Healthy Skepticism Library item: 19860
Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.
Publication type: news
Hansen J, Farrow N
Doctoring the Spin
Sunday 2002 Aug 16
http://sgp1.paddington.ninemsn.com.au/sunday/cover_stories/transcript_1121.asp
Full text:
JANE HANSEN, REPORTER: It’s September 9, 1998 – the launch of a new drug in Australia. The level of media hype surrounding it is creating marketing history. The drug is the anti-impotence pill, Viagra. The makers, Pfizer – the world’s biggest pharmaceutical company – have already seen it break sales records in the US. Pfizer have good reason to be confident about the media coverage from all of this. They’re using a tried and tested formula. Just about everything the press could need to spread the company message is right here in the room. There’s a renowned medical expert. And for the human element, there’s Arthur – ready with his personal account of impotence.
ARTHUR: My self esteem went down a bit, I might say not a bit but a lot. I became dissatisfied with myself.
REPORTER: Within a week there’d be seven prime time television stories about Viagra, 89 newspaper articles and hundred of mentions on radio.
PROFESSOR DAVID HENRY, CLINICAL PHARMACOLOGIST: The media can easily be hostage to the public relations machinery that’s created around these new drugs.
PROFESSOR JOHN MARLEY, DEAN OF HEALTH, NEWCASTLE UNIVERSITY: I think that people are not aware, that they see it as a news item and they take it as face value as a news item and they’re not aware that in fact what it is is a marketing item.
REPORTER: Pharmaceutical companies spend as much money on marketing as they do on research and developing new drugs. Now by law, they’re not allowed to advertise directly to consumers in Australia but they’re adept at getting around that. We’re being bombarded by health messages all of the time, often from drug companies using the media to push their products or prime the market. The trick is to pitch your product as newsworthy and let the journalists do the rest. Now, how do they get around the media’s professional scepticism? Well, as you’ll see, they take a step back, allowing their carefully nurtured experts, patient groups and disease awareness campaigns to speak for them and to create the demand. Often it’s just not clear that many of the stories we see and read are actually well-disguised drug company promotions. That coverage is credible and extremely effective.
LOUISE SYLVAN, AUSTRALIAN CONSUMERS ASSOCIATION: It is an outstandingly sophisticated machine and I think we don’t have enough really critical questioning done about the way they manipulate consumers, the media and so on.
DR CHRISTINE JENKINS, RESPIRATORY SPECIALIST: No doubt things get sensationalised, overdramatised, things get put to people as if they don’t have downsides.
REPORTER: Exaggerated, misleading, a beat up…
DR NEIL FORMICA, COMMONWEALTH SERUM LABORATORIES: That’s not the case.
REPORTER: ..for the purpose of selling vaccinations.
DR NEIL FORMICA: OK, well thank you, I appreciate you for your time.
REPORTER: So how do pharmaceutical companies sell sickness to consumers? Let’s go back to the launch of Viagra.
ARTHUR: My problem started when I was, around 19 – about 42 and probably a little earlier than that but 42 it became quite obvious that I did have a problem.
REPORTER: Arthur, the impotence sufferer, played a crucial role. Through him, Pfizer were directly marketing to men with impotence problems who were reluctant to seek treatment. Here was a key part of the pitch: Encouragement for men to talk to their doctors like Arthur did about Viagra.
ARTHUR: I went and saw my GP and he helped me through the hoop. Now when I went to see my GP, Viagra, or sildenafil, was not available…
REPORTER: The power of the patient – a well-recognised concept recommended in the authoritative industry guide to campaign planning, ‘Pharmaceutical Marketing’. Clear advice here on how patient groups should be used:
“They are also of course a key conduit for education directed at patients, relatives or carers – and the first port of call for the media on any new product. It pays, therefore, to ensure that you have them involved in your activities”.
REPORTER: Unlike diabetes, asthma or arthritis, there was no patient group for men with impotence until three years ago, when Pfizer helped set one up. Pfizer donated $100,000 to Impotence Australia, a patient group running an advisory service about treatment options. The following year, Pfizer chipped in another 100,000 and now has a yearly commitment of $50,000. It’s been alleged that Impotence Australia is just a front for Pfizer.
BRETT McCANN, IMPOTENCE AUSTRALIA: We are not a front for Pfizer. We’ve got an independent board of directors and we don’t have any of our sponsors on our board and they don’t have any say in how we run the organisation.
REPORTER: But you are very closely aligned to Pfizer?
BRETT McCANN: We are a closely aligned to anyone in the industry that’s producing impotence drugs.
PELE IN TV COMMERCIAL: I’ve had triumphs and disasters here.
REPORTER: How close are they? There’s just no missing it.
PELE IN TV COMMERCIAL: But one thing was never discussed, erection problems. If men suffered, they suffered in silence.
REPORTER: Pfizer funded this advertisement featuring soccer superstar Pele.
PELE IN TV COMMERCIAL: Talk to your doctor. I would.
REPORTER: Timed to run throughout the World Cup, the print and electronic campaigns seemed to be everywhere. The contact name and phone number – Impotence Australia. Do you call this an Impotence Australia ad or a Pfizer ad?
BRETT McCANN: I would call it – it’s certainly a Pfizer ad in…
REPORTER: Yet all the contact numbers come back to you.
BRETT McCANN: OK. It is a Pfizer ad in association with Impotence Australia to increase awareness of erectile difficulties.
LOUISE SYLVAN: It’s such a totally integrated thought out strategy which is presented as helping people, educating people…
REPORTER: Louise Sylvan from the Australian Consumers Association is concerned about commercial agendas buried within the sponsorship of patient groups, in particular, Impotence Australia.
LOUISE SYLVAN: I think certainly that people with a condition – impotence or any other condition – can benefit from a support group, so it isn’t the case that it’s bad that there is a support group. I guess the question arises when you find that most or all of the funding for such groups actually comes from an industry with a product to sell and in this case, with a drug to sell. By funding such groups, you create a lobby organisation basically, for lobbying to have, for instance, a product put on a Pharmaceutical Benefits Scheme and subsidised by government and you – essentially without appearing as a company, you put forward the consumers or the patients of your products who have a lot more credibility in a place like Canberra than a drug company would promoting its own product.
REPORTER: Brett McCann insists the advice Impotence Australia gives about treatment is independent because they also accept money from other companies. Faulding, another impotence drug manufacturer, gave a one-off grant of $5,000. From condom makers Glyde – another $1,000. That is a total of $6,000 against Pfizer’s $250,000. What you’re trying to argue is that Pfizer is doing this out of the goodness of their hearts to raise awareness about erectile problems, not that they’ve got a drug to fix it.
BRETT McCANN: They do have a drug to fix it, as there are other drugs available from a GP and a patient makes their decision…
REPORTER: And therein is the crux of the matter.
BRETT McCANN: No, the patient makes their decision with their doctor and their partner if they are going to use treatments. That’s where decisions should be made, not through advertising, not through any other means.
REPORTER: Impotence Australia says the latest advertisements are intended to raise awareness of the problem. But these awareness campaigns can also be seen as an effective sales strategy. They can prime the market and create a demand. What’s wrong with a drug company being involved in a disease awareness campaign?
PROFESSOR JOHN MARLEY: I think there are a number of problems. It may be an area that’s not actually recognised as a disease at that particular time. One of the interesting things is that countries who’ve got most to spend on health their populations regard themselves as more sick than countries that have less to spend on health and part of that is that we actually create, we make people unwell.
REPORTER: Two years ago, Professor Marley took on Pfizer over what he saw was an attempt to use distorted statistics about the level of impotence among younger men.
PROFESSOR JOHN MARLEY: What the texts said was that a large proportion of men in the middle-aged age group would have problems with erection, see your doctor and it had a big red ‘V’ in the corner. Getting an erection has quite a large psychological component. If you say to people in this age group and you repeat that message, and it was repeated on a lot of occasions that if you’re in this age group you’ve got a very large chance of having problems with erection, then the psychology will kick in the next time the person goes to have an erection and lo and behold, they’ll have problems. Now, that is actually creating a market for a drug.
REPORTER: This is obviously an advertisement… Professor Marley’s complaint about the ad to the Australian Pharmaceutical Manufacturer’s Association was upheld. Pfizer’s next campaign featured a couple in their 40s. The caption claimed that 39% of men aged between 18 and 91 have erectile problems. The statistic came from a study by the Keogh Institute in Perth, but that research actually found the incidence of impotence around the age of the man in the ad is just 2%. In a statement, Pfizer denied the ad had been misleading. They said the average age of the men in the study was 66 and a third of the men aged between 40 and 69 had erectile dysfunction. It’s an example of what’s been called “disease mongering”.
RAY MOYNIHAN, AUSTRALIAN FINANCIAL REVIEW: Disease mongering is a term that has been around for a while now and it’s really just about trying to expand the definitions of disease in order to expand the markets for new products for those who sell them and those who deliver them.
REPORTER: Some of these awareness campaigns have to deal with an extra challenge, when doctors and even patients don’t think a disease warrants treatment. That’s what Glaxo-Wellcome found when it hired a PR company to prime the market for a drug called Lotronex, a treatment for irritable bowel syndrome – or, as it’s known, IBS. The PR company was nothing if not candid. Their assessment was:
“Irritable Bowel Syndrome suffers from the common perception that ‘with IBS there is nor real disease and no real treatment’. Patients who do not seek medical advice need to be convinced that IBS is a common and recognised medical disorder, not just a woolly syndrome that is either too trivial to bother a doctor with, or just as easily managed by over-the-counter home remedies”.
REPORTER: As for the doctors, they…
“Must be convinced that there is now an effective clinically proven therapy for IBS.”
REPORTER: The document was leaked to Ray Moynihan, a health reporter for the ‘Australian Financial Review’.
RAY MOYNIHAN: What you see here is the attempt to create the market. That’s what you see here. You see the PR company or the medical education company working for or with the drug company to try and help build a new market for its products and I think we just need to ratchet up the scepticism towards those sorts of campaigns.
REPORTER: But problems in the US meant the awareness campaign and launch of Lotronex in Australia were shelved. Glaxo voluntarily withdrew the drug in America for a short period after five people taking it died due to unexpected complications.
RAY MOYNIHAN: Often what happens with a disease awareness campaign is that a drug company will work with medical specialists and they will often work with patient foundations or medical foundations. Often this will happen through a PR company and that’s where the media comes in. The media is used to target consumers with all these messages about diseases. The trouble is, vested interests are involved in constructing those messages and many of us don’t think it’s appropriate that a drug company which stands to benefit from an enhanced market, should be playing a role in defining that disease.
REPORTER: Creating or expanding a medical market appears to be remarkably easy. On April 30 this year, CSL, the Commonwealth Serum Laboratories, which makes flu vaccines, sent out a press release announcing a new study by the Gallup organisation into the effects of influenza on the community. They followed it up with a press conference, as usual, with specialists and victims on hand. Until this, flu vaccinations were recommended for just the elderly and specific high risk groups, like health workers and people with immune system problems. CSL were, for the first time, targeting the young and healthy and highlighting the financial effects of flu on the business community.
DR NEIL FORMICA: I think it’s been very successful in raising the awareness that there is a vaccine available which is extremely well tolerated and effective against preventing illness and raised some of the other issues about the annual impact of influenza within the community.
REPORTER: The CSL press release clearly stated that one in five, or 3.9 million Australians, are affected by influenza each year, but that statistic is simply not true.
DR CHRISTINE JENKINS: I don’t think there’s evidence that influenza in fact occurs in four million people a year in Australia.
REPORTER: This is the spin?
DR CHRISTINE JENKINS: That’s right.
REPORTER: Unfortunately for CSL, that comes from the very expert they commissioned for their press conference. Dr Christine Jenkins is a respiratory specialist and a member of the Institute of Respiratory Medicine at the Royal Prince Alfred Hospital in Sydney.
DR CHRISTINE JENKINS AT PRESS CONFERENCE: People generally don’t appreciate how truly contagious it is and the devastating effects it can have…
REPORTER: She was the face of credibility for CSL, but found her views being taken out of context in the news reports that followed.
DR CHRISTINE JENKINS: I wasn’t at all comfortable with the coverage. I wasn’t comfortable even before the coverage occurred. In fact, even before the press conference. The initial information that was provided in the media releases, the drafts, actually suggested that flu was the problem that had been discussed in the Gallup questionnaire. In fact, it was influenza and flu-like illness and that tends, then, when you simplify that to flu, to grossly exaggerate the impact of influenza in the community by including flu-like illness. So by including flu-like illness in talking about influenza, you are grouping – bundling – two diseases which have similar symptoms, different causes, different virus, and one of them will be significantly helped by influenza vaccination, and the other group of them won’t.
REPORTER: As people filled in the Gallup questionnaire themselves, they could easily exaggerate how sick they really were. CSL were including those who probably just had bad colds. Is it alarmist?
DR CHRISTINE JENKINS: It’s highly alarmist and it highly overstates the gravity of influenza for our community.
REPORTER: Do all these figures in here – 26% of households requiring an adult to miss work, 3.9 million GP visits for influenza annually – do these figures relate to influenza only?
DR NEIL FORMICA: I could sit down with you and go through them individually with…
REPORTER: The answer’s no, isn’t it?
DR NEIL FORMICA: No – that’s not the case at all.
REPORTER: Because influence-like illness has been included?
DR NEIL FORMICA: Influenza-like illness is a group of symptoms which is the best measure that we have when we’re conducting this kind of research to assess the illness that’s occurring in the community.
REPORTER: So you have no idea whether people had influenza or influenza-like illness?
DR NEIL FORMICA: And it’s acknowledged in the clinical trials that use this thing called influenza-like illness.
REPORTER: Could you answer that question for me please?
DR NEIL FORMICA: It is not something we have constructed.
REPORTER: You have become part of, basically a campaign by a vested interest to add credibility to their product?
DR CHRISTINE JENKINS: That’s of concern and I agree. It makes me seriously reflect on whether it’s better just to pull out and not do it at all or not ever do it again.
REPORTER: Will do you it again?
DR CHRISTINE JENKINS: I would not do it for this particular group and for this message.
REPORTER: You see, if your own respiratory expert is saying these figures are based on a flawed study…
DR NEIL FORMICA: Again, all I can say is…
REPORTER: ..they are therefore alarmist and misleading.
DR NEIL FORMICA: ..I’m happy to sit down with Dr Jenkins, go through the way the study was conducted and the results that came out of it and show her the clinical research on the assessment of the effectiveness of influenza vaccine against influenza-like illness.
REPORTER: Now, you’re in the business of selling vaccines, you have a vested interest. Now here we have a report that’s flawed. The figures are taken out of context.
DR NEIL FORMICA: No that’s not the case at all.
REPORTER: And it’s been called…
DR NEIL FORMICA: I’m sorry, I believe I’ve answered your question and if you…
REPORTER: ..exaggerated, misleading, a beat up for the purpose of selling vaccinations.
DR NEIL FORMICA: No, that’s not the case. OK, well thank you, I appreciate you for your time.
REPORTER: Every day, pharmaceutical sales reps do their best to persuade doctors to favour their products over their rivals. A lot is at stake. In Australia, this fiercely competitive industry is worth more than $7 billion a year. Drug companies know many experienced GPs easily resist the sales patter, so it’s far more effective if they can apply pressure by encouraging patients to ask for a drug by name.
PROFESSOR DAVID HENRY: Given the way that medical care is organised in this country, with short consultation times, doctors paid for each consultation, in some cases it’s easier for doctors to write a prescription, and let’s face it, if the drug doesn’t appear to be any worse than what they were using before, but it’s just more expensive, neither they nor the patient is paying the full price because it’s being subsidised through the scheme, then they may just end up prescribing the drug. It’s the easiest route.
REPORTER: The priming of the market starts long before that. When they launch a new product, pharmaceutical companies need specialists to talk about the validity of the drug. They’re referred to as key opinion leaders. How do drug companies get people like you on board?
DR GEOFF McCOLL, RHEUMATOLOGIST: Well, they ask our advice and in that asking your advice about a particular drug and whether you believe the literature and so on, they are then taking you on board.
REPORTER: Dr Geoff McColl was one such specialist asked to be on an advisory board by the makers of the arthritis drug, Celebrex. This was marketed so effectively, that early last year it threatened to bankrupt the PBS, the Pharmaceutical Benefits Scheme that subsidises prescribed drugs. The marketing spin was that Celebrex promised fewer side-effects than its older and much-cheaper competitors.
DR GEOFF McCOLL: I don’t think I ever really felt I was there as a puppet for the companies that were marketing it. Maybe that shows their sophistication in the manipulation of me – I don’t know.
REPORTER: According to the industry guide ‘Pharmaceutical Marketing’, getting specialists onto an advisory board that’s monitoring a new drug is a key tactic.
“Not only does it help shape medical education programmes overall, it can help in the process of evaluating exactly how individuals can best be used, motivate them to want to work with you – and with subliminal selling of key messages ongoing all the while”.
REPORTER: And then this:
“How can you best get them to know and like you and your products? The simplest answer is to talk to them, involve them, and take their advice. Everyone is susceptible to being asked what they think and the advisory process is one of the most powerful means of getting close to people and of influencing them.”
REPORTER: How do you feel about basically becoming part of a sophisticated marketing machine?
DR GEOFF McCOLL: Um, oh I can’t say that I’m not feeling slightly uncomfortable about it. But it’s – the problem is I’m an advocate for my patients as well.
REPORTER: When Celebrex was listed on the PBS in June 2000, it was a accompanied by an extraordinary media blitz which included endorsement from the then Health Minister, Dr Michael Wooldridge.
DR MICHAEL WOOLDRIDGE SPEAKING TO PRESS: And we expect 500,000 Australians will benefit from this decision.
DR GEOFF McCOLL: It hit fertile ground, but also, the patients knew about it.
REPORTER: How did they know about it?
DR GEOFF McCOLL: Well, mostly I think they’d seen it on television, on the news, on the 6:30 programs on various networks, that they’d seen it before and they’d seen the testimonials from people they saw as themselves and they seemed to get better and they went – that’s all the evidence they need.
REPORTER: Now, Dr Geoff McColl was the face of credibility in those early media blitzes.
DR GEOFF McCOLL: One of the faces, yes. One of the faces.
REPORTER: How do you feel about that now?
DR GEOFF McCOLL: Well, I think we look back now and feel a little less comfortable. Probably what I said about the drug in terms of its safety I still stand by now. Whether my face sold some of those 2.8, whatever it is, million scripts, I doubt it very much, but whether the campaign that involved me and patients and other people did, I can’t say that they’re not part of a very effective marketing campaign.
PROFESSOR DAVID HENRY: That new class of drugs, sometimes called Cox-2 inhibitors, has been the most successfully marketed class of drugs probably in history.
REPORTER: 2.9 million scripts written in the first nine months of its subsidy.
PROFESSOR DAVID HENRY: Yes, with over $100 million as the bill, yes.
REPORTER: Professor David Henry was a member of the Pharmaceutical Benefits Advisory Committee from 1993 to 2000. Having seen the success of the drug and the way it was marketed in the US, the board advised Health Minister Wooldridge of the financial consequences if Celebrex was ever listed on the PBS. He was warned?
PROFESSOR DAVID HENRY: I think he would have been aware of the potential blow-out from the advice that was received.
REPORTER: But the Minister himself appeared to have been caught up in the positive spin surrounding Celebrex.
DR MICHAEL WOOLDRIDGE SPEAKING IN PARLIAMENT: And I have to say in my entire time as Health Minister this is the only pharmaceutical where I’ve actually been stopped in the streets and had people say thank you and it is a widely…
REPORTER: He came out and basically endorsed it.
PROFESSOR DAVID HENRY: I do recall, I think it may have been on national news, that he endorsed the drug once it was listed. I think he probably genuinely believed this was a major advance for patients with arthritis.
REPORTER: Again, a marketing coup?
PROFESSOR DAVID HENRY: It was a remarkable marketing coup. I don’t know that the minister would view it that way, the ex-minister, would view it that way. He probably believed it was a good drug and there was some basis for believing that.
REPORTER: Again, a patient group was to be a key to success. In May 2000, the companies who made Celebrex, Pfizer and Pharmacia, gave $250,000 to the Arthritis Foundations for the running of Arthritis Week. The Foundation used the money to make both print and television commercials and what was the message of those adverts? There had been a breakthrough in the treatment of this painful condition.
PROFESSOR DAVID HENRY: It’s misleading because that group should have legitimacy, should be unbiased, should be un-conflicted and when groups like that start to take substantial amounts of money and then become a de facto advertising arm of the company, I think it misleads the public and I think it’s very bad for the organisation itself.
REPORTER: Dr McColl, who was a member of the Arthritis Foundation in Victoria, was one of those within the organisation troubled by the relationship with such obvious vested interests.
DR GEOFF McCOLL: To my mind, the management of arthritis is a much bigger thing than a single drug and for the 3 million sufferers you might say that Celebrex only forms a very small component amongst the other anti-inflammatories, a whole lot of things – exercise,.. And that’s what the Arthritis Foundation stands for. So I don’t think they’ll make that mistake again.
REPORTER: Mmm. Compromise their independence?
DR GEOFF McCOLL: Well, if those kind of NGOs aren’t seen as independent by the consumers, we are in trouble.
REPORTER: Early last year, the smooth Celebrex spin developed a distinct wobble. The costs of the drug versus the benefits became a political liability for the Government.
DR MICHAEL WOOLDRIDGE SPEAKING IN PARLIAMENT: We rely on data from the companies which did seriously underestimate the volume of Celebrex and the strength.
REPORTER: Celebrex was also failing to live up to its media billing as a wonder drug. It was clear that for managing pain, Celebrex was no more effective than older cheaper drugs. Only a small percentage susceptible to stomach ulcers would benefit. In two years, 7 million prescriptions have been filled out for Celebrex. There’s been an unprecedented number of adverse reactions to the drug, a total of 3,235 reports, including 22 deaths. Was the media far too accepting of the Celebrex spin?
PROFESSOR DAVID HENRY: I think the media was too accepting of it. I think benefits tend to be exaggerated, side-effects tend to be minimised, conflicted sources tend not to be revealed and all of these features are present in that episode.
DR GEOFF McCOLL: I’m a little bit uncomfortable that in retrospect we might have looked at targeting where these drugs ended up much better, saving some money as a result. and then looking at a balance between… I mean, maybe the agenda has been too much in the hands of the company itself where really where it should lie is not with me but maybe with the health bureaucrats, with people who can objectively assess the best thing for my patients.
REPORTER: Right now, it’s the drug companies that are defining disease. They fund the research and patient groups, direct the disease awareness campaigns and the public relations spin that binds it all together.
LOUISE SYLVAN: I think journalists in their training are taught to question and to question very severely, and I think not only should they be horrified if they’re being used by companies, they should re-think, in fact, how they’re producing information and whether they’re really serving, in terms of their public responsibility, appropriately.
