Re: What's Black & White & Sells Medicine?

[Guest guest]

Hhhhhmmmmmm. Funny.

My son had a doctor's appt on Friday. We sat in the office, waiting for the

doctor for 1/2 hour. My son started commenting to me about how everything in

the room had the name of some medicine on it. We commented on the really

cute clock in the room. It had a zebra in the center and on each of the big

numbers, 3, 6, 9 and 12, there were cute pictures of cherries, a piggybank,

and diaper pin (at least they hint at cloth) and the pic at the top, a

spoonful of medicine.

I then come home to find this email to tell me just what that clock was

advertising! It upsets me that the room was so filled with this propoganda

that my 8 year old was bothered by it.

I also noticed a magnet with Poison Control info on it. I asked if they had

these to give out. They didn't. At first they didn't even know what I was

talking about. Now if I had asked for a sample of cough syrup or

something....THAT would have been a different story!

Katrina

>From: Sheri Nakken <snakken@...>

>Reply-Vaccinationsegroups

>i-v-yegroups, Vaccinationsegroups, avml@...,

>avnegroups, SonandRox@..., FRANSWRLD@..., " j w "

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>Subject: What's Black & White & Sells Medicine?

>Date: Fri, 15 Sep 2000 15:31:11 -0700

>

>From at whaleto

>http://www.whale.to/v/conf.html

>http://www.nytimes.com/library/financial/sunday/082700biz-pfizer.html

>

>What's Black and White and Sells

> Medicine?

>

> By MELODY PETERSEN

>

> 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.

> 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. "

>

> 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

> Kline 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.

>

> Two of Pfizer's most vocal critics, Dr.

> 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. 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.

>, 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. 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. 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. 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. "

>

> Mr. 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.

> 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 Pfizer and his cousin,

> 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.

> 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 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.

> E. 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. , 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. Kline

>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. 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. 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. "

>

>

>

> Ask questions about Personal Finance, Entrepreneurs, Small

> Business and more. Get answers and tell other readers what you

> know, in Abuzz, new from The New York Times.

>

>

>Copyright 2000 The New York Times Company

>

>

>--------------------------------------------------------

>Sheri Nakken, R.N., MA

>Vaccination Information & Choice Network, Nevada City CA

>http://www.nccn.net/~wwithin/vaccine.htm

>ANY INFO OBTAINED HERE NOT TO BE CONSTRUED AS MEDICAL OR LEGAL ADVICE. THE

>DECISION TO VACCINATE IS YOURS AND YOURS ALONE.

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