Wednesday, April 18, 2012

The Ethics of Converting Allergy Slacker Moms

There's a video that's moving like wildfire today through the various local advocacy groups. (Note: as of 4/20, it's been taken off Facebook/Youtube so I can no longer link to it here.) It was just released by Mylan Pharmaceutical (formerly Dey), the makers of the EpiPen® autoinjector. In case you can't hear the audio, here's the script:

Slacker Allergy Mom: "Excited for Max's birthday party? Should be pretty awesome."

Adorable Kid: "Yep"

Slacker Allergy Mom: "Even with your peanut allergy and a cake made with who knows what. Because we're prepared - with EpiPen®."

When I first saw this last night, I reacted in the way I've seen 99% of other posters react  with disgust. How dare this mother think she can just give her kid any random cake! Doesn't she understand that an EpiPen® is a BIG DEAL? An automatic hospital trip? Traumatic for the kid and stressful for the parent?

But then I did a little thinking...and a little research. I came across the Indeed profile for the brand manager for the EpiPen® injector*. He states the objective of the new ad series pretty clearly:
Repositioned the EpiPen professional campaign to better capitalize upon an expanded "at risk" indication.
For those of you who don't speak fluent Resume-eeze, this means they're trying to get moms who DON'T currently use an  EpiPen® injector to buy one by making them feel they need one.

So who are these Slacker Allergy Moms they're targeting? Based on their commercials so far, there seem to be two types:

1) Moms who are a little scared about allergies but just not scared enough to get that prescription filled. There are two commercials for these moms, called BUS and CAMPING. Both of these ads target situations where anxiety for mothers is already ratcheted up - that first day of school or camp. (Just to snark here for a minute...does anyone else think that blond, ringletted child and dark-haired mother are genetically improbable?) By associating the EpiPen® injector with that anxiety, they're hoping to tip these mothers over into GETTING THAT SCRIPT FILLED!

2) Moms who don't like the hassle of food allergies. Our SAM in this ad is socially cool. She's definitely not going to want the hassle of taking that kid to the ER after she gives him an EpiPen. So...this commercial is about her convenience. She probably already lets him eat that cake, as long as it passes the simple "does it have peanuts in it?" test, but now she doesn't have to feel guilty about it. Sure, we know he's going to need an ER afterward, but if that gets emphasized up-front she'll never buy that EpiPen® injector in the first place. Better to just bury it in the mumbled warnings all these commercials have to have and emphasize the convenience. It's a magic bullet!

So now that you know what they're doing...what's wrong with it? Is there really any difference between the strategy used to "convert" SAM #1 vs. SAM #2?

Before you decide, you need to understand the size of this under-penetrated market. Here's a great study that shows how parents in the real world deal with allergies. Of 14,677 patients in an HMO (gotta love HMOs for epidemiology!) who received an EpiPen® prescription, only 46% filled the prescription even once. Patients with a food allergy diagnosis and those under age 12 filled them at a higher rate, but the numbers are still nowhere close to 100%. Talk about opportunity to expand market share! the incensed advocates who are out there right now posting and fuming, I have this question: who does this commercial hurt?
  • Mylan makes more money.
  • FAAN's new CEO is a former marketeer for Dey -- they're gonna be fine with it.
  • Slacker Allergy Mom gets an  EpiPen® injector. It may be because she's been emotionally manipulated...she may not understand the need for that hospital trip...but she still orders one
The only people upset about this are the food allergy community members who already buy EpiPen® injectors, and we're not their target market. It may feel wrong to manipulate mothers into buying pens simply for their convenience, but keep in mind that our SAM #2 probably already lets him eat the cake

If scaring allergy moms into compliance is perfectly ethical, why is greeding allergy moms into compliance (their wish for convenience) suddenly not? Doesn't the end of them having an EpiPen® injector in hand justify the means of emotional manipulation? Don't we use emotional manipulation every day on our allergy chat boards for the same purpose? 

Leave me a comment if you're thrilled by the first example but horrified by the second. 

*Removing his name and profile link as of 4/24...don't want to Google-bomb the poor guy forever!

Follow me on Facebook for updates! 


  1. Interesting perspective and I think it's a good point of view. What I worry about, however, is people who don;t deal with food allergies who see this ad. It can make it a lot more difficult to get some people to take allergies seriously. I can see the host at the next birthday party we attend insisting my daughter have a piece of cake because, after all, we have an epipen. (also, since you mentioned it, blonde is a recessive trait so it is very possible to have a dark-haired mom with a blonde daughter; The father may have blonde, curly hair. Also, why must we assume that mom and child are genetically related?)

  2. Hey, I said the comment about mom/daughter was snarky! (Here's another snarky comment: they made sure to include the return trip to underline the fact that she did indeed come home...thanks to the EpiPen.)

    This comes down to a very utilitarian assessment: is the good of getting mothers (especially the casual ones) to carry an EpiPen more important than the harm this may do to the desired advocacy image of food allergies as life-threatening?

    If 1000 new moms, or 10,000 new moms, start carrying EpiPens as a result of this commercial and one kid is saved, isn't that more important than us having to explain to our family and friends that an EpiPen is *not* a magic bullet?

    It would be nice to think this company could get the message across and not throw their current users under the bus in the process... but maybe they can't. Maybe this is really the only thing that's going to work on these moms.

  3. I suppose time will tell. But personally, I don't think it's going to be effective, and may drive away loyal customers who are already mildly irked by the clunky redesign.

    My big problem with the ad is that it overstates the effectiveness of the device. I think the harm of that outweighs the good of converting a few slacker moms who probably won't renew it once it's expired anyway.

  4. This comment has been removed by the author.

  5. Regarding the ads, I too feel somewhat horrified by the second ad. I think that mostly comes from the fact that I am horrified the kid is going to be served some random cake and from the sense that depicting that situation somehow endorses it or tells the mother that it's OK to eat the cake.

    I do think the ads along the lines of Scenario 2 can misinform another side audience -- people who don't have food allergies or children with food allergies who tend to judge us as overprotective and unreasonable in insisting on bringing food from home for our son and his own separate cupcake for birthday parties, etc.

    Yes, the slacker mom's kid was going to eat the cake anyway, but it is somewhat painful to see the medical establishment further normalizing that behavior by suggesting that preventative avoidance is the just mark of overzealous parenting when all you really need is an Epi in the wings to make everything all right.

    I'm not saying that the ads won't work. Or even that Epi shouldn't run them if they get more parents to carry the pens. But it would be nice if there was another way for them to get there.

  6. Our community is big on saying "even one death from food allergies is too many" and "only epinephrine can save lives." Do we mean it? Do we support the message or support the child, even if it's one child?

    I don't know if the ad will work, but obviously they think so or they wouldn't invest in a national campaign. Perhaps it will fail dismally and take care of itself, although the message will still be out there by that time.

  7. I'm horrified that the stereotypical "don't you have one of those pen-thingies" attitude has just been not only endorsed, but actively promulgated by an agency that really-- no, REALLY-- should know better.

    They are saying to the public "It's okay-- live YOUR way. Epi will fit into that, too." How quaint.

    Epi as "lifestyle drug." Uhhh-- NO? Not and still be used as prescribed. Dey is basically promoting an off-label use.

    The reason? A pair of things crop up again and again in studies of fatalities:

    a) Most of the time, people rationalize NOT doing carrying meds. Hey-- day to day, they're careful, right?? I guess it's good this mom is... uh...cheerfully PLANNING her child's high risk exposure with epinephrine in mind? If Mom is *thinking* about epinephrine, then maybe the message OUGHT to be that epi is for every outing, rather than for "managing higher-than-normal risk," which is already a lethal myth.

    b) teens and young adults take LARGE risks for social reasons. They are already developmentally programmed to think that death can't happen to them. Did they need HELP there? SURE-- take that risk! Why not? You have magic-EPIPEN...when they ~plan~ to do something risky, I mean. (Oy)

    Risk reduction and emergency planning are not a zero sum game in the first place.

    I'm a cynic. I think that there is an overlooked strategy here on the part of Dey/Mylan. If more people managed their allergies like this, odds are pretty good that there will be a LOT more epinephrine autoinjector use, at least short term (which is what corporate profits are about now). Theoretically this drives compliance with physician directives for filling those scripts (good) and also drives risk-taking behaviors and therefore drives reactions (obviously very, very bad). But-- more reactions *does* = more autoinjectors.

    I can see why Dey would be all over it like white on rice. Given that some subset of anaphylactic events are non-recoverable even with timely epinephrine, I'm not sure that is good overall, however.

    That is the part of this which I find very depressing indeed. Dey cares more about sales than about the fact that this marketing gambit just paradoxically increased risks for the people who are going to be lifetime customers. Great-- even more instant experts who know LESS than nothing about my family's daily reality.

    Who, me? Bitter?

    {snark alert}
    I wonder how many epipens I'd need to go enjoy the seafood buffet with some colleagues. They think I'm a real downer-- if only I'd considered carrying epinephrine years ago!! (smacks self in forehead) Oh, and I've always wanted my DD to try that Indian restaurant...

    maybe we'll get a nice glimpse of the local EMS and ER, too! BONUS!

    My 13 yo saw the ad and, uncoached, quickly quipped; "AWESOME! Reckless driving? WHY NOT? That's what we have auto and medical for, right?" I think she saw this one quite clearly. She's just as real, and she's one of the ones being thrown under the bus. Sure, she's just one child. But she's MY child.

    It's just terrific that in addition to (IMO) illegally promoting an off-label use in a prominent TV spot, they're simultaneously making us look like loons. Great. I was starting to have trouble looking QUITE so crazy to others. Gee, thanks, Dey. Glad that my $500 annually to you is being put to such good use.

  8. Interesting utilitarian perspective; does the good of getting more epinephrine out there with parents outweigh any possible negative consequences of poor message the ad presents? Personally, I think they can achieve their objective of selling more EpiPens without offending current customers. With the new e-cue auto-injector expected to be released by competitor once approved, I am sure EpiPen will probably have more ads coming though.

  9. This commercial bothers me on many levels. First of all us Allergy Moms already deal with discrimination and a very nonchalant attitude towards our children and their food allergies. We are viewed as being over protective and ridiculous when we question ingredients and how they are prepared. When we bring our own food we aren't trusting and are surely making our children fearful and full of anxiety. Mothers who aren't already diligent enough to have their children's prescriptions filled are never going to get it. Secondly I don't want someone viewing this making a judgment that they can give a food allergy child something to eat because they have an epi-pen "just in case"! Or a child or teenager thinking that epi-pen is a always going to work. There are cases where it has been too late. I think this is irresponsible marketing!

  10. you think as long as 90% of food allergy moms DON'T carry Epi-Pens (that was Mylan's figure in their release about the commercial) that things will get better for us? Isn't it possible that the *source* of the discrimination and nonchalant attitude you mentioned are these non-compliant parents?

    If you are right and these parents will never be "diligent enough", then frankly we're all screwed. Food allergies will never be taken seriously as long as 90% of mothers of children who have them don't take them seriously. We'll always look like the crazy ones.

    This situation reminds me so much of politics in America right now. It seems like the goal is always "spike their tires" instead of "solve the problem."

    Hooray. We spiked Mylan's commercial. Problem's still there.

  11. I don't think we were trying to spike anyone's tires. At least I wasn't. I objected to misleading information being presented. I worried about a mother watching that commercial and thinking that it's OK to take that level of unnecessary risk and that the EpiPen would magically save the day. That is just not an acceptable message for them to convey. I don't want non-FA moms thinking that and I don't want NEW FA-moms thinking that...I don't want ANYONE thinking that. It was an irresponsible commercial and did not have to exist or be aired. That commercial would have put more lives at risk, than it would have saved. SAMs would have felt reinforced in their reckless behavior and felt "backed up" by their EpiPens and perhaps might have even stepped up their recklessness a notch, for all we know. We don't have to idly by and let everything slide. Sometimes, when safety is at issue, we need to speak up. They can get the attention of the SAMs, without spreading misinformation. Marketing firms get paid to figure out those kinds of things and they can go back to the drawing board.

    As far as solving the problem, perhaps it needs to be a group effort. We non-SAMs need to keep educating others about the need for EpiPens and doctors need to stress the importance of filling the prescriptions. (I was just handed mine and was never told "this can save your child's life"), etc. It can't be all up to Dey, because some may see it as a self-serving message, since they profit from sales. It's tricky for them, because people really do need their EpiPens, but Dey would come off self-serving telling people that, outright.

  12. Oh, I think the food allergy community was definitely out to spike Dey's tires on this commercial. There were congratulations all around when the commercial was pulled. (I was amused to watch all the different groups take credit.)

    I know the "true believers" want advocacy to happen only one way. And, again, my point is that strict adherence to only one script results in many mothers just deciding they don't want to be associated with the crazy women. Education alone - at least the way we're doing it now - is not enough. It may even be the biggest part of the problem, since many advocates have one trick in the bag - *scaring* mothers into compliance.

    What's the definition of crazy? Doing the same thing, over and over, and expecting different results?

  13. I think there are lots of parents/caregivers out there who don't carry epipens, not so much becuase they are slackers, but because their doctor didn't tell them to get one.

    My DD's pediatrician just had his nurse call us with the result of her allergy labs and say "she's allergic to peanuts", and hang up the phone. No couseling was given on how to manage the allergy, no training on what anaphalaxsis is, or how to recognize it, no prescription, no mention to carry benadryl, etc.

    Thankfully I knew better, and got DD a good allergist.

    I can see how the pharm company wanted to get the word out, because there are lots of folks who haven't been warned by their doctor how serious an allergy can be, or how to manage it.

    I agree, however, you don't want to give folks the impression that you don't have to practice strict avoidance, so long as you have that epipen. That's the wrong message.


Note: Only a member of this blog may post a comment.