The Times: How drugs companies secretly push their wares - An investigation
That famous face revealing all about their illness may be part of a secretive sales ploy. David Rowan exposes how drug companies use celebs to push products at the public, as part of a policy that also covertly influences research and journals
Barry Greenberg needs to find a celebrity with erection problems. He's not too bothered whether it is an actor or a musician -he just wants someone reasonably well known, whose erections happen to be partial, brief or nonexistent. The celebrity will have to go public, of course - the usual round of talk shows, candid interviews and magazine shoots - but the money should make up for the jokes and sniggers: perhaps as much as £100,000 a day, for at least two weeks.
"The amount is partly determined by the embarrassment relationship with the disease," Greenberg explains, very matter-of-factly, at his desk in central Los Angeles. "It's one thing to talk about your sinus problem, quite another to discuss your erectile dysfunction."
As the chairman of Celebrity Connections, a "celebrity co-ordination company" that provides Hollywood stars to front PR and advertising campaigns, Greenberg has been thinking a lot lately about male sexual disorders. "We have just been approached to get another erectile dysfunction pharmaceutical promoted and I'm looking forward to wading further into this market," he says cheerily. "My clients don't care so much about who the celebrity is, as they do about finding someone who legitimately and openly has whatever the cause du jour is."
The client's cause today is the latest challenger to Viagra; tomorrow it could be an arthritis treatment or a weight-loss pill. When pharmaceutical companies have a new drug to promote, they turn to agents such as Greenberg for showbiz names willing to publicise a particular ailment. Through his database of thousands of celebrity contacts -including such stars as Richard Gere, Emily Watson and George Clooney - he knows who among the "talent" has experience of specific medical disorders. The challenge then is to persuade them to talk.
This is not, Greenberg stresses, about up-front advertising but is instead a far more "clever and subtle" way of building market share -particularly in countries where overt drug promotion to consumers is banned. "Where you have restrictions on advertising, as in Britain, someone going on a chat show becomes a much more precious commodity for the pharmaceutical company," he explains. It works, he says, even if the product is not named.
"The message from the celebrity gets out there - 'I have got this terrible problem, go see your doctor to make sure you don't have it'. And if the company's promotional arm is doing its job, there will be samples of this wonderful new product with the doctor."
What consumers will not be told about is the celebrity's lucrative financial incentive for opening his or her heart. When The New York Times exposed this covert trend last summer, the US television networks scrambled to draw up ethical guidelines to safeguard editorial integrity.
They had good reason to be worried. Kathleen Turner had gone on CNN and ABC to talk about her rheumatoid arthritis and had failed to disclose, as she recommended an information website, that both she and the website took funding from Immunex, the maker of the arthritis drug Enbrel. When Lauren Bacall told viewers of NBC's Today programme that a friend had gone blind from a disease called macular degeneration, and mentioned a helpful new drug called Visudyne, she neglected to add that Novartis, its manufacturer, had paid her a fee.
Regulations are stricter in Britain, but here too the media provide effective channels for pharmaceutical firms' celebrity-fronted promotions. When the former Brazilian footballer Pele visited the UK last year and gave interviews encouraging men to discuss their sexual problems with their partners, it was not always made clear that he was speaking for Pfizer, the makers of Viagra.
Nor were readers of the sports pages told that the cricketer Shane Warne had been paid a reported £80,000 by the makers of Nicorette during his well-publicised attempt to stop smoking. No wonder he was furious when a fan photographed him at a one-day match holding a cigarette "I don't think that anyone in Britain should presume that, because a lot of these pharmaceutical companies are in the US, you aren't affected by their global marketing campaigns," says Ray Moynihan, the author of Too Much Medicine? and a critic of the industry's covert promotions.
"We're increasingly going to see celebrities wheeled through our towns and on TV talking about particular diseases. The stakes are enormously high, and the industry has a lot of money to spend." Moynihan's concern is that many such marketing campaigns aim to persuade healthy people that they are unwell.
"You often have very large PR infrastructures, largely hidden, spending a lot of effort behind the scenes subtly to change the way we think about our bodies," he says. "So we think about a runny nose as an illness, about sexual difficulties as a medical condition. It's designed to turn more and more of human experience into a market that can be 'fixed'."
In a British Medical Journal (BMJ) investigation last year, Moynihan traced the origins of a newly prominent disorder: female sexual dysfunction. The condition, according to countless journal articles and magazine features, was reported to affect about 43 per cent of women aged 18 to 59. Yet Moynihan found that 18 of the 19 doctors who had agreed a definition for the condition in 1998 had financial ties with drug firms that stood to gain from this new market. The figure of 43 per cent came from a 1999 paper in The Journal of the American Medical Association, two of whose authors later disclosed close links to Pfizer. The company also sponsored key meetings in which the "disorder" was debated.
"The conflict of interests is absurd," Moynihan says. "Clearly some women have serious legitimate physiological difficulties but this is 'disease-mongering' - using the media to create fears and to draw attention to the latest treatment."
The strategy is well established. Just before Merck's hair-growth drug Propecia gained approval, a flurry of newspaper articles examined the emotional trauma associated with hair loss. Readers were not to know which of the widely quoted trichology experts were provided by Edelman, Merck's PR firm. Current concern about irritable bowel syndrome, too, is in part the result of a PR campaign. A leaked memo from In Vivo Communications, produced for GlaxoSmithKline, explains how, over three years, the "syndrome" could be perceived as a "credible, common and concrete disease". First, a panel of respected gastroenterologists should help to establish it in doctors' minds; then, patients should be persuaded that it was a "common and recognised medical disorder" -which GlaxoSmithKline's drug, Lotronex, could treat. GlaxoSmithKline says that the strategy was never adopted.
When a PR battle-plan is taken up, the results can be remarkable. For the launch of National Eating for Pleasure Week in December 2001, a celebrity chef pledged to teach Britain how to get the most out of good food. A new survey suggested that a third of men risked indigestion by rushing their meals and a behavioural psychologist warned the nation to slow down and enjoy our food.
In fact, the various "Eating for Pleasure" activities -from the website to the charity auction at the Dorchester -were part of a co-ordinated campaign by Jo Spink Public Relations to promote Johnson & Johnson's new indigestion remedy Pepcidtwo. The campaign was featured in 18 magazines, three national newspapers and 13 radio interviews and, according to the trade magazine Pharmaceutical Marketing, reached the equivalent of 140 million consumers. Pepcidtwo's sales were quickly boosted to 18,000 packets a month. As Johnson & Johnson told the magazine: "PR was key to the successful launch of Pepcidtwo, providing third-party endorsement alongside awareness."
Of greater concern to consumer groups is the industry's sponsorship of ostensibly independent UK patient groups and information websites. The Impotence Association, which has called for greater availability of impotence treatments on prescription, claims not to favour any particular treatment; yet its website is funded by "an educational grant" from Pfizer. The Action Asthma website - "a comprehensive online guide for people with asthma" - goes a step further: it is owned by GlaxoSmithKline, which sells asthma treatments.
"The disease-awareness campaigns are really quite clever and can circumvent the legal restrictions on marketing directly to consumers," says Wendy Garlick, of the Consumers' Association. "There is currently a campaign about incontinence. You ring up the number and get a recorded message from Anna Raeburn, who promises to send you information and leads you to an incontinence awareness website backed by Pharmacia. It raises awareness, which is great, but you're not necessarily getting the full picture -it could be guiding you to a product that might not be the most appropriate or cost-effective."
The Consumers' Association believes that there should be an independent body offering patients objective health information. But doctors, too, are becoming increasingly concerned about the objectivity of papers published in the medical journals. Two years ago, 13 journals -including The Lancet and the New England Journal of Medicine - published a joint attack on what they called the profit-driven distortion of scientific research. The drugs companies, they said, use their grants, or the threat of their withdrawal, to prevent researchers from reporting freely on the results of drug trials.
Richard Smith, the editor of the BMJ, believes that he and his readers are being unwittingly manipulated by the pharmaceutical giants. "It bothers me more and more," he says. "Unfortunately, we're seen as an extension of the industry's marketing arm." According to Smith, drug firms fund between 30 per cent and 70 per cent of drug trials published in the main journals. "It's cleverness, not wickedness," he says. "Nobody's doing anything illegal here -but it's not good science. It puts the pharmaceutical industry's interests ahead of the community's as a whole."
A solution, he says, would be public funding of drug trials. But they are an expensive business. "We invest £9 million a day on R&D in the UK," Richard Ley, of the Association of the British Pharmaceutical Industry, (ABPI) says. The ABPI, the main trade lobby for pharmaceutical companies, says that it takes on average about ten to 12 years and £350 million to develop a new medicine, with no guarantee of commercial success.
Perhaps it is inevitable that the industry employs covert promotional techniques, whether in the form of paid celebrity spokespeople or the rigorously controlled release of trial data. After all, it is illegal to market prescription drugs directly to UK consumers -and the industry says patients have a right to know about treatments that could benefit them. The APBI has been pushing for the rules to be relaxed.
"We've been pressing for more direct-toconsumer information but not for advertising," Ley says. "I don't think at this stage advertising directly to the consumer is appropriate for the European culture."
Ley rejects as "complete nonsense" Ray Moynihan's accusations of "disease-mongering". "There's nothing to suggest that the pharmaceutical industry 'invents' diseases it happens to have a solution for on the shelf," he says. "We're simply getting better at understanding disease and it's a question of refining products based on this new knowledge."
Female sexual dysfunction is a genuine complaint, Ley insists. "It's all very well to suggest to people that their problem is imaginary but that's not always the case. Male sexual dysfunction was also greeted with derision at first." As for patient-centred websites and information groups, the industry has strict guidelines to avoid conflicts of interest.
Everything should be open, he says, and donations should not be used to promote a particular product. After all, he adds, The Times manages both to print objective news reports and to accept advertising. "Of course, you can keep the two things separate," he insists. "This is an exaggerated debate led by people who have a vested interest in denying people information about their condition. The information we provide is backed up by data."
How, then, does the ABPI explain a briefing it reportedly gave to the Pharmaceuticals Marketing Society in 2000, in which it pledged a "battle plan" to fight existing marketing restrictions by deploying "ground troops in the form of patient support groups, sympathetic medical opinion and healthcare professionals"?
"We're certainly lobbying for reform, yes, but it's overtly not covertly," Richard Ley says. "What we do is provide information and hope the messages are understood. We firmly believe that talking to patient groups and healthcare professionals is correct. But it's not some secret mission plan with stooges in place."
(The Times, October 25 2003)
Barry Greenberg needs to find a celebrity with erection problems. He's not too bothered whether it is an actor or a musician -he just wants someone reasonably well known, whose erections happen to be partial, brief or nonexistent. The celebrity will have to go public, of course - the usual round of talk shows, candid interviews and magazine shoots - but the money should make up for the jokes and sniggers: perhaps as much as £100,000 a day, for at least two weeks.
"The amount is partly determined by the embarrassment relationship with the disease," Greenberg explains, very matter-of-factly, at his desk in central Los Angeles. "It's one thing to talk about your sinus problem, quite another to discuss your erectile dysfunction."
As the chairman of Celebrity Connections, a "celebrity co-ordination company" that provides Hollywood stars to front PR and advertising campaigns, Greenberg has been thinking a lot lately about male sexual disorders. "We have just been approached to get another erectile dysfunction pharmaceutical promoted and I'm looking forward to wading further into this market," he says cheerily. "My clients don't care so much about who the celebrity is, as they do about finding someone who legitimately and openly has whatever the cause du jour is."
The client's cause today is the latest challenger to Viagra; tomorrow it could be an arthritis treatment or a weight-loss pill. When pharmaceutical companies have a new drug to promote, they turn to agents such as Greenberg for showbiz names willing to publicise a particular ailment. Through his database of thousands of celebrity contacts -including such stars as Richard Gere, Emily Watson and George Clooney - he knows who among the "talent" has experience of specific medical disorders. The challenge then is to persuade them to talk.
This is not, Greenberg stresses, about up-front advertising but is instead a far more "clever and subtle" way of building market share -particularly in countries where overt drug promotion to consumers is banned. "Where you have restrictions on advertising, as in Britain, someone going on a chat show becomes a much more precious commodity for the pharmaceutical company," he explains. It works, he says, even if the product is not named.
"The message from the celebrity gets out there - 'I have got this terrible problem, go see your doctor to make sure you don't have it'. And if the company's promotional arm is doing its job, there will be samples of this wonderful new product with the doctor."
What consumers will not be told about is the celebrity's lucrative financial incentive for opening his or her heart. When The New York Times exposed this covert trend last summer, the US television networks scrambled to draw up ethical guidelines to safeguard editorial integrity.
They had good reason to be worried. Kathleen Turner had gone on CNN and ABC to talk about her rheumatoid arthritis and had failed to disclose, as she recommended an information website, that both she and the website took funding from Immunex, the maker of the arthritis drug Enbrel. When Lauren Bacall told viewers of NBC's Today programme that a friend had gone blind from a disease called macular degeneration, and mentioned a helpful new drug called Visudyne, she neglected to add that Novartis, its manufacturer, had paid her a fee.
Regulations are stricter in Britain, but here too the media provide effective channels for pharmaceutical firms' celebrity-fronted promotions. When the former Brazilian footballer Pele visited the UK last year and gave interviews encouraging men to discuss their sexual problems with their partners, it was not always made clear that he was speaking for Pfizer, the makers of Viagra.
Nor were readers of the sports pages told that the cricketer Shane Warne had been paid a reported £80,000 by the makers of Nicorette during his well-publicised attempt to stop smoking. No wonder he was furious when a fan photographed him at a one-day match holding a cigarette "I don't think that anyone in Britain should presume that, because a lot of these pharmaceutical companies are in the US, you aren't affected by their global marketing campaigns," says Ray Moynihan, the author of Too Much Medicine? and a critic of the industry's covert promotions.
"We're increasingly going to see celebrities wheeled through our towns and on TV talking about particular diseases. The stakes are enormously high, and the industry has a lot of money to spend." Moynihan's concern is that many such marketing campaigns aim to persuade healthy people that they are unwell.
"You often have very large PR infrastructures, largely hidden, spending a lot of effort behind the scenes subtly to change the way we think about our bodies," he says. "So we think about a runny nose as an illness, about sexual difficulties as a medical condition. It's designed to turn more and more of human experience into a market that can be 'fixed'."
In a British Medical Journal (BMJ) investigation last year, Moynihan traced the origins of a newly prominent disorder: female sexual dysfunction. The condition, according to countless journal articles and magazine features, was reported to affect about 43 per cent of women aged 18 to 59. Yet Moynihan found that 18 of the 19 doctors who had agreed a definition for the condition in 1998 had financial ties with drug firms that stood to gain from this new market. The figure of 43 per cent came from a 1999 paper in The Journal of the American Medical Association, two of whose authors later disclosed close links to Pfizer. The company also sponsored key meetings in which the "disorder" was debated.
"The conflict of interests is absurd," Moynihan says. "Clearly some women have serious legitimate physiological difficulties but this is 'disease-mongering' - using the media to create fears and to draw attention to the latest treatment."
The strategy is well established. Just before Merck's hair-growth drug Propecia gained approval, a flurry of newspaper articles examined the emotional trauma associated with hair loss. Readers were not to know which of the widely quoted trichology experts were provided by Edelman, Merck's PR firm. Current concern about irritable bowel syndrome, too, is in part the result of a PR campaign. A leaked memo from In Vivo Communications, produced for GlaxoSmithKline, explains how, over three years, the "syndrome" could be perceived as a "credible, common and concrete disease". First, a panel of respected gastroenterologists should help to establish it in doctors' minds; then, patients should be persuaded that it was a "common and recognised medical disorder" -which GlaxoSmithKline's drug, Lotronex, could treat. GlaxoSmithKline says that the strategy was never adopted.
When a PR battle-plan is taken up, the results can be remarkable. For the launch of National Eating for Pleasure Week in December 2001, a celebrity chef pledged to teach Britain how to get the most out of good food. A new survey suggested that a third of men risked indigestion by rushing their meals and a behavioural psychologist warned the nation to slow down and enjoy our food.
In fact, the various "Eating for Pleasure" activities -from the website to the charity auction at the Dorchester -were part of a co-ordinated campaign by Jo Spink Public Relations to promote Johnson & Johnson's new indigestion remedy Pepcidtwo. The campaign was featured in 18 magazines, three national newspapers and 13 radio interviews and, according to the trade magazine Pharmaceutical Marketing, reached the equivalent of 140 million consumers. Pepcidtwo's sales were quickly boosted to 18,000 packets a month. As Johnson & Johnson told the magazine: "PR was key to the successful launch of Pepcidtwo, providing third-party endorsement alongside awareness."
Of greater concern to consumer groups is the industry's sponsorship of ostensibly independent UK patient groups and information websites. The Impotence Association, which has called for greater availability of impotence treatments on prescription, claims not to favour any particular treatment; yet its website is funded by "an educational grant" from Pfizer. The Action Asthma website - "a comprehensive online guide for people with asthma" - goes a step further: it is owned by GlaxoSmithKline, which sells asthma treatments.
"The disease-awareness campaigns are really quite clever and can circumvent the legal restrictions on marketing directly to consumers," says Wendy Garlick, of the Consumers' Association. "There is currently a campaign about incontinence. You ring up the number and get a recorded message from Anna Raeburn, who promises to send you information and leads you to an incontinence awareness website backed by Pharmacia. It raises awareness, which is great, but you're not necessarily getting the full picture -it could be guiding you to a product that might not be the most appropriate or cost-effective."
The Consumers' Association believes that there should be an independent body offering patients objective health information. But doctors, too, are becoming increasingly concerned about the objectivity of papers published in the medical journals. Two years ago, 13 journals -including The Lancet and the New England Journal of Medicine - published a joint attack on what they called the profit-driven distortion of scientific research. The drugs companies, they said, use their grants, or the threat of their withdrawal, to prevent researchers from reporting freely on the results of drug trials.
Richard Smith, the editor of the BMJ, believes that he and his readers are being unwittingly manipulated by the pharmaceutical giants. "It bothers me more and more," he says. "Unfortunately, we're seen as an extension of the industry's marketing arm." According to Smith, drug firms fund between 30 per cent and 70 per cent of drug trials published in the main journals. "It's cleverness, not wickedness," he says. "Nobody's doing anything illegal here -but it's not good science. It puts the pharmaceutical industry's interests ahead of the community's as a whole."
A solution, he says, would be public funding of drug trials. But they are an expensive business. "We invest £9 million a day on R&D in the UK," Richard Ley, of the Association of the British Pharmaceutical Industry, (ABPI) says. The ABPI, the main trade lobby for pharmaceutical companies, says that it takes on average about ten to 12 years and £350 million to develop a new medicine, with no guarantee of commercial success.
Perhaps it is inevitable that the industry employs covert promotional techniques, whether in the form of paid celebrity spokespeople or the rigorously controlled release of trial data. After all, it is illegal to market prescription drugs directly to UK consumers -and the industry says patients have a right to know about treatments that could benefit them. The APBI has been pushing for the rules to be relaxed.
"We've been pressing for more direct-toconsumer information but not for advertising," Ley says. "I don't think at this stage advertising directly to the consumer is appropriate for the European culture."
Ley rejects as "complete nonsense" Ray Moynihan's accusations of "disease-mongering". "There's nothing to suggest that the pharmaceutical industry 'invents' diseases it happens to have a solution for on the shelf," he says. "We're simply getting better at understanding disease and it's a question of refining products based on this new knowledge."
Female sexual dysfunction is a genuine complaint, Ley insists. "It's all very well to suggest to people that their problem is imaginary but that's not always the case. Male sexual dysfunction was also greeted with derision at first." As for patient-centred websites and information groups, the industry has strict guidelines to avoid conflicts of interest.
Everything should be open, he says, and donations should not be used to promote a particular product. After all, he adds, The Times manages both to print objective news reports and to accept advertising. "Of course, you can keep the two things separate," he insists. "This is an exaggerated debate led by people who have a vested interest in denying people information about their condition. The information we provide is backed up by data."
How, then, does the ABPI explain a briefing it reportedly gave to the Pharmaceuticals Marketing Society in 2000, in which it pledged a "battle plan" to fight existing marketing restrictions by deploying "ground troops in the form of patient support groups, sympathetic medical opinion and healthcare professionals"?
"We're certainly lobbying for reform, yes, but it's overtly not covertly," Richard Ley says. "What we do is provide information and hope the messages are understood. We firmly believe that talking to patient groups and healthcare professionals is correct. But it's not some secret mission plan with stooges in place."
(The Times, October 25 2003)
posted by David Rowan at Saturday, October 25, 2003
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