mind. “You know,” I told him, “whatI would really love to see are the mar-ket research studies.” Goodness knowswe are inundated with crowing newsreleases when companies get favorableresults from research on drugs, butwhen was the last time you heard apharmaceutical company tout resultsof the research they do on us?

His question sparked memories ofstories I’ve written about tobaccocompany market research. Companysecrets began spilling out after a troveof internal documents literally landedon the doorstep of anti-tobaccoactivist and University of CaliforniaSan Francisco cardiology professorStan Glantz, PhD.

In an interview a few years ago, Dr.Glantz told me about walking into hisoffice in May 1994. There was a largeexpress shipment box on his desk. Thesender’s name: “Mr. Butts.” Inside thebox were 4,000 pages of internal doc-uments from the files of the Brown &Williamson Tobacco Corporation dis-playing 30 years of research, market-ing, and legal maneuvering. The paperpayload blew apart decades of tobaccoindustry secrecy.

“When I opened it and realizedwhat they were, it was kind of like anarcheologist discovering King Tut’stomb or being let into Hitler’s bunk-er,” he told me. “I mean, it was thisincredible view inside the tobaccoindustry. Just amazing.”

Since then, lawsuits and othersources have brought to light manymore tobacco industry files. Most areavailable online at http://legacy.library.ucsf.edu

‘Goody-Goodies,’ ‘Preps,’‘Rockers,’ ‘Party-Parties,’‘Burnouts’One of my favorites is titled “Suc-cessful Marketing to Younger AdultSmokers.” This R.J. Reynolds marketresearch report from the 1980s slicedyoung people into segments including“Goody-Goodies,” “Preps,” “Rock-ers,” “Party-Parties,” and “Burnouts.”Each segment was linked to attributesalong a spectrum from conformity tonon-conformity.

While the “Goody-Goodies” and“Preps” were said to favor Mercedescars and t-shirts with mild slogans,“Burnouts” just wanted to have wheels,any wheels, and might sport t-shirtslogans like “Time Flies When YouDon’t Know What You’re Doing.”

The point, of course, was to helpthe company’s marketers aim effectivemessages at the people most likely tobe drawn into smoking their brands.

What are PharmaceuticalMarket Equivalents?So, what are the pharmaceutical mar-ket equivalents of the “Goody-

41oncology tim

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Scriptdoctor | Medicine in the Media

ANDREW HOLTZ, MPH, is a former CNNMedical Correspondent and the author ofThe Medical Science of House, M.D. Sendquestions to him about how the mediatreat medical topics or suggestions forfuture columns to OT@lwwny.com

A Peek into the Ways Drug Companies Analyze ConsumersBY ANDREW HOLTZ, MPH

Igot a call the other day from a reporterat a public-relations newsletter, who wasworking on a regular feature about how

to pitch stories to journalists. He asked mewhat kind of news releases I might want toreceive from pharmaceutical companies.“Short ones,” I chuckled, adding that I getthe drug study news I need from journals.

But then another thought popped into

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While parents of childhood can-cer survivors are typicallywatchful of neurocognitiveproblems that arise in their

children, a recent study suggests that a 30-minute neurocognitive screening method ismore accurate in identifying children at riskfor future cognitive and academic difficul-ties and who need more comprehensive fol-low-up.

The researchers, from St. Jude Chil-dren’s Research Hospital, said in an articlepublished in the September 1 issue of theJournal of Clinical Oncology (2008;26:4138-4143) that their screening method is practi-cal, cost effective, and clinically useful.Further, they said, it offers a more specificand sensitive evaluation than parents’ obser-vations.

As many as 40% of childhood cancersurvivors may experience neurocognitiveimpairment in areas such as processingspeed, attention and memory, noted the

authors, led by Kevin R. Krull, PhD, Asso-ciate Member in the Department ofEpidemiology and Cancer Control.

They cited the Children’s Oncology

Group as recommending regular evaluationto monitor development after cranial radia-tion therapy and/or antimetabolite chemo-therapy. But for a variety of reasons, includ-ing costs and time restraints—a full evalua-tion can cost $1,500 and take four hours ormore, the article notes—routine evaluationsare difficult to implement.

Dr. Krull said in an interview that thisscreening method could be administered atannual follow-up visits by a technician ornurse.

The study included 240 patients ages sixcontinued on page 45

Goodies” and “Burnouts” market segments? I turned to veteran market researcher

Carol Morgan to get some insight into howdrug companies analyze consumers. “In thelong process of making and keeping a phar-maceutical sale, intuition and logic aren’treliable in determining what will motivateconsumers,” she wrote in a magazine arti-cle. Ms. Morgan and her partner, DoranLevy, PhD, have more than 35 years experi-ence studying consumers for corporateclients, including pharmaceutical compa-nies.

They have given labels to varieties ofmedical consumers such as “Proactives,”“Faithful Patients,” “Trusting Believers,”and “Informed Avoiders.” She says that ifyou show a TV drug ad to a couple of peo-ple from different segments, even if theyhave similar health situations, they are like-ly to respond quite differently.

“One, the ‘Faithful Patient,’ will say,‘Gee, that sounds really interesting. I’ll gotalk to Dr. Smith. Maybe he’ll get me onthis drug and that will solve my problems,”Morgan explained. “And the other person[the ‘Informed Avoider’] will say, ‘Anotherdisgusting ad! This isn’t for me.’”

And those attitudes predict their likelybehaviors. She says data show that FaithfulPatients take far more drugs.

‘Psychographic Segmentation’Unlike demographic categories, such as“mothers with young children” or “college-educated retirees,” or lifestyle descriptionsthat tote up favorite sports, TV shows, andthe like, Morgan tries to understand con-sumers at a deeper level using what’s calledpsychographic segmentation. In their bookMarketing to the Mindset of Boomers andTheir Elders (Attitudebase, 2002), Morganand Levy lay out the results of more than adecade of study of 20,000 Americans. Theysynthesize their segmentation of medical

consumers into the Morgan-Levy HealthCube, in which “the four Health, fourHealth Compliance and six HealthInformation segments are combined to pro-vide greater in-depth insight into patientmotivation.”

“What we are attempting to do is reallylook at these deep-rooted, deep-seatedmotivations or evidence of those motiva-tions. Pharmaceutical companies are inter-ested in those in order to position theirproducts more effectively.”

Her clients’ ultimate goal? “Reach thegreatest number of patients at the highestprice.”

But certainly people dealing with cancerare making treatment decisions based onthe facts and advice they get from physi-cians, nurses, and pharmacists, right? TVads for chemotherapy agents or supportivetreatments remain rare, although Procrit(epoetin alfa), for example, was widely pro-moted on network news and other shows.

DTC vs DTPStill, even cancer therapies are actively mar-keted to consumers, although rather thantrying to blanket the country with Direct-to-Consumer (DTC) pitches, the makers ofoncology products are more likely toemploy DTP (Direct-to-Patient) cam-paigns.

Venues include magazines intended forpatients and their families. For example, a2006 review of advertising to cancerpatients by Gregory A. Abel, MD, MPH,and colleagues not surprisingly found adsfor Xeloda, Taxotere, Aloxi, Femara,Armidex, Emend, and other medications ina magazine for cancer patients.

The media kit claims that 14% of read-ers said their treatment decisions havechanged because of something they read inthe magazine, and that 20% of readers saidthey have requested information from atleast one of the advertisers.

To pharmaceutical marketers, thoserequests are golden. Carol Morgan says

companies often use short quizzes or othertechniques to pigeonhole consumers andthen send them customized information:“They would be sent promotional materialsthat are appropriate for that segment. Or, iftheir segment is not very appealing to thepharmaceutical company, maybe they’ll getless information. It’s a way for the pharma-ceutical company to justify an investmentin this prospect.”

Of course, everyone knows that patientsare not all the same, and that it takes differ-ent techniques to motivate different people.But doctors and industry marketers justaren’t in the same league. While mosthealth care professionals learn their com-munications skills on the job, marketerstake a far more sophisticated approach tounderstanding patients.

“I would say, unfortunately, that theyare at opposite extremes,” Morgan said.“Pharmaceutical companies are investingmillions of dollars in this kind of research,studying their advertising to measure theireffectiveness, and then spending money ontheir direct-to-consumer advertising versus,at the other end…it’s still not at the level ofthe doctor quickly understanding what seg-ment the patient is in.”

Morgan says she and her colleagues arelooking into developing tools and trainingto help providers do a better job decipher-ing patients, but for now it’s as if doctorsare getting by with only the findings of caseseries reports, while pharmaceutical mar-keters have the benefit of randomized, con-trolled trials and systematic reviews.

What’s more, that vast knowledgebase—with its rich insight to patient attrib-utes, motivations, and effective interven-tions—is proprietary.

Maybe someday the vaults of pharma-ceutical marketing studies will be priedopen. Maybe someday a mysterious “Mr.Pills” will drop off a bulging box of internaldocuments, so we can see, in stark detail,what the medical marketers really think ofus. O

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S C R I P T D O C T O Rcontinued from page 41

Pediatric Neurocognitive Screening Method Foundto Be More Accurate than Parental ObservationBY ROBERT H. CARLSON

JCO 2008;26:4138-4143

KEVIN R. KRULL, PhD: “The longer outfrom diagnosis, the more likely achildhood survivor is to have cognitiveproblems. So if we catch this earlyenough, we may be able to retrain someof these underlying cognitive foundationskills such as attention and memory, tohelp future learning.”

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