MM&M 2018 staff predictions: From gift bans to Google Assistant

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Marc Iskowitz, editor in chief

I begin my prediction for the year ahead by looking back. The past 24 months or so have seen a high degree of animosity directed at the pharma industry, specifically for the high cost of drugs and the opioid epidemic. This has spurred a trio of state legislatures to renew focus on an issue that has seen little if any attention for roughly the last five years: pharma payments to physicians for marketing-related activities

What's bizarre is, while Maine is one of the states, the two other legislatures that have taken up restrictions on promotional payments to clinicians are in states that serve as hubs for the pharma and biotech industries — New Jersey and California, respectively. That's exactly what makes it likely this trend could continue beyond the coasts.

Moving into the new year, the industry is bound to face more such challenges. Citing the potential of pharma to influence clinicians, states will throw everything but the kitchen sink at the healthcare comms industry. We could see more so-called ethics bills involving payment restrictions, such as in New Jersey and California, or even gift bans, such as in Maine.

See also: Industry on edge

Ban or no, casualties could include the venerable pharma speakers bureau. While some of the proposed state laws maintain carve-outs for payments for CME by accredited providers — as well as for market research payments made by a third party — promotional medical education typically has no such exemption. That means dinner meetings, speaker training, and the like will become increasingly difficult to carry out.

Never mind the fact that, rather than helping combat the opioid epidemic, limits on payments to prescribers could actually aggravate it by lessening the ability to educate them about the drugs and about addiction treatment. Several studies have shown there's a correlation between doctors' willingness to prescribe drugs and receiving free food or other gifts from drug companies. And that's good enough for critics.

None of the issues driving public discussion are going away anytime soon. That's why this is a trend you're probably going to see this coming year.



Virginia Lau, digital editor

Drugmakers, healthcare pros, and payers will continue integrating voice assistants as the
tech becomes increasingly sophisticated. Google Assistant can already decipher the voices of different members of a household, while startups such as Orbita are working with healthcare providers to track patient care at home.

A 2017 DRG survey found 73% of respondents are interested in using tools that allow them to input EHR data by speaking rather than typing. As it stands, the top three physician uses of voice assistants are recording clinical notes (58%), looking up medical information (55%), and verifying dosing information (55%).

Voice assistants also have the potential to help patients take control and manage their condition at home. Seniors stand to benefit greatly, via activity and medication reminders that don't require picking up a phone or typing.

See also: Drugmakers turn to tech to better demonstrate empathy

This year, the Alexa Diabetes Challenge, sponsored by Merck, launched with an open call for concepts that seek to improve the experience of patients with type 2 diabetes. The winner, Wellpepper, developed a prototype of an Alexa-enabled scale for potential use in an interactive diabetes care plan channeled through a patient's mobile device.

The timetable for voice assistants going mainstream among drugmakers and HCPs likely hinges on a range of factors, including privacy concerns and HIPAA regulation. OptimizeRx CEO and director William Febbo said he expects it will take at least two years until voice-activated tech achieves mainstream adoption.

“Once the integration happens with the EHR, you'll get adoption because physicians are used to transcribing. So it'll be a similar service, but directly connected to the EHR,” he explains.


Larry Dobrow, senior editor

Point of care has never been the sexiest of channels for marketers. It's the place where people find themselves when they, or somebody close to them, are either in active distress or anticipatory prevention mode. Waiting rooms aren't exactly the DMV in the final few days of the month, but they're not a venue that excites the senses.

And yet no other marketing channel is riper for growth in 2018. We saw the first signs of the surge earlier this year, when A-list investors — Goldman Sachs and Alphabet, among others — pumped hundreds of millions of dollars into the coffers of two of the point-of-care space's biggest and savviest players, Outcome Health ($500 million) and PatientPoint ($140 million).

It's easy to make the story about those investments, which signal the extent to which the moneyed set has confidence point of care will continue its rise. But what should make the channel such a fascinating follow in 2018 is an unusual confluence of factors that all seem to work in its favor.

See also: Point-of-care group rolls out guidelines

To wit: Pharma wants to more effectively target its consumer messaging. And where are patients more in a healthcare state of mind than during their waiting room detention? Physicians crave quality educational content that cuts down on patient confusion (questions can be answered before patients reach the exam room). Today's tech, in the form of triple super hi-res screens and information kiosks, facilitates message delivery (and that's before we get into beacons and other proximity marketing tchotchkes, which remain of great interest to pharma marketers).

Even old-school publishers want in on the point-of-care action. Time and WebMD have launched publications specifically for point-of-care environments, while Condé Nast and Hearst (through its pending purchase of Rodale, publisher of waiting room mainstays such as Prevention) have similarly upped their POC presence.

There are potential drawbacks, of course, starting with that palm-sized miracle of mirth conveyance known as the smartphone. I challenge any marketer — David Ogilvy, Mary Kay Ash, even Don Draper — to divert my attention to a screen or publication when I have a few blissful minutes alone with my phone in a waiting room. And Outcome Health has some amends to make with pharma after allegedly overstating the reach and effectiveness of ads aired on its point-of-care network.

That said, point of care is the channel to watch in 2018. Between the opportunity and the intrigue, the waiting room will prove the place to be.

Kevin McCaffrey, senior reporter

Last year, I predicted the FDA's Office of Prescription Drug Promotion (OPDP) would issue fewer enforcement letters in 2017. But even I didn't anticipate we would only see two letters total, the lowest since before 2012.

Going forward, we'll see more of the same. Even as drugmakers upped their DTC spend by 9% in 2016, enforcement letters have been on a steady downward slope for some time. That year, OPDP issued 11 letters, up slightly from nine in 2015 and 2014. The sum was down significantly from 2012 and 2013, when the agency sent 28 and 24 letters, respectively.

What's behind it? Pharma marketers have more and more channels open to them. New tech has raised the bar for marketers. It has also left them less likely to simply push their messages during primetime.

See also: The FDA issues its second enforcement letter of 2017

However, the two OPDP letters issued this year shouldn't be ignored because they offer a glimpse into the agency's enforcement priorities. The first letter was sent to Orexigen Therapeutics over its weight-loss drug Contrave. The ad it referenced, Your Brain, cited some of the drug's risks, but not all of them.

The regulator also took issue with the risk information presented. Some of the risks were shared visually, while “unrelated” risk information was cited in audio messages.

The second OPDP letter was sent to Cipher Pharmaceuticals in reference to the marketing of its opioid Conzip. The agency charged that the drugmaker failed to include significant risk information in a detail aid.

Next year, enforcement letters will be scarce, but the agency is likely to make exceptions out of marketers who try to obfuscate or dare to skimp on risk information for an opioid. 


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