Last week an item posted by Ed Silverman on his ever-interesting blog,Pharmalot, made us do a double take. "At week's end," Silverman e-wrote,"[Merck] will introduce a marketing shake-up and flesh out its 'NewCommercial Model.'" Reporting that sales reps were "bracing for teleconference calls," the 'Net newshound linked to a source indicating that the drug giant plans to cut its doc-promo spend by 9 percent.

This had us seeing a flurry of pink slips. Such a move would get a bear hug from Wall Street, which is chomping at the bit to see the rest of Big Pharma follow the lead of Pfizer CEO Jeff Kindler, who announced last December that he would slash the firm's storied sales force by 20 percent by next year.

But Merck spokeswoman Amy Rose wasn't having any of it. "Our 'New Commercial Model' won't be in place until 2010," Rose said, adding (most emphatically), "This is not a head-count reduction." As for following Pfizer, she pointed out that the blueprint for Merck's new model had gone live in 2005. (Uh, we clearly hadn't done our homework.)

Silverman's post suggested that Merck's model involves refocusingpromotional efforts around specific therapeutic areas--and away from theindustry "arms race" of 100,000 sales reps who have long since worn outtheir welcome at doctor's offices. True or false?

"Just adding sales reps is a broken model," Rose agreed.

Did that mean Merck was cutting its sales force?

"Our new model calls for an increased use of technology [and metrics], and it is much more customer-focused," Rose said. "Gauging the feedback of our customers is a core piece of our strategic direction." And that was that.

Indeed, Merck CEO Richard Clark, during his annual business briefing onDecember 12, had talked up the company's new commercial approach--though he, too, kept it vague. Clark did get specific, however, when discussing company cost cutting, including plans to trim head count by 7,000 in order to save up to $5 billion over the next five years.

"It sounds like Merck is rebalancing its portfolio, like Pfizer, Lilly,Wyeth and other big pharmas," said Michael Goodman, editor in chief of"Insight Pharma Reports," Cambridge Healthtech Institute. "The focus isincreasingly on niche and specialty diseases. But the new sales model willrequire understanding the world of the specialist."

Turning an army of perky primary-doc sales reps into savvy specialtymarketers will present Big Pharma with yet another interesting challenge.But Merck will be two steps closer to meeting it now that the firm's topmanagement is playing with a full team again. Last Friday, Pete Kellogg wasnamed new CFO. Kellogg boasts a diverse portfolio, having done stints atFrito-Lay and Arthur Andersen before jumping to pharma by way of Biogen,Inc., where he oversaw its merger with IDEC Pharmaceuticals in 2003. Hejoins David Anstice, the longtime Merck commercial exec who ran Europe, Asia, and the Americas before stepping up as new Interim Head of Global Human Health following Peter Loescher's exit.

In the end, Friday passed with no ax falling on Merck sales divisions. Hmm...why do we have pink slips on the brain?

Articles

News Analysis

Or: No news is good news--for everyone but us reporters

Merck's Not-So-New Marketing Model

Physicians may have to rethink prescribing SSRIs to their patients who are over the age of 50.

Three studies appearing in the Archives of Internal Medicine suggest a link between the use of selective serotonin reuptake inhibitors--including Prozac, Paxil, Lexapro, and Zoloft--and an increase in fractures in both men and women over 50.

"Because depression itself is associated with an increased risk for boneloss in older people, a better understanding of the impact ofantidepressants on bone is urgently needed," wrote Kenneth Saag in "Mind the Mind, but Mind the Bones!" in the June 25 issue of journal. The report alsonoted that depression affects as many as 40 percent of adults over 55.Saag's concern regarding prescribing SSRIs was echoed by a second reportnoting that the use of SSRIs was associated with an increased rate of boneloss in the hip in women (average age at onset was 78.5). This same studynoted that bone loss did not occur with the use of TCAs, or tricyclics, anolder class of antidepressants.

But there's a catch. Unfortunately, simply switching patients to TCAs maynot be the answer.

"Because of concerns about the arrhythmogenic potential of TCAs, there is a strong preference for SSRIs in older adults in whom depression commonlycoincides with heart disease," Saag writes.

To add to the confusion, the mechanism behind SSRIs and bone loss has not been clearly identified. Recent studies have shown a direct link betweencalcium consumption and bone formation in pre-adolescents, which begs thequestion of whether younger patients taking SSRI have an increased lifetimerisk for bone loss.

Manufacturers of SSRIs will no doubt consider this dilemma and the economic fallout from this research.

"While Lilly supports efforts to learn more about this class of medications, due to the inherent, uncontrolled variables between the SSRI user and non-user groups, a causal relationship cannot be established between SSRI use and bone loss," said Charles McAtee, spokesman for Eli Lilly.

"The current Prozac product label lists 'osteoporosis' as an adverse eventoccurring on a rare basis--less than 1 in 10,000 patients, based upon datafrom clinical trials. Decisions concerning the potential risk vs. benefit ofusing any medication should be made with the advice of a physician who iswell-informed about the patient's medical history. As a side note, manystudies show that osteoporosis and depression often coexist," McAtee added.

Blockbuster antidepressants linked to bone loss in seniors

Marketing Blues for SSRIs?

You may have missed it, but June 27 was National HIV Testing Day--an opportunity to raise public awareness not only of the persistent risk of that viral scourge but also of the latest innovation in rapid-testing devices.OraQuick Advance, which can detect both HIV-1 and HIV-2 antibodies within 20 minutes, is the only rapid HIV test on the market that can use oral fluid--via a mouth swab--to provide a result. Other quickie tests require a blood sample.

"We recognized the need for rapid HIV test in the marketplace," said Ronald Spair, chief financial officer for Bethlehem, PA-based OraSure Technologies, the maker of OraQuick Advance. "And in terms of marketing, we considered not only the convenience of the OraQuick Advance but also its noninvasive nature."

Spair pointed to Centers for Disease Control and Prevention (CDC) estimates that one-third of the 2.2 million Americans tested for HIV at public health clinics each year using the traditional lab-based test do not follow up two weeks later to learn the results. "We think the reason may be multifactorial, including the time lapse between testing and getting the result and [the patient's] lack of basic understanding of the result itself," Spair said. The company is also developing a test for hepatitis C, a leading coinfection among people with HIV.

In order to heighten visibility for OraQuick Advance--and to underscore the importance of knowing your HIV status--the company joined with the National Association of People with AIDS to host Testing Day's main event, the third-annual Mayors' Campaign Against HIV. The campaign counters the stigma and fear of HIV testing by showcasing mayors in major US cities opening wide for the rapid oral-fluid method. To date, more than 30 mayors' offices have participated.

Because HIV infection is growing disproportionately among people of color and the poor, the CDC launched an initiative in 2004 to establish HIV testing as a routine part of most medical exams--for example, at hospital ER visits. The initiative has proved controversial among advocates and some doctors because it does not require written consent, raising the specter of mandatory testing. The CDC is spending some $2.3 million this year on OraQuick Advance tests.

The device maker is aiming for FDA approval to sell its test, which was initially approved for use in 2004, to consumers in the United States in early 2009. OraQuick Advance got the green light for marketing in the European Union earlier this month. The current price for clinics, community-based organizations, and other prevention groups is $17 a kit. But since these groups often administer the test for free, it remains to be seen how big the consumer market will be.

Catching up with the first ouchless fast test on National HIV Testing Day

Pharmaceutical Executive-07-03-2007

Merck's Not-So-New Marketing Model

Marketing Blues for SSRIs?

Testing, Testing, H-I-V