Brand Indigestion

"Gut Guy," Xifaxan's infamous intestine-shaped mascot, is disturbing, but it's OK; he's gonna make Valeant Pharmaceuticals a billion dollars this year.

By Ernie Smith

Today in Tedium: Mascots can be great ways to promote a product, but sometimes they're full of crap. The Xifaxan intestine, which I've been going on about for months now, fits into the latter category. Xifaxan, if you're not familiar, is a medication for irritable bowel syndrome. Some marketing company somewhere got paid millions of dollars to create an animated character that runs around ready to lose its … y'know, every time it turns a corner. It's been around for the past few months, but its parent company, Valeant Pharmaceuticals, chose to promote it during the Super Bowl this year, introducing "Gut Guy" to a whole new audience that wasn't ready. To be fair, this is not an easy product to market. But there has to be a better way. Today's issue of Tedium is about pharmaceutical advertising. We're going for the gut. — Ernie @ Tedium

"While brands themselves are intangible concepts, mascots created and adopted by them act as protagonists of brands’ stories and endeavors. Brand mascots start out as being the personification of a brand’s value then make the brand’s personality more explicit through their characters, traits and mannerisms."

— Cardiff University Marketing Lecturer Adriana Campelo, discussing the nature of how companies use mascots to reflect the values of a brand, which include telling its story. So in the case of Xifaxan's Gut Guy, the brand's value is affiliated with the idea that your intestine won't have a similar impulse to Gut Guy if you take this prescription drug. But why use an intestine to make this point? Why not use, I don't know, anything else? Turns out, it's a challenge across the medical industry.

Five medical mascots attempting to put a cute face on gross topics

  1. "All I want is to get under here and live under your nail." — Digger the Dermatophyte, an annoying piece of toenail fungus that made its name by promoting Lamisil. Digger is something of a ground-breaker in the world of pharmaceutical mascots, first appearing way back in 2003.
  2. "It's a mucus family reunion!" — Mr. Mucus, the mascot for the over-the-counter drug Mucinex, taking the snottiest tone possible before the drugs kick in. (He was recently redesigned, by the way, and is now voiced by T.J. Miller.)
  3. “I just checked and I am way more than half full today. It's going to be a great day!” — Petey P. Cup, the mascot for HealthPartners, a healthcare firm in Minnesota. As you might guess by the mascot's name, the firm does drug testing. As you might not have guessed, he has a partner named Pokey the Syringe.
  4. "I'm your prostate—I know urinary issues when I see them!" — Wally, the mascot for Rapaflo, a medication for dealing with enlarged prostates. As pharmaceutical blogger Pharmaguy helpfully points out, Wally looks a heckuva lot like a walnut.
  5. "The worry your pipes might leak means you don't always detour from your route." — The voiceover from a commercial for Vesicare, an overactive bladder medication that promotes its products using pipe-shaped people.


The estimated cost of a single Xifaxan pill, according to GoodRx. A pack of 42 pills, the standard 14-day course of treatment recommended by the Food and Drug Administration, will cost nearly $1,300 from your local pharmacy. The New York Times notes that the drug is expected to become the first Valeant Pharmaceuticals drug to top $1 billion in annual sales, which means there are a lot of Gut Guys running for the restroom.

Xifaxan Gut Guy

How medical advertising became a symptom of pharmaceuticals' high prices

The United States has a few things in common with New Zealand. Both countries used to be British colonies, both countries tend to speak English, and each country has taken a liking to the music of Lorde.

But perhaps the most unusual thing the two countries have in common is that they're the only two countries in the world that allow for direct-to-consumer medical advertising for prescription drugs. And New Zealand, which approved the move in 1981, was something of a trailblazer on the move—the U.S. didn't allow for the same until 1997.

But the decision has always been an uncomfortable one for the medical industry, which associates the rise of direct-to-consumer advertising with the increasing prices of drugs. In fact, the American Medical Association last year voted in favor of a resolution that would recommend banning such ads from the airwaves, claiming that they helped raise the prices of drugs.

“Today’s vote in support of an advertising ban reflects concerns among physicians about the negative impact of commercially-driven promotions, and the role that marketing costs play in fueling escalating drug prices,” the association's board chair, Patrice A. Harris, M.D., said in a statement. “Direct-to-consumer advertising also inflates demand for new and more expensive drugs, even when these drugs may not be appropriate.”

For drug-makers, let's be honest, this advertising works—no matter how ugly the use cases may often be. The average American spends just under $1,000 per year on pharmaceuticals, according to statistics from the Organisation for Economic Co-operation and Development gathered by PBS Newshour.

That level is far above any other developed country—including 40 percent above second-place Canada and more than three times what New Zealand spends. There are a number of reasons for this, including the higher rates of certain diseases in the United States, but some of it is also the fact that brand-name drugs are so expensive.

In fact, those high drug costs lead to the fast rise of generics in the U.S. as soon as they come on the market. After a patent expires, a generic drug quickly takes over the market share.

Which is why drug-makers like Valeant need to flog their cash cows now before their investment fades from view. They can only flog the patent for Xifaxan for so long, and there are a lot of research dollars to recoup, a lot of testing that went into the drug that led to Gut Guy.

Something tells me New Zealand's pharmaceutical ad industry isn't nearly as disturbing as our own.

"[Irritable bowel syndrome is] pretty simple to self-diagnose, so we think that going directly to the patients to make them aware of the treatment for this … will really drive demand."

— J. Michael Pearson, the CEO of Valeant Pharmaceuticals, discussing the strategy that the company used when planning its advertising campaign for Xifaxan. Pearson claimed that the ad would be a supercharged version of the company's 2015 Super Bowl ad for the toenail fungus treatment Jublia. According to one estimate, Valeant had spent more than $20 million on Xifaxan ads just last fall, on top of the $5 million Super Bowl ad. All that money spent on the second-worst-rated Super Bowl ad, according to USA Today … just ahead of another Jublia ad.

One thing you may have missed when you saw all the clips of Martin Shkreli stonewalling a Congressional committee last week was the fact that he wasn't alone in Congress' crosshairs.

Also there was Valeant's interim CEO, Howard Schiller, who attempted to defend the firm's high prices for the generic drugs Isuprel and Nitropress. (Pearson was out of commission due to pneumonia.)

Schiller's argument wasn't nearly as divisive as Shkreli's smirking, but it nonetheless shouldn't be missed.

"When these drugs are priced to reflect more closely their true clinical value, the more accurate price signals incentivize generic competition and innovation," Schiller said, according to Business Insider. "Higher prices draw generic competitors into the market, which in turn tends to put significant downward pressure on prices."

Granted, this argument is in terms of generic drugs rather than brand-name drugs like Xifaxan, but it's still worth pondering this argument in action. So many drugs out there are in the hands of just a few companies, or in the case of patented drugs, one company.

Often, these companies are fighting between a variety of masters, including the massive costs of research and development, the needs of Wall Street, the health of the public, and what consumers are willing to pay for drugs. In this equation, without some form of regulation, the consumer usually loses out—being sold drugs they probably don't need at prices they can't afford.

The scope of some of these drugs blows up the budgets everywhere—advertising, research, mergers—and those costs get paid down to hospitals or medical facilities, and eventually … you.

It's enough to make you sick.

Ernie Smith

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Ernie Smith is the editor of Tedium, and an active internet snarker. Between his many internet side projects, he finds time to hang out with his wife Cat, who's funnier than he is.

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