Re: Check out What's Black and White and Sells Medicine?
From: art fougner, md (evsono@pipeline.com)
Sun Aug 27 13:36:31 2000
americans spend 3x per annum more for medical care now than in 1990 - it
ain't going to the docs, that's for sure.
and so it goes.
art
At Sun, 27 Aug 2000, DoctorJoe@aol.com wrote:
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>Interesting story... When you hear hoof beats, think of horses, not zebras.
>When you see a zebra, think of Pfizer! LOL
>
>Joe P.
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>From: Toalcyn@aol.com
>Full-name: Toalcyn
>Message-ID: <3e.383998.26daa417@aol.com>
>Date: Sun, 27 Aug 2000 13:04:23 EDT
>Subject: Check out What's Black and White and Sells Medicine?
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><A
>HREF="http://www.nytimes.com/library/financial/sunday/082700biz-pfizer.html">C
>lick here: What's Black and White and Sells Medicine?</A>
>
>http://www.nytimes.com/library/financial/sunday/082700biz-pfizer.html
>
>August 27, 2000
>
>What's Black and White and Sells Medicine?
>
>By MELODY PETERSEN
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>Joseph Kugielsky for The New York Times
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>Pfizer created Max, a zebra mascot, to help sell Zithromax, an antibiotic.
>
>Chang W. Lee/ The New York Times
>
> Janice Saunders, left, of Pfizer, gave a presentation on the antibiotic
>Zithromax to Dr. Naomi Jackman in Manhattan.
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>Replicas of Max, a small plastic zebra, hang from the stethoscopes of so many
>pediatricians at the Children's Hospital in Boston that at least one family
>has asked whether he was the hospital's mascot. But no, Max is a creation of
>Pfizer Inc., intended to sell an antibiotic called Zithromax. And with Max's
>help, Zithromax has become a billion-dollar drug in just a few years.
>Pediatricians open their mailboxes to find medical journals wrapped in paper
>covered with Max's stripes. Zithromax sales representatives hand out stuffed
>zebras to doctors to help console their young patients. And Pfizer has
>donated a real zebra to the San Francisco Zoo and invited scores of children
>to a celebration at which the zebra was named Max.
>
>Last year, after federal health officials said that other antibiotics were
>not only cheaper, but worked better for children's ear infections, Pfizer
>sponsored a season of "Sesame Street," enlisting Elmo, the Muppet, to help in
>the campaign.
>
>The sales effort is classic Pfizer. It is also an example of what makes
>Pfizer both the company that rivals try to emulate and a target of critics
>who worry that the use of many prescription drugs now has more to do with
>marketing than with the effectiveness or actual need for a drug.
>
>Pfizer, based in New York, spends more than any other drug company to
>advertise to consumers, and its marketing efforts have garnered warnings from
>federal regulators and criticism from doctors. In recent months, the
>complaints have grown, as state and federal officials have blamed aggressive
>consumer advertising by drug companies in general for the skyrocketing cost
>of drugs.
>
>Pfizer, the largest drug maker in America, was probably the first in the
>industry to transform itself so clearly from a research-driven company to one
>that operates more like Procter & Gamble, the maker of Tide.
>
>At Pfizer and a growing number of other drug companies, marketing executives,
>not scientists, are in charge. William C. Steere Jr., the company's chairman
>and chief executive, began his career there as a sales representative,
>marketing the antibiotic Terramycin. Henry A. McKinnell, who will take over
>when Mr. Steere retires next year, also came from Pfizer's business side.
>
>In Pfizer's laboratories, marketers work side by side with scientists, even
>during a drug's early development. Using financial forecasts, the sales
>executives help to ensure that any drug the scientists are developing has a
>ready market. Other drug companies use this system, too, but Pfizer says it
>was one of the first to emphasize it.
>
>Pfizer says its worldwide army of 20,000 sales representatives is the
>industry's largest. And while the company has the biggest research budget in
>the industry, it spends more than twice as much on marketing and
>administrative expenses.
>
>Last year, the company spent 39 percent of its $16 billion in revenue on
>those expenses -- a rate that was about one-fifth higher than the industry
>average.
>
>Pfizer brushes aside the concern. In an interview, Mr. Steere said the
>company's ads were helping to improve the public's health, not only by
>supplying effective drugs to ailing patients, but also by prompting people
>long reluctant to go to the doctor to set up appointments. And those
>appointments, he said, may also lead to detection of other problems: some men
>who have gone to the doctor to get a prescription for Viagra, Pfizer's
>popular anti-impotence drug, have found out they had other medical problems,
>like diabetes.
>
>"Direct-to-consumer advertising is a good thing," he said. "We get more
>complaints about our ads from politicians than consumers."
>
>Peter DaSilva for The New York Times
>
> In late 1998, Pfizer donated a zebra to the San Francisco Zoo. The animal
>was later named Max, just like the drug's mascot.
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>Pfizer's strategy has been so successful that the company expects to set an
>industry milestone this year -- eight drugs that bring in sales of more than
>$1 billion each. Six of those blockbuster drugs were discovered in Pfizer's
>labs or in those of Warner-Lambert, a competitor that it acquired early this
>year.
>
>Pfizer is so respected as a marketer that more and more of its sales come
>from drugs discovered by other companies that have hired Pfizer to help sell
>their drugs. SG Cowen Securities estimates that Pfizer's revenue from
>marketing just two drugs discovered by other companies -- Celebrex, a pain
>reliever from Pharmacia, and Aricept, a treatment for Alzheimer's, from Eisai
>-- will increase to $2.4 billion by 2004 from $680 million last year.
>
>Pfizer's need to market so aggressively is, in part, a product of its
>success. Its strong performance over the last decade has raised investors'
>expectations, and its acquisition of Warner-Lambert brought together
>America's two fastest-growing drug companies, only adding to the Wall Street
>pressure for sales growth. Mr. Steere said this year that Pfizer planned to
>increase sales by 13 percent a year through 2002. That means more than $3.5
>billion in new revenue this year, the equivalent of three new blockbuster
>drugs.
>
>"We've got to get everything out of a product in a short amount of time," Mr.
>Steere said.
>
>There is no doubt that Pfizer's drugs have helped millions of ailing
>patients. The company is giving away millions of doses of Zithromax, for
>example, to developing countries to help stop an eye infection that can lead
>to blindness.
>
>But criticism of the company's marketing tactics is growing. Last year, the
>Food and Drug Administration requested a meeting with Mr. Steere, wanting to
>discuss the repeated warning letters it had sent to Pfizer. The letters
>contended that the company failed to follow federal drug-marketing
>regulations by making claims about certain drugs that could not be supported.
>
>Pfizer has received 11 warning letters since the end of 1996, including one
>ordering it to stop using brochures that the agency says improperly implied
>that Zithromax was more effective than Augmentin, an antibiotic made by
>SmithKline Beecham. Other drug companies have received more warning letters
>from the F.D.A., but an agency spokeswoman said it was "rare" for a chief
>executive to be called in for a visit with Dr. Janet Woodcock, director of
>the F.D.A.'s center that approves drugs.
>
>Thomas McDonald for The New York Times
>
> Two Pfizer scientists, Arthur E. Girard, left, and Gene Michael Bright, were
>involved early on with Zithromax, used to treat children's ear infections.
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>Two of Pfizer's most vocal critics, Dr. Joshua Sharfstein, a pediatrician at
>Boston Medical Center, and Dr. Sidney Wolfe of Public Citizen, the consumer
>group, have complained about Pfizer's Zithromax campaign to Donna E. Shalala,
>the secretary of health and human services. The two doctors had obtained an
>internal Pfizer document that listed a toll-free phone number for
>pediatricians to call if they wondered whether to prescribe Zithromax to
>children. When they called, they heard recorded advice from Dr. Russell
>Steele, vice chairman of pediatrics at Louisiana State University's school of
>medicine. He said, among other things, that most children's ear infections
>would be cured with a drug like Zithromax.
>
>The Pfizer internal document said the purpose of the recorded advice was to
>"counter" recommendations of the Centers for Disease Control and Prevention
>that were published in early 1999. Those guidelines said other antibiotics
>were more effective than Zithromax at curing children's ear infections.
>
>In their complaint, Dr. Sharfstein and Dr. Wolfe argued that part of the
>advice from Dr. Steele, whose university had received a payment from an
>advertising company hired by Pfizer, was not based on prevailing scientific
>evidence.
>
>"There is even more evidence now that Zithromax does not work for many kids,"
>Dr. Sharfstein said. "It just prolongs pain and suffering for many kids and
>is much more expensive than the other medications." He said, however, that he
>believed Zithromax was effective in treating pneumonia.
>
>Dr. Steele said that he disagreed with the C.D.C. recommendations, and that
>he stood by what he said on the recording.
>
>Pfizer says any problems that regulators found with its marketing were
>isolated incidences that were corrected immediately. J. Patrick Kelly, the
>vice president for worldwide marketing, said the company had investigated the
>two doctors' complaint but did not find that it had done anything wrong. Mr.
>Kelly said that Pfizer regularly gives grants to outside experts to talk
>about its drugs as part of educational programs for doctors, but that the
>experts give their own opinions. "We don't control the personal opinion of
>doctors," he said.
>
>Dr. Michael W. Dunne, director of clinical research for Pfizer's
>anti-infective drugs, said the company had conducted studies comparing
>Zithromax to all drugs recommended by the C.D.C. panel and found that
>Zithromax was just as effective.
>
>Aggressive marketing of any antibiotic, whether made by Pfizer or its
>competitors, is increasingly controversial. C.D.C. officials say they fear
>that overuse of antibiotics is threatening the public's health as more
>bacteria become resistant to the drugs. But to drug companies, limiting the
>sale of an antibiotic would be altruism that would not be good for the bottom
>line.
>
>"There is a conflict between the public health interest and the industry's
>interest," said Dr. Scott Dowell, the C.D.C.'s acting associate director for
>global health, speaking about all drug companies. "The industry is concerned
>about resistance, but they need to sell their drugs."
>
>The Associated Press
>
> Pfizer and the producer of ``Sesame Street'' made a video featuring Elmo
>going to a doctor with an ear infection.
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>Mr. Kelly said Pfizer was monitoring which bacteria have become resistant to
>Zithromax. So far, he said, Zithromax is holding up better than many other
>drugs. It is now the nation's top-selling branded antibiotic.
>
>In its marketing efforts, Pfizer has addressed the government's concerns
>about antibiotic resistance, Mr. Kelly said. Company advertising, for
>example, has urged parents not to demand a prescription for an antibiotic
>from the doctor if a child's ear infection is caused by a virus -- a practice
>that is contributing to antibiotic resistance.
>
>Pfizer has acknowledged a downside to advertising. While Mr. Steere contends
>that advertising has benefited consumers, he said it had also helped make the
>industry a new corporate demon in some people's eyes.
>
>"We used to be invisible," he said, "but now we're very visible."
>
>Since its founding in 1849 by Charles Pfizer and his cousin, Charles Erhart,
>in Brooklyn, Pfizer has had a knack for getting people to take more medicine.
>They had their first breakthrough when they took a bitter treatment for
>parasitic worms, blended it with almond-toffee flavoring and shaped it into a
>candy cone.
>
>Pfizer's presence in antibiotics dates to just before World War II, when the
>company found how to produce penicillin in mass quantities. And in the late
>1940's, Pfizer's scientists discovered Terramycin, which went on to become a
>top seller. When the drug was approved by the F.D.A. in 1950, eight Pfizer
>sales representatives were waiting for word at pay phones across the nation.
>
>The company has been building its sales force ever since. Even during the
>early 1990's, amid the uncertainty over managed care and President Clinton's
>plan for a national health care system, Mr. Steere took a gamble by hiring
>people when other drug companies were firing them.
>
>With the Warner-Lambert merger, Pfizer now has 8,000 sales representatives in
>the United States alone, the most in the industry.
>
>Pfizer plans to spend about $4.7 billion this year on research -- an amount
>that is more than the budget of the National Science Foundation in
>Washington. The company's 12,000 scientists are focused both on finding drugs
>and, with the help of sales experts, creating an ever greater market for
>them.
>
>At the main laboratory in Groton, Conn., the scientists call that teamwork
>"Cram," for "Central Research Assists Marketing." About 25 percent of
>Pfizer's research money finances clinical studies of drugs that Pfizer is
>already selling. These studies, known as Phase 4, are common in the industry
>and are conducted after the F.D.A. approves a drug.
>
>Aimed at increasing the sales of existing drugs, Phase 4 studies try to show
>that the company's drugs can be used by patients suffering from other
>illnesses or that they work better than competitors' drugs. In effect, they
>try to expand the claims that Pfizer's sales representatives can make about
>the drugs.
>
>"You can't promote a feature of a drug unless you've proven it," said Dr.
>John F. Niblack, Pfizer's top scientist and vice chairman.
>
>Outside the lab, Pfizer is also working hard to supplement its products. It
>has aggressively wooed other companies that are developing new drugs, asking
>to let Pfizer help sell them. In fact, of the four drugs in Pfizer's pipeline
>that the company estimates could become billion-dollar-a-year sellers, two
>were discovered by other companies. In a recent report, McKinsey & Company,
>the consultants, called Pfizer "superior" at getting these contracts. Indeed,
>the antibiotic that became Zithromax was discovered by Pliva, a company in
>Zagreb, Croatia. Pfizer's scientists came across Pliva's patent in 1981 in a
>search of records at the United States Patent Office. The companies soon
>signed a licensing agreement.
>
>The drug fascinated Pfizer's scientists because, in experiments, it stayed in
>the body tissue of animals longer than other antibiotics.
>
>Pfizer's marketers quickly realized that the science behind Zithromax would
>make great ad copy. Gene Michael Bright and Arthur E. Girard, two Pfizer
>scientists involved with early work on the drug, recalled how the marketing
>executives decided to send them to international conferences to talk about it
>years before it was approved.
>
>At the suggestion of Pfizer's marketers, the scientists repeatedly used
>snappy phrases like "the tissue is the issue," Dr. Bright said, to deliver
>the message that Zithromax would be a powerful new drug.
>
>When Zithromax was approved in 1992, Pfizer's marketing message changed to
>focus on consumers. Because the drug stays in the body so long, patients need
>fewer doses than they would of other antibiotics. Pfizer's marketers knew
>that this would be a great selling point to parents struggling to get sick
>children to take medicine. The marketing message became "just five doses and
>you're done."
>
>Although Zithromax is approved for use in adults with pneumonia and other
>illnesses, Pfizer's marketers have focused much of their effort on millions
>of children who get ear infections. Federal statistics show that almost
>two-thirds of children under 5 get an acute ear infection every year.
>
>When the pediatric formulation of Zithromax was approved in 1995, Dr. Candice
>E. Johnson was a pediatrician at a clinic at Case Western Reserve University
>in Cleveland. She said her clinic "was wallpapered with Zithromax zebras"
>supplied by Pfizer sales representatives.
>
>Dr. Johnson, now a pediatrics professor pediatrics at Children's Hospital in
>Denver, recalled how Pfizer representatives had distributed rubber ink stamps
>to doctors so that writing a prescription required only a quick stamp and
>signature. She became upset, she said, when she found that emergency-room
>doctors were prescribing Zithromax for illnesses like strep throat, which
>could be treated with less powerful medicine.
>
>A few years ago, she said, she asked to give a talk to the emergency-room
>personnel on the proper use of antibiotics. But before she spoke, a Zithromax
>sales representative was allowed to hand out pens and calendars, make a
>five-minute presentation and pay for the breakfast buffet. "It really
>disturbed me," she said.
>
>Pfizer says its use of a zebra to promote Zithromax is typical of the
>industry's approach to marketing pediatric drugs. SmithKline Beecham, for
>example, uses "Auggie the Froggie" to market Augmentin, and Abbott
>Laboratories uses a bulldog called Bix to sell Biaxin. Both drugs compete
>with Zithromax.
>
>Concerned early last year about the growing resistance of bacteria to drugs,
>a C.D.C. panel of doctors recommended which antibiotics should be used to
>treat children's ear infections. The panel recommended that a pediatrician's
>first choice should be amoxicillin, which has been used for years. As a
>second choice, the panel recommended several drugs made by Pfizer's
>competitors.
>
>Dr. Dowell, the C.D.C. official, said the panel did not recommend Zithromax
>because most studies had shown that it was not as effective as the
>recommended drugs against the bacteria that is the leading cause of
>children's ear infections, if that bacteria had become resistant. A growing
>number of ear infections are caused by resistant bacteria, he said.
>
>"We still stand by the recommendations," he said. "The studies that have come
>out since have supported them."
>
>But Pfizer moved quickly to offset the recommendations. Soon after they were
>published, Pfizer paid the Children's Television Workshop to sponsor a season
>of "Sesame Street," running 15-second Pfizer announcements at the beginning
>and end of each show.
>
>Then, in an unusual partnership, Pfizer and the Children's Television
>Workshop produced a video featuring Elmo going to a doctor with an ear
>infection. Zithromax was not mentioned in the video, which was distributed to
>doctors and child care centers, but the drug was advertised on a Pfizer Web
>site, KidsEars.com, where the video was also given away in a drawing.
>
>"We used something kids love," Mr. Kelly said, "to get them past something
>they don't like."
>
>Pfizer also paid for a children's health magazine that was produced by the
>Children's Television Workshop and included Zithromax ads.
>
>What happened next is open to interpretation. The latest sales statistics
>suggest that the C.D.C.'s recommendations could be changing pediatricians'
>minds. In the first half of this year, Zithromax sales fell 10 percent,
>compared with the corresponding period last year. And prescription statistics
>show that amoxicillin prescriptions began to climb in 1999 after declining
>for years.
>
>But Mr. Kelly of Pfizer said Zithromax prescriptions fell because the flu
>season was shorter this year than last, and total sales of all antibiotics
>declined. Zithromax continues to gain market share, he said.
>
>To make sure it does, Pfizer is working on two new formulations for children,
>including one that would require only one dose to treat an ear infection
>instead of five.
>
>The company is also working on a clinical study that could create a huge new
>market for the drug. The study, nicknamed the Wizard trial, is looking at
>whether the antibiotic could become part of the treatment for heart disease,
>the leading cause of death among Americans.
>
>Mr. Steere said the study was an expensive, high-risk gamble. "But if we
>win," he said, "we win big."
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>--part2_cc.959e988.26daa417_boundary--
>
>--part1_cc.959e988.26daab76_boundary--
>
--
art fougner, md
A series of 1000 cases begins with but a single anecdote.
