Recession-proof

The pharmaceutical industry, they say, is recession-proof. From the perspective of someone who got paid well to make doilies on the fringes of pharmaceutical marketing campaigns for the strangest seven years of my life, here is what that means: In good economic times, things is good, dig? But in lean times—from “proactive belt tightening” on the high end of lean to “one narrow layer of services removed from total systemic collapse” on the low—things is real good, dig?

The rationale is pretty simple: among the many and miraculous treatments available in today’s advanced modern society of today, pills are the cheapest and most cost-effective. They are cheaper, of course, than surgery and every kind of in-patient care; cheaper, naturally, than other interventions and therapies that require trained personnel, time, and special facilities. They are cheaper, even, than many diagnostics and thus often interchanged with them in proven low-risk gambles. Practitioners are inclined and, in tight-belted Managed Care settings, incentivized to guess once, twice, thrice with pills before ordering the scan or the RT NISP (roundtrip neural impulse synchronization plot. Not real; made it up.) that might catch the culprit in the act, or that might establish which band and gram of antimicrobial—if any—is indicated.

In good times, we suddenly hear a lot of empathetic talk on the TV about baldness, sexual dysfunction, bourgeois anxiety, and the misunderstood stigma of bushy nose and ear hair. The prosperous vanity wing of pharmacotherapy makes a killing making shame, imperfection and unhappiness things of the past. In hard times, they shovel the crumbling prednisone out of troughs, and everyone gets a Z-Pak. Just for showing up.

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It’s boom, or, on the other hand, boom! Take your pick.

Big Pharma, of course, challenges this narrative at every turn, in the way that so many millionaires insist that they are middle class, and that they know struggle, too. It is expensive to research drugs, to develop, patent, test, manufacture, and market them competitively. It can take decades of white coats staring long-time at beakers through goggles to bring a new agent to the gates of the market, where a single really, really adverse event in Stage 3 can sink Phukitall™ (phludinirab hcl 30mg) on the virtual eve of its christening, or force you to go to market tainted by a “black box warning.” Scratch off that black box and find the lucky skull and crossbones underneath; it killed someone.

Plus, the complaint continues, selling in pharma is not like selling in any other verticals. It is highly regulated, multi-player, and scientifically complex. A clinical trial might prove that a drug is effective in a way deemed statistically significant (meaning measurably more effective than your standardized cocktail of sugar and belief). But effectiveness is not the same as efficacy. Pharma must make and maintain credible clinical and statistical arguments that their pills, shots, gels, and drops not only work but save money by working.

For instance, would the money spent on controlling hypertension in your patient population be made back in indirect savings associated with reduced rates of congestive heart failure and other co-morbidities? Or not? This dense field of argument is called pharmacoeconomics, or, less syllabically, outcomes. My company was neck deep in it—in fact I believe we designed the very first interactive outcomes modeling software on CD-ROM. Well, not me. I wrote music and text for animated dancing nose videos.

Pharma requires a large sales force vastly more educated than those in virtually any other industry. Even the “enjoy these complimentary pens and sandwiches, Doctor” field reps could stand to have some background in medical science. But above that are fleets of clinical liaisons and paid thought-leaders—many with MDs and PhDs and commensurate rates—whose job it is to influence clinical thought and practice and to create favorable conditions for the adoption of the little pill of interest. And of course, the composition of that sales force changes with each pill. You can’t send an endocrinologist off an hepatologist’s errand, now can you?

Above all, pharma marketing is maddeningly indirect. There is no simple direct-to-consumer appeal, and word of mouth is mediated. You have to work every angle: patient, provider, payer, with a different story for each.

As we know in this Chomskyian world, every Coke ad is a Pepsi ad, too. What matters is not so much what cola you drink but that you drink cola and that you perceive a binary cola choice as a self-defining decision that you simply must make. When a pharma firm allocates a budget for Web sites and interactive services, only a tiny portion will go the drug’s branded site, Phukitall.com, which will usually be little more than prescribing information brochure-ware spiced with a bloodstream, particle-view animation or two. The lion’s share of Web resources will be spent on a content- and multimedia-rich disease-state informational Website meant to elevate the fame and urgency of the condition you treat, a “health portal” designed to be a one-stop, credible, interactive resource for suffering people and their loved ones.

This site will feature content and tools for diet, exercise, and stress reduction. It will paint a picture of a condition under-diagnosed and misunderstood. It will “indirectly direct” consumers to pressure professionals in certain specific ways. In its pursuit of neutrality and balance, it will even include information on competitor products and any natural treatments supported by at least half a shred of evidence. But everything is on an incline; everything rolls one way. The sponsors are implicated in the fine print. Hell of a circuitous way to sell a product, though!

So not only do I believe Pharma’s cry that their business is different, really complicated, risky; I lived it. When I wasn’t providing comic relief, I once wrote—almost by myself—an entire disease state Web site about erectile dysfunction (we wanted to call it ifffystiffy.com but were met with resistance) to support a new ED product that would be pulled last minute because of that old death thing. Some of my finest work, not to mention 10 years of R&D, down the tube.

So why, if their wealth is bottomless, did I get laid off then, in the early 2000s? My understanding is that the Internet bust of the very late 20th century (What was that? Two, three economic collapses ago? I forget) sent all the biggest interactive agencies from all verticals scrambling to pharma, because recession-proof. The competition grew fierce. Belts had to be tightened. Today, I gaze fondly at the richly manicured, 3,000-acre lawns of south Jersey’s exquisite pharma campuses, remembering a time when I sat in the brilliant glass cage of a conference rooms on the umpteenth floor of Satan’s tower and pitched Flash videos about singing noses.

Read more installments of Village Voices by John Burdick.