Tuesday, July 13, 2010

The Business of Diabetes: Death of Sanofi Aventis' "GoInsulin" YouTube Channel - Good Bye, or Good Riddance?

I sincerely doubt that many of my blog readers even noticed that pharmaceutical giant Sanofi Aventis (best known to the patients with diabetes as the seller of the Lantus and Apidra insulin analogues) even noticed that the company's "GoInsulin" YouTube channel was rather abruptly terminated by the company recently without much advance notice. But another blogger, Andrew Spong, noticed and he addresses the rather sudden termination of the "GoInsulin" YouTube channel, which according to him, was reportedly one of pharma's biggest (bigger than J&J's YouTube channel, which now rates as #1 since "GoInsulin" was terminated, see here for more detail). Sanofi Aventis has replaced the former campaign with "WhyInsulin" (like type 1s even have a choice) instead.

One reason so few of my readers may have noticed it is because much of my readership has some connection to type 1 diabetes, while the "GoInsulin" campaign completely disregarded people with type 1 as irrelevant, without so much as an acknowledgement of the fact that Lantus is even approved for patients with type 1. I try my best to be as objective as I can and to present facts clearly, but when it comes to insulin, one thing is clear: the type 1 audience is anything but irrelevant (Exubera, anyone?). And for a company that earlier this year (in February 2010) that identified diabetes as a "top priority" in pharmaceuticals and even established a global division to help the company achieve its aim of becoming the top firm in diabetes treatments (see here for the text of that story) to help unseat Novo Nordisk, and the narrowly-focused "GoInsulin" strategy was downright moronic from a business perspective. As I've noted before, at one point, the U.S. Centers for Disease Control estimated that 75% of all insulin users have type 1 diabetes. Many doctors believe this is because fewer type 2 patients use insulin than should be, but regardless of the reason, any ad campaign that completely dismisses type 1s as irrelevant is doomed to fail.

I made no secret of my disdain for the Sanofi Aventis "GoInsulin" campaign when it first began, in fact, I blogged about it about it back on March 12, 2008. I still contend that casting the majority of insulin users aside as completely irrelevant to the insulin sales, which is what the GoInsulin campaign effectively did, the company's marketing strategy was, at best, pound-wise but penny-foolish. In effect, the company decided: "look, there are tens of millions of type 2s, many of whom aren't using insulin ... fuck the type 1 audience -- they have no choice in the matter anyway, and instead target the entire campaign and every cent in marketing dollars on insulin-naïve type 2s". That does little to endear the brand, or the company to type 1s, and is not the appropriate way to market Sanofi's insulin products. And with a product whose linkage to cancer (see here) has yet to be completely dispelled, I don't think Sanofi Aventis could afford to be too arrogant, even if the American Diabetes Association pretty much came rushing to the product's defense, telling patients to keep taking the product in spite of their concerns.

Shallow Campaign

The shallow marketing campaign ignored the not-so-little reality, which is that the therapeutic options for type 2 are greater today than at any point in history, while type 1s now have fewer insulin options available to them that they did in 1976, the year I was diagnosed with type 1 diabetes. Anyone who questions this should consider the facts: today we have no mid-range insulin analogue -- although many endos and commenters on the Novo Nordisk board on Cafe Pharma, including Novo Nordisk salesmen, swear that's the case with Levemir. In addition, the Lente series for Humulin and Novolin have both been discontinued, leaving patients requiring less than 18 hours basal coverage with only isophane insulin, which was widely regarded among doctors as inferior to Lente except that it could be used in premixed insulin varieties (which is the very reason NPH remains on the market today, according Lauren Grossman, Lilly's vice-president of research and development in Canada, according to this testimony before Canadian parliament). This also helps to explain the huge growth in insulin pumps, because alternatives are relatively few. Meanwhile, Eli Lilly & Co., who once dominated the U.S. market, has seen it's market share slip further (see here), although last year, the company reorganized, giving diabetes therapies a new, senior executive vice president (Enrique Conterno) reporting directly to the CEO for the first time in over a decade (since Prozac drove the company's earnings) to turn the sinking ship around.

Marginal Benefit To "GoInsulin" Campaign

While I do believe the Sanofi Aventis "GoInsulin" campaign did aim to dispel many of the common misconceptions about insulin, it did so in a way that was, frankly, rather offensive to the patients who do not have the option to "choose" insulin, and have no other alternative other than choosing a different type or manaufacturer. A campaign that includes all patients is likely to be more memorable, and more effective.

The original "GoInsulin" campaign, and YouTube channel was quite obviously poorly thought-out, thus the plug was pulled on the campaign. A woman at Sanofi Aventis by the name of Lynn Crowe, who was Sanofi's senior product manager for metabolism marketing was widely quoted in the pharmaceutical trade press for the campaign. She told one publication, Medical Marketing & Media (see here), that the "GoInsulin" launch was "... indicative of our belief that expanding social media platforms will play an increasing role with patients, and can be used to effectively deliver information on the risks and benefits of diabetes treatment and care," said Crowe. The campaign, website and YouTube channel. You can thank an interactive agency named Intouch Solutions, of Overland Park, Kansas (located in suburban Kansas City) for the campaign that all but dismissed the critical type 1 audience as being completely irrelevant.

At the time the so-called social media campaign (which ignored a big segment active in social media) launched, Sanofi Aventis completely disabled any YouTube comments, which was by design. Sanofi's site did not take advantage of YouTube's comment feature, technology that pharma has largely avoided to avoid off-label conversations, which could attract the wrath of FDA regulators who have recently cracked down on practices that were tolerated under the leadership of Bush FDA Chief Andrew von Eschenbach, a man known to favor the interests of the pharmaceutical industry rather than the agency's goal to protect the public safety. The company told PharmaExec Marketing Direct Marketing Edition that it was looking into a way to incorporate patient feedback. "We are working to find a way to support a two-way conversation," Crowe said. "It is definitely our goal to be able to utilize this medium to its full extent." Obviously, that never happened.

Sanofi's Lantus Still Rules Basal Insulin -- For Now

As of today, in spite of negative research and press, Lantus still rules basal insulins. While Lantus maintains a unique niche for basal insulin that presently has little real competition (Novo Nordisk's Levemir is widely regared as lasting about 12 hours), but type 1s have been abandoning basal insulin altogether in favor of insulin pumps in increasing numbers.

Levemir is widely panned on Cafe Pharma as lasting half as many hours as Lantus, but the less subtle but possibly more important market trend has actually been the widespread migration of type 1 patients towards insulin pumps, which use only prandial insulin varieties. Rival Novo Nordisk has been on press-release overtime lately promoting it's newest analogue insulin that's still in development, which not suprising, is also a basal insulin (one they're calling "Ultra" Long-Acting, when in reality, the data indicates it lasts about as long as Sanofi's Lantus does). This replacement has been widely expected considering how slow sales of Levemir have grown -- which is considered a sales dud, frankly. The company is calling it's latest invention degludec, which is viewed as a more realistic competitor to Lantus, but it's not ready for approval yet, but it is very likely coming in the next few years. Similarly, Lilly now claims to be working on a new basal insulin (after ignoring that market for over a decade), but it has nothing solid in it's pipeline right now, and even if it comes up with something, it won't be ready for market for another decade.

But several of the startups I noted in January are once again ready to eat Lantus (and Lilly's) lunch. Perhaps furthest along among the startups, which is still only in pre-clinical (animal testing) development, is a product from Biodel, Inc., the Connecticut-based startup that has a rapid-acting non-analogue it calls VIAject now pending FDA approval, and some reports are suggesting we could see an FDA decision on that abbreviated new drug application as early as November 2010. Biodel's basal insulin product has been dubbed BIOD620 which it says is a "Glucose-Regulated 'Smart' Basal insulin" (see here for details). But the company's strategy with this product is similar to that used with VIAject: to use an already-approved product, and modify it slightly using FDA-approved addititives to alter the time-activity profile of the already-approved version. Using this strategy, the company saves costs by avoiding the lengthy brand-new drug approval process needed to demonstrate the product's safety, and therefore increases it's liklihood of gaining regulatory approval in a timely fashion.

Another startup is Cleveland-based Thermalin Diabetes, which has the rights to a number of different analogues (reportedly over 100) developed by Case Western University researcher Dr. Michael Weiss, but all are still in very early stages.

All of this means that the limits to patient, insurance company and doctor choice in insulin may soon change as I suggested in my January 2010 article, see my post here for more details. That cannot come a moment too soon. Presently, the insulin market in the U.S. is highly-concentrated, and the major manufacturers, including Sanofit Aventis, have aggressively raised prices on insurance companies in recent years, even while patent-protection for the earliest analogues is due to expire shortly and follow-on versions of analogues are anticipated by 2012. In fact, an Indianapolis area (in Greenwood, IN, to be precise) company begun by some former Lilly scientists called Elona Biotech, has stated it's intention to enter the field of follow-ons, and Israeli generics giant Teva, as well as a handful of Indian biotech firms are also seen as likely to move into the space, few have done so. The real question is what inherent drivers the brand-name competitors can hold onto. Analysts point to the salesforces, which companies have been cutting back in recent years, as well as their delivery devices (pens), but those so-called advantages may not be the house made out of stone that analysts credit them with.

Is The Complete Exclusion of Type 1s Really Necessary In A Social Media Campaign?

There may very well be millions of untapped type 2 patients out there, but was it really necessary to have a web page and a YouTube channel where type 1s weren't even considered or addressed to be at the core of a campaign that is featured on such TV programs as dLife, which is aimed at both type 2 as well as type 1? Why was there not a single reference to type 1 at all in the campaign, including the not-so-little detail that it is approved for type 1? A type 1 vistor to the "GoInsulin" campaign found not a shred of relevant or even useful information there -- not even a link to a general information page -- which strikes some marketers as peculiar. Whatever the reason, let's try to frame this discussion in a slightly different manner so those who defend the campaign can see it in a different light.

Imagine a company, let's say Coca Cola or PepsiCo for example, derived three quarters of it's sales and profit from a particular market segment. For convenience sake, let's say that market was was females whose very survival was dependent on Pepsi or Coke, while males for some reason seldom consumed soft drinks of any type, only water (or liquor), and had many misconceptions about soft drinks. In effect, it would be akin to saying "Hey guys, we know you have plenty of choices when it comes to beverages (screw you gals because we know you have no choice but our products anyway). That's a bit like Sanofi Aventis' "GoInsulin" comes off to the ignored audience -- a tad offensive, to say the least, especially considering the importance that females actually have in this scenario to the bottom line -- women might even be a tad offended that Pepsi or Coke was taking their business for granted, leaving them out of advertising altogether, and might consider that when evaluating whether a company is trustworthy.

Right now, type 2s are indeed driving much of the growth of Lantus, but today, competition in that space is quite limited. But patent protection on Lantus will expire in a few years, and competition is indeed coming. Whether material changes to the social media marketing strategy are likely to occur remains unclear. Sanofi Aventis' "WhyInsulin" does not make any material changes to the old campaign, raising questions why it even bothered to kill the old one. Like the now-cancelled "GoInsulin" campaign, this one provides not a single reference to type 1 diabetes. Perhaps Lynn Crowe, Sanofi's senior product manager for metabolism marketing, should be reading this blog. But investors should be asking how Sanofi plans to overtake rival Novo Nordisk when it continues to ignore three fourths of the insulin market completely?


Pieces of My Life said...

Of course I understand your point, Scott, and this echoes against the neglect of t1 support/education, research funding, and even misunderstanding in the general public. And I feel that same anger, BUT...I understand why they've done it.

Even if only 25% of t2s use insulin, that's still greater than the entire t1 population. And regardless of whether we dislike Sanofi (I do, for other reasons...namely from having worked with them and seen things I wished I hadn't...) it won't affect which insulin we choose. Most of us don't even know which pharma produces their insulin, and even though I realize Apidra is produced by Sanofi, I use it because it works best for me, regardless of how I feel about the company making money from me.

So they target t2s because it's the t2s they need to convince to become consumers. To use your example, men are afraid of Coke, and need to be convinced that it's safe. Women are already hooked on Coke, know it's safe and so don't warrant their advertising dollars. Even if Coke commercials are only directly targeted at men, the women won't care because they're already hooked, and don't even look on YouTube to find the commercials...

Anonymous said...

A very interesting read with some good content. A few thoughts/issues did pop into mind as I was reading this:

1. At least give s-a credit for doing what 95% of other pharmas refuse to do...take the risk of getting into social media before FDA provides its long-overdue thoughts.

2. All of your points on why GoInsulin was a poor campaign were based around "because the campaign didn't target you and others with Type 1". Are you saying people with Type II are not deserving of their own campaign? Clearly you realize these two audiences have different needs and habits that might require different campaigns?

3. You stated GoInsulin made no attempts to contact subscribers/friends...but I did receive an email from them/their channel several days before it went down saying the channel was going away. Check your facts.

4. Anyone can point out problems...where are your solutions? You sound like you are just ranting at times, bring constructive feedback.

Scott S said...

Anonymous: Constructive feedback? Pharma should quit bitching about a lack of FDA guidance for social media; the FDA doesn't owe the industry guidance about anything.

Anonymous said...

Thanks for the mention, Scott. This is a hefty piece of anaylsis I intend to RT to the #hcsmeu #hcsm communities for their comment. Thanks for keeping the conversation around this topic going.