ChangeWave Research: Obesity and Statins

ChangeWave Research Report:

Latest Survey Results on Obesity and Statins

Overview

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During the week of November 8-11, 2005, we surveyed Alliance healthcare members about general health issues, including obesity and statins. A total of 206healthcare members participated, including 111 doctors.

Bottom Line:The surveyfindings point toa continued increase in the number of obese patients, though at a more moderate rate of increasethan was found in our February 2005 survey.

With regards to weight control products, slightly more doctors are recommending the current most popular product, Weight Watchers, to their obese patients than in our February survey. But we also note that Slimfast has experienced the biggest momentum increase since February. Not surprisingly, doctors believe that diet programs like Weight Watchers will experience the largest increase in popularity over the next year.

While Xenical and Meridia are still the leadingweight control drugs recommendedby our doctor respondents to their obese patients,Phentermine and Fastin have made gains since our February survey.

Focusing on statins, in asomewhat surprising finding, doctorsappear less in favor of the prophylactic use of statins by patients than they were back in November 2003. Lipitor remains the most prescribed statin, with Zocor coming in a distant second. However, nearly one-in-five doctors say they’ll begin prescribing a generic version of Zocor when it becomes available.

(A) Obesity

  • Increase in Obese Patients. Sixty-four percent (64%) of doctor respondents report an increase in the number of obese patients over the past year (21% “Significant Increase; 43% “Moderate Increase”) – down slightly from our previous survey nine months ago.
  • Top Dietary Interventions. One-in-three doctors (32%) believe Diet Programs likeWeight Watchers will experience the largest increase in popularity over the next year, up 8-points from February 2005.
  • Top Weight Control Products. Weight Watchers (48%; up 4-points) remains the number one weight control product doctors recommend to obese patients, but Slimfast (23%; up 10-points) has experienced the biggest momentum increase.
  • Top Weight Control Drugs. Xenical (21%; down 8-points) and Meridia (15%; down 4-points) are still the top weight control drugs doctor respondents recommend to obese patients. But notably, Phentermine (10%; up 4-points) and Fastin (9%; up 5-points) have experienced the largest increases since February.
  • Gastric Bypass vs. Gastric Belts. In a reversal from February, 29% of doctors now see the gastric bypass surgery market growing slower than the gastric banding market. Only17% see gastric bypass growing faster.
  • Obesity-Related Illnesses. Not surprisingly, Diabetes (60%) is seen as the illness most commonly related to obesity, followed by Hypertension (22%).

(B) Statins

  • Current Statin Use. Overall, doctors reportthat approximately 20% of the patients in their practice currently take a statin.
  • Prophylactic Use of Statins. Overall, doctors think that a smaller percentage of patients are currently using statins for prophylactic reasons (as opposed to therapeutic reasons) than they did back in November 2003. Moreover, doctor attitudes regarding the prophylactic use of statins have changed over the past two years – with only 43% now believing statins should be used prophylactically, as opposed to 57% in 2003.
  • Lipitor is Most Prescribed Statin. Doctors say Lipitor (54%) is the statin prescribed most by their practice/clinical environment. The most common reasons cited for Lipitor were its efficacy, minimal side effects and supporting clinical data.
  • Zocor Patent Expiration. Zocor (13%) came in a distant second in terms of being the most prescribed statin. But an additional 9% of doctors have recently begun prescribing it to new patients, and 18% say they’ll begin prescribing generic Zocor when it becomes available.

Summary of Key Findings

The ChangeWave Alliance is a group of 6,000 highly qualified business, technology, and medical professionals in leading companies of select industries—credentialed professionals who spend their everyday lives working on the frontline of technological change. ChangeWave surveys its Alliance members on a range of business and investment research and intelligence topics, collects feedback from them electronically, and converts the information into proprietary quantitative and qualitative reports.

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Table of Contents

Summary of Key Findings...... 2

The Findings...... 4

(A) Obesity...... 4

(B) Statins...... 7

ChangeWave Research Methodology...... 13

About ChangeWave Research...... 14

I. The Findings

Introduction

During the week of November 8-11, 2005 we surveyed Alliance healthcare members about general health issues, including obesity and statins.

Total Respondents (n = 206)

Doctor Respondents (n = 111)

(A) Obesity

(1) Question Asked: Within your practice or institution, have you seen an increase in the number of Obese patients, a decrease, or has the number of Obese patients remained the same over the past year?

Doctors Current Survey
Nov ‘05 / Doctors Previous Survey Feb ‘05
Significant Increase in Obese Patients (More Than 10% Increase) / 21% / 27%
Moderate Increase in Obese Patients (1%-10% Increase) / 43% / 48%
Decrease in Obese Patients / 2% / 2%
No Change in the Number of Obese Patients / 26% / 19%
Don't Know / 3% / 2%

Increase in Obese Patients. Sixty-four percent (64%) of doctor respondents report an increase in the number of obese patients over the past year (21% “Significant Increase; 43% “Moderate Increase”) – down slightly from our previous survey nine months ago.

(2) Question Asked: What percentage of your practice or clinic's Obese patient population would you estimate are currently receiving medications and/or other treatments for Obesity, or have undergone surgery for Obesity?

Doctors Current Survey
Nov ‘05 / Doctors Previous Survey Feb ‘05
1-10% / 53% / 42%
11%-25% / 24% / 24%
26%-50% / 5% / 7%
Greater than 50% / 2% / 6%
Don't Know / 13% / 14%
Not Applicable / 4% / 7%

*Current Survey:Consensus Estimate = 12%

Previous Survey:Consensus Estimate = 17%

*Note: Consensus Estimate represents the weighted average of respondents.

(3) Question Asked: Over the next year, which of the following dietary interventions do you think will experience the largest increase in popularity among Obese patients and recommending physicians? (Choose No More Than Two)

Doctors Current Survey
Nov ‘05 / Doctors Previous Survey Feb ‘05
A Diet Program (e.g. Weight Watchers) / 32% / 24%
A Diet Emphasizing a Reduction in Calories / 31% / 44%
Any Diet the Patient has Used Successfully in the Past / 23% / 10%
A Diet Emphasizing a Reduction in Carbohydrates / 21% / 26%
A Diet Emphasizing a Reduction in Fat Intake / 13% / 17%
A Diet Emphasizing a Radical Reduction in Calories (i.e., 1100-1200 Total Calories Per Day) / 7% / 8%
A Diet Emphasizing Supplements (Slimfast, Medifast) / 7% / 12%
Don't Know / 16% / 15%
Other / 4% / 6%

Top Dietary Interventions. One-in-three doctors (32%) believe Diet Programs likeWeight Watchers will experience the largest increase in popularity over the next year, up 8-points from February 2005.

(4) Question Asked: Which of the following OTC supplements or weight control products does your practice or clinic recommend to Obese patients? (Check All That Apply)

Doctors Current Survey
Nov ‘05 / Doctors Previous Survey Feb ‘05
Weight Watchers / 48% / 44%
Other Weight Loss Programs (i.e Jenny Craig) / 28% / 26%
SlimFast / 23% / 13%
Fat Absorption Blockers / 10% / 17%
Medifast / 9% / 14%
Appetite Suppressants (e.g., Xenadrine, Dexatrim) / 7% / 8%
Other Diet Supplements (e.g. Cortisol, Acutrim Natural, Twinlab Diet Fuel) / 6% / 4%
Ephedrine Based Products / 0% / 0%
Don't Know / 17% / 14%
Other / 16% / 15%

Top Weight Control Products. Weight Watchers (48%; up 4-points) remains the number one weight control product doctors recommend to obese patients, but Slimfast (23%; up 10-points) has experienced the biggest momentum increase.

(5) Question Asked: Which of the following pharmaceuticals for weight control does your practice or clinic recommend to obese patients? (Note: If you prescribe the generic form, please check the brand name.) (Check All That Apply)

Doctors Current Survey
Nov ‘05 / Doctors Previous Survey Feb ‘05
Xenical / 21% / 29%
Meridia / 15% / 19%
Phentermine / 10% / 6%
Fastin / 9% / 4%
Ionamin / 6% / 4%
Adipex / 5% / 6%
Tenuate / 5% / 5%
Bontril / 3% / 5%
Didrex / 1% / 1%
Don't Know / 31% / 30%
Other / 14% / 18%

Top Weight Control Drugs. Xenical (21%; down 8-points) and Meridia (15%; down 4-points) are still the top weight control drugs doctor respondents recommend to obese patients. But notably, Phentermine (10%; up 4-points) and Fastin (9%; up 5-points) have experienced the largest increases since February.

(6) Question Asked: Gastric Bypass surgery and Adjustable Gastric Banding (gastric belt) surgery are both used to reduce the ability of patients to consume food. Which of the following statements best reflects your opinion on the relative market growth of these two procedures?

Doctors Current Survey
Nov ‘05 / Doctors Previous Survey Feb ‘05
The market for gastric bypass surgery is growing faster than the market for adjustable gastric banding (gastric belt) surgery / 17% / 29%
The market for gastric bypass surgery is growing slower than the market for adjustable gastric banding (gastric belt) surgery / 29% / 24%
The market for gastric bypass surgery is growing the same as the market for adjustable gastric banding (gastric belt) surgery / 12% / 13%
Don't Know/ No Answer / 43% / 35%

Gastric Bypass vs. Gastric Belts. In a reversal from February, 29% of doctors now see the gastric bypass surgery market growing slower than the gastric banding market. Only 17% see gastric bypass growing faster.

(7) Question Asked: What would you say is the most common related illness you see in obese or morbidly obese patients?

Doctors
Diabetes / 60%
Hypertension / 22%
Cardiac Disease / 6%
Arthritis / 5%
Depression / 2%
Stroke / 0%
Cancer / 0%
Other / 4%
No Answer / 1%

Obesity-Related Illnesses. Not surprisingly, Diabetes (60%) is seen as the illness most commonly related to obesity, followed by Hypertension (22%).

(B) Statins

(1A) Question Asked: Overall, what percentage of patients in your practice/clinical environment currently takes a statin?

Doctors
Less Than 5% / 5%
5% - 10% / 24%
11% - 25% / 41%
26% - 50% / 11%
More than 50% / 5%
Don't Know/ No Answer / 13%

Consensus Estimate = 20%

Current Statin Use. Overall, doctors reportthat approximately 20% of the patients in their practice currently take a statin.

(1B) Question Asked: What percentage of patients do you think are currently using a statin for prophylactic rather than therapeutic reasons?

Doctors Current Survey
Nov ‘05 / Doctors Previous Survey Nov ‘03
Less Than 5% / 41% / 24%
5% - 10% / 20% / 31%
11% - 25% / 11% / 22%
26% - 50% / 3% / 6%
More than 50% / 8% / 8%
Don't Know/ No Answer / 17% / 8%

(1C) Question Asked: Do you believe statins should be used prophylactically?

Doctors Current Survey
Nov ‘05 / Doctors Previous Survey Nov ‘03
Yes / 43% / 57%
No / 41% / 29%
Don't Know/ No Answer / 17% / 14%

Prophylactic Use of Statins. Overall, doctors think that a smaller percentage of patients are currently using statins for prophylactic reasons (as opposed to therapeutic reasons) than they did back in November 2003. Moreover, doctor attitudes regarding the prophylactic use of statins have changed over the past two years – with only 43% now believing statins should be used prophylactically, as opposed to 57% in 2003.

(2) Question Asked: Overall, what statin would you say is prescribed the most by your practice/clinical environment?

Doctors
Lipitor / 54%
Zocor / 13%
Crestor / 8%
Mevacor / 2%
Lescol / 1%
Pravachol / 1%
Other / 1%
Don't Know / 5%
No Answer/Not Applicable / 15%

Lipitor is Most Prescribed Statin. Doctors say Lipitor (54%) is the statin prescribed most by their practice/clinical environment. The most common reasons cited for Lipitor were its efficacy, minimal side effects and supporting clinical data.

(2A) Question Asked: Why?

(a) Lipitor (54%)

  • Doctor STE3218 writes, “Profile of drug, probably slightly better marketed.”
  • Doctor WJH7828 writes, “Perception of being most effective with greatest experience.”
  • Doctor SIL8037 writes, “Most potent and effect on HDL/LDL.”
  • Doctor MTA6607 writes, “Most effective & least side effects.”
  • Doctor POR7751 writes, “Most clinical experience and along with Crestor most impressive results obtained.”
  • Doctor VIR43893 writes, “More frequent visits by the drug rep to the office with adequate sampling. Also the product is very effective.”
  • Doctor TDA3174 writes, “More effective with less side effects. Crestor is slightly more effective, but has more side effects in my experience.”
  • Doctor BTB1963 writes, “Leastside effects- muscle aches, etc- for % reduction in cholesterol.”
  • Doctor ALA7205 writes, “It has the best profile for efficacy.”
  • Doctor MIC25389 writes, “Ironically, because patients demand it-not because it is the best. This is the power of direct to consumer advertising on TV.”
  • Doctor H_H8615 writes, “Good results with more difficult lipid problems.”
  • Doctor 8486810 writes, “Efficacy and safety.”
  • Doctor LRH24714 writes, “Effective against hypertriglyceridemia as well as LDL elevation. Low frequency of pathological muscle disease and other side effects.”
  • Doctor WSU8151 writes, “Best track record.”
  • Doctor RTC42911 writes, “Best data from large trials to support its use.”
  • Doctor JON43812 writes, “Best cost/effectiveness combination.”
  • DHA7570 writes, ”Covered by most insurance in standard formulary.”
  • P2P3810 writes, ”Lipitor is the path with least resistance both clinically and administratively. 1) ATPIII guidelines are getting more stringent and therefore, physicians are held more liable to bring LDL down. 2) Prove-it study clearly shows Lipitor has clinical superiority and relatively cleaner drug profile. 3) Lipitor is covered by most health care plans so when physicians prescribe Lipitor, the chance of getting rejected is minimal. Zocor generic is going to have dramatic change to the current statin market, including Lipitor market share.”
  • NIT31970 writes, ”Marketing, familiarity, can dose in morning versus evening or bedtime as required by others in class.”
  • PGO46357 writes, ”Most direct-to-consumer advertising.”
  • RXT42222 writes, ”Most effective at lowering ldl.”

(b)Zocor (13%)

  • Doctor HAN48720 writes, “Long experience. Shorter half-life than Lipitor. Available in Vytorin with Zetia.“
  • Doctor MRA46388 writes, “Familiarity and price.”
  • Doctor DR.8915 writes, “Anecdotal success. Few side effects. Familiar with biochemistry and studies.”
  • LEX0170 writes, ”It is still the mainstream prescription practice. All others are me too drug.”
  • PBH24530 writes, ”Sales reps better looking,feed them better,give them better trips.”
  • 08J44762 writes, ”Special contract pricing from MRK.”
  • FFR2565 writes, ”Therapeutic substitution policy.”

(c)Crestor (8%)

  • Doctor ZEB4159 writes, “Only Lipitor and Crestor can raise the HDL and lower LDL's, the rest lower both. You do not want to lower HDL's. Of the 2, crestor gets much more bang for your buck and IS equally safe as Lipitordespite media hype.”
  • Doctor VDS1474 writes, “It is the most active of all statins; more patients reach goal than with other statins.”
  • Doctor RJR3451 writes, “It is not explained as a biograph to potential users.”
  • Doctor SSI32377 writes, “Efficacy.”
  • Doctor DOC46346 writes, “Effective as it is a potent cholesterol reducing agent.”
  • Doctor WPW6938 writes, “Better efficacy in reducing total cholesterol and triglycerides with good safety profile at normal doses.”

(d)Mevacor (3%)

  • REG43636 writes, “Actually Mevacor and Zocor usage are about same at ourinstitution, due to cost factor (are in our formulary).”
  • ELW4764 writes, “Effective History Price.”

(e)Lescol (1%)

  • Doctor GHM8270 writes, “Cost and formulary requirements.”
  • BBO43468 writes, “It seems to work most effectively.”

(f)Other (1%)

  • Doctor LEO7024 writes, “Vytorin, suppresses cholesterol absorption as well as the hepatic effect.”
  • SAS0831 writes, "Zetia, combination therapy that is more effective than statin alone.”

(3) Question Asked: The patent for Zocor is set to expire in mid-2006. What effect – if any – will this have on how you or other members of your practice write prescriptions for statins in 2006?

Doctors
We already prescribe Zocor to new patients who require a statin / 14%
In anticipation of a generic Zocor, we recently began prescribing Zocor to new patients who require a statin / 9%
We will wait until generic Zocor becomes available, and then begin prescribing it to new patients who require a statin / 18%
The availability of generic Zocor will have no impact on what is prescribed to new patients who require a statin / 16%
Don't Know / 9%
No Answer/Not Applicable / 28%
Other / 6%

Zocor Patent Expiration. Zocor (13%) came in a distant second in terms of being the most prescribed statin. But an additional 9% of doctors have recently begun prescribing it to new patients, and 18% say they’ll begin prescribing generic Zocor when it becomes available.

(4) Question Asked: Have any insurance companies/payors contacted you or your practice about prescribing Zocor to new patients who require a statin?

Doctors Current Survey
Nov ‘05
Yes / 12%
No / 60%
Don't Know / 8%
No Answer/Not Applicable / 20%

Influence From Insurance Companies. Twelve percent of doctors (12%) say insurance companies have contacted them about prescribing Zocor to new patients requiring a statin.

II. ChangeWave Research Methodology

This report presents the findings of a recent ChangeWave Alliance survey on general health issues, including obesity and statins. The survey was conducted fromNovember8-11, 2005 and a total of 206Alliancehealthcare members participated, including 111 doctors.

The Alliance’s proprietary research and business intelligence gathering system is based upon the systematic gathering of valuable business and investment information directly over the Internet from accredited members.

ChangeWave surveys its Alliance members on a range of business and investment research and intelligence topics, collects feedback from them electronically, interprets and reconciles the information in a cohesive manner and converts the information into valuable quantitative and qualitative reports.

The Alliance has assembled its membership team from senior technology and business executives in leading companies of select industries. Nearly 3 out of every 5 members (58%) have advanced degrees (e.g., Master’s or Ph.D.) and 94% have at least a four-year bachelor’s degree.

The business and investment intelligence provided by the Alliance provides a real-time view of companies, technologies and business trends in key market sectors, along with an in-depth perspective of the macro economy – well in advance of other available sources.

III. About ChangeWave Research

ChangeWave Research, a subsidiary of Phillips Investment Resources, LLC, identifies and quantifies "change" in industries and companies through surveying a network of thousands of business executives and professionals working in more than 20 industries.

ChangeWave has a very unique asset in its 6,000-member Alliance. We have assembled our membership team from a broad cross section of more than 20 vertical markets such as telecom, semiconductors, data storage, and biotechnology, along with a wide range of professional disciplines including CIOs, IT managers and programmers, executive management, scientists, engineers and sales personnel.