Gastric bandwagon

Over recent years, television and medical stories reporting on the wonders of lap band surgeries seem to be everywhere. That’s no accident, nor are they actual medical news stories. As today's Wall Street Journal reveals, we’ve been witnessing the largest, slickest marketing ever seen for an elective surgery. It’s being led by two industry giants, medical-device makers and venture capitalists, along with surgeons eager to cash in on the next big thing in commercial medicine.

The WSJ article, “Competitive Squeeze: Industry giants push obesity surgery,” portrays the fierce competition that has pitted Johnson & Johnson, Inc. against Allergan, Inc. JFS readers will probably see a very different story here than readers of medical device publications.

Allergan, Inc., best known for its antiwrinkle drug Botox, acquired Inamed for its portfolio of cosmetic medical devices in 2006. But, said Allergan’s chief executive officer, “we quickly realized the real jewel was Lap-Band.” In November 2006, it began advertising the Lap-Band directly to consumers on television, even though that’s an unusual tactic for a surgical device, according to the WSJ.

The campaign was an immediate success: Within a week, visits to Allergan's Lap-Band Web site had increased nearly fivefold. Sales of Lap-Band and other obesity-intervention devices soared 50% last year to $270 million, making them Allergan's fastest-growing product line.

J&J’s Ethicon Endo-Surgery makes surgical devices and recently got FDA approval to sell its gastric band. J&J’s Ethicon Endo-Surgery has created its own slick website to lure customers by showing them what they can look like in a new wardrobe, let them shop for new clothes, as well as have their progress followed. J&J has also been working on doctors, bringing them in for “weekend training sessions to teach them how to implant the device.” With its “small army of specialized salespeople selling other bariatric surgery supplies and instruments,” J&J is expected to grab a chunk of the market almost immediately, said the WSJ.

Fighting back, Allergan rolled out a new multimillion dollar campaign this month, featuring television spots targeting female watchers of daytime soaps. Allergan also recently signed a co-marketing pact with Covidien, J&J’s largest competitor in the bariatric field, said the WSJ. Covidien’s sales force will be used to scout out general surgeons to interest them in getting into “the banding business.”

The WSJ article itself reads like marketing copy in parts as it uncritically depicts the studies showing the benefits and minimal risks for lap bands. But it reveals what’s been driving the spin on the research that we’ve been hearing: “There's no question that advertising and the commercialization of the band is what's driving it," said Dr. J.K. Champion, an Atlanta bariatric surgeon. Doctors who once dismissed gastric bands as a gimmick, said the WSJ, are now jumping on the “gastric bandwagon.”

Around the country, the television ads bombarding the public aren’t just coming from the makers of the bands, but from growing numbers of for-profit banding centers that are backed by venture capitalists. The reason they’re advertising so vigorously is because “unlike the band makers, physicians and clinics can make advertising claims that aren't subject to the strict rules imposed by the Food and Drug Administration.” They can also use testimonies, like one ad featuring a woman saying: “I’m going to be around much longer for my family.”

According to the director of Cleveland Clinic's bariatric center, people who’ve heard about the bands through advertisements come in regularly. He told the WSJ that the ads exert a powerful influence. “You don't see commercials for gastric bypass,” he said.

True Results clinics in Texas says it has performed more than 11,000 surgeries since 2001. “We basically took the Lasik playbook and ran it for banding,” said founder Peter Gottlieb, referring to the popular eyesight-correction surgery. Band Surgery Centers Inc., in Los Angeles, Las Vegas and Orange, Calif., has a billboard and is running commercials on the "Dr. Phil" and "Oprah Winfrey" television shows.

These new bariatric centers and chains sprouting up around the country are spending “liberally on marketing to lure cash-paying customers,” according to the WSJ. “Banding typically costs $17,000, versus $25,000 for gastric-bypass surgery, though surgeons sometimes charge much more,” it said. Growing numbers of doctors are signing on for this entrepreneural opportunity. “Unlike gastric bypass, gastric banding is a relatively simple procedure, making it easy for surgeons to pick up,” in a weekend. “Now, scores of surgeons across the country are touting weight-loss surgery at free seminars.”

To capture the most patients, these giants have been working hard on changing the minds of insurers’, many of whom “are still reluctant to cover the procedures” due to the unknown efficacy of the procedure. Allergan has employed 100 people devoted to working on insurers and are beginning to see their efforts pay off, said the WSJ:

The federal agency that oversees the Medicare program instituted coverage for bariatric surgery in early 2006. That was followed by a favorable assessment on gastric banding last year from the BlueCross BlueShield Association, whose member health plans look to it for guidance. In September, the federal Tricare program, which provides coverage for 9.2 million active and retired U.S. military personnel, as well as their families, said it would cover gastric banding, retroactive to February 2007.

Allergan is also working to expand Lap-Band applications to younger and lighter patients. It is sponsoring human tests in teens between the ages of 14 and 17 as well as adults who aren't as heavy as most bariatric surgery candidates.

If you’ve been wondering how the actual research on lap bands could differ so much from everything you’ve been hearing, it might be that salesmen often see the facts differently than scientists.