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August 26, 2016 Bob Ehrlich0

The FDA has done a mixed job overseeing patient side effect education. Consumers have a right to know what the possible side effects are for any medication. They also need to know the real odds of getting them. The FDA has regulated the first well. Patients do get to see and hear the litany of side effects on DTC ads under fair balance requirements. What the FDA has regulated less effectively is educating the public on how often risks and side effects are really likely to occur. Side effect and risk discussion, improperly communicated can scare people away from taking their medication.

Bob Ehrlich
“How about a clear system listing…odds of getting the serious side effect?”
-Bob Ehrlich

Consumers are inundated with side effect information from inserts with their prescriptions, DTC ads, web site chat rooms and online drug sites, and their doctors. Lawyers advertise for clients touting drug side effects. So how is a consumer to know when a prescribed drug might be dangerous? After all everyone has a different risk tolerance. It is also disease dependent in terms of the seriousness of the disease and risk a patient may be willing to accept for a cure or relief of symptoms.

The FDA is exploring requiring less risk disclosure in DTC ads in order for consumers to hear the most important. That is a good first step. What really matters, however, is that consumers make a rational data driven decision on drug use. What are the odds I might die or be permanently injured? A cancer patient may think a 1/100 fatality rate is acceptable while someone considering a statin may find 1/10,000 a risk worth taking.

If you watch DTC ads you do not know how often those serious side effects might occur. Sometimes the package insert has that data, but often that is in medical terms and hard to decipher. The FDA needs to find a reasonable, quantifiable method of telling consumers what might happen. Just lessening the advertised number of risks and side effects is not enough. Our media outlets love to run stories highlighting risks of drugs. They also rarely put these risk in context, thus scaring current and prospective users off. “Deadly drug in your medicine cabinet” is a better headline than “new drug kills one in every 20,000 seriously ill patients.”

So how about a clear system listing the numerical odds of getting the serious side effect? Maybe list only the numerical odds of life threatening side effects to make it easier to communicate. Accurate data exists to provide such odds. Using vague terms like “rare case of fatality” just confuses consumers. My definition of rare might be 1/100 but the real data may show 1/100,000. Therefore, it is time to rework the fair balance in a way that is fair to the public.

August 25, 2016 admin0

The theme of this month’s DTC in Focus newsletter is “From the Patient’s POV”, so I want to start with a little experiment. Si escribo esta frase en español, va a entender?

Did you understand that? The Spanish sentence simply says, “If I write this sentence in Spanish, will you understand?” I’ll admit that I used Google’s translate tool to help with the translation, and yes, I’m aware that online translations are not always 100% accurate.

Unless you are fluent in Spanish, those nine words probably confused you. Did you try to figure them out? Did you get close? For many of the 58 million Hispanics1 living in the United States, trying to translate isn’t just a nine-word experiment – it’s the everyday reality of living in a country where the majority of the health information is only available in a language different from the one they speak.

A Growing Market

The fact that many pharmaceutical and healthcare brands continue to ignore the Hispanic market is remarkable when you consider the numbers. According to research from Telemundo:

  • 1 out of every 4 babies born in the United States is Hispanic (25%)1
  • Nearly 1 in 5 Americans will be Hispanic by 2020 (19%)1
  • Every 30 seconds, a Hispanic turns 18,2
  • By 2020, Hispanics will account for more than 50% of the total U.S. population growth.1

When you see these numbers presented this way, it’s staggering to realize the opportunity that lies within the growing Hispanic population. But don’t forget that as a brand marketer, you have to at least meet these consumers halfway. According to The Curve Report by NBCUniversal, 77% of Hispanics feel underserved and wished brands reached out more (versus 43% of non-Hispanics), meaning that they are waiting to hear from you.

The truth is that every brand will say that multicultural education and marketing is important to them, but when it comes time for budget cuts, Spanish-language marketing is the first to go. However, armed with the statistics above, you can make the case for implementing these programs into your existing plan and begin delivering results by reaching the Hispanic consumer at the point of care.

Hispanic doctor explaining pamphlet to client in office
Hispanic doctor explaining pamphlet to client in office

Myth Versus Reality

Even with the staggering statistics presented above, some brands are still reluctant to target the Hispanic consumer. It seems as if there are two prevailing myths that are clouding their judgments and a quick reality check might further reveal the tremendous opportunity with the Hispanic population.

MYTH: Hispanics prefer cost-saving generic drugs instead of the often more expensive name brands.

REALITY: Over a third of Hispanics (35%) are much more loyal toward companies that show appreciation for their culture by advertising in Spanish.3 Many immigrants who came to the United States support brands that are available/marketed in their home country, while Hispanics who were raised in the United States tend to trust the brands that their parents and grandparents relied on while establishing the family’s new roots.

MYTH: Healthcare products are a “luxury” that Hispanics are not willing to purchase.

REALITY: 44% of Hispanics are willing to pay anything when it concerns health versus 36% of non-Hispanics, according to Simmons One View research. And, according to one PatientPoint study, 48% of Hispanic patients (compared to 37% of non-Hispanics) responded saying they go to the pharmacy immediately after – when the brand their physician recommended is still top of mind.

By ignoring popular misconceptions and relying on the facts, marketers can tap into an underserved market that is seeking Spanish-language education materials and from brands that understand the cultural nuances to healthcare communication.

Opportunities Abound

Did you know that Hispanics suffer from more health issues than the general population? For example, Hispanic children are 40% more likely to die from asthma compared to Non-Hispanic whites, and Hispanic adults have the greatest prevalence of obesity and nearly 30% have diabetes. In one PatientPoint survey, a higher percentage of Hispanic women who participated – 32% – had never had a pap test compared to 6% of the Caucasian women and 4% of African American women.

These statistics underscore the desperate need for quality education customized for the Hispanic audience, including a more robust Spanish-language offering. At the rate the Hispanic population is growing, combined with the lack of healthcare education that has historically been available in Spanish, marketers will realize there is a tremendous opportunity to reach Hispanics now, and develop loyal customers for the future.



1. Census 2014 National Population Projections

2. Pew Research Center as quoted in “Every 30 Seconds, a Latino Reaches Voting Age”, The Atlantic, 8/26/15.

3. New Simmons stat (Source: Simmons Winter 2016 NHCS Full Year Study, Hispanics A18+)


About the Authors

Linda Ruschau is the Chief Client Officer at PatientPoint, the trusted leader of patient and physician engagement solutions at the point of care. She brings nearly 25 years of experience in pharmaceutical marketing, point-of-care expertise, client service leadership and business acumen to the role. As one of its first employees, Ruschau helped PatientPoint pioneer the point-of-care industry in exam rooms, waiting rooms, clinical areas and throughout a patient’s hospital stay. She is now one of the company’s longest-tenured leaders. Ruschau can be reached by email at or telephone at (513) 936-6819.


Ellen Falb-Newmark is the Vice President of Client Development at NBCU Hispanic Enterprises and as such serves as a personal consultant to clients on all things pertaining to the Hispanic consumer. With more than 25 years of Latino Marketing and Advertising experience, she utilizes consumer insights, research and custom data to demonstrate the value of this vibrant customer. Falb-Newmark represents all the company’s media assets including network, cable, digital, mobile, out-of-home, custom content and promotions. Falb-Newmark can be reached at or (212) 664-3503.


August 25, 2016 Deb Salzer0

Nothing makes one better at their job as a healthcare marketing art director than actually experiencing healthcare firsthand. I’ve always been relatively healthy – doing my fair share of exercising physically and mentally, and eating “kinda” well. I rarely visited my doctor’s office, except for the usual appointments. More honestly, I steered clear of doctor visits almost entirely. I routinely even avoided taking ibuprofen for common aches and pains associated with running. As healthcare marketing creatives, we put ourselves in the shoes of patients to find out what messaging resonates with them. Pretty ironic stuff – here I am in this healthcare advertising world that I clearly try to avoid in my non-working world through my own preventive measures. I’ve gleaned a solid chunk of my healthcare knowledge purely from being surrounded by it for the past 10 years – concepting campaigns, learning about healthcare technology, reading statistics, focus groups, etc. You can gain a lot of information that way (and I have), but to experience healthcare firsthand was an area that I personally lacked.

To read the Deb Salzer’s full article about “stepping into the role of a patient”, click here. This blog post has been shared with permission from HTK Marketing Communications.

August 25, 2016 Scott Ehrlich1

Part 1: Testing And the Lancing Device

Editor’s Note: Last month, DTC Perspectives’ President & Chief Operating Officer, Scott Ehrlich, was diagnosed with diabetes. Join us in the multi-part series as he shares a first-hand account of his experiences as he moves along his treatment journey.

About a month ago, I went for a blood test and found out my A1C was over 10%. This, combined with an unexplained weight loss of about 30 pounds, led doctors to the obvious conclusion that I had joined the ranks of about 30 million Americans who had diabetes. At this point, the two major questions were which type of diabetes, and how can I treat it? Because it came on suddenly and quite severely, my doctors suspected type 1. I, knowing my diet and physical activity regime over the last 30 years, suspected type 2.

As diabetes is very complex, it’s more than just taking medication every day to treat this disease; there is a great deal a patient has to know about diet, exercise, devices, drug interactions, dosing, and testing. As there was so much to take in, I decided to detail my experience as a newly diagnosed diabetic and the challenges I have faced, having spent so much of my time on the marketing side, to now be on the patient side. In this article, I detail with the lancing devices I have had to learn to use. My future articles will deal with the various monitors and medications available, and the overall consumer experience of being a newly diagnosed diabetic.

After going to my GP with my initial blood results, I went to an endocrinologist for a follow-up. After taking a quick and painful finger prick with the lancing device at the office, they quickly confirmed that I had diabetes, with a fasting blood sugar of 273mg/dL at that time. (A normal result for fasting blood glucose ranges from 70-110 mg/dL.) I was also told that the blood work, to determine which type of diabetes I had would take a week. However, because of how high my blood glucose was and that the doctor suspected type 1, he decided an aggressive course of treatment should be tried, well beyond diet and exercise. Being that I was deathly afraid of needles, this was awful news for me. I was told I needed to test my blood sugar at least four times a day and inject insulin into my stomach three times a day on a sliding scale depending on where my glucose was. After a very brief demo, the nurse sent me home with an Accu-Chek meter, a FastClix pen, and 100 units/mL of Humalog fast-acting insulin.

Testing with the Well-Knowns

The first thing to deal with was the testing. I had read, prior to this visit, that FastClix was one of the preferred pens of diabetics as far as reduced pain and ease of use was concerned. The FastClix device was small and came with a cartridge for lancing devices that held six lancets. When pushing the button, you never actually saw the needle, which was good for a needle-phobe like myself. After mustering up the courage to prick myself, I put it on the second lowest depth and proceeded to prick the side of my finger. The button to give the injection is like the button on the back of a pen, except you have to push pretty hard. I kept pushing and pushing, holding my breath, waiting for that stinging pain. Finally, after pushing down a good bit, it finally kicked into action, the lancet pricked me, a little blood bubble was drawn, and I had done my first test.

I was pleasantly surprised to see that this really didn’t hurt. However, I was not happy that it wasn’t comfortable and, the knowledge that I’d have to do this three to four times a day at least, every day, for possible the rest of my life, would leave my fingertips pretty torn up. This was confirmed by the fact that, by the end of the second or third day, and even though I would switch up fingers, they were pretty sore. There’s not a lot of places you can inject on the fingertips and, being useless with my left hand, there is really only one hand I could use for the pen. FastClix also isn’t meant for alternate site testing so I could see my index and middle fingers on my left hand were due for a rough ride. Still, for the price and ease of use, as well as the lack of any real pain (like briefly pricking your fingertip on a thorn at worst), it could have been a lot worse than the FastClix.

Trying an Alternative Device

Still, I was concerned about the frequency of the testing and the accumulated discomfort. Knowing I had to do this a lot, I tried to see if there were any devices that could be better and provide less discomfort or more choices as to where to do the testing. I came across an interesting device called Genteel, developed by an engineer. There weren’t a ton of reviews I could find on it and the price of $129 for a lancing device seemed a bit steep, compared to the $20 or far less most others would cost. Furthermore, most of the positive reviews I could find either came from the site itself or from people given a free sample for testing. The website featured a video of a sleeping child getting tested on their shoulder by a parent and not being woken, which also seemed hard to believe. Still, hating needles more than I hated parting with my money, I decided to order one and give it a try, as it’s only available via online order.

When I received it a few days later, it was much bigger than the other device and came with a bunch of highly visible lancets. There are also some attachments you put on top to control the depth of the stick. It is certainly less intuitive than the FastClix, with a lot more moving parts, to start. I put on the one for the smallest stick, which is largely recommended for finger sticks, since body skin may be thicker. I set it up, put it on my shoulder as in the video, and pushed the button. At that point, the plunger pops up and you are supposed to hold the button for a few seconds before taking it off. Aside from the loud pop it makes when you push the button, I didn’t feel anything. No stick, no pressure like with the FastClix. I took it off and figured I’d need to put on the cap for a deeper stick on the arm when I looked down and saw a perfect blood droplet sitting there. I couldn’t believe it.

I tried the same thing on my finger. It wasn’t easy to find a spot on my fingertip that would fit the device at first due to its size, and also it needs a vacuum seal to work properly. However, once I lined it up right and did it, it was much the same result. Painless, and, unlike the FastClix, largely sensationless. You’d also usually draw more blood with each prick, even on the lowest depth, which could be very helpful in machines that require a good amount of blood for each test (more on these in the next article).

One of my only complaints about it is that, for the price, it’s not the most durable device. I dropped it on the floor when trying to set the plunger and the back part fell off. While it is removable for cleaning, it was a pain to get back on and even when I did finally get it back on, the device didn’t work properly, either flying off when I tried to test or pricking way too deep leading to real pain. I was able to get it working again, however, in a few hours and I am certainly no engineer when it comes to fixing devices. I was also sent another device immediately after I said something to their customer service rep, who was available to be reached through an online chat, on a Sunday night no less. Their service is superb. My only other issue with this device is that it is a bit bulky compared to others, so carrying it in a pocket or a small carrying case, such as the one provided, along with my other diabetes supplies, isn’t easy. However, it’s a great device and I haven’t used my FastClix since I received it.

Factors Impacting Compliance

Testing is one of the most important things for a new diabetic to learn and compliance with testing is paramount, regardless of the type or severity of the disease. With the FastClix, I didn’t fear testing, but I certainly would not do it more than I had to; I sometimes had to talk myself into it. With Genteel, I had no trouble convincing myself to test. In fact, I was testing so frequently I ran out of my first month’s supply of testing strips in about a week. For someone like me that hates needles, doesn’t do well with pain, and likes to be able to vary their testing sites, Genteel has been a tremendous help in frequent testing, the first step in keeping my blood sugar numbers stable.

However, I am also a consumer that has both means and did a lot of research. Neither my endocrinologist or his assistant had ever heard of it. Most insurances won’t cover it. It doesn’t come with any glucose meter. There is no DTC behind it. It’s not sold at pharmacies. So most consumers will be using something like the FastClix or the OneTouch Delica (which came included with my OneTouch Meter). These are good devices and I’m sure much better than what preceded them. They are cost effective (both of them were free for me) and get the job done. They both come with glucose meters, are widely available, and are backed by well-known and respected companies.

If testing was infrequent, cost was a major driver, or the patient was a bit tougher around needles than I was, I think both would be perfectly sufficient. However, if you were like I was, and building up the courage to do each and every single finger prick was a struggle, the Genteel was well worth it. And if my two-year-old son, for example, was the one who had diabetes instead of me, the Genteel is a no brainer. It has been a game changer for me in maintaining testing compliance, and pharma companies would do well to integrate it or a similar lancing device into their treatment packages. Because no matter the diabetes type, no matter the severity, no matter the treatment plan, regular and frequent testing is a necessity. That becomes much harder when the patient has any amount of fear of or dislike for their lancing device.


August 25, 2016 Jennifer Kovack1

JenniferAniston-ShireShire and Digitas Health LifeBrands (the agency of record) announced a new celebrity spokesperson today, partnering with Jennifer Aniston to raise awareness and understanding of chronic dry eye. By sharing her own experiences with the condition, she hopes to “educate and inspire people” to learn and communicate more with their healthcare professional. According to the news release, the educational awareness campaign, eyelove, is “inspired by the wonderful things we can do and see because of our eyes.” As part of the campaign, NYC’s High Line will host an “eyelove art project” in October, encouraging visitors to share their own stories and “[create] a unique artistic image of their eye via a customized photo capture. The photo will then be projected onto a large screen, showcasing each person’s one-of-a-kind eyelove art. Participants have the option to share their eyelove art via social media channels. People can also visit to create their own art.”

Another component to the campaign are two unbranded television ads – one with and one without Jennifer Aniston. The ad with their celebrity spokeswoman showcases the actress discussing her own experience with dry eye before she “finally decided to show [her] eyes some love”, followed by a female voice over suggesting consumers talk with their doctors. The non-celebrity TV ad focuses on three different women, each enjoying their favorite activity, or, “the things [they] love to do with their eyes”, as a female voice over states before urging consumers to talk to their doctors.

Click here to read more about Jennifer Aniston’s partnership with Shire’s disease education launch campaign.

August 19, 2016 Bob Ehrlich1

DTC spending continues to be very strong in 2016 based on a number of new brand advertisers. I fully expect the 2016 spending to top 2015 by 5% or more. That would put the total at about $5.5 billion. Driving much of the growth in 2016 will be diabetes drugs.

The number of diabetes advertisers used to be relatively small and often confined to print publications. Now many diabetes brands are all over television. There have been several new categories of diabetes drugs launched in the past few years. One is long lasting insulin for both Type 1 and Type 2 patients. Toujeo and Tresiba are the big spenders. There are also new injectables that are non-insulin that control blood sugar. Victoza is the big spender here with Trulicity in the mix. A whole new category of pills that help the kidneys excrete excess sugar burst on the scene in the past few years. Farxiga, Invokana, and Jardiance are all heavy spenders. Another new category of pills help regulate insulin after meals and these recent entrants include Onglyza, Tradjenta, and Januvia.

Bob Ehrlich
“Critics should welcome..awareness created by diabetes DTC..”
-Bob Ehrlich

Why are Diabetes drugs investing so much and launching so many new brands? The market is huge at 29 million people with diabetes. With aging baby boomers swelling the population, this market will receive heavy investment in R&D and marketing. We are also seeing an emphasis on early diagnosis by alerting people with blood sugars over 100 that they have pre-diabetes.The American Diabetes Association says there are 86 million adults with pre-diabetes. While most do not receive treatment they are increasingly made aware of the risks of developing diabetes. That early awareness should help the adoption of advertised drugs as those pre-diabetics evolve to diabetes.

There are many products on the horizon that will be launched that improve blood sugar as companies are looking for new pathways to control blood sugar. A company in Israel is developing an oral insulin which would be a welcome alternative to injections. There are many companies working on devices to test blood sugar non-invasively to replace the finger sticks.

While many DTC critics say drug companies push drugs in categories where treatment may be overused, this is hard to argue in diabetes. The CDC reports that only 57% of diagnosed diabetics have numbers under control (HbA1c under 7). Even small changes in blood sugar have a significant impact reducing complications. The advertising for all these drugs emphasizes control of blood sugar. The challenge for all these drugs is how to say control in advertising that differentiates one brand from another. With so many ads on mass media this is a category that needs continuous innovation in creative development.

Because of the significantly higher incidence among African Americans and Hispanics diabetes DTC has many opportunities for multicultural campaigns. Given the many new types of diabetes treatment pathways there is a need for education on which might be right for patients. That means fertile ground for the use of DTC for years to come. Even the DTC critics should welcome all the awareness created by diabetes DTC advertisers. The estimated annual healthcare cost of diabetes is $245 billion in America. Telling people about blood sugar control serves both societal and drug company objectives in controlling the numerous devastating complications.

August 12, 2016 Bob Ehrlich0

In a heart wrenching story by a husband of a lung cancer patient, Opdivo DTC received harsh criticism. The op-ed in the 8/9 New York Times titled Cancer-Drug Ads vs. Cancer-Drug Reality delivers a rebuke to Opdivo for creating false expectations. The author Matt Jablow writes a touching story about his 48 year old non-smoker wife diagnosed with lung cancer who passed away in 2013.

Bob Ehrlich
“I disagree that the commercial is misleading.”
-Bob Ehrlich

Mr. Jablow recently saw the DTC ad for Opdivo and felt it was misleading in saying it could extend the lives of lung cancer patients. He goes on to say that the drug only helps 20% of patients and only a small added survival benefit measured in months. While I understand Mr. Jablow’s concern I disagree that the commercial is misleading. It says Opdivo gives you a chance to live longer vs. chemotherapy. It says the survival in the clinical study added a few months vs. chemotherapy.

I agree the ad is majestic and bold in showing a headline about a chance of living longer. An ad always features the main benefit and is designed to get you to pay attention. No patient seeing this ad will think their cancer is going to be cured by Opdivo. They will at most ask their oncologist about the potential use for their case. The oncologist will explain benefit and risk and the added survival time will be disclosed.

The idea that a patient will see this ad and have false hope is disingenuous. Any patient or family member of a patient with lung cancer is not going to read too much into the first five seconds of an ad. These patients will investigate the drug advertised and get a lot of information before using it.

We all know Opdivo wants to make patients aware of this new drug because they want to sell more of it. That is what all advertising is designed to do. Mr. Jablow thinks the ad overstates the benefit. The FDA reviewed the ad and did not agree with Mr. Jablow. Mr. Jablow wants Opdivo to withdraw the ad. What about the patients who do benefit from seeing it? While it did not apparently help his wife who was in a clinical trial, it may help someone else’s wife.

I do not expect Mr. Jablow to agree with me. No one can fully understand his anguish about losing his wife and his opinion should be respected.  I think his critique is not fair, however, and the commercial is truthful and provides valuable information.

August 10, 2016 Bob Ehrlich0

You know the ubiquitous ads soliciting clients who were “injured” by prescription drugs. Lawyers all over the country create a drumbeat of fear over prescription drug side effects. The American Medical Association(AMA) is now concerned that this fear mongering is causing patients to get off or refuse to start needed therapy. Last month the AMA called for warnings in these lawyer ads telling patients not to stop taking their meds without consulting their doctor.

The stats are amazing. About 360,000 lawyer ads were run in 2015 on drugs and devices. Many of these law firms are just bundlers who get leads from the ads and turn the names over to trial firms for a cut. The AMA has called for a ban on drug company DTC which seems odd if they are concerned about the scare tactics used by law firms. Drug ads give the positives and negatives while law firms only give negatives. One would think the AMA would want the positives out there if they fear the effects of fear based lawyer ads.

Bob Ehrlich
“FDA should conduct a study to determine affect lawyer ads have on consumer attitudes.”
-Bob Ehrlich

The most ads were run against Xarelto, with Pradaxa, Invokana, Risperdal and Androgel in the top 10. FDA should conduct a study to determine what affect lawyer ads have on consumer attitudes. While they do not regulate what lawyers say a study could help them determine how consumers react to these risk ads. That might help them determine how drug companies discuss risk.

There is no doubt some patients have legitimate claims against drug companies. Lawyers can play useful roles in protecting patients. These ads go beyond that role as they chase clients and create a climate of fear. That being said, these law firms make money doing this direct response advertising. The fact that 360,000 ads were run show they work. A Congress filled with lawyers is unlikely to hold any hearings take steps to stop these ads.

One would hope ethics would mitigate the egregious nature of these ads. Ethics are clearly not the main concern of those drumming up business by scaring patients off their meds.