Two pharma brands debuted on TV’s biggest stage in 2016, sparking a host of unfortunate bowel jokes I’m sure you’ve already heard. 

One of the spots, by Valeant’s Xifaxan, introduced much of America to “gut guy”—the latest DTC character to either charm or disgust audiences in the service of patient empowerment. The other spot, from AstraZeneca and Daiichi Sankyo, got Americans talking about constipation and opioid use on a day dedicated to, well, chicken wings as anesthetic. About the only thing more unlikely? League MVP Cam Newton suffering a 16.9 quarterback rating in the game itself. But these things happen.

Joking aside, pharma marketers are all wondering if these exorbitant media buys ($4.9 million for 30 seconds) were worth the investment for Valeant and AstraZeneca. Was either strategy successful? 

The answers will eventually appear on the companies’ balance sheets. For now, we can study footprints that consumers left across the digital terrain this past weekend. That should help us assess each spot’s relative performance.

For starters, here are some comparative data I gathered with sources noted:

OIC Is Different – AstraZeneca / Daiichi

Xifaxan – Valeant


9,547 visits on Sunday (est. using Similarweb data)

11,705 visits on Sunday


1,099,078 views of TV spot as of Monday night (YouTube) 

48,730 views of TV spot as of Monday night


8.9 million estimated impressions Feb. 8-10 (TweetReach)

13.5 million estimated impressions Feb. 8-10


Index of 14 for February (Google Trends)

Index of 100 for February

OIC Is Different
With more than a million views of its TV spot on YouTube, AstraZeneca scored a touchdown. The “extra point” was good, too: Adweek reported more than 20,000 website visitors to by Monday. That’s around twice my Sunday-only traffic estimate, which tracks pretty well. And 8.9 million Twitter impressions can’t be ignored. 

Yet Twitter is where Xifaxan made its play of the game. According to TweetReach data, social chatter about each spot reached around the same number of Twitter accounts: 6.1 million. Then Entertainment Weekly stepped in. The magazine wrote an article about “gut guy” and tweeted it to its nearly five million followers. Those tweets were promptly retweeted 134 times the past few days, driving 9.9 million impressions alone, per TweetReach. All that free buzz helped Google searches for Xifaxan spike relative to opioid induced constipation.  

So, which pharma really won? 

To decide, we must first acknowledge that each was playing a different game. AZ’s strategy was to get millions of people talking about a relatively uncommon condition, making it easier for those with the condition to seek a solution—ideally, Movantik tablets. In contrast, Valeant’s play-calling hearkened back to last year’s Super Bowl when it built massive awareness for Jublia, a “me too” antifungal, creating a groundswell of prescription asks. (As a hedge, Valeant also ran an updated Jublia spot in this year’s game.)

Give credit to AstraZeneca, which certainly got people talking about opioid induced constipation. Unfortunately, most of the generated dialogue wasn’t good. Consider this ding from the White House’s press secretary:

Then, unexpectedly, opioid addiction became a major campaign issue during the New Hampshire Primary—held two days after the big game. As the pols might say it, AstraZeneca’s optics were bad.

What about Xifaxan? Well, we know “gut guy” was a crowd-pleaser:

Yet Valeant doesn’t make money selling intestine-shaped plushies. It sells Xifaxan. And at a price of around $1,300 for a typical two-week supply (per GoodRx), Xifaxan won’t always be approved by payers. Neither Cigna nor UnitedHealthcare will reimburse the medicine without prior authorization, for example. That could create a frustrating experience for perhaps hundreds of thousands of prescription-seekers who now want their Xifaxan. Valeant should have softened that blow with helpful information about prior authorization on its consumer and HCP websites, but I couldn’t find anything there. You know, except for “gut guy.”

Marketing foul—too many DTC characters on the field!

Can AstraZeneca capitalize? I think it can. Yes, the OIC TV spot drove a lot of negative press around opioid abuse. That negativity, however, galvanized AstraZeneca’s real target audience: patients taking opioids to relieve chronic pain. When comedian Bill Maher sent a vulgar tweet implying opioid users are “junkies,” chronic pain advocates bombarded his feed:

AstraZeneca, it turns out, was prepared for the backlash. It partnered with several patient-advocacy groups, including Creaky Joints, to develop its TV spot. Those voices have been instrumental the past week in combating stigma and perhaps empowering patients with OIC to seek a medical solution.

Speaking of which, the company purchased search ads that linked not only to its unbranded site, but also to its branded site, Knowing TV viewers would jump to Google, AstraZeneca’s subtle maneuver helped convert its unbranded effort into potential prescriptions, all within bounds of FDA regulations.

And the winner is …

The OIC Is Different spot created a deep emotional impact with its target audience, which rallied further around a single crass tweet. AstraZeneca gave chronic pain sufferers empathy and a voice; I won’t be surprised if they now use that voice to ask their physicians about treating this uncomfortable side-effect of opioid therapy. Valeant created emotional impact as well, but it’s hard to believe Twitter love for an animated intestine will translate into many prescriptions for an expensive, Tier 3 medication. Congratulations to AstraZeneca and Daichii Sankyo—my Super Bowl of Pharma winners. 

Jeff Greene is partner and digital strategy lead at New Solutions Factory.