perspective, and that may not appeal to the authors who expect the media to play that role.

Evista the Osteoporosis drug from Lilly, recently added the claim that it helps reduce the risk of breast cancer. That is a winning consumer benefit combination and Lilly just debuted its DTC television ad. Who said DTC has to show scenes of beach goers or mountain climbers? In this ad, scantily clad post menopausal women are shown in a group scene with the announcer voice over describing the new benefit of Evista to them.

When the announcer says Evista can also reduce the risk of breast cancer the women all get this Mona Lisa like smile. I think this ad will have a positive impact because the creative is so arresting and the claim is powerful. These are not old ladies who looked like my grandmother did at 60. They say 60 is the new 45, and these women look good. Of course, that could be because I am getting old as well and my measure of attractiveness is changing.

Lilly did a good job of letting the claim speak for itself. The female announcer had just the right balance of gravitas and warmth in her voice as she described the new benefit. Lilly also managed to cover the gamut of all ethnic and racial groups using the camera slowly panning the group of women.

I think this ad illustrates the less is more philosophy. I do not mean the wardrobe. No fancy backgrounds. No extraneous story line. Showing the women in a bed sheet was enough of a creative hook. Copy was clear and to the point. I know some people will find it a bit odd, or surreal. After all, it is not a scene that one can envision in real life. It will, however, get attention and word of mouth.

So congratulations to Lilly for making an interesting DTC ad that did not let the creative overpower the message. When a brand has something powerful to say, it is best to say it clearly. In this case Lilly did exactly that.

I keep hearing this election year that under the Bush administration drug companies have done so well raking in high profits. So I went back to January 2001 through April 2008 to see how stock holders have done in this supposed period of government largesse.  Not surprisingly, the opposite is true. Owners of drug company stock have had a miserable 7 years, with values cut by half to three quarters.

It is true that drug companies have historically made good profits, but the only important measure for current investors is what the business is now worth. Based on dreary expectations for future profits, stocks are reeling.  Employees have found most or all of their stock options worthless. Many are losing their jobs. So what do the three leading candidates for the White House want to do?

They want to drastically cut prices drug companies receive in the United States making for even more stock price and employment declines.  I admit drug companies have made numerous ethical mistakes in clinical disclosure timing and by violating laws on price fixing. Those responsible should be fined, jailed, and jeered by the press.  That being said, we should not be driving an industry to oblivion for political convenience. I am sure Clinton, Obama, and McCain do privately get the point that by no objective measures are drug companies really doing well. To admit that, however, would hurt their simplistic campaign arguments that the drug companies are making record profits while citizens die because of unaffordable drugs.

Unfortunately, there is no chance that any of the candidates will change their rhetoric. It is just too easy to attack drug companies because true understanding of the issues takes work. No one, including me likes to pay a lot for drugs. I also do not like hearing about enormous compensation packages senior executives “earned” while stock prices were free falling. Blogger discovered internal memos showing questionable business practices also make it easy to dislike drug companies. All these things, however, should not make drug companies saddled with the same negatives as big tobacco.

I assume all three candidates would like to restrict drug company marketing in addition to forcing down prices. We can expect to hear more of that in the Congressional hearings and Presidential campaign ahead. The only viable long term sales and profit solution for drug companies is to actually succeed in introducing innovative new products.  To do that, however, they need some cash flow from current products, even if they are me-toos. Unless shareholders and employees are seeing growth in their investments and option values, who will want to work at drug companies or provide them capital?

I ask the critics of the drug industry to ask themselves what are the unintended consequences of reducing profits? Can government, instead of big pharma, really discover and produce drugs effectively? Can we rely on smaller entrepreneurial companies to do it? Are universities going to invent all the cures? It may be that drug critics will find that there is no easy way to replace big pharma. They may just have to hold back their disgust and allow drug companies to make some money. Otherwise one day we will rely on the Chinese to provide most of our drugs, as forced price reductions lead to cost cutting and eventually offshore development and manufacturing.   I just hope the next President recognizes that campaign rhetoric appealing to populist sentiments needs to be replaced by intelligent analysis after Election Day.

In what I think was much ado about nothing, the May 8 House hearings led by Bart Stupak/John Dingell raised no new DTC issues or concerns. The usual concerns were raised and judging by so few Congressmen attending it does not appear to be an urgent issue for most. The hearings were precipitated by the recent flap over the Liptior Jarvik ad and Vytorin/Zetia clinical studies on lack of benefit versus statins.

After hearing the same positions for years from the pro and con forces it is getting to the point where these discussions are just repetitive. The anti-forces feel DTC cons the public into asking for expensive and often unnecessary drugs. The pro forces believe DTC educates and provides a free flow of information on treatment options. Neither side has or will convince the other side of their argument.

The testimony was from doctors, researchers, drug company marketers. Highlights are below.

Nancy Nielsen, of the AMA, said DTC is acceptable if it meets its seven guidelines which are similar to DDMAC guidelines and PhRMA principles. It does want FDA pre-approval of ads and a moratorium on ads for new drugs. She said the recent Vytorin events heighten AMA’s concerns. She denied that doctors are bought off by drug companies, as Henry Waxman asserted in his opening statement on non-DTC promotion. Finally, she did not like that erectile dysfunction drugs were being advertised in daytime hours because her grandchildren saw them.

The drug marketers were aggressively questioned by Dingell and Stupak on their respective ad claims. Dingell was particularly hard on J&J’s Procrit for what he said was overstatement of benefits in commercials. All the drug company marketers said they are following PhRMA DTC guidelines which are consistent with AMA guidelines. Dingell pressed them on would they be willing not to advertise before outcome studies were completed. They all said yes since they had already done these. They also answered affirmatively to Dingell’s odd question about whether they would agree not to do off label claims in their ads. Obviously, DTC is only for approved label claims.

Stupak was hard on Pfizer related to Jarvik’s credentials and potential for consumer misinterpretation. The Pfizer team leader did a good job answering the questions confidently that Pfizer did not do anything wrong. He also questioned the claims of Vytorin about how they could advertise benefits when the clinical studies(Enhance) did not show an outcome benefit. Stupak was disbelieving that the Enhance results took so long to be analyzed and released. He also hammered J&J on Procrit’s FDA citations for misleading promotion.

Dingell wants to bring back Presidents of these companies because the lower level representatives would not speak for their entire company and Dingell was clearly frustrated with vague answers to some of his questions. His yes or no questions were not answered as yes or no but with usual drug industry caution.

Some of the Republicans defended the drug company actions and questioned whether there was any inappropriate behavior at all.

So what was accomplished? Not much, except to give a forum for Congressmen to question the ethics of drug companies. Stupak said he wants another hearing just for Vytorin. I think the issues in this hearing are more related to overall drug company clinical and claims behavior than DTC specifically. I do not expect any actions to come from the hearing that would affect DTC.

In a mock election we conducted at the 2008 DTC National, Barak Obama won handily versus John McCain winning 56% of the vote. Obama thrashed Hillary 59% to 40% in our primary. Of course this result raises questions about why an industry thought of as Republican would give Obama the nod.

It could be that John McCain is not seen as a traditional Republican. In fact he has made numerous anti-drug industry comments and favors re-importation to lower drug prices. Or, more likely it is that drug industry people have a lot more that affects their vote than just where they work.

Now, believe it or not I am also thinking of voting for Obama. I have been described as a conservative by some bloggers, but I actually voted for Carter (big mistake) and Clinton (1992 only). As I get older I am thinking more about what kind of world I will leave my children and their yet to be born kids. I know financially Obama will not be good for my bank account. On the other hand, I do care if we have a livable environment, a middle class, a quality education system, a chance to end the war, and good health care for all. I do not mention Hillary because I just cannot vote for her. I am tired of family dynasties and the Clinton style of destructive politics. What next? Chelsea in 2016!

It would be nice to be able to travel overseas and be welcomed as an American. I also would like my President to be able to get through a complete sentence without stumbling. I must take responsibility for my votes in 2000 and 2004. Yes, I voted for Bush. I did do well tax wise. Now, however, is the time to take stock about what kind of America I want, even if it costs me some additional taxes.

It would be nice if all those CEO’s who made hundreds of millions of dollars, while driving their stock prices down and laying off thousands, would be the only ones additionally taxed. I realize this is not possible given the vast societal investments needed and all those making above $100,000 will likely get hit.

Would any of the candidates affect the DTC industry? I doubt it. They will all bluster and threaten but the reality is they will not legislate DTC away. I could not vote for anyone who would destroy the industry and my business. So, although I have not decided yet, I may be one of those Obamicans. This is not an endorsement but just an attempt to explain why most drug industry people pulled the mock lever for Obama. Whether the majority of people who work for or with the drug industry will pull that actual lever remains to be seen. Given the serious issues we face as a country it is clear that drug industry people will not be voting on corporate interest alone.