When I returned home from hospital following my heart attack, I brought with me a small old-growth forest’s worth of heart health reading material that the Coronary Care Unit staff had given me upon discharge. Included in this pile was a free subscription offer for an e-newsletter called My Plavix Partner from Bristol-Myers Squibb and Sanofi-Aventis.

These are the drug companies that manufacture Plavix (clopidogrel) – an anti-platelet drug commonly prescribed to inhibit blood clots in those of us with coronary artery disease. So I dutifully signed up to subscribe to My Plavix Partner.

Every month, I’d get an e-newsletter with photos and stories from my Plavix partner, ostensibly written by a chubby middle-aged American man who told me that he too, just like me, had survived a heart attack. In every issue, he and his Plavix-taking friends would now become my friends too by sharing their helpful info about heart health with me.

This was my first introduction to what’s called permission-based e-mail marketing, in which companies get permission (via the subscription application I’d completed, for example) to get in touch directly with their customers.  

About that same time, Lisa Roner, editor of the drug industry journal Eye for Pharma, wrote in her column:

“E-mail marketing works wonders with patients. Survey respondents who receive permission-based e-mails from pharma companies report improved prescription compliance and increased brand loyalty. E-mail marketing also raised recipients’ opinions of the drug industry.”

No wonder drug companies like these programs. The My Plavix Partner permission-based e-mail marketing program actually picked up an industry award last spring from The Center for Business Intelligence and its Strategic Patient Adherence Awards in the Best Disease State Program category.  Robert Nauman, one of the awards event judges, was interviewed at the time by another drug industry journal, Pharm Exec, for his take on branded drug adherence marketing programs like My Plavix Partner. He shared this concern with Pharm Exec:

“Some of these therapies have millions of patients on these drugs, but only register 15,000 people in the programs.”

Plavix, for example, is now the second biggest selling drug in the world (after Pfizer’s cholesterol superstar drug, Lipitor). That’s a lot of Plavix-takers who could be following my chubby Plavix partner every month, but aren’t.

Earth to Robert Nauman:  After I’d read just one issue of My Plavix Partner, I could have easily explained why registration for this permission-based marketing program from Plavix-takers is low. At no point did I ever believe, for instance, that the industry-funded heart information my chubby new friend was sharing with me wasn’t already available – with virtually no self-serving conflicts of interest – from at least a dozen far more credible (read independent) sources.

Here’s what the French non-profit journal Prescrire International* had to say about drug company-sponsored patient education like My Plavix Partner:

“Beware of commercially biased education.

“Therapeutic education is intended to help patients become more aware of factors affecting their health, as well as their illnesses and treatments.

“As such, it whets the appetite of drug companies, particularly those seeking to increase patient loyalty to products used for longterm treatment.”

For example, this argument was used at the industry-sponsored 7th Annual Patient Adherence & Engagement Summit last October in this pitch to drugmakers: ‘Behavioural Influences and Compliance: Learn How Empowering Patients Can Improve Your Return on Investment!”

Brand loyalty is particularly important to improving that return on investment for Big Pharma.

High-priced branded drugs like Plavix will soon be losing their exclusive patent protection before facing global competition from cheaper generic versions and two new competing drugs. Bad news hit last year, as well, when the common drug combination of Plavix and Prilosec, an over-the-counter antacid drug, was found to adversely affect some patients. Last year, Plavix revenues declined 40% in Europe, for example, due to increased generic competition, although the drug continued to grow at a decent rate in North America (up 7.2%) and at a robust rate in both Japan (up 28.8%) and China (up 31.1%).  But Plavix is expected to lose its American patent protection in May, 2012.

Lisa Roner suggested that many consumers may use e-mail communications with drug companies mostly to seek out perks like coupons. Among survey respondents in her report, in fact, 78% said they had downloaded or printed a coupon. In addition:

• 72% of recipients of an e-mail from a drug company had clicked on an embedded link to learn more
• 58% had shared a coupon or forwarded an email to someone else
• 53% had asked for a drug by name or brand as a direct result
• 49% had downloaded a discussion guide or information packet
• 38% had contacted their doctor to ask about the drug
• 34% had typed or copied a website URL directly into their browser
•  25% of those receiving permission-based e-mails joined an industry-sponsored online forum or support group

Two months later, Roner wrote another Eye for Pharma column about the link between drug compliance and brand success.

“Compliance“ means that patients take your drug faithfully, day in and day out. Roner quoted Marta Wielondek, Brand Director of Hemostaseology at drug giant Novartis, who says that when physicians have only about five seconds to choose a drug to prescribe for their patients, your drug company’s brands must be top-of-mind to “win”.  This is how Brand Directors of Hemostaseology apparently talk. She also told Roner (emphasis added):

“Patient compliance is a problem that has a two-fold impact on Pharma. The first is a very direct one: patients that could be taking a product are not, lowering drug consumption and subsequently sales.”

“But perhaps more importantly, companies suffer a loss of brand equity because we fail to prove drug efficacy.

“We’re failing with not just doctors and patients, but also in the end with reimbursement authorities. They’re looking more and more at patient outcomes, and not just at clinical trials.”

Read that last paragraph again.

And again, until you get what these Big Pharma senior execs are telling each other. “Reimbursement authorities” are those that approve paying for or supplying or endorsing your drug.

Drug companies are concerned because these authorities are now looking at actual results – how real-life patients are doing, and if your drug is actually working without harming them – instead of just at clinical research trials that were done in order to get the drug approved in the first place.

These trials, in fact, may have actually been commissioned and paid for by the drug company, written about by their hired medical ghostwriters, and submitted for publication in medical journals with the names of respected physicians or academics falsely claiming to be the actual authors.

* “Patient Education: Keep The Best, Avoid The Rest” Prescrire Int 2011; 20 (116): 138 

See also:

• Why Patients Hate the “C” Word
• Why Patients Don’t Take Their Meds as Prescribed
• NEJM Editor: “No Longer Possible To Believe Most Clinical Research Published
• Lipitor and Nine Other Drugs That Are ‘Falling Off the Patent Cliff’
• How A New Drug Gets Approved
• What If Everybody Started Telling The Truth About Medical Ghostwriting
• Medical Ghostwriting: If You’re Not Alarmed, Maybe You’re Not Paying Attention
• Medical Ghostwriting and ‘Guest Authorship’:  Twins Separated At Birth?
• 50-100% of Medical Journal Articles Paid For By Big Pharma?
• Partners in Slime: Why Medical Ghostwriting Is So Alarming
• When You Use Bad Science To Sell Drugs