Every year the pharma industry spends billions of dollars on direct-to-consumer (DTC) advertising with the hope that patients go to their doctors and ask about their brand. In today’s world, however, patients are much more proactive in taking the time to learn more about their disease as well as their treatment options before and after consulting with their doctors. And, as pharma marketers are well aware, that research consists of a lot of time spent online looking at brand websites, various health and disease portals and social media sites—including whole patient communities dedicated to a specific disease.

These online communities now give patients a direct line to others in a very similar position, and that allows them to pick the brains of people who have experience using the various treatment options available. But how do these consumer-to-consumer conversations affect a brand’s reputation? And does all of this DTC advertising have any effect on a consumer’s perception of a drug? Panorama enlisted the help of Wool Labs to answer these very questions.

Wool Labs used WebDig, a social cognition business intelligence system, combined with pharmaceutical expert analysis to analyze the 10 brands that spent the most on DTC advertising in Q1 2012, according to Nielsen. WebDig uses the entire Internet to find conversations on any subject—industries, companies, brands and/or specific topics. Wool Lab’s unique use of a natural language processor combined with human intervention eliminates all of the off-topic comments and spam to get to the real conversations about a subject. And by scouring the entire Internet, the Dig retrieves everything regardless of where and when it was posted even in places the major search engines and other tools cannot find.

For this Dig, a total of 261,299 conversations were analyzed on the top 10 advertised drugs of Q1 2012 that were posted from across all blogs, user forums and message boards on the Internet. Those top 10 drugs were:

1. Cymbalta

2. Lipitor

3. Cialis

4. Abilify

5. Celebrex

6. Humira

7. Chantix

8. NovoLog FlexPen

9. Nasonex

10. Lyrica

Defining the Evaluation Process 

Before we get to how these drugs rated in the social space we have to define exactly how Wool Labs evaluated these brands. Here are the terms you need to know:

Sentiment Index: The ratio of positive conversations minus the ratio of negative conversations with a range of 100 (all positive) to -100 (all negative). An index of 0 is neutral.

Conversation Count: The number of conversations across the Internet specific for each drug as of October 2012.

Conversation Density: This is defined below and can differ based on the size of the disease state and the number of patients prescribed a particular treatment. For this study, all of the medications have a large patient base.

  • Low: less than 10,000 conversations
  • Medium: 10,000 to 25,000 conversations
  • High: more than 25,000 conversation

Sales to Spend Index: The ratio of Q1 2012 sales of each drug and the Q1 2012 published advertising spend with a low end of 0 (no sales). The index assumes that there was some advertising spend. (Ratio of Rx Sales to Advertising Spend for Q1 2012 as reported by Fierce Pharma in August 2012.)

Advertising Efficacy: The ratio of Sales to Advertising Spend in the first quarter of 2012.

  • Low: <10
  • Medium: 10 to 20
  • High: >20

Risk Level: There are three risk level assignments. Contributing to risk are sentiment, number of conversations, number of patients on the drug, and exposure of patients and potential patients to the drug based on advertising spend. A large advertising spend drives more people online. Even if people do not post, the advertising spend increases the numbers of readers of the posts, therefore increasing exposure to either positive or negative sentiment.

  • Low:
    • Positive sentiment OR
    • Neutral sentiment with Low Conversation density
  • Medium:
    • Neutral sentiment with Medium or High Conversation Density OR
    • Negative sentiment with Low to Medium Conversation Density
  • High:
    • Negative sentiment with a High Conversation Density OR
    • Negative sentiment with Medium Conversation Density AND Large Advertising Spend

Risk metrics are important for a drug brand. Patients share and seek the experiences of others when making their own medication decisions. When a drug has a large patient base, typically there are tens of thousands of conversations in which patients are participating. Negative experiences, misperceptions and misunderstandings can impact a drug’s reputation and eventually, sales. A brand that is being extensively advertised also draws more attention to that drug, which may dramatically increase the level of conversations and expose even more patients and potential patients to a negative environment.

The converse is true as well. Fostering and encouraging a positive environment online for patients ensures that the strongest features of a brand are forefront in patients’ and potential patients’ decision making process and should have a strong positive impact on sales.

With all of that out of the way, let’s take a look at how these brands performed.

Overview of the Top 10 Drugs

Each drug was analyzed by sentiment, conversations and sales to advertising spend. Overall, none of the brands faired particularly well in the social space. The sentiment for each drug is negative without exception. Cialis has the highest sentiment at -2.4 but it is still negative. Cymbalta has the lowest sentiment at -32.3. The following chart and graph summarize the findings.


Sentiment Index 

Number of Conversations (Thousands) 

Sales to Spend Index 

Q1 2012 Advertising Spend (Millions) 

Q1 2012 



Cymbalta  -32.3 58.3 21.4 46.7 1,000
Lipitor  -25.8 23.8 18.9 44.5 842
Cialis  -2.4 37.6 4.9 42.3 207
Abilify  -19.5 35.1 37.3 35.9 1340
Celebrex  -15.1 17.6 13.4 32.2 431
Humira  -22.8 12.7 31.6 29.4 928
Chantix  -27.6 20.4 6.6 26.7 175
NovoLog FlexPen  -5.0 4.2 8.6 26.4 227
Nasonex  -20.6 13.8 10.7 25.6 275
Lyrica  -30.6 37.7 18.2 25.1 458



Among all the drugs, common experiences led to negative sentiment. For instance, side effects impact sentiment more than any other issue. However there are nuances to side effects that are important and that also negativity impact a brand. For example:

  • Side effect concerns go unacknowledged by physicians leading to noncompliance and increased tenor of negativity.
  • Nurses and pharmacists, rather than physicians, deal more directly with patient concerns and side effect complaints.
  • Physicians seem to underplay side effects with patients, which tends to make patients more fearful and distrusting of the drug.

It is also important to point out that a product may have a strong Sales to Spend Index, thereby being efficient and effective in advertising, but may still be portrayed negatively in conversations—which impacts the overall brand’s reputation.

For example, Abilify has the highest Sales to Spend Index at 37.3, but also has a Sentiment Index of -19.5. For Abilify, patients report a high level of side effects and weigh their negative experiences with the benefits they receive. Once their negative experiences outweigh the benefits, patients are at risk for poor adherence.

Meanwhile, Cialis has the weakest Sales to Spend Index at 4.9 but the highest sentiment (although still negative) at -2.4. Cialis seems to get treated interchangeably with the other ED drugs by patients, but it also seems to be the ED treatment of choice for patients recovering from prostate cancer treatments and that helps temper sentiment.

In the months ahead, we will take a closer look at the online reputation of each drug in the top 10 list. These profiles will include the main issues that contribute to each brand’s negative sentiment, the aspects of the drug that patients cast in a positive light, and some of the potential areas of risk for each brand. Marketers will finally be able to get an idea of just what all of that DTC money is buying them, at least in terms of patient-to-patient conversations. Tune in next week as we dive into the social statuses of Cymbalta and Lipitor.


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