Healthy Skepticism International News

March 2005

Book Review: Building Global Biobrands

Abstract:

Review of Françoise Simon and Philip Kotler. Building Global Biobrands: Taking Biotechnology to Market. 2003; New York: Free Press/Simon & Shuster
ISBN 0-7432-2244-X

My attention was originally drawn to this title because it contains a case study of the cancer drug Glivec/Gleevec as an example of a success story. The authors credit Novartis with achieving blockbuster sales success for Glivec due to the winning combination of its status as a real medical breakthrough and of the manufacturer’s humanitarian generosity in offering a patient assistance program for it. Before examining their analysis of the Glivec phenomenon, it is instructive to look at the content and context of the book. Authors Simon and Kotler are academics, at Columbia and Northwestern Universities respectively, specializing in business strategies and marketing. Those of us who view rational promotion of and access to medicines through a different lens, can learn much from this volume that will assist us in developing new strategies for our work. The text makes for dry reading, and the extensive use of rhetoric and business jargon terms and acronyms is tiring. (There is a glossary at the end of the volume, but it contains only biomedical terms and no business ones). The book is essentially a marketing blueprint for manufacturers of the new products made by what the authors dub ” Big Biopharma “, as they explain that the concepts of ‘biotech’ and ‘pharma’ are now obsolete.

It is interesting that this text by experienced academics-Simon serves on both the Public Health and Business faculties of Columbia University, and Kotler is a prolific author and marketing specialist at Northwestern-seems at times short on scholarship. Some sweeping generalizations are made, with little effort to present background data or contrasting analyses.

For example -

the $800+ million figure for cost to develop a new drug is stated several times and only in the last citation on page 209, is a source from a pharma trade magazine, given for the Tufts study.

The superficial approach is also extends to discussion of the need to consider consumers in planning for marketing, a topic which is examined in each chapter of the book. On p.38, one finds the comment that a 2001 survey on public satisfaction with national health systems, showed ranges from 90% satisfaction in Denmark, compared to less than 60% in Germany and the UK and only 40% in the US, with no source given for the data nor any attempt to explain these findings. The focus instead is on how the ‘biopharma’ sector can tap into the yearnings and dissatisfactions of consumers in the markets deemed viable. It is interesting also that while the title refers to ” Global Biobrands,” most the examples in the test are drawn from the USA, Europe and Japan, with an occasional mention of Australia, New Zealand, India, Asia, and only the briefest mention of Latin America, and none of Africa. Most of the citations come from trade publications, news media, business texts and occasionally medical journal articles.

The last section of the book, Part Three, is entitled ” Meeting the Global Challenge,” with subchapters on pricing considerations, access issues, and how best to reach consumers, the true customers, and the challenges the industry is facing from governments and employment-based health systems in the USA. A defensive stance can be seen in the justifications for pricing that the authors develop, such as the statement that ” the public is highly sensitized to drug prices, it is not well informed of research and supply costs” ( p.210) . They also exhort the biopharmas to do a better job of explaining these factors to consumers as well as stressing the cost effectiveness of the new therapies.

In the closing chapter, the authors also recommend that to meet the marketing challenges, the biopharma firms should heavily utilize the Internet both as a way to get around the DTCA restrictions in all countries but the US and NZ (as users worldwide are not barred from viewing US websites) and to attract the well-educated, economically-active segment of the public who are actively seeking solutions to their health problems. They warn that if the companies do not do their outreach correctly, others will step in to fill the consumer desire for health education.

The case of Glivec (Gleevec in the USA) which first drew me to this title, deserves special mention. Simon and Kotler heap accolades on Novartis, starting with incorrectly stating that “it took Novartis decades to develop it” ( p.138) and describing its actual status as a medical breakthrough. While they say that ” A Global Assistance Program” was designed for uninsured patients, they give only eligibility criteria for the USA: ” Drug free of charge to anyone earning less than $43,000 per year. Drug cost capped at 20 percent of income for those earning between $43,000 and $100,000 per year.” (pp. 141, 249) . Novartis’ largesse is depicted as generating value for the company because all eligible patients could get the medicine and it gave the firm both a competitive edge over competitors and positive publicity as the creator of the first donation program for a cancer drug. (p.249). The sources cited for this information are Simon’s interviews with Novartis officials and an article from a pharma biz magazine.

While Novartis has certainly achieved its publicity and profit motives for this new drug, the access reality for patients who could potentially benefit from Glivec has been quite different, including in the USA. By mid-to-late 2002/early 2003, it was not uncommon to hear in oncology social work circles as well as in the online cancer patient communities, of great difficulties that patients were facing to obtain Glivec/ Gleevec. Besides reported price increases, it seemed obstacles were frequently being put in the way of those seeking help from the Patient Assistance Program, even for those who appeared to meet the means test for eligibility. Typically there were denials and sometimes the requirement that patients pay up-front for the medicine and then wait months to be reimbursed ( an average dose costs $3000 USD per month) , impossible for most. In some cases, patients who had some drug coverage were being charge co-pays of over $1000 USD/month, and then were told that they were not eligible for the PAP because they had drug coverage. Some patients covered by Medicaid (the federal indigent health care program which has differing eligibility requirements and administration in each state) found that when they were prescribed Gleevec, they could not readily find any pharmacy willing to fill the script. Having drug coverage, Medicaid patients too were ineligible for the PAP. Other patients who had been approved and had received the drug told of being left without medicine for up to several weeks due to delays in paperwork processing by the company administering the PAP .The situation was such that I was approached to write a troubleshooting guide on access to Gleevec in the US, which can be found on my website. (Ramos, 2003).

About the same time, a lengthy front-page article appeared in the New York Times, detailing numerous problems and inconsistencies with Novartis’ international donation program for Glivec. (Strom & Fleisher-Black, 2003) The Times article describes not only the plight of patients desperately seeking Glivec, but also illustrates the type of courtship of patient-consumers by pharma that Simon & Kotler recommend as a marketing strategy in their book. The articles authors show how the outreach and branding strategies of Novartis made their mark, and left patients blaming their governments for lack of access to Glivec while overlooking the role that its manufacturer’s pricing played in creating the situation. I also wonder about another aspect not discussed in the critique, of determining the avowed rationale of Novartis is charging an exorbitant global price for Glivec but not allowing global eligibility criteria to qualify for the assistance program. (The matter of the Glivec donation program showing yet again why donation programs are not viable or sustainable is beyond the scope of this review). Simon & Kotler’s laudatory review of the Gleevec/Glivec assistance program in their book relied solely on Novartis sources, and they missed the opportunity to share with their readers any lessons learned from real life experiences of patients.

Those interested in learning more about the mindset of the biotech and pharma industries as well as how they view consumers and prescribers of their products, would do well to persevere and read this title.

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