What Pfizer’s Super Bowl Ad Should Have Been

There’s been a lot of discussion around Pfizer’s decision to spend an estimated $14–21 million on its “Here’s to Science” Super Bowl ad. I’d like to boil it down to two questions: Why did they do it? Did it accomplish their objective?

For the question of ‘why,’ STAT News reported, “The ad comes as the pharmaceutical company celebrates its 175th anniversary and looks to promote a dynamic, optimistic message about Pfizer’s future to the general public, investors, and the company’s own employees.”

Pfizer spokesperson Faith Salamon said the goal was to “celebrate science in a fun, engaging and uplifting way.”

Unfortunately, The New York Times didn’t buy it. In their review of Super Bowl ads, the NYT placed Pfizer in the category entitled, “The Flagrant Missteps: Famous people and millions of dollars that together can’t quite amount to mediocrity.”

Flagrant sounds too intentional. This is a case of missed opportunity (except for the soundtrack — who doesn’t love Queen’s “Don’t Stop Me Now”?).

I had an array of reactions, but these were the key moments:

Most horrifying: A corpse comes alive, with his arm dissected from shoulder to fingertips — depicted in Rembrandt’s The Anatomy Lesson of Dr. Nicolaes Tulp — looking like he wants to get off the table.

Most confusing: The inclusion of a tartigrade (“little water bear,” an eight-legged creature about one millimeter long) swimming across the screen.

Most inspiring: The positive message sent by highlighting four women scientists, one of color.

Most overreaching: It seems the ad makers knew most of the public couldn’t differentiate between famous scientists or science disciplines, so they threw some recognizable names out there. The relevance was questionable since half of the science luminaries depicted were mathematicians and physicists, yet Pfizer is a healthcare company.

Most jarring: The words “Here’s to the next fight” come across the screen but don’t connect to anything seen previously. The next words are “LetsOutdoCancer.com” followed by some video of a little girl being applauded for what must have been successfully completing treatment. (A lovely moment, to be sure.)

The Let’s Outdo Cancer website details Pfizer’s research pipeline and product portfolio. There’s also important information on how to participate in a cancer clinical trial and a partnership with the American Cancer Society to “improve health outcomes in medically underrepresented communities across the United States.”

There is no doubt that we’re benefiting from the discoveries made by Pfizer and their partners. We’re living better, healthier lives. There’s a ton of good information on the site but it doesn’t have much to do with “Here’s to Science.”

A one-off effort like a Super Bowl ad can help achieve specific objectives but, in my experience, plans need follow-through and messages require repetition. I don’t know their actual plan, of course. I’m not an insider. But if Pfizer seeks to promote a positive message and increase engagement with stakeholders, I have a suggestion. They have an enormous opportunity to create a more receptive public if they work towards increasing trust in science.

Engaging a wide array of audiences on the value of science is critically important to elevate trust. Dr. Marijn Dekkers, former CEO of Bayer and former Chairman of Unilever, pointed out at a financial conference several years back that “even the most outstanding ideas and scientific breakthroughs have no chance if people do not accept, appreciate and support them. All too often, people are afraid of — or uneasy about — new ideas, inventions, processes or products.”

The public acceptance of innovation is clearly at risk according to the 2024 Edelman Trust Barometer, an annual trust and credibility survey. It found that respondents believe innovation is poorly managed by nearly a two-to-one margin. And while technology as a whole is trusted by 76 percent, gene-based medicine is only at 50 percent. (It gets worse. GMO foods are trusted only by 32 percent.)

The issue goes far beyond industry interests. Poor science literacy can eat at the core of our democracy. Professor Jon D. Miller, now at the University of Michigan, warned us nearly 20 years ago that “people’s inability to understand basic scientific concepts undermines their ability to take part in the democratic process.” He continued that for many issues affecting society, “if you don’t know a little science [it’s] hard to follow these debates. A lot of journalism [will] not make sense to you.”

So, here we are. The current state is that science and scientists are under attack. Facts are being denied and misinformation proliferates. Critical thinking is being abandoned. Education is underfunded. Science is politicized and weaponized. It must stop.

It’s not a problem that can be addressed by a one-year budget cycle or even a five or ten-year plan. It will take a generational blueprint that needs to be comprehensive, coordinated, and well capitalized to see a return on the investment.

Getting the message out is only one side of the coin, though. Ensuring the message is received requires the same sort of effort. The Super Bowl ad should have been the kick-off of an ongoing effort to engage, inform, and educate the public about science and scientific principles. But it’s not too late. We need conveners. Partners need to be assembled and resources gathered. Objectives must be determined and milestones assigned.

Let’s get started.

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Moving the Needle on Clinical Trial Recruitment

Poor Communication is Among the Obstacles to Research
The passing of Senator Ted Kennedy has come to dramatize many things, like the importance of representing all stata of society and the need for new voices of compromise in the Congress. And, the necessity of further advancements in cancer therapeutics.

Senator Kennedy died of glioblastoma, one of those cancers that goes tragically hand-in-hand with “death sentence.” He had the best care available but, obviously, it wasn’t nearly good enough. There have been advancements, of course. Survival for this particular form of cancer has improved from about four months to about 15 since President Nixon’s famous 1971 declaration of a “war” on cancer.

The change has been incremental. A big obstacle to the discovery of truly breakthrough medicines has been the maddeningly complex nature of the disease. There is hope, however, that our ever-increasing understanding the molecular biology of tumors will lead to new interventions.

But that brings us to another big obstacle. When new, experimental therapeutics are available, they must be tested in clinical trials to ensure that they meet agreed upon standards of safety and effectiveness in people. The problem is that there is a chronic shortage of patient volunteers. Currently, there are more than 6,500 cancer clinical trials available (most trying to fine-tune cocktails of existing drugs) yet only three percent of adult patients agree to participate. In a recent article in The New York Times (“Lack of Study Volunteers Hobbles Cancer Fight”), Gina Kolata reported that “more than one trial in five sponsored by the National Cancer Institute failed to enroll a single subject, and only half reached the minimum needed for a meaningful result.”

The article cited a number of reasons for this low participation rate, among them: oncologists not wanting to refer patients away from their practices, reimbursement headaches, record-keeping and staff requirements and patients wanting to avoid any additional hassles.

Then, there’s fear. Even with Institutional Review Boards checking the ethics of study protocols and crafting of extensive Informed Consent documents, patients worry about being guinea pigs. They worry about getting a placebo instead of the active agent, even though the vast majority of studies only use the current standard of care and the investigational product. For some, tragedies of the past are proof of what can go wrong. The Tuskegee study (looking at the long-term effects of untreated syphilis in African-American men) and the Atomic Energy Commission study (that gave pregnant women radioactive iron but were told it was a “vitamin cocktail”) continued into the 1970s. That’s recent history for some of us.

Another barrier to patient recruitment is just a plain lack of information – most patients (and many physicians) are unaware of the existence of clinical trials that might be appropriate for them. It has been reported that 85 percent patients and 31 percent of physicians lack sufficient information about available studies. For those who were aware of trials, the top reason for refusing to participate was concern over their privacy and confidentiality (according to the Institute of Medicine).

Professional and patient advocacy organizations, the National Institutes of Health, hospitals and biopharmaceutical companies all promote clinical trials in some form or another, and try to communicate privacy safeguards. Now, Pfizer is taking a new step to address these impediments to research progress. They announced a partnership with Private Access to allow patients to “be more quickly and precisely matched to appropriate clinical trials while simultaneously protecting their confidential personal health information.” This on-line platform is planned for introduction late this year.

This could be an important, innovative step but perhaps a small one. A Harris Interactive survey in 2007 showed that the public’s confidence that their health records will be kept confidential is already fairly high. Seventy percent of respondents agreed that they are “generally satisfied with how their personal health information is handled with regards to privacy protections and security.”

So, where are the gaps? What else can be done to help convince patients to participate in clinical trials?

1. Clearly, we must keep communicating and educating – keep pushing the rock up the hill. The word must continue to get out with information targeted to the audience.

2. The process must be made as simple as possible – simple to understand for the patients and simple to administer for the study coordinators. And, some of the trials and their reporting requirements must be simplified. Not slackened – simplified. I have consulted on a number of patient recruitment projects and, after reviewing the protocol, and surveying the investigators, study nurses and the study population, have told the sponsors on a number of occasions that their study is just too complicated, just too onerous. First, sharpen the objectives and focus on what is truly important. Then, find ways to cut down on the number of office visits, the number of needle sticks, whatever.

3. The “what’s in it for me” question must also be addressed for all the parties involved. What would it take to get more physicians to refer their patients? What changes to reimbursement need to be made? What can be said to patients and their families so that they better understand their contribution, and feel more connected to the study and its outcome? What new incentives can be created to ensure that investigators don’t just sign on to the protocol but actively recruit study volunteers?

We can’t expect to achieve all that we want by attempting to address just one piece of the patient recruitment puzzle. We need to look at these issues – including privacy – together to really move the needle.

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Disclosure - Keep It Coming

Try to Avoid Taking Two Steps Forward and One Step Back

Slowly but surely, pharmaceutical companies are stepping up. Unfortunately, at times (too many times) it's been painful to watch the industry progress toward a more open and transparent orientation.

On the good news side, Pfizer announced that it is the first pharmaceutical company to be accredited by the Association for the Accreditation of Human Research Protection Programs (AAHRPP). This helps to ensure the ethical treatment of clinical trial volunteers no matter where the research is conducted. The accreditation process is rigorous and took 15 months.

On the bad news side, this is 2009. Reports of unethical clinical trials have been popping up for decades. Indeed, Pfizer said that "AAHRPP accreditation is another step in Pfizer's ongoing efforts to earn public trust for integrity in research." So, why has this taken so long and why is Pfizer the only pharmaceutical company to mark the milestone so far? The AAHRPP has been awarding accreditation to programs since 2003.

This reminds me of the years that it has taken for pharmaceutical companies to post information about their clinical trials in public databases. Even after it was reported that a number of pharmaceutical companies were cherry-picking data from selected clinical trials that favored their investigational products, there was intense resistance to disclosing the existence of the previously unknown studies. Only after exposure in the news media and threats from Congress did the industry acquiesce. And still there's a steady flow of news about critical information being withheld here and there from the FDA.

There's just too much kicking and screaming, and it's not only about the progression toward more openness. Think of the history of the Medicare drug benefit, or instituting reforms on gifts and promotions.

The industry is full of smart, driven and ethical people, and they are supported by a lot of smart, driven and ethical consultants. I'm sure that they all recognize that the best way to run a business and to manage an issue is to move the information -- good or bad -- out quickly. More often than not, it's the tone and timing of the message that matters more than the severity of the issue. In practice, though, it's a different story. Of course, there are legitimate secrets and there are sometimes limits on what can be said. Still, we see companies (and governments and all manner of institutions) undermining their reputations by dribbling out crucial information over long periods of time.

There are lots of issues out there. Many companies are good at taking stock of their situations, writing extensive Q&A documents, developing "what if" scenarios and building advocacy networks to support their positions. But a lot of companies stumble on the next step -- getting out ahead of the issues. They're coming, you can see them. So, step over them, step around them, confront them head on, whatever. Just don't get run over again.

Let’s Not Get Burned and Drowned (By Information)

Right, Wrong; Too Much, Too Little; Too Early, Too Late
If Martha Stewart was in public relations she might say, “Information – it’s a good thing.” Information can educate. It can inspire. But, it can confuse. It can even harm.

We’re exposed – sometimes bombarded – by health information everyday. It comes from our healthcare providers, from the media, from consumer groups, from government institutions and advertisements. Shirley Wang wrote in The Wall Street Journal last week, “Too much information about drug safety – disseminated through media, online alerts from consumer watchdog groups and even by the Food and Drug Administration itself – might overwhelm patients and raise undue alarm, some medical professionals caution." Indeed, also reported in this story was a survey of 300 medical professionals released last March by Pfizer that found nearly all (89 percent) were at least “somewhat concerned that patients might stop their medications if potentially negative safety information was released to the public too early."

The clutter and confusion is an issue not only for patients and caregivers but for physicians, too. The database of clinical guidelines (those standards of care developed by a wide array of medical societies) maintained by the American Medical Association contains over 2,200 entries. Some were not subjected to peer review and some contradict others outright. Dr. Darshak Sanghavi, a pediatric cardiologist at the University of Massachusetts Medical School, wrote in The New York Times recently that in the past year “the American Academy of Pediatrics abruptly reversed its recommendation that healthy infants avoid peanuts and other potential food allergens, without citing any new data. Weeks after the American Heart Association widely publicized the need to perform cardiac testing in children treated with drugs for attention problems, the academy issued a contradictory guideline discouraging such testing.”

These guidelines carry weight in determining if a drug, device or procedure will be reimbursed by insurance, and are supposed to be developed using hard clinical data – so called evidence-based medicine. But here, too, lie a bevy of contradictions. For example, Stephanie Saul wrote in The New York Times last week about the CyberKnife, an FDA approved treatment for the treatment of a variety of tumors made by Accuray. In prostate cancer, the key advantage is that treatments take five days instead of eight weeks for conventional cancer radiation. “As it turns out, Medicare pays for the treatments in 33 states — but not in 17 others. “You can live on one side of the street and get a procedure, but on the other side of the street you can’t,” said Dr. Steven D. Pearson, president of the Institute for Clinical and Economic Review.”

Where does this leave us? Here are a few thoughts:

For consumers: Trust, but verify. We’re told to rely on sources of information that we trust. But be careful. Trust is easily misplaced – just ask those who invested with Bernard Madoff. Look for information that lists its authors. Look for references. Additional comfort can be gained if the information is attached to a major medical institution, or a government agency like the NIH or CDC.

For health information providers: Release information when it’s ready, not when it’s half-baked. Many studies and interim results are made public too early. Clearly, if there’s a serious potential adverse event or public health issue, it’s important to err on the side of safety. But, in other cases, try less for a change. Not everything is news, not everything needs an announcement.

For healthcare decision-makers: Set expectations in advance for what information is needed to render judgment, while leaving room for some flexibility in a dynamic field. We need a clearer understanding of the thresholds of acceptability, when enough information is enough and transparency in the review process.

Positive steps have been taken, to be sure, but we still need to work to ensure that information is of higher quality, delivered at the right time and conveyed in language appropriate to the audience.

Let's Get a Little More Serious

Enhancing Corporate Reputation By Playing It Straight

I held a session on risk preparedness, issues management and crisis communications, last week in my Strategic Communication class at NYU. One of the truisms I talked about was how, so often, damage to reputation, morale, operations and financial performance is self-inflicted.

The pharmaceutical industry, unfortunately, serves as a prime example. In my view, some of the fights to differentiate products and gain market share have fanned the flames of antipathy toward the industry. DTC advertising has helped a number of brands become household names but these efforts have not always enhanced the public trust. We’re not making our best effort to properly set expectations or adequately communicate the balance between risk and benefit when animated characters or claymation body parts are used to sell medicines. I’m sure these ads test well in focus groups but this environment calls for a more serious approach to marketing and education.

This doesn’t mean that we can’t or shouldn’t be creative. We just need to redefine what creative means. The default definition of “creative” can’t be hosting big events or using celebrity spokespersons. It has to be more encompassing and it has to involve real analysis – a clear link to the needs of stakeholders.

Pfizer represents an interesting yin and yang on this subject. On the one side, they have Chantix(R), the smoking cessation product, with its ads using the tortoise and the hare to illustrate the importance of perseverance and compliance. But how seriously should we take the safety warnings when we see a petting zoo on TV? On the other side is the retooled Lipitor(R) campaign featuring an actual heart attack survivor who now takes the cholesterol reducer. If this guy is giving me the good and the bad, I’ll pay attention.

But what really interests me is the Company’s recently launched Medicine Safety Education web site. I don’t have any knowledge about how well this has been promoted, received or utilized, but this site looks like a good start in both communicating and collecting information on drug safety. And, beyond the attempt at putting safety in perspective, there’s another critical element – a step toward educating the public on risk perception. It’s a small but worthy – and creative – step toward rebuilding trust and reputation.