With Dr Nigel Eastmond 13 Dec 2024.
It may have been Friday 13th (December 2024) but we had better luck than with our previous monthly meeting, abandoned because the clubhouse was blocked with heavy snow. Welcome to winter in the Peak District!
Other matters held sway as Edinburgh-born Dr Nigel Eastmond, long-standing member of the Business Club, gave us a fascinating journey into the murky world of marketing for big pharma. The son of a consultant rheumatologist, after a BSc (Hons) and PhD in pharmacology from Aberdeen University and four years as post-doctoral assistant at Liverpool University, he took a variety of posts including under contract to Novartis before setting up his own business 14 years ago. He described his work as specialising in “the technical stuff between manufacturers and users” – by which he means, the doctors who prescribe the medications, in the UK and world-wide.
Macclesfield, he said, is one of the global centres of drugs marketing. There’s a clear reason for this. The various stages of testing of drugs are well established. Phase I – the first time the drug is being tested on humans. Phase II has two parts – IIA when diseased patients are tested; Phase IIB when additional questions can be asked prior to full Phase III. Only when the drug has been shown to be both effective and safe, or at least with side effects within acceptable or predictable levels, can it be licensed and put on the market; that’s the result of Phase III (there’s a Phase IV, a follow-up process).
Decades ago drug manufacturers realised that keeping a full-time marketing team for occasional surges in activity around Phase III is not cost-effective, so they sacked their own departments and instead placed contracts with smaller, agile operators. Often of course they’re the same individuals still clustered round the great names such as AstraZeneca. In practice this means that small businesses with few employees but a lot of expertise have become a vital part of this huge industry.
The cost of getting communications and marketing wrong in the public arena is immense, often in the billions. In 2012, GSK agreed to pay $3 billion to the US government to settle criminal and civil charges, included misbranding drugs, failing to report safety data, and false price reporting. The settlement was the largest healthcare fraud settlement in US history at the time. GSK also agreed to reform its compensation policy, including removing sales-based bonuses and allowing the company to claw back pay from employees who engaged in misconduct. Separate charges in China and Poland resulted in further payments. And the story continues: in 2022 Ohio-based pharmaceutical distributor, Cardinal Health, agreed to pay $13m to resolve allegations that it violated the US False Claims Act by paying “upfront discounts” to its physician practice customers, in violation of the Anti-Kickback Statute. That was just the start; by the time cities such as Baltimore and states had finished suing Cardinal Health and others marketing opioids, the total bill reached $26bn and the Marketing Director went to jail. The scale of jeopardy is eye-watering, and so were the methods used. Nigel referenced the Netflix 2023 film Pain Hustlers, based loosely on the US company Insys Therapeutics, another part of the opioid crisis; first class flights, 5-star hotels, money for gambling in casinos and more were the norm for both marketers and medics.
It’s taken a long time for regulators to catch up. Eli Lilly had a problem with its Opren medication (benoxaprofen) a painkiller for arthritis, launched in 1980. Opren was marketed with (amongst other events) an Orient Express junket which was secretly filmed by Panorama (I wonder if our previous speaker Cat Lewis knows something about this!!). It had to be withdrawn on 4 August 1982, as there were numerous side-effects, with up to 61 deaths in the UK and was banned by the Thatcher government a month later. Back then, only self-regulation existed through such bodies as the ABPI (Association of British Pharmaceutical Industries); in Nigel’s view the Italian version of this was effective, but most were not. I recall dealing with Roche, who marketed some medications through special interest groups of sufferers, protesting that the UK government was being unfeeling when we pointed out that there were no tangible benefits. We now have NICE, the National Institute for Clinical Excellence introduced by Health Secretary Frank Dobson in 1999 which decides what can be prescribed by the NHS – effectively, a cost-benefit examination (it’s now called the National Institute for Health and Care Excellence). Frank always reckoned it was the best thing he had ever done.
Eastmond Medicomm’s USP is “Delivering and consulting on medical education, communication, meetings, publication projects, and digital media for the global healthcare industry,” according to their LinkedIn profile (he adds, “Our real USP is doing all this without p***ing about and spending needless mountains of cash”). Nigel’s firm does not do marketing in the USA or UK, but covers Europe, the Middle East, Canada, Australia and other jurisdictions. Each has its own rules, which change constantly; the marketer has to get these right, and it can involve very rapid adjustments.
Marketing starts with getting research and data published. Successful clinical trials will produce a mass of data, which must be manually cleaned and a primary paper written. From the end of the trial to publication is at least a year, and probably far longer. Nigel can do all that slog including writing the paper and finding a publication, usually niche: “In 13 years of trying I’ve only once got a paper into the New England Journal of Medicine,” he says. The big publications are only interested in “changing therapeutic approaches for the rest of forever” – and for large numbers of patients. Usually he has to tone down the expectations of the researchers in this frustrating process.
Then events have to be set up, or attended – the stall at a single international conference can cost as much as $1m, and at the end of 5 days it’s trashed. Local upsets can upend long-laid plans, from the State Opening of Parliament in The Hague to the Venezuelan revolution – there’s a book there, Nigel, of your adventures, surely?! “Brexit is a pain,” he said in answer to one question, as cross-border controls mean shifting goods is a problem, so manufacture may be outsourced to another country, though digital marketing is less affected. CME, continuing medical education, required for practicing doctors, provides a constant stream of attendees; but as health care systems don’t pay for this and pharma companies do, the ethics continue to be a quagmire. What is legal, and effective, can include setting up a competition – in order to scrape emails, which become the basis for future communications.
For rare conditions, however, firms like his come to the fore, with targeted events and audiences. He can make the videos, advise on presentation, contact the right attendees. And it’s clearly a job which still gives him a buzz, when it goes right.
We heard about many scandals – Seroquel, the AstraZeneca schizophrenia drug which led to increased weight and diabetes; Vioxx, an NSAID from Merck in 2004 which treated inflammatory conditions but caused problems for cardio patients. One common factor seemed to be suppression of adverse data; another, marketing for conditions where no approval had been given. The AZ Medical Director of the day praised suppression of adverse information as “all smoke and mirrors.” Quite…
We asked about the COVID vaccines, which were available within 10 months of identification of the virus (see our meeting with Dr Peter Coleman of Cobra in January 2022). Nigel pointed out that the mRNA vaccines developed by AstraZeneca had already been invented but were as yet unused in the fight against SARS; for COVID “they had the largest Phase III trial in history” with millions, like myself, willingly lining up for immunisation. Would the blood clot problem, which eventually led to its withdrawal, have been revealed had there been more time? “Yes, probably.” But in a global epidemic, time is a luxury that is not available.
It was Christmas, so we ate delicious Filipina buns produced by Ann Marie (Mrs Eastmond), and handed out 2025 calendars from Peak Lass (Suzanne Howard of Hathersage). We look forward with hope to a prosperous and peaceful 2025. Happy New Year everyone!