-----Original Message-----
From: Peter R Mansfield [mailto:peter@healthyskepticism.org]
Sent: Sunday, 23 November 2003 8:28 PM
To: 'Woods, Paul B'
Cc: Jon Jureidini (E-mail)
Subject: RE: Nexium advertisement


Paul,

Your company has not taken our concerns as seriously as other companies in
the past. For example, when we wrote to Sandoz about bromocriptine the
Australian CEO was instructed to focus his time on our concerns and the head
of public relations flew from Basel to meet with us in Adelaide to arrange a
2 day meeting in Basel including some hours with the CEO, Daniel Vasella.
This was despite the fact that they were all busy with the takeover of
Ciba-Geigy.

What would we need to do before your company would take our concerns as
seriously as Sandoz did?

It seems understandable to us that your company would want to maintain your
current standards (which you believe are high standards) because your
current performance is currently being rewarded by the market.
See:
A "remarkable year" for AstraZeneca. Scrip 2003 Oct 29;2897:5
(We note that Nexium sales increased by 86% to US$ 2.5 billion in the first
9 months of 2003 and that your company's fortunes depend heavily on drugs
that have little or no advantage over less expensive alternatives.)

Do you agree?

By contrast, we aim for improvements in medical decision making and
pharmaceutical promotion.  We also aim to improve the quality of our own
work so we actively seek and do our best to respond to constructive
suggestions for improvements.

Our approach is based on many ideas including the 1963 speech by advertising
executive Pierre R. Garai.
See:
www.healthyskepticism.org/editions/2003/10.asp
Garai suggested that because drug companies do whatever works to influence
doctors it is up to health professionals to improve our decision making.

Do you agree with Garai?

We are testing the following hypotheses:
1) Harm from misleading drug promotion will be reduced by developing healthy
skepticism amongst health professionals and the general public.
2) Drug companies will adapt to produce whatever the market rewards.
3) Self regulatory systems will defend current standards rather than drive
improvements.

What do you think about those hypotheses?


You have indicated that you believe that the self regulatory system is
superior to the feedback collected by AdWatch on Nexium before you have seen
that feedback.

We will not make judgements about whether or not the self regulatory system
is helpful or not in this case until after we have seen the results. (If
your company can show that the Nexium advertising is not misleading or if
your company provides adequate correction then we will not need to test the
self regulatory system.)

The AdWatch and the self regulatory system address different questions about
different people.

The self regulatory system judges drug advertisements according to the
current standards of the industry.

By contrast, we aim to improve standards for the benefit of health
professionals and the public.

We have done our best to provide visitors to AdWatch on Nexium with good
quality information so that they can decide for themselves. We have not
received any specific suggestions for improving that information from your
company despite several requests. In fact Mike Bull wrote: "I have no
objection to any part of Adwatch on Nexium." By contrast we are continuing
to identify improvements.

Our volunteer samples will give an indication of the views that at least
some health professionals and members of the public will hold if given the
benefit of the information we have provided.

Volunteer samples can be more useful than random samples for producing
feedback that is useful for improving standards.
See:
Barlow J, Møller C. A complaint is a gift. Using customer feedback as a
strategic tool. Berrett-Koehler Publishers. San Francisco 1996
www.healthyskepticism.org/gift.htm

Volunteer samples may give more useful information than random samples to
enable companies to plan for possible future scenarios. It has been
suggested that the choices for drug companies include learning to "respond
more quickly and efficiently following customer feedback" or following "the
buffalo herd" over the cliff.
See:
Who are the pharmaceutical industry's customers? Scrip 2003 July 1;2865:14

We would consider supplementing AdWatch with a random sample surveys if we
had the resources but the two different methods would be used for different
questions.


The only defence for the Nexium advertisements that we have received from
your company is that "The current Nexium claims, and those included in the
stated advertisement, have been fully examined by experts and they have not
been ruled in breach of the Code."

This type of argument was described by Locke in 1690. He named it the
argumentum ad verecundiam (appeal to modesty).
See:
Locke, J.  An essay concerning human understanding. Vol IV 1690. (Chapt 18
Of reason. Section 19.)
http://etext.library.adelaide.edu.au/l/l81u/under67.html

How do you think health professionals and members of the public should feel
about your company's use of this type of argument?

Do you have any other arguments in defence of your company's advertisement?

Do you believe that all health professionals and members of the public who
have concerns about your advertisement are incompetent to form their own
opinions on drug advertisements?

Do you believe that their concerns are not justified?

I will now give you another opportunity to answer my previous questions and
request that you answer each question separately.

Do your agree that the Nexium advertisement is unhelpful and misleading?
If no, why not?
If yes, what is being done about it?
In either case, why has there been so little communication from your
company?

I look forward to receiving your replies to my questions.


regards,

Peter

Dr Peter R Mansfield
GP
Research Fellow, Department of General Practice, University of Adelaide
NHMRC Public Health Postgraduate Scholarship 250465
Director, Healthy Skepticism Inc
Improving health by reducing harm from misleading drug promotion.
peter@healthyskepticism.org
www.healthyskepticism.org
Flinders University Convocation Medal 2003
34 Methodist St, Willunga SA 5172 Australia
ph/fax +61 8 8557 1040



> -----Original Message-----
> From: Woods, Paul B [mailto:Paul.Woods@astrazeneca.com]
> Sent: Monday, 10 November 2003 10:04 PM
> To: 'peter@healthyskepticism.org'
> Subject: RE: Nexium advertisement
>
>
> Peter,
> I'm sorry you feel your concerns haven't been properly dealt
> with but I
> think your criticism is not justified.  My perspective on the
> events to date
> are:
> 1. You asked for my comments and I provided general comments
> on the Adwatch
> approach.
> 2. You had criticised specific claims in an ad issued by our
> Australian
> company and they responded.
> 3. You then recently published your final Adwatch article and
> also stated
> your intention to pursue further discussions with the company.
> 4. You have requested contact details for our CEO so you can
> pursue those
> further discussions. I supplied them. You didn't ask for an
> e-mail address
> but he can be contacted through: Pam.Bishop@AstraZeneca.com
>
> All of this has occurred with reasonable speed.
>
> You have asked for further comment from me.
>
> Although I welcome your decision to seek companies' comments before
> publishing Adwatch my fundamental concerns remain. I still
> don't believe it
> is the best way to further the cause of high standards in
> pharmaceutical
> advertising - a cause which I and AstraZeneca hold in high regard.
>
> There are often at least 2 views on an issue, so how can it
> best be decided
> which is most valid?  The ad in question was considered acceptable by
> AstraZeneca Australia and this judgement has been confirmed
> twice through a
> well established code of practice complaints system -
> independent of the
> company and which includes review by highly experienced
> individuals from
> various backgrounds outside the pharmaceutical industry.
> Your critical
> comments have been brought to the attention of a self
> selecting group of
> subscribers and a survey conducted by a process which
> inevitably leads to a
> negative conclusion.  Being frank, it seems to me that there
> is a striking
> difference in the robustness and validity of these two
> approaches. From the
> evidence available to me, my answer to your question must
> therefore be that
> the ad is not misleading and is in line with widely accepted
> standards of
> quality, as reflected in the Australian code of practice.
>
> In the past I have been involved in making complaints under
> code of practice
> systems and I know how frustrating it is when the
> adjudicating body rules in
> favour of the other viewpoint.  However I firmly believe that
> these bodies
> are the best way of deciding which viewpoint is the most
> valid. Codes and
> regulations, like most things, should be capable of
> continuous improvement
> and I have tried to influence their future development and
> application.  I
> know you have done the same.  I see that as the best way forward in
> maintaining high promotional standards.
>
> regards
>
> Paul
> -----Original Message-----
> From: Peter R Mansfield [mailto:peter@healthyskepticism.org]
> Sent: Mon 03 Nov 2003 21:49
> To: Woods, Paul B
> Subject: RE: Nexium advertisement
>
>
> Paul,
>
> We are very surprised by the lack of action on our concerns
> by your company.
>
> What do we have to do to get your company to take our
> concerns seriously?
>
> Lack of action not only harms the reputation of your company.
> It also harms
> large numbers of people who suffer from the opportunity costs
> caused by the
> way Nexium has been marketed.
>
> Our concerns deserve urgent attention people in your company
> who have the
> authority to resolve them. Your decision to send me only a
> postal address is
> disappointing. Successful dialogue requires timely exchange of views
> (preferably in person). Please send me one or more appropriate email
> addresses.
>
> We would also appreciate your informal comments on the
> feedback about the
> prototype:
> www.healthyskepticism.org/editions/2003/8.asp
> and the final version of AdWatch on Nexium:
> www.healthyskepticism.org/adwatch.asp
>
> Please comment specifically on the following:
> We hope that AstraZeneca would agree that if doctors have developed
> incorrect impressions about a drug as a result of advertising
> then measures
> should be taken to correct those impressions. Therefore we
> would like to
> work with AstraZeneca to develop a new set of advertisements
> that would run
> until surveys of doctors show that any mistaken beliefs have
> been corrected.
>
> Do your agree that the Nexium advertisement is unhelpful and
> misleading?
> If no, why not?
> If yes, what is being done about it?
> In either case, why has there been so little communication from your
> company?
>
>
> regards,
>
> Peter
>
> Dr Peter R Mansfield
> GP
> Director, Healthy Skepticism Inc
> Improving health by reducing harm from misleading drug promotion.
> peter@healthyskepticism.org
> www.healthyskepticism.org
> 34 Methodist St, Willunga SA 5172 Australia
> ph/fax +61 8 8557 1040
> Flinders University Convocation Medal 2003
>
> > -----Original Message-----
> > From: Woods, Paul B [mailto:Paul.Woods@astrazeneca.com]
> > Sent: Tuesday, 4 November 2003 12:58 AM
> > To: 'peter@healthyskepticism.org'
> > Subject: RE: Nexium advertisement
> >
> >
> > Peter,
> > Thank you - yes I have been receiving the Adwatch updates.
> > Having made my
> > initial comments on the Adwatch process I have left it for my
> > colleagues in
> > Australia, who issued the ad in question, to correspond with
> > you over the
> > specific medical/technical criticisms you raised. I haven't
> > chosen against
> > informal dialogue and if I, in my general promotional
> > regulatory capacity,
> > can provide any additional contribution at this point I
> > should be pleased to
> > do so.
> >
> > I note that you would prefer to continue your interaction
> > with AstraZeneca
> > by writing directly to our Chief Executive Sir Tom McKillop and, as
> > requested, here are his contact details:
> >
> > Sir Tom McKillop
> > Chief Executive
> > AstraZeneca plc
> > 15 Stanhope Gate
> > London W1K 1LN
> > UK
> >
> > regards
> >
> > Paul
> >
> > Paul Woods
> > AstraZeneca
> > Alderley House
> > Alderley Park
> > Macclesfield  SK10 4TF
> > UK
> >
> > tel:       +44 (0)1625 514456
> > mobile: +44 (0)7803 079367
> >
> > www.astrazeneca.com
> >
> >  .
> >
> >
> >
> >
> > -----Original Message-----
> > From: Peter R Mansfield [mailto:peter@healthyskepticism.org]
> > Sent: Tue 28 Oct 2003 01:24
> > To: Woods, Paul B
> > Cc: jon@healthyskepticism.org
> > Subject: RE: Nexium advertisement
> >
> >
> > Paul,
> >
> > I have assumed that you were receiving updates on AdWatch
> > along with other
> > Paid Subscribers and have chosen against further informal
> > dialogue. If you
> > have sent me any messages since July I have not received them
> > so please let
> > me know.
> >
> > In case you have not seen them the feedback on our prototype is at:
> > www.healthyskepticism.org/editions/2003/8.asp
> > and the "new improved" AdWatch on Nexium is at:
> > www.healthyskepticism.org/adwatch.asp
> >
> > We have been collecting more feedback and will be ready to
> > commence formal
> > dialogue with your company soon.  We would prefer to
> > correspond with your
> > CEO, Tom McKillop so I would appreciate your advice on how
> > best to get in
> > contact with him.
> >
> >
> > regards,
> >
> > Peter
> >
> > Dr Peter R Mansfield
> > GP
> > Director, Healthy Skepticism Inc
> > Improving health by reducing harm from misleading drug promotion.
> > peter@healthyskepticism.org
> > www.healthyskepticism.org
> > 34 Methodist St, Willunga SA 5172 Australia
> > ph/fax +61 8 8557 1040
> > Flinders University Convocation Medal 2003
> >
> > > -----Original Message-----
> > > From: Woods, Paul B [mailto:Paul.Woods@astrazeneca.com]
> > > Sent: Thursday, 24 July 2003 7:24 PM
> > > To: 'peter@healthyskepticism.org'
> > > Subject: RE: Nexium advertisement
> > >
> > >
> > > Peter, Thanks for the copy. I'm travelling again over the
> > > next couple of
> > > weeks (promotional standards training in India this time) but
> > > will try to
> > > keep in touch with the issue.
> > >
> > > regards
> > >
> > > Paul
> > >
> > > -----Original Message-----
> > > From: Peter R Mansfield [mailto:peter@healthyskepticism.org]
> > > Sent: 24 July 2003 08:26
> > > To: Bull, Mike AU
> > > Cc: Woods, Paul B
> > > Subject: RE: Nexium advertisement
> > >
> > >
> > > Mr Bull,
> > >
> > > Thank you for your concise message.
> > >
> > > Your message raises some questions.
> > >
> > > 1. When was that particular advertisement last used?
> > >
> > > 2. Why have you stopped using it?
> > >
> > > 3. Are you aware that there are 2 advertisements containing
> > > some of the same
> > > claims in Medical Observer 25 July 2003 (dated for tomorrow
> > > but arrived here
> > > today)?
> > >
> > > 4. Do you have any disagreement with any part of our AdWatch
> > > on Nexium?
> > >
> > > 5. Would you like to see the feedback we have received about
> > > AdWatch on
> > > Nexium?
> > >
> > > 6. Can you give us any reason for not reporting your
> current Nexium
> > > advertising to the Medicines Australia Code of Conduct Committee?
> > >
> > > 7. What do you think of the following?
> > >
> > > Barlow J, Mxller C. A complaint is a gift. Using customer
> > > feedback as a
> > > strategic tool. Berrett-Koehler Publishers. San Francisco 1996
> > >
> > > The introduction to the first part of the book is as follows:
> > >
> > > "When customers feel dissatisfied with products and services,
> > > they have two
> > > options: they can say something or they can walk away. If
> > > they walk away,
> > > they give organizations virtually no opportunity to fix their
> > > dissatisfaction. Complaining customers are still talking with
> > > us, giving us
> > > an opportunity to return them to a state of satisfaction so
> > > they will be
> > > more likely to buy from us again. So as much as we might not
> > > like to receive
> > > negative feedback, customers who complain are giving us a gift.
> > >
> > > If we shift our perspective in this way to see complaints as
> > > gifts, we can
> > > more readily use the information the complaints generate to
> > > grow our own
> > > businesses. Customer complaints are one of the most
> > available and yet
> > > underutilized sources of consumer and market information; as
> > > such, they can
> > > become the foundation for a company's quality and service
> > > recovery programs.
> > > This is no small gift!
> > >
> > > In order to better understand complaining customers, Part 1
> > > of this book
> > > examines the behavior and desires of dissatisfied customers. With
> > > understanding comes acceptance. We must welcome these
> > > complaining customers
> > > and make them want to come to us with their feedback."
> > >
> > >
> > > regards,
> > >
> > > Peter
> > >
> > > Dr Peter R Mansfield
> > > GP
> > > Director, Healthy Skepticism Inc
> > > Improving health by reducing harm from misleading drug promotion.
> > > peter@healthyskepticism.org
> > > www.healthyskepticism.org
> > > 34 Methodist St, Willunga SA 5172 Australia
> > > ph/fax +61 8 8557 1040
> > >
> > >
> > >
> > >
> > >
> > > > -----Original Message-----
> > > > From: Mike.J.Bull@astrazeneca.com
> > [mailto:Mike.J.Bull@astrazeneca.com]
> > > Sent: Thursday, 24 July 2003 10:45 AM
> > > To: peter@healthyskepticism.org
> > > Subject: Nexium advertisement
> > >
> > >
> > > Dear Dr Mansfield,
> > >
> > > With regard the Adwatch critique of a medical journal
> > > advertisement
> > > for Nexium, AstraZeneca stands by all the claims made in this
> > > advertisement.
> > > Each of the claims made are clearly referenced to an
> > > appropriate publication
> > > and these references are fully cited within the body of the
> > > advertisement.
> > > While this particular advertisement has not been used for
> > > some time, the
> > > claims made are accurate, balanced, and correct.
> > >
> > >
> > > Your sincerely
> > >
> > >
> > > Mike Bull
> > >
> > > Director, Sales and Marketing
> > > Primary Care
> > > AstraZeneca Pty Ltd
> > >
> > > ph: 612 9978 3632
> > > fax:612 9978 3740
> > >
> > >
> > >
> >
> >
> >
> >
> >
>
>