Since 2014, nonprofit RxBalance has been battling what it calls the “undue influence” of pharma marketing by running its own campaigns with such partners as Georgetown University for “Are You Prescribing Under the Influence? “[of pharma], targeted largely at healthcare providers.
Now, RxBalance has begun focusing more on telling the general public how pharma marketing can be less than transparent. It recently launched an effort against costly Medicare drugs, focusing in particular on evidence that Eliquis from Bristol Myers Squibb/Pfizer’s Eliquis is no more effective than generic Warfarin in preventing strokes caused by atrial fibrillation -- despite ad boasts of being “a better treatment.”
Green, a former pharmacist and pharma ad copywriter whose resume includes such agencies as Grey Healthcare and KPR (since absorbed into Omnicom), is supported by a cadre of volunteers and consultants, all also former pharma advertising professionals.
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“We used to be part of the marketing machine devoted to convincing America that medication was always the best solution,” Joe Garamella, board member and former executive creator director of Sudler & Hennessey (later VMLRx), says in a statement. “Now, we’re using those same communication skills to advocate for public health, and empower people with transparent, evidence-based, plain-language information about risks and benefits.”
Pharma & Health Insider spoke with Green about her background, why she sees non-branded pharma ads as worse than product ads, the upcoming Trump administration, and other issues.
This Q&A has been edited for space and clarity.
Pharma & Health Insider: What led you to found RxBalance?
Lydia Green: I worked alongside wonderful people in pharmaceutical marketing, but the relentless pursuit of profits in healthcare can sometimes lead to harmful outcomes that are difficult to ignore. Over time, I grappled with the unintended consequences of some of the practices I participated in.
P&HI: In a 2020 Tedx talk, you talked about the final straw that caused you to leave pharma marketing for good, but avoided mentioning anyone by name. Can you tell us?
Green:. I was working on a Johnson & Johnson drug called Risperdal, one of the first atypical antipsychotics for schizophrenia. What hit me hard was that it was being marketed as safer than older drugs like Haloperidol, which was off market. They wanted psychiatrists to prescribe this new drug instead.
Serious side effects started to emerge, such as diabetes, enlarged large breasts in boys, and obesity. The client was focused on downplaying these, instead of addressing them transparently.
P&HI: How has pharma marketing and your ability to counter it changed since the founding of RxBalance?
Green: A lot of what we’ve been doing over the last 10 years is trying to convince people of things they find hard to believe [such as] that a doctor would make a decision…based on something that a sales rep told them.
Now it’s much easier. So many of the concepts embedded in care right now were not established 10 years ago. And the pandemic created a sense of distrust in authority. People are much more open to our message.
If you want to make informed decisions about your health, you have to realize all the ways that money and greed permeate the system and affect what your doctor recommends to you.
P&HI: Do you foresee any changes under the new Trump administration?
Green: The person I like the most who I hope gets confirmed is Marty Makary for the Food & Drug Administration. He’s written this amazing book. It’s called “Mama Maggie,” about this woman in Egypt who started an organization to help children who live in slums. [Editor’s note: akin to Green’s own career path, Maggie left a career in marketing to do it.] He’s also written books about how health care today often exploits people and puts them in debt.
P&HI: What about RFK Jr., Trump’s pick for Health & Human Services, particular his earlier calls to ban pharma ads on TV?
Green: I personally would be happyto see no pharma advertising, and no brand awareness advertising.
When I starting working in pharma advertising in the 1980s, there was no direct-to-consumer advertising. I think it has had a pretty damaging effect on our culture. In particular, non-branded disease awareness has had serious consequences.
P&HI: Can you give examples?
Green: I remember working on campaigns for ADHD drugs. These drugs were used for a certain group of kids, and drug companies wanted to expand their usage. They started doing a lot of non-branded education to parents, guidance counselors and teachers. I worked on a campaign where we were telling people that if a child was argumentative, that was a sign of ADHD and maybe they needed medication.
They would train teachers in how to diagnose ADHD. Then teachers would tell parents, “Your kid raises his hand too much, he jumps out of the seat. You need to get him evaluated to see whether he has ADHD.”
P&HI: And RxBalance’s own diabetes campaign?
Green: Pharma had so much influence on guidelines that suggested everyone should achieve the goal of an AIC under 7 that it turned into a problem. Older patients were being overtreated, and then were lining up with low blood sugar and going into the emergency room for falls and fractures.
One of the problems the Veterans Administration was having: Doctors would tell older patients, “You don't have to achieve an AIC of 7,” and patients would be upset, “No, no, you’re wrong. I know it should be a 7.” Patients were pushing back.
Disease awareness is more dangerous to me than product marketing, because when people see a product being marketed, they’re probably naturally skeptical. But when someone tells them your AIC has to be 7 or lower, people just assume that’s coming from best evidence -- and not realizing that often those numbers are being promoted because somebody has an agenda.
P&HI: What’s in RxBalance’s future?
Green: We want to find collaborators, either academic or people in the pharmaceutical industry, particularly retired executives, on solving some of the problems that we face right now in pharmaceutical care.
My colleagues who work with me are generally former advertising writers. We’re dreamers who believe the system is out of balance.
P&HI: What kind of reaction have you gotten to what you’re doing now from former pharma marketing colleagues?
Green: Of those I’ve spoken with, approximately 85% agree with my perspective, but are reluctant to publicly express their support, primarily out of concern for jeopardizing their primary source of income.
About 15% strongly believe that the FDA’s regulations ensure the industry operates in alignment with science and evidence and, therefore, see no issue with current practices.
People who work at drug companies, or are vendors whose livelihood depends on drinking the pharmaceutical “kool aid,” … are more inclined to see no issue with current practices than those who work more tangentially with the industry, e.g., selling media to pharmaceutical companies and being vendors (such as a PBM [pharmacy benefit managers]) but not directly creating drug marketing content.