This document discusses the need for good promotional practices across different constituencies in the healthcare industry. It begins by outlining what doctors, companies, and board members want, which is largely reliable information, sales, and avoiding issues. The document then provides four actionable strategies for implementing good promotional practices: 1) Transforming sales reps into information concierges, 2) Using content management systems, 3) Implementing good promotional practices, and 4) Forming and supporting initiatives to bridge information gaps. It emphasizes that good promotional practices protect all parties and should be systematically institutionalized.

1. Different hats, same needs:
Marketing compliance from
doctor’s office to boardroom
Jonathan M. Sackier
May 4, 2011
2011 Pharma Marketing Summit

2. “Nothing political is correct”

3. Are you paying attention?
“When teachers are speaking, only 11% are
paying attention, 23% are thinking about
personal issues and 66% are having a
sexual fantasy.” (Rod Machado)
If this holds true, regardless of what I say at
least 2/3 of us will be having fun!

4. Goals for today
Understand why Good Promotional
Practices serve all constituencies and….

5. Structure
Establish my bona fides and viewpoint
What do I, representing different
constituencies, want and need?
Provide four groups of suggestions

6. I need your help…
no longer elbow-deep-in-gore,
but still need timely, focused &
accurate product information
Teach at UVA
Supervise research
Lecture and write
AOPA Medical Counsel

7. Healthcare philanthropy/social activism
First Star
Montel Williams MS Foundation
Foundation for Surgical Fellowship
Board of the American College of Surgeons
Foundation
Presidents Council of AOPA
….all involve interaction with the
pharmaceutical, biotechnology & medtech
sectors

8. Consumer – they used to call us
patients

9. Entrepreneurial recidivist

10. Board member/advisor
“you don’t need to know that Jonathan…”
Adenosine Therapeutics - sale to CLDA/Forest
Drug discovery and safety
IP identification/market intelligence
Enabling the paralyzed to walk again
Support Good Promotional Practices

11. A bumper crop ……. of settlements
in promotional wrongdoing
Forest - $313m
Novartis - $422.5m
“…prosecuting pharma executives for
misdemeanors is on the cards” (Eric
Blumberg, FDA Deputy Chief for
Litigation)
Allergan $600m (I can’t go for that no can
do)

12. Tell ‘em….
Compliance is the new dirty word, real dirty
I come at this from several perspectives
Lay of the land
Four solutions:
Turning your sales reps into information
concierges;
Use of content management systems;
Good Promotional Practices ;
Form & support product information exchanges

13. Lay of the land
What do doctors want?
What do companies want?
What do directors want?

14. What do doctors want?
Reliable, digestible information delivered in a
sensitive, timely & efficient manner
Make their patients happy
Treated with respect
Partnership with integrity
Balance the books
Get some time back
Avoid aggravation

15. What do companies want?
Sales to…
…generate profits…
….to create jobs, reward investors and
fund future products
New compounds; IP span; trial;
compliance; retention…..
Avoid aggravation

16. What do directors want?
Intellectual success while having….
…fun and if that pans out then…
…financial rewards
Avoid aggravation….

17. So given these alignments,
why…
…is there so much aggravation?

18. “God, grant me the serenity to
accept the things I cannot
change, the courage to change
the things I can and the wisdom
to know the difference.”
(Reinhold Niebuhr)

19. The things I cannot change (probably)
Patent life
New blockbuster
compound
Doctor’s working day
The competition
Human behavior
The regulations

20. The things I can change
(possibly)
Conflict of interest & Good Promotional
Practices debate
How physicians view your company
How you present yourself to physicians
What you present to physicians
The relationships you fashion
The attention to detail for good
promotional practice

21. The wisdom to know the
difference
The facts speak for themselves:
Pens and paper, meals and trips
CME
Conflict of interest
Price controls
Fair balance
…..and on, and on
Good Promotional Practices are the
solution!

23. The wisdom to know the difference: an
aviation parallel
Digital fuel gauge
Backup digital fuel
gauge
Analog fuel gauge
Backup analog fuel
gauge
On-board computer
Look in the tanks!!

24. Four actionable strategies
Turning your sales reps into
information concierges;
Use of content management systems;
Good Promotional Practices ;
Form & support product information
exchanges

25. 1. Transform your sales reps into
information concierge
There when you want them
Situation-appropriate & compliant material
Make things happen
No lies, no alibis
Who are your reps talking to?

26. Not your father’s doctor…
More are female
180,000 are FMG’s (1/4) and growing
Increasing debt on graduation
Average first year income (age 33) is
$120K, but…….
Golf?
Secretarial assistance?
Fancy lifestyle?

27. “I feel like the frog in the pan. The temperature on the stove has
been turned up degree by degree. And being the over-achiever I
am, I have accommodated to each escalation to the point of
looking around to see the water boiling all around me. The
demands for menial record-keeping mandates keeping me from
what I am better qualified and prepared to do, and the gate-
keeping milieu has clipped my capacity to soar to where I have
had adequate flight training!”

28. Rep behavior
Best use of time?
What defines prescribing habits?
Who specifically is your target audience?
What do your reps know about the
medical literature?
What do the doctors know?

29. Target audience
Devices vs pharma?
DNA with PAP
Typical pharma ad
Personalize your material
and presentation
Good reprint practices

30. What do your reps know?
Medical literature how to
read and use
The content of the
literature is complex
The structure of medical
literature is becoming
more complex
Your reps time with
doctors is ever more
valuable
The rules are changing…
…..the more they
understand, the more
confident they will be in
your job.

31. How do physicians read the
medical literature?
Osmosis
Scan titles, names,
institutions
Read abstracts
Compass rose

32. Data in abstracts of published
research articles
.
• Abstract most likely part of article read, so it must reflect the article
• Random 44 articles 7/1/96 – 6/30/97: Ann Int Med, BMJ, JAMA, Lancet, &
NEJM & 44 articles 7/1/96 – 8/15/97: CMAJ
• Proportion of deficient abstracts varied 18%-68%. Statistically significant
degree (P<.001) among the 6 journals studied.
• Deficiency either lack of concordance, omission of data or both
• Abstract: “population consisted of 42 consecutive patients" Body "44
consecutive patients of which 42 agreed to participate."
• Abstract: “estimated 15-year survival 48%” Body: “58%.”
Pitkin RM, Branagan A, Burmeister LF JAMA. 1999;281:1110-1111

33. Parachute use to prevent death and major trauma related to
gravitational challenge: systematic review of randomised
controlled trials
Smith GCS, Jill P Pell JP
BMJ 2003; 327:1459 - 1461
Objectives To determine whether parachutes are
effective in preventing major trauma related to
gravitational challenge.
Design Systematic review of randomised controlled
trials.
Data sources: Medline, Web of Science, Embase,
Cochrane Library databases; appropriate websites &
citation lists.
Study selection: Studies showing the effects of using a
parachute during free fall.
Main outcome measure Death or major trauma, defined
as an injury severity score > 15.
Results We were unable to identify any randomised
controlled trials of parachute intervention.
Conclusions As with many interventions intended to
prevent ill health, the effectiveness of parachutes has not
been subjected to rigorous evaluation of randomised
controlled trials. Advocates of evidence based medicine
have criticised the adoption of interventions evaluated by
using only observational data. Everyone might benefit if
the most radical protagonists of evidence based medicine
organised and participated in a double blind, randomised,
placebo controlled, crossover trial of the parachute.

34. Solutions:
Publication & presentation strategy – think
it through. Curealldiseaseallol – plan, plan,
plan some more. And planning does not
stop with launch….
Train reps how to read & use the literature
to suit yours and doctor’s needs
Internal journal club
Challenge conventional wisdom on
reprints

35. Four actionable strategies
Turning your sales reps into information
concierges;
Use of content management systems;
Good Promotional Practices;
Form & support product information
exchanges

36. 2. Use content management systems
A day in the life of a doctor
The round file
Compliance rules are complex and getting
more so
International standards – highest should
apply
Belt and braces – use everything that
might help

37. Strategies: Data
Data acquisition for regulatory approval
insufficient for payor approval. EBM is the order of
the day
Where you do your studies: best markets
Who does your studies – it really does matter who
you know …. and who they know!
Where and when you publish/present. And follow
– on publications
Look at NICE, HTA, iTAPP

38. Rep support
Getting in the door is step 1
Before (database assets)
During (presentation assets)
After (permission-based marketing, GPP)
Buy off on GPP? Buy off on Rep v2.0. This
truth is self-evident!

39. Four actionable strategies
Turning your sales reps into information
concierges;
Use of content management systems;
Good Promotional Practices;
Form & support product information
exchanges

40. 3. Good Promotional Practices
Where has all the trust gone?”
“Where have all the ethics
“ gone?”
This new world of compliance
presents you with
opportunities as well as
threats
If you engage with GPP now,
you help define the space.
The “flexible” marketing
budget
Jollying along reps
“I didn’t know…..”
Don’t be silent, speak up

41. Other actions?
Check out
www.goodpromotionalpractices.com
No, on second thoughts, contribute to
www.goodpromotionalpractices.com

43. Four actionable strategies
Turning your sales reps into information
concierges;
Use of content management systems;
Good Promotional Practices;
Form & support product information
exchanges

44. 4. Form & support initiatives to bridge
the information gap
Journal ads? DTC TV
ads?
We know about CME,
what about UME, GME?
Own media landscape?
Episodic bombardment?
No, become the trusted
purveyor, the concierge
motivated by good
promotional practices
“Consortium” Mark
Handforst

45. Ethics & good promotional
practices
I have heard it said that human beings are
inherently corrupt so sadly you need
systems to remind and prevent them from
doing wrong. It is you who will pay the
fines/settlements. Or go to prison.
Let us systematically institutionalize the
culture of intent – good promotional
practices protect all constituencies.

46. Primum non nocere
Maybe Good Promotional Practices could
become the Declaration of Geneva or
Hippocratic oath for healthcare marketing?

47. Pharmaceutical industry
Employs: over 600,000 people and supports 3m
Advances science & invests: > $60B
Contributes to tax base & exports: $23B NJ
alone
Saves lives…..mine included, so thank you.
Lets stop apologizing for our industry and proudly
proclaim our value….while dealing swiftly and
transparently with miscreants

48. “Do the right thing”
“Everything is for the
patient”
“Ready, fire, aim!”

49. Good Promotional Practices: The
culture of intent
The times they are a’changin
Compliance is an opportunity as well as a
threat
When the going gets tough, the tough go
shopping
Accept that the medical landscape is
changing and stay ahead of the curve
Good Promotional Practices are not only the
wise thing to do, they are the right thing to do!

50. The world according to Rush (not
Limbaugh)…
You can choose a ready
guide in some celestial
voice.
If you choose not to
decide, you still have
made a choice.
You can choose from
phantom fears and
kindness that can kill;
I will choose a path that's
clear-
I will choose Free Will.

51. Thank you
Jonathan M. Sackier
jonathan@pshcconsulting.com
P: (434) 245 8801
F: (434) 245 8804
C: (434) 566 3061