Novo Nordisk (Finally) Faces Some Consequences for Their Deceptive Marketing Tactics - Part 1

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If you have read this newsletter for any period of time, you’ve read my accounts of how pharmaceutical company Novo Nordisk has been using extremely shady marketing practices (many taken from the playbook that Purdue Pharma used to push oxycontin) to promote their drugs for weight loss. Things like

Putting doctors on their payroll to promote their drugs to the media without disclosing their ties to the Novo

Creating astroturf organizations that claim to be advocacy groups for higher-weight people but are, in fact, funded by Novo and other pharma and weight loss surgery groups.

Marketing their drug through Grand Rounds presentations

Creating PSAs and Sponsored Content using people who (you can’t make this stuff up) play doctors on TV

Co-opting the concept and language of anti-weight-stigma activists in order to sell their weight loss drugs

And I’m far from the only person talking about this.

Mikey Mercedes has publicly called this out. 

Louise Adams from Untrapped has been all over it  (I had the chance to join Louise Adams and Fiona Willer on Louise’s Podcast All Fired Up to talk about this)

Asher Larmie, The Fat Doctor, has also been talking about this

And there are plenty of others.

Part of the issue is that in the United States pharma companies are allowed to market direct-to-consumers , and the rules and regulations that exist are often loosely enforced. That’s why I was thrilled to learn that The Association of the British Pharmaceutical Industry (ABPI,) a trade association that works in England, Scotland, Wales, and Northern Ireland in partnership with the government and the NHS on behalf of their members, had suspended Novo Nordisk for being in breach of the ABPI code of practice.

Interestingly, just a month ago, the president of ABPI was Novo Nordisk UK General Manager and Corporate Vice-President Pinder Sahota. Sahota stepped down from the board in February “to avoid an ongoing process around a Novo Nordisk ABPI Code of Practice breach becoming a distraction from the vital work of the ABPI.”

The complaint was made to The Prescription Medicines Code of Practice Authority (PMCPA) which is “the self-regulatory body which administers the Association of the British Pharmaceutical Industry (ABPI) Code of Practice for the Pharmaceutical Industry, independently of the ABPI. It was established by the ABPI on 1 January 1993.”

The complaint centers around a LinkedIn post offering practitioners a free “weight management” course. The only “weight management” treatment covered in the course was GLP1-RA drugs. Novo Nordisk was, at the time, the only company selling these drugs. The course was “sponsored” (paid for) by Novo Nordisk, but that was not clear in the LinkedIn Ad.

Not only did this “course” offer information, but they also offered a free Patient Group Direction (PGD). Per the NHS a PGD is  

“a written instruction for the sale, supply and/or administration of medicines to groups of patients who may or may not be individually identified before presentation for treatment. May or may not be identified means an individual can either be known to the service/have an appointment (e.g. a baby immunisation clinic) or not be known in advance of presenting at a service (e.g. a walk in centre).

PGDs are not a form of prescribing. PGDs allow health care professionals specified within the legislation to supply and/or administer a medicine directly to a patient with an identified clinical condition without the need for a prescription or an instruction from a prescriber. The health care professional working within the PGD is responsible for assessing that the patient fits the criteria set out in the PGD.”

The complainant pointed out that the PGD was part of what was being offered to individual health professionals by Novo Nordisk, that it had a value, and that it was being given to individuals for their own personal benefit to run private clinics. The complainant suggested that this amounted to bribing health professionals with “an inducement to prescribe.”

The complainant noted that on the website the course had been run several times, so it was likely that a large number of health professionals had received this offer.

The ABPI review panel found that the training was provided by a third party, but attendees and PGDs were sponsored by Novo Nordisk. The training mentioned three drugs, the first two (orlistat and naltrexone/bupropion) were presented as having significant side effects and contraindications, while the third drug, Novo’s Saxenda, did not include side effect information (though they are significant) and the training noted that Saxenda could be provided by an appropriate health professional with a valid PGD (which was provided by the course.)

The training included 21 slides about Saxenda, but no such detail on the other two drugs.

Sponsorship of third party trainings by drug companies are permissible by APBI “only if there had been a strictly arm’s length arrangement with no input by the company and no use by the company.” In this case, the agreement between the training provider and Novo stated that “Novo Nordisk will be in attendance at training meetings and will be given delegates to follow up” and the panel found that “Novo Nordisk had reviewed the training materials used on the course for medical and factual accuracy.”

The panel concluded that “the course (webinar and e-learning) was, in effect, promotional material for Saxenda for which Novo Nordisk was responsible”

The Panel found that “the webinar, in effect, promoted Saxenda which Novo Nordisk was responsible for, and considered that Novo Nordisk’s involvement in relation to such promotion, including that its medicine would be discussed in detail, was not made sufficiently clear at the outset. Therefore, a breach of the Code was ruled. Novo Nordisk’s appeal on this point was unsuccessful.”

The contract between Novo and the third party was signed in February 2020, with the intention that 13,000 professionals be trained over 2 years, each of whom were to be provided a PGD making Novo Nordisk’s maximum contract £357,500 (about $455,578 USD). As of July 1, 2021, 4,399 health professionals had completed the training and 599 PGDs had been activated.

The Panel found that “the provision of funding by Novo Nordisk for the PGD was clearly linked to the promotion of Saxenda; the Panel did not consider there could be any intention other than to directly increase the use of Saxenda. Furthermore, the Panel noted that the cost of the provision of the PGD to prescribe Saxenda was given to individual health professionals. Such funding to individual health professionals did not meet the requirements of the Code and was an inducement to prescribe, supply, administer and/or recommend Saxenda and the Panel therefore ruled a breach of the Code. Novo Nordisk’s appeal on this point was unsuccessful.”

“The Panel considered that the arrangements between Novo Nordisk and the training provider, particularly in relation to the PGD, brought discredit upon, and reduced confidence in, the pharmaceutical industry. A breach of Clause 2 was ruled. Novo Nordisk’s appeal on this point was unsuccessful.”

Novo Nordisk’s decided to appeal on the basis that they didn’t know it was a breach. This backfired spectacularly.

The Appeal Board was “very concerned that Novo Nordisk did not recognise that this was a large-scale Saxenda promotional campaign which Novo Nordisk knowingly paid for and which was disguised. In the Appeal Board’s view the gravity of the breaches was compounded by Novo Nordisk’s failures to recognise that its own behaviour was not compliant with the Code…The Appeal Board was concerned about the potential impact on patient safety of providing unbalanced information to a wide audience, particularly given that the arena of weight loss was a highly emotional arena, and particularly given the lack of balance of Saxenda’s safety profile and side effects when comparing it with its competitors.”

The Appeal Board decided to publicly reprimand Novo Nordisk for “its failings and the potential impact on patient safety.” They also ordered an audit and decided that “the circumstances were so egregious that a report to the ABPI Board was the only appropriate course of action.”

The ABPI Board unanimously decided that further action must be taken, and while they chose not to expel Novo outright, they noted that this option could be exercised at a later date. While a majority wanted to immediately suspend Novo Nordisk’s membership, they didn’t reach a 75% threshold and so decided to conduct an audit.

Subsequent to that audit they determined that Novo Nordisk’s actions were ““likely to bring discredit on, or reduce confidence in, the pharmaceutical industry” and suspended them for two years, with reinstatement pending a future audit.

In Part 2 we’ll talk about some investigative journalism that caught Novo Nordisk in more shady marketing practices.

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More research and resources:
https://haeshealthsheets.com/resources/

*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrison Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.