The Soul of Biotech

You may have already heard that the Republican party recently announced a new motto: “The Change You Deserve.” Politics aside, some brouhaha has been made of the fact that this slogan is already in use by Wyeth’s Effexor antidepressant. High comedy, of course. In fact, Pharmalot, one of my favorite pharma blogs, wondered if Wyeth should sue the Republicans for copyright infringement. I feel such an idea is ludicrous.

Look at some of the coverage of the Republican Party / Effexor tangle-up:

• Washington Post
• NY Times
• The Daily Show

The Post article in particular includes:

• Pictures of Effexor
• Copies of Effexor’s marketing messages
• The starting dose
• Coverage of side effects

If I was the Effexor brand director, I would have been dancing when the news was announced. It resulted in some completely free DTC advertising in most major media outlets. I might have provided the reps who carry Effexor with some guidelines for reactive answers to physician questions about the news, simply to clarify that the move by the Republicans was not in concert with Wyeth, and Wyeth has no position on the issue. Other than that, I’d sit back, enjoy the free press, the new hits on my website, and the resulting bump in sales. It’s a nice treat for an off-patent medication.

I would only sue the Republicans over this in order to get it back in the papers again a couple of months from now. But even then, I’d be reluctant to potentially damage relations with either political party over something that has been fairly positive for the company (Wyeth has donated evenly to both parties, Pharmalot reports).

By the way, if there are any political parties looking for another idea, I suggest “Enough is Enough,” which is Enbrel’s DTC slogan. I think the bump in our sales would probably net me at least a new iPod.

My name is Jonathan Sheffi, and I approved this blog post.

I’ve got my nose in binders and CD-ROMs about treatments for psoriasis and psoriatic arthritis, so I won’t be able to write quite as lengthy posts as I’d like, at least until I get my feet under me in my new role.

Recently, however, a news item passed my virtual desk that I couldn’t resist writing about. Novartis is running a YouTube contest, called FluFlix. In brief, the contest is designed to encourage aspiring filmmakers to create ads about the flu. It’s reminiscent of Doritos’ Crash the Superbowl contest, which, by the way, ended up creating a great ad.

Novartis’ investment in this is appears to be trivial. In fact, given the tiny prize and fall timing, it wouldn’t surprise me to learn that this is an MBA intern’s project on non-personal promotion. [Non-personal promotion refers to the promotion of a product without using a rep.] Nevertheless, NPP is a hot topic in the industry, so I’m guessing that other pharma companies are watching to see how Novartis’ experiment pans out.

Given the emergence of “Web 2.0 media” like YouTube, Facebook, and MySpace, one wonders what a more interactive version of pharmaceutical DTC marketing could look like. Will drug brands get their own Facebook groups and Myspace profiles? We as consumers already know that we often prefer one pain reliever over another. Could we start to see consumers identify themselves with Advil over Tylenol the way that they prefer Nike to Adidas? It isn’t a big leap to imagine many over-the-counter drugs being marketed the same way sports drinks are. Although I highly doubt that it would make sense for any therapy but the most commonplace, teenagers and young adults have formed tight allegiances to brands on less.

Last week, I watched Big Bucks, Big Pharma, which is more or less what SiCKO would have been if Michael Moore had focused on pharmaceutical marketing, although BBBP’s criticisms are much more well-reasoned and well-researched. In fact, many of its facts are more or less right, although I question some of the business interpretations.

For example, one of the talking heads questions the pharma industry’s claims that R&D is what drives up the cost of medicine, rather than marketing, whose budget is often larger than that of R&D. He asks how that claim can be true if a drug company spends more on marketing than R&D each year.

What is missing from his position is an ROI analysis. Compare:

• A $1 million promotion that delivers $3 million this year with a 95% probability.

• A $1 billion drug development budget that delivers $5 billion spread out over the next fifteen to twenty years with a 30% probability.

Which is better? Well, it depends on the priorities of the company to raise cash now versus planning for the future. When measuring the near-term budget, the marketing option seems to cost almost nothing, because it pays back so quickly. On the other hand, if you only marketed drugs and didn’t develop anything in-house — well, you’d be Pfizer. Balancing the portfolio of projects across R&D and marketing is a major challenge for any company. Too little sales and marketing, and you can’t turn the lights on. Too little R&D, and you have to keep spending money buying other companies just to get their compounds.

My friend Lexi sent me a link to a NYT article that discusses personalized medicine (also known as pharmacogenomics), which is an area of great interest to me. It’s what I focused on in my master’s work, and it’s an area that, given the right opportunity, I intend to start a biotech in one day.

The article describes the promise of personalized medicine reasonably well: The opportunity to select the best therapy for a patient based on his or her genetic profile. Dr. Friedman correctly notes the opportunity for improvements in patient outcomes in terms of drug efficacy and safety, with a special eye towards his own specialty of psychology. He goes astray, however, at the very end:

Aside from the potential to transform clinical psychiatric practice, these new developments will surely change the relationship between doctors and the drug industry and between the industry and the public. Direct-to-consumer advertising will become nearly irrelevant because the drugs will no longer be interchangeable, but will be prescribed based on an individual’s biological profile. Likewise, doctors will have little reason to meet with drug company representatives because they won’t be able to give doctors the single most important piece of information: which drug for which patient. For that doctors will need a genetic test, not a salesman.

I find several things wrong with this paragraph.

Although doctors may find it challenging to select the right treatment for a condition (especially depression!), the available therapies are hardly interchangeable, even today. That’s one of the most important reasons why clinical trials exist: to demonstrate clinical attributes that differentiate a given drug from other existing therapies. Also, Dr. Friedman assumes that the genetic screens will always produce extremely clear results — but what if they don’t? Or what if the screens can only point to a set of therapies — what then? Those are critical situations in which reps will be able to consult physicians on the remaining differentiating attributes.

Furthermore, reimbursement education (for both the genetic screen and for the drug itself) is also a major function of most reps. Many doctors and caregivers struggle to understand whether or not a patient can afford a therapy, especially if the patient is on Medicare. Drug companies, including Amgen and many others, often step up to help educate physicians and guide patients to the form of coverage that best allows the physician to treat in the manner they see fit. That role will become even more critical with a screen to pay for on top of the therapy.

Finally, I don’t see personalized medicine making direct-to-consumer advertising irrelevant. If anything, marketers would focus even more on getting patients into the office to get the test, thus feeding the genetic screen funnel.

What about you? What do you think genetic screening will mean for the pharmaceutical and biotech industries?