Patients are taking on DTC ads. How will drugmakers respond?

Let's get this out of the way up front: For all the talk about digital migration and channel agnosticism, pharma companies remain huge fans of direct-to-consumer television ads. In 2016, pharma spent $4.06 billion on TV buys, up 4% from $3.91 billion in 2015, according to Kantar Media. This is, as they probably don't say in the biz or anywhere else, a metric triple-megaton of support. Related: Spending in and around much-heralded digital channels was more or less flat ($515 million in 2016 versus $516 million in 2015).

So, pharma loves TV and TV loves pharma — or, to be more specific, its endearing generosity. But in the past 18 months or so, there has been an increasing sense that the rest of us may not be quite as sold on the marriage.

The first vocal pushback arrived in October 2015 when ­members of the MS community expressed some less-than-appreciative thoughts about the images and patient depictions in a Biogen TV spot for Tecfidera. Bristol-Myers Squibb found itself on the receiving end of a similar response when its own series of ads for Opdivo made promises that, patients and caregivers alike proclaimed, the drug could not keep.

See also: The 2017 DTC Report: All the data in one place

Taken in tandem with the anti-DTC sentiment preached by the American Medical Association (which has aggressively advocated ending the practice of advertising drugs directly to consumers) and the link alleged by many activists between pharma DTC spend and drug prices (which, once more for the record, is specious at best), one might well wonder if DTC on TV has reached an inflection point.

Could it be all downhill from here?

As with anything else relating to the charged issue of pharma DTC, it depends on the person you ask. Jack Barrette, CEO of patient-community champion WeGo Health, believes that TV remains a go-to venue for near-instant awareness generation, especially during a drug's first months on the market.

At the same time, Barrette notes that “nobody's ever been fired for a big TV spend at launch, and the reality is that they should be. You can spend TV-size dollars on programs that reach people and communities in a much more effective way. TV may be what we know, so to speak, but the world and media have changed.”

Not surprisingly, DTC stalwart Mike Rutstein, founder and CEO of Strikeforce Communications and a 2016 DTC Hall of Fame inductee, disputes that. “Some people want to believe that digital is where it's all happening, but the reality is that it's hard to showcase a [product's] value proposition the way you can on TV,” he says. “This holds for patient communities and the public at large. Digital is best as an extension of, not as a surrogate or substitute for, TV.”



THE PATIENT IMPASSE

Biogen likely had little idea that it would become patient zero for this particular debate when it debuted its first Tecfidera ad, the imaginatively titled Relapsing Multiple Sclerosis, in October 2015. As far as pharma spots go, the ad is creatively unexceptional: It depicts a woman — ostensibly an MS patient — hiking, swimming, and enjoying an evening of low-key mirth at a carnival. Even as the voice-over intones about less-than-cheery potential side effects (“a rare brain infection that usually leads to death or severe disability”), the images and background music pulsate with life. The overall effect is one of uneventful blitheness.


Indeed, if there's a sign that the woman in the ad is afflicted with MS — or, really, with anything that in any meaningful way impairs her day-to-day functioning — one would be hard-pressed to tell. The suggestion? Tecfidera is wildly, almost magically, effective in managing the disease.

When Relapsing Multiple Sclerosis began its appearance, reaction from the MS community verged on disbelief. Vocal patient advocates noted that the ad undermined the reality of living with the disease, especially given how often other people inadvertently diminished its impact on their lives with such rejoinders as, “but you look so great and healthy!” These assessments are necessarily subjective, but it's hard to dispute that the woman in the ad looks “great” and “healthy,” even as she manages a day's worth of physical activity without a cane or other visible support.

See also: The Top 10 DTC Ads of 2016

In a much-quoted post from her blog Inside My Story, MS patient and advocate Laura Kolaczkowski tried to explain just how wrong Biogen got it. “You show everyone that if we take this blue pill once a day we can do anything. I am the first one to be encouraging, but your ad takes it beyond that. Even people with ‘normal' health will not hike, swim, and go to the fair in one day and still look so good. Someone with MS would be out of the day before they hit noon,” she wrote. Her post concluded by noting that the ad “is doing more harm than your creative marketing team imagined.”

Bristol-Myers Squibb absorbed similar criticism about overstating the effectiveness in the similarly inventively titled Most Prescribed Immunotherapy, designed to pop sales for lung-cancer drug Opdivo. In the spot — which, according to iSpotTV, was still running in March — the faces of patients and family members widen with awe as they see messages like “Opdivo significantly increased the chance of living longer versus chemotherapy” beamed Jumbotron-style onto the surfaces of nearby buildings.


The Opdivo ad managed not only to upset lung-cancer patients and their families — one caregiver, Matt Jablow, took to the editorial page of The New York Times to describe it as “utterly misleading and exploitative” — but also the medical community. Writing in JAMA Oncology, oncologist Dr. Lowell Schnipper dismissed BMS' contention that the ad was designed to encourage patients “to have an informed discussion with their physician about available treatment options,” as a BMS spokesperson put it in an emailed statement to MM&M last August.

“It is difficult to conceive that a medical oncologist would fail to discuss the potential use of [Opdivo] or another immunomodulatory agent for second-line therapy of squamous non-small cell lung cancer,” Schnipper wrote.



THE LEARNING CURVE

It's hard to tell whether Biogen and BMS learned anything from their experiences butting up against newly empowered patient communities. When contacted about the possibility of an interview with a member of the Tecfidera brand team, a Biogen spokesperson responded, “Given the length of time it's been since we ran the campaign, and that the ad isn't a focus of our strategy now, we'll need to pass.” BMS, for its part, did not respond to a request for further comment about Opdivo.

See also: The DTC Ads of 2016 That Shouldn't Have Happened

Pundits with DTC on the brain, of course, are happy to fill in the blanks. Howard Courtemanche, president of the global health practice at Y&R and a 2014 inductee into the DTC Hall of Fame, still wonders how the Tecfidera brand team got Relapsing Multiple Sclerosis past the FDA. “The FDA is usually the first one to jump on overstatement of efficacy,” he notes. “But in this case, it was users throwing the flag, so to speak. You wonder if maybe that was a sign of things to come.”

Barrette is only slightly more inclined to cut Biogen some slack. “The ad didn't respect the reality of the disease, clearly, plus it was for a disease with a community that's particularly active and engaged,” he says. “The community knows how expensive TV ads are and were probably thinking, ‘Biogen isn't doing any online communication and then they give us this?'”

As for the Opdivo spot, Rutstein both justifies BMS' big-money TV buys and criticizes the specific approach. “BMS needed to be out there and be in peoples' living rooms. Doing the ad was the right call,” he explains.

“Where they went wrong was in failing to layer in the hope and desperation of the population. Often what is said in an ad is not what's heard by patients and their families,” Rutstein continues. “When people in a desperate situation hear ‘you can live longer,' they think years, not months. You can't really knock them for going into these dimensions of magical thinking when an ad tells them that.”



DTC CULPA?

Perhaps, then, it makes some sense to “blame” the medium as much as the brand teams that are using it so inarticulately. “The reality is that no TV ad can do justice to a disease, because the medium doesn't allow it,” Barrette says. “Sixty seconds just isn't enough time to be thoughtful and thorough. Very, very few of these ads are deliberately trying to mislead people. They're just so constrained by the medium that they can't do the job right.”

Others call instead for an increased degree of self-regulation on pharma's part. “Common sense has to come into play here,” Courtemanche explains. “If you're depicting a condition that affects a patient's movement, you can't have the people in the ad power-walking. The dog has to walk faster than they do. These people don't want to run a marathon. They just want to get off the couch.”

See also: What doctors have to say about those DTC ads

Rutstein agrees. “We have a responsibility as an industry to check ourselves a little bit. We have to ask how much we're delivering a sense of false hope,” he says, adding that l'affaire Opdivo certainly got everyone's attention. “All our clients are still talking about it. They've tightened their belts since that happened. They're going out of their way to make sure that communications aren't misleadingly or deceptively hopeful.”

Perhaps, then, the legacy of these two campaigns — and the community pushback that neutered their impact — will be less that they prompted pharma marketers to rethink DTC on TV than that they forced those marketers to reality-check all the work that followed. It's anyone's guess how (or if) the FDA will bring its weight to bear. The agency has requested comments on studies about the use of quantitative data and “animation and distracting images” in broadcast ads. Perhaps industry will head off these concerns by preemptively addressing them?

In any event, patients have sounded their opinions loud and clear, in social media and elsewhere. Whether pharma's many DTC-on-TV boosters have heard them remains very much open to debate.

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