What Lilly Learned From Steak n Shake: A Q&A on Cymbalta

Eli Lilly's Cymbalta is fast adding indications. Today the company announced the results of a trial to see if the drug can be used for back pain and last week it was approved in Europe for generalized anxiety disorder.

Its wide variety of uses -- Cymbalta is also indicated for fibromylagia, depression, incontinence and diabetic nerve pain -- have made the drug a commercial success. It recorded $1.2 billion in sales for the first six months of 2008, a 31 percent increase on last year.

But its widespread use and equally widespread indication list have also been a source of controversy. The Indianapolis Star called Cymbalta the "Swiss Army Knife of drugs," and suggested that perhaps it was over-prescribed:

"I think the question is, should one drug compound do so much?" said Shannon Brownlee, author of "Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer -- This is a drug that may have a really serious side effect called suicide -- Don't we have other drugs available that are safer and just as effective for such things as the management of chronic knee and low back pain?"
Bloggers who write about depression -- there's a huge number of them -- have listed wild stories of Cymbalta's side effects and withdrawal symptoms, including hallucinations and loss of sex drive. Check out this thread from Furious Seasons, and the dozens of comments from users that it drew.

In a story I wrote for today's Brandweek, I noted the difficulties in doing mass consumer marketing for Cymbalta without confusing consumers as to what the drug actually treats. I was struck by how the marketing challenge is essentially similar to a supermarket-packaged-goods brand extension: The company has to convince consumers that a brand used for one thing is also good for another, just like Jack Daniels is now a brand of both bourbon and mustard. In fact, the drug business becomes more and more like the consumer goods business with every passing year. Check out the sites for Lipitor and Ambien CR. Ambien is offering a $100 discount on prescriptions, while Lipitor has a whole hard-sell anti-generics section titled, "There is no generic form of Lipitor."

It turns out that Lilly has been learning lessons from the supermarket business. As Lilly prepares to extend Cymbalta's marketing into all its varied indications, they're considering whether "Cymbalta is going to be synonymous with something the way Febreze is synonymous with freshness," one exec at their interactive marketing agency told me.

I spoke to Jacopo Leonardi, U.S. Cymbalta brand leader at Eli Lilly, for the article, but unfortunately there wasn't much room to quote him at length. So here's a Q&A with him on these issues.

BNET: You have indications for depression, generalized anxiety disorder, diabetic nerve pain and fibromyalgia. How do you advertise all these indications without confusing patients as to what the drug is actually for? Jacopo Leonardi: Currently we only have mass advertising around our depression indication. [Our advertising] puts the patient first. All our research is rooted in deep customer insight. In many cases patients with depression were only having part of their depression managed. They were having painful physical symptoms like fatigue and numbness in the body. For the first time someone was actually addressing them. It really starts with that point in mind.

BNET: Isn't there a risk that patients who have fibromyalgia will feel insulted that they're being given a drug for depression? JL: To the consumers we're trying to speak to it's very clear. We have asked ourselves that exact point. For fibromyalgia patients, oftentimes they have been stigmatized and been told this isn't a real disease, it's all in your head. Cymbalta's mechanism of action is different as a pain drug from its mechanism of action as a depression drug. But it's a challenge.

BNET: Do you have separate marketing teams for each indication, or do you all work on a single team across all indications? JL: We do have one team. Where we separate more by customer type is by healthcare provider. We're not trying to build two different brands. We don't want to create a situation where a primary care physician thinks it's two different brands.

BNET: Nonetheless, you have to now extend your consumer marketing toward different patient groups who have different symptoms than depression. It's a bit like a packaged goods brand extension. Companies like Procter & Gamble have been doing this for years. Do you draw anything from their experience? JL: We absolutely do. P&G is a company we have a tremendous amount of respect for. We've looked at all industries for that big learning. You can't be all things to all people -- in pharmaceuticals it's a bit more complex.

BNET: To that point, you have a U.S. Cymbalta consumer marketing director, Gary Walker, whose previous experience was at P&G and also the burger chain Steak n Shake. JL: He has tremendous experience. The reason we brought a guy like Gary on is because of that experience. [Compared to packaged goods marketers] we're still in our infancy.

BNET: When the media calls Cymbalta the "Swiss Army Knife of drugs," does that hurt or help? JL: Most important to us is we want to put the patient first. We don't want Cymbalta to be used in patients where it doesn't make sense. We're not one size fits all.

(This interview was edited according to the Deborah Solomon rules, described at the bottom of this item.)