Subjects

Keep abreast of our marketing and media insights about what’s shaping digital pharma, healthcare communications, marketing tech and the future of brand/consumer dynamics.

Subscribe

COVID-19 Impact on Pharma Marketing Strategy & Spend Survey Results

By Robert Kadar

The global pandemic has transformed society and everyday life, directly impacting consumers’ media consumption patterns and preferences, as well as their decision-making process as it relates to healthcare. In-person interactions have sharply declined, for patient-HCP and also salesforce-HCP interactions, forcing pharma companies and their marketing partners to take another approach to communicating product benefits and facilitating prescriptions.

This post first appeared on PM360.

As a leading media strategy, planning, and management agency dedicated to the pharmaceutical and healthcare industry, we wanted to quantify and better understand exactly how the pandemic is impacting our clients, colleagues, and the industry as a whole. We’ve thus created, distributed, then analyzed the results from our own pharma survey.  

We received responses from a wide swath of healthcare industry marketing teams including Theravance, Ixcella, Collidion, DePuy, Isoray, Alk, Flexion Therapeutics, Acorda, BMS, Integra, Vertex, Horizon, EMD Serono, Genentech, Astrazeneca, Amag, JNJ, UCB, Pfizer.. Their brands span product types,  life-cycles and therapeutic areas, including Pulmonology, Oncology, Mental Health, Respiratory,  Neurology, Cardiology, Orthopedics, Immunology and Gastrointestinal, Cystic Fibrosis, Ophthalmology, Rheumatology, Women’s Health, Infectious Disease, and others.

Our survey included questions regarding personal and non-personal promotion, shifting investments, creative tactics, and more. We strove to gain a clear snapshot of our fellow marketer’s mindset and how they are addressing challenges, to learn from other’s expertise, and better understand how we can leverage our own expertise to help. While these are challenging times, we see great opportunity, particularly in the digital realm.

Sales Rep Access

Personal promotion is still the bedrock of pharma marketing, as brands seek to provide 1:1 communication and detailing to key treatment decision makers.

Although sales rep access to physicians has diminished over the last two decades, many HCPs nonetheless state that pharma sales representatives are one of their most-valued ways to learn about treatments and new launches. Many physicians are still eager to see reps: But are reps able to access physicians at the height of a pandemic and physical distancing lockdowns across the country?

We asked pharma brand managers, marketing and communications decisions makers, and other key influencers the question: “How has the pandemic impacted in-person sales rep access?”

  • 63%: “Rep access is near zero at this time” while another
  • 12%: “Rep access is reduced by 25% or more”
  • 10%: “Rep access is reduced by 25%-50%

Write-in comments from survey respondents including statements such as:

  • “We pulled all reps from field 4 weeks ago”
  • “We are doing webinars and video meetings only”
  • “We’re focused on performing virtual calls instead”
  • “Both clinical research and new product evaluations were stopped at seven hospitals across the country two weeks ago. We have zero clinical research or sales activity at this time.”
  • “We only are doing virtual consultations now and they are very limited.”

Implications

What does this historic and unprecedented reduction in sales rep access mean for HCP marketing and sales impact? Does this new reality suggest pharma and healthcare marketing teams should increase their non-personal promotional activity to compensate for the reduction in face-to-face sales calls?

The answer depends on multiple factors, some known and some unknown. The duration and intensity of the state-mandated lockdowns and physical distancing protocols vary, so we cannot be sure when and where most rep visits will commence again. That said, how should teams react now?

Since every treatment and device is different, the optimal media strategy depends on the competitive landscape, lifecycle milestone, distinct target audiences, and other factors. Digital media and NPP does a great job of filling in sales rep white spaces; now these spaces dominate, so opportunities abound. Point of Care Access

Given physical distancing we can assume that much like sales rep visits, patient visits to physician offices have also plummeted. Rather than assume, we wanted to get a better read, so we asked the question: “To what extent have patients reduced their visits to their physicians at the point of care?”

  • 50%: “Down by 50% or more”
  • 13%: “Down by less than 50%”
  • 11.5%: “Patient visits are near zero at this time”

One comments stated: “Inpatient and residential are still near capacity but outpatient is 97% virtual.”

Implications

Not surprisingly, patients advised to stay at home aren’t going to physically see their doctors. This begs the question of alternate means for point of care experiences, which we’ll explore with another questions shared below. It also begs the questions of what marketers should do to fill the vacuum.

We’ll explore that below, also. Suffice to conclude based on these answers that the pharma and healthcare industries aren’t immune to the impact felt from retailers and other industries dependent on physical promixity and social gatherings. With dimished POC visits come diminished Rx, simple as that.

Telehealth Utilization

With in-person patient visits substantially down, does this imply increased use of telehealth through video consults and similar virtual means? Turns out the answer is yes. Consider the answers to our question: “Are you aware of an increase in the number of patients engaging with their HCPs via telehealth, video consults and similar technologies?”

  • 62%: Telehealth engagements have “increased greatly”
  • 19%: Telehealth engagements have “increased somewhat”

Implications

Of all the lasting changes to our healthcare delivery system resulting from this pandemic, we predict this one as most significant. Telehealth technology has been available for many years but has never achieved wide-spread adoption. A recent Bloomberg opinion piece also predicts that the pandemic may be the impetus to transform telehealth into a viable and prevalent alternative to physical point of care visits.

“Medicare, which used to pay a much lower rate for telemedicine when it reimbursed it at all, is now covering a wide range of telemedicine services at the same reimbursement rates as in-person offerings. Private insurers are following, voluntarily or by demand from state regulators. That equal treatment likely won’t continue once the pandemic passes, but it sets a precedent for how to think about telemedicine: It doesn’t have to be a quick, cheap and transient service offered by companies without bricks-and-mortar investments in local clinics. It could also serve as an addition to primary care, especially for patients with chronic conditions — if reimbursement rates reflect clinic overhead.”

Pharma Marketer Impact: Telehealth Video Utilization

Given the reduction in both in-person sales rep and face-to-face patient visits, we were curious to see if pharma marketers were doing anything to encourage patients to use telehealth and video technologies to meet with their physicians and receive prescriptions based upon these remote consults.

Our results confirmed our hunch: that’s exactly what’s occurring now. When we asked the question “Has your company done anything to encourage more telehealth or video consults?”

  • 48%: “Yes”
  • 13%: “No, but we’re planning to”
  • 11% : “No”

Implications

A possible pandemic silver lining is the exponential increase and long-term adoption of telehealth. The challenge for marketers, especially now, is how to encourage its utilization in lieu of POC visits through paid, earned, shared, and owned media opportunities. Our next questions dives into digital media.  

Digital Media Engagement

Our results were no surprise here given the national and unprecedented physical distancing mandates and the work from home new normal. Specifically, we asked: “Have you found engagement with your digital content and/or ads has increased or decreased since the pandemic started?”

  • 31%: “Increased greatly”
  • 25%: “Increased slightly”
  • 15%: “Stayed about the same”
  • 9%: “Decreased greatly” or “Decreased slightly”

Implications

Results suggest that most pharma marketers think that engagement with their digital content has increased since the pandemic lockdowns. Given data that we have seen from Version and other sources, this makes sense considering that overall screen time has also increased with millions of people homebound and often idle. The bad news: Reps and patients can’t physically go to the point of care; the good news: digital marketers might be able to pick up some of the slack with a captive audience.

Such a silver lining amid the chaos presents a unique but challenging opportunity for pharma marketers. Even if our audiences are hungrier for digital content, what kind of content is most impactful, relevant, and actionable given their inability to physically go to the point of care? As we’ve seen telehealth could play a significant role; how are marketers able to incorporate messaging and calls-to-action for this new and disruptive channel? On the NPP side, how can digital not only supplement but temporarily replace sales rep visits and detailing? These are questions that need speedy answers – and action.

Pharma Marketing Investments

The relative level of investment is the surest indicator of pharma marketer commitment. Given all the current disruption, pharma marketing teams are not sitting idly by. When asked “On a scale of 1-10, to what extent has the pandemic altered your existing or near-term marketing and media investment plans? (1= not at all 10 = re-thinking all of our marketing and media plans)” the average response on a scale of 1-10 was an 8. Clearly pharma and healthcare marketing teams are paying attention and adjusting.

Implications

Paradoxically, an unprecedented pandemic that’s diminished time at the point of care for both patients and sales reps is nonetheless encouraging pharma marketing teams to invest more heavily in media than less. The contradiction likely makes sense if viewed through the lens of hidden opportunities in terms of increased screen time from captive audiences, and the unique power of digital technologies.

Increased Investment: HCP vs DTC

But where is most of that increased investment happening? We drilled down further “Which of your audience-focused marketing investments has it impacted more – HCP or Patient/Consumer (DTC)?”

  • 49%: HCP
  • 23%: DTC
  • 12%: “Both equally”

Implications

Disproportionate emphasis on HCP makes sense considering prior spends and success with digital non-personal promotion (NPP) for physicians. As we’ve seen telehealth adoption for patients has increased, but likely not to the point of becoming a comprehensive substitute for actual point of care visits.

Marketing Budgets

Spend is literally the bottom line of pharma marketing commitment to media, so the answer to “How has the pandemic impacted your 2020 marketing and media budget?” reveals the most about what’s on everyone’s mind and their feelings about the quarter ahead:

  • 12%: “Reduced over 50%”
  • 27%: “Reduced 25-50%
  • 27%: “Reduced by less than 25%”
  • 12%: “Increased by 25%” or more

Implications

Budgetary allocations are a business, strategic, and ultimately an intuitive decision. Do you decrease marketing and media outreach to reflect plummeting sales rep and patient visits and therefore reduced sales in the near term — possibly including supply-chain issues that preclude treatments even being available? Or do you increase media spend at least within certain channels knowing that your audiences are spending more time online and in front of their TVs? Is now the time to grow market share, or at the very least build awareness for sales that might not happen for weeks if not months?

 Owned Media Considerations

After we discovered pharma marketer response to investment, budget, and targets, we next turned to specifics around pandemic content and messaging. We asked: “Are you or do you intend to make changes to your website and/or creative to reflect COVID-19 issues?”

  • Nearly 80%: Yes to core website or creative changes
  • 14%: No changes

Implications

Regarding content strategy, an overwhelming majority of pharma marketers are either currently or will soon reach and engage their audiences with COVID-19 related content. Obviously relevant and top of mind, the topic creates immediate interest; how marketers pull that messaging through to retain engagement and trigger a call to action varies based on campaign goals. But clearly the opportunity is ripe to address concerns and tie response opportunities back to corporate and even brand benefits.

Campaign Types: Branded vs Unbranded

We drilled down further to learn if any patterns could be discerned for investment levels by audience and type of campaign: “For the following campaign types, please indicate your most likely disposition to decrease, increase or maintain current spend levels”

Implications

One interesting comment we received in response to this question is: “We are focused on nurturing interest and creating awareness given long sales cycles and recognizing people at home have more time to research and plan.” Depending upon the product or service, this appears to be a very smart, long term response to the pandemic for a brand building perspective.

Content Strategy

Next we wanted to discover pharma marketer attitudes and practices around any pandemic-related changes to content. “Have you changed your ad messaging – i.e. your creative, as a result of the pandemic?”

  • 45%: Changing creative
  • 20%: “Thinking about doing so”
  • 29%: Not changing creative

Implications

The global pandemic has fundamentally transformed our lives and changed our mindsets in the short term and will likely persist for quite some time to come. A majority of pharma marketers revealed that these seismic shifts necessitate changes to content and creative, and have committed their resources to tweaking and in some instances evolving their entire campaigns.  

Pandemic Impact: Open Responses

Finally, we provided the opportunity for all respondents to respond to this open-ended question: “Please share any other ways in which the pandemic is impacting your business or your customers and what you are doing in response”

  • “We launched a new service delivery vehicle and need to overcome objections to online therapy.”
  • The pandemic has “impacted our ability to collect data for clinical trials due to risk of infecting patients during study visits.”
  • (Our goal is to) “Support HCP’s and patients as best we can during this pandemic”.
  • “We need to have a long-term strategy that re-thinks our go-to market model.”
  • “Elective surgeries are all but postponed.”
  • “The level of interaction with HCPs is greatly decreased. As a result we need to be present via digital media.”
  • “We let go of our commercial team.”
  • “Patients and visitors to our laboratory have been stopped. Our reps cannot physically visit HCP offices. They are doing a lot of email, phone calls and video conferencing.”
  • “We are helping customers work from home with special licenses. we are also giving free licenses to people working on COVID.”
  • “Fear of returning to the dental office due to infection concerns.”
  • We need to “focus, resources and funding moving to ICU care area. Protocols/guidance are being rewritten to address COVID-19 patients. Very new focus. Getting questions we’ve never faced even about a product that has been in the market for 10+ years.”
  • We are “Creating a new virtual promotion platform for reps.”

Implications

We are all living in real time through an unprecedented healthcare crisis that impacts every aspects of our lives, the pharma marketing response is varied, complex, and continuously evolving. In general, the survey reveals that sales rep and patient visits to the point of care have plummeted, while media engagement is high and has often increased.

Pharma marketers have responded to this strange set of circumstances with increased investment and often budgets, have created COVID-19 specific creative and messaging, and are doing their best to maintain and even heighten awareness to a captive audience.

How strategy, planning, and commitment will evolve depends to a large extend on the trajectory of the pandemic, but one rule won’t change: The best prepared and most strategic media teams will survive and even flourish throughout this time of crisis and opportunity.  

This survey represents a current, snapshot in time. No doubt if we run this survey again in 3 months, we may receive quite different responses. We appreciate everyone’s participation and again, hope you find some value here. Thank you.

If you would like to discuss how CPM can help adjust your marketing and media investments during this challenging time please provide your contact information below:

1,714 Replies to “COVID-19 Impact on Pharma Marketing Strategy & Spend Survey Results”

  1. Hi, If you’re anything like me, you probably remember someone who helped you along the way.Maybe that person was a mentor, or just someone with a little more knowledge than you, who could guide you in the right direction.Maybe it was an author…Maybe it was a coach…Maybe it was just a friend who really cared…But it’s certainly someone who had a MAJOR influence on your life, your goals, and your career.How would you like to spread that type of influence, but also make some money while helping others the way you were once helped?Win-win, right?Don’t wait another second.Click HERE to get started today!

  2. Hello There. I found your weblog using msn. That is a very neatly written article.
    I will make sure to bookmark it and come back to learn more
    of your useful info. Thank you for the post. I’ll certainly comeback.

    Also visit my web site – CBD for sale

  3. You are so awesome! I don’t think I have read through a single thing like
    this before. So great to find somebody with unique thoughts
    on this subject. Really.. thanks for starting this
    up. This web site is something that is required on the
    internet, someone with a bit of originality!

  4. Hi there, There’s no doubt that your blog might be having browser compatibility problems.

    When I look at your blog in Safari, it looks fine however, if opening in Internet Explorer, it has some overlapping
    issues. I merely wanted to provide you with a quick heads up!
    Besides that, fantastic blog!

  5. After looking over a few of the blog posts on your
    blog, I truly like your technique of writing a blog.

    I saved it to my bookmark site list and will be checking
    back in the near future. Please check out my web site
    as well and tell me what you think.

  6. Hey I know this is off topic but I was wondering if you knew of any widgets I could add to my blog
    that automatically tweet my newest twitter updates.
    I’ve been looking for a plug-in like this for quite some time and was hoping maybe you would
    have some experience with something like this. Please let me know if you
    run into anything. I truly enjoy reading your blog and I look
    forward to your new updates.

  7. Hello There. I found your weblog using msn. This is a very well written article.
    I’ll be sure to bookmark it and return to learn more
    of your helpful information. Thank you for the post.
    I will certainly return.

  8. Hi there would you mind sharing which blog platform you’re working with?
    I’m planning to start my own blog soon but I’m having a difficult
    time choosing between BlogEngine/Wordpress/B2evolution and Drupal.

    The reason I ask is because your layout seems different
    then most blogs and I’m looking for something unique.
    P.S Sorry for getting off-topic but I had to ask!

  9. I’m not that much of a online reader to be honest
    but your sites really nice, keep it up! I’ll go ahead and bookmark
    your website to come back later. Cheers

  10. This design is incredible! You obviously know how to keep a reader entertained.
    Between your wit and your videos, I was almost moved to start my own blog (well,
    almost…HaHa!) Wonderful job. I really loved what you had to say,
    and more than that, how you presented it. Too cool!

  11. Thanks for your marvelous posting! I seriously enjoyed reading it,
    you may be a great author.I will always bookmark your blog and
    definitely will come back in the foreseeable future.
    I want to encourage that you continue your great job, have a nice day!

  12. Have you ever thought about creating an ebook or guest authoring
    on other blogs? I have a blog based upon on the same information you discuss and would really like to have you share
    some stories/information. I know my audience would enjoy your work.
    If you are even remotely interested, feel free
    to send me an e mail.

  13. Hello, i believe that i noticed you visited my blog so i came to go back
    the choose?.I am trying to to find things to enhance my website!I assume its good enough to make use of a few of your
    ideas!!

  14. Hi there! I know this is kinda off topic but I was wondering if
    you knew where I could get a captcha plugin for my comment
    form? I’m using the same blog platform as yours and I’m having difficulty finding one?
    Thanks a lot!

  15. Good post. I learn something new and challenging on sites I
    stumbleupon everyday. It will always be useful to read through articles from other writers and use something from other web
    sites.

  16. Hello There. I discovered your blog using msn. This is an extremely smartly written article.
    I will be sure to bookmark it and return to learn extra of
    your useful info. Thanks for the post. I’ll certainly comeback.

    My site … Mireya

  17. Oh my goodness! Incredible article dude! Many thanks, However
    I am encountering troubles with your RSS. I don’t understand why I cannot join it.
    Is there anybody else getting the same RSS problems?
    Anyone that knows the answer will you kindly respond? Thanks!!

  18. Its such as you read my mind! You appear to know so much approximately this, like
    you wrote the e book in it or something. I believe that you just
    could do with a few p.c. to force the message home a
    bit, however other than that, this is great blog. An excellent read.

    I will certainly be back.

  19. I am really inspired along with your writing talents as well as with the structure for
    your weblog. Is that this a paid topic or did you customize
    it your self? Either way stay up the nice quality writing, it’s
    rare to peer a great blog like this one today..

  20. I don’t know if it’s just me or if perhaps everybody else experiencing
    issues with your site. It appears as if some of the written text in your posts are running off
    the screen. Can somebody else please comment and let me know if this is happening to them as well?
    This could be a issue with my web browser because I’ve had
    this happen previously. Appreciate it

  21. It’s a pity you don’t have a donate button!
    I’d certainly donate to this fantastic blog! I suppose for now i’ll settle for bookmarking
    and adding your RSS feed to my Google account. I look forward to
    brand new updates and will share this site with my Facebook group.
    Chat soon!

  22. Hey there! I’m at work browsing your blog from my new iphone!
    Just wanted to say I love reading your blog and look forward to
    all your posts! Keep up the excellent work!

  23. Thanks for some other informative blog. Where else may I
    get that type of information written in such an ideal approach?
    I have a project that I am simply now operating on, and I’ve been at the look out for such info.

  24. Greetings from Ohio! I’m bored at work so I decided to check out your website on my iphone during lunch break.
    I love the information you provide here and
    can’t wait to take a look when I get home. I’m surprised at how fast your blog loaded
    on my phone .. I’m not even using WIFI, just 3G .. Anyhow, good site!

  25. obviously like your web-site however you have to take a look
    at the spelling on several of your posts. Many of them are rife with spelling issues and I in finding it very bothersome to tell
    the truth then again I’ll definitely come again again.

  26. You actually make it seem so easy with your presentation but I in finding this matter to be really one thing that I think I might never understand.
    It seems too complex and very large for me. I’m taking a look ahead
    on your next post, I will try to get the hold of it!

  27. Hello would you mind stating which blog platform you’re
    working with? I’m planning to start my own blog soon but I’m having a difficult time
    deciding between BlogEngine/Wordpress/B2evolution and Drupal.
    The reason I ask is because your design and style seems different then most blogs and I’m looking for something completely unique.
    P.S My apologies for being off-topic but I had to ask!

  28. Great post. I was checking continuously this blog and I am
    impressed! Very useful information particularly the last part :
    ) I care for such info a lot. I was seeking this particular information for a very long time.
    Thank you and good luck.

  29. I am extremely impressed along with your writing skills and
    also with the structure to your blog. Is that this a paid theme or did you modify it your self?
    Either way stay up the excellent quality writing, it is rare to see a nice weblog like this one
    nowadays..

  30. Oh my goodness! Amazing article dude! Many thanks, However I am having
    problems with your RSS. I don’t know why I can’t subscribe to
    it. Is there anybody having the same RSS problems?
    Anyone that knows the answer can you kindly respond? Thanks!!

  31. After looking over a few of the blog posts on your site,
    I really like your way of blogging. I book marked it to my bookmark website list and will be checking back in the near future.

    Please visit my web site as well and let me know what you
    think.

  32. Right here is the perfect website for anyone who really wants to understand this topic.
    You know a whole lot its almost tough to argue with you (not that I actually will need to…HaHa).
    You definitely put a brand new spin on a topic that has been discussed for years.

    Wonderful stuff, just excellent!

  33. Thank you for any other informative web site.
    The place else may I am getting that type of information written in such an ideal way?

    I’ve a mission that I’m just now running on, and I’ve been on the glance out for such info.

  34. Hello there, just became aware of your blog through Google, and found that it’s really informative.
    I am going to watch out for brussels. I will be grateful if you continue this in future.
    Many people will be benefited from your writing. Cheers!

  35. Its like you read my mind! You appear to know a lot about this, like you
    wrote the book in it or something. I think that you could do with a few pics to drive
    the message home a bit, but instead of that, this is magnificent blog.
    An excellent read. I’ll definitely be back.

  36. Hello there! This is kind of off topic but I need some guidance from an established blog.
    Is it very difficult to set up your own blog? I’m not very techincal but I can figure things out pretty quick.

    I’m thinking about creating my own but I’m not sure
    where to start. Do you have any points or suggestions?

    Many thanks

  37. Hello! This is kind of off topic but I need some help from an established blog.
    Is it very hard to set up your own blog? I’m not very
    techincal but I can figure things out pretty quick.
    I’m thinking about creating my own but I’m not sure where
    to start. Do you have any ideas or suggestions?

    Thanks

  38. Heya just wanted to give you a quick heads up and let you know
    a few of the images aren’t loading correctly. I’m not sure why
    but I think its a linking issue. I’ve tried it in two different web browsers and both
    show the same outcome.

  39. I do agree with all the ideas you have offered for your post. They’re really convincing and can definitely work. Nonetheless, the posts are too quick for starters. May just you please lengthen them a bit from subsequent time? Thanks for the post.|

  40. I have been exploring for somewhat for just about any high-quality articles
    or blog posts on this sort of area . Exploring in Yahoo I finally stumbled upon this site.

    Studying this information So i am just happy to convey that I have got a
    very good uncanny feeling I learned just what
    I needed. I most without a doubt can certainly make certain to do
    not overlook this website and present it a glance on a constant basis.

    My page; KyleUPlumb

  41. My programmer is trying to persuade me to move to .net from PHP.
    I have always disliked the idea because of the expenses.
    But he’s tryiong none the less. I’ve been using Movable-type on a variety of websites for about a year
    and am anxious about switching to another platform. I have heard great things about blogengine.net.
    Is there a way I can import all my wordpress content into it?
    Any help would be really appreciated!

  42. Nice blog here! Also your site loads up fast! What host are you using? Can I get your affiliate link to your host? I wish my website loaded up as quickly as yours lol.

  43. I think this is among the most vital information for me. And i am glad reading your article. But should remark on some general things, The site style is wonderful, the articles is really great : D. Good job, cheers.

  44. Hi! This is kind of off topic but I need some guidance from an established blog.
    Is it very difficult to set up your own blog? I’m not very techincal but I can figure things out pretty quick.
    I’m thinking about making my own but I’m not sure where to start.
    Do you have any points or suggestions? Cheers

  45. Write more, thats all I have to say. Literally, it seems as though you relied on the video to make your point.

    You obviously know what youre talking about, why throw away your intelligence on just
    posting videos to your site when you could be giving us something informative to
    read?

  46. You are so cool! I don’t believe I have read anything like that before.
    So good to find another person with some unique thoughts on this topic.
    Really.. many thanks for starting this up. This website is one thing that is needed on the web, someone with some originality!

  47. I’d like to thank you for the efforts you’ve put in writing this
    blog. I am hoping to see the same high-grade content from you later
    on as well. In truth, your creative writing abilities has inspired me to get my own site now 😉

  48. Today, I went to the beach front with my children. I found a sea shell and gave
    it to my 4 year old daughter and said “You can hear the ocean if you put this to your ear.” She put the shell to her ear and
    screamed. There was a hermit crab inside and it pinched
    her ear. She never wants to go back! LoL I know this is entirely off topic but I had to tell
    someone!

  49. With havin so much written content do you ever run into any problems of plagorism or copyright violation? My website has a lot of
    completely unique content I’ve either authored myself or outsourced but it looks like a lot of it is popping it
    up all over the internet without my authorization. Do you know any ways to help prevent content
    from being ripped off? I’d genuinely appreciate it.

  50. I am extremely impressed with your writing skills as well as with the layout on your blog.

    Is this a paid theme or did you customize it yourself?
    Anyway keep up the nice quality writing, it’s rare to see a nice blog like this one nowadays.

  51. I am really inspired with your writing abilities and also with the layout on your blog. Is this a paid subject or did you modify it yourself? Anyway keep up the nice high quality writing, it is uncommon to peer a nice blog like this one today.

  52. I think that is among the such a lot vital information for me.
    And i’m glad studying your article. But should commentary
    on some common issues, The site style is great, the articles is in reality
    great : D. Excellent task, cheers

  53. Hello would you mind letting me know which hosting company you’re utilizing?
    I’ve loaded your blog in 3 completely different internet browsers and I must say this blog loads a lot quicker
    then most. Can you suggest a good web hosting provider at a reasonable price?
    Kudos, I appreciate it!

  54. Hey! I’m at work surfing around your blog from my new iphone 4!

    Just wanted to say I love reading through your blog and look
    forward to all your posts! Carry on the outstanding work!

  55. Yesterday, while I was at work, my cousin stole my iphone
    and tested to see if it can survive a 25 foot drop, just so she can be a youtube sensation. My iPad
    is now destroyed and she has 83 views. I know this is entirely off topic but I
    had to share it with someone!

  56. Have you ever considered creating an e-book or guest authoring on other blogs?
    I have a blog based upon on the same ideas you discuss and would love to have you share some stories/information. I
    know my subscribers would value your work. If you are even remotely interested,
    feel free to send me an e-mail.

  57. Howdy just wanted to give you a quick heads up and let you know a few of the pictures aren’t loading properly.
    I’m not sure why but I think its a linking issue.
    I’ve tried it in two different browsers and both show the same outcome.

  58. Greetings from Florida! I’m bored to tears at work so I decided to
    browse your blog on my iphone during lunch break.
    I love the info you present here and can’t wait to take a look
    when I get home. I’m shocked at how quick your blog loaded on my cell phone ..
    I’m not even using WIFI, just 3G .. Anyhow, great site!

  59. I’m more than happy to uncover this web site. I wanted to thank you for your time for
    this particularly wonderful read!! I definitely loved every little bit
    of it and i also have you saved to fav to check out new things
    on your blog.

  60. I’m extremely inspired together with your writing abilities and also with the layout in your weblog. Is this a paid subject matter or did you customize it your self? Anyway stay up the nice quality writing, it is uncommon to peer a great weblog like this one these days.

  61. I’m extremely inspired together with your writing talents as neatly as with the layout for your weblog. Is this a paid theme or did you customize it yourself? Anyway keep up the nice quality writing, it’s rare to look a great blog like this one these days.

  62. According to the 2007 National Health Interview Survey NHIS , which included a comprehensive survey on the use of complementary
    health approaches by Americans, 65 percent of respondents who had ever been diagnosed with cancer had used complementary approaches.
    http://ltdviagragogo.com/ According to the
    2007 National Health Interview Survey NHIS , which included a comprehensive survey on the use of complementary health approaches by Americans, 65 percent of respondents who had ever been diagnosed with cancer had used
    complementary approaches.

  63. Hello, Neat post. There is an issue together with your web site in internet explorer, could test
    this? IE nonetheless is the market chief and a good part of other people will miss your wonderful writing due to this problem.

  64. I’m extremely impressed with your writing skills and also with the layout on your weblog.
    Is this a paid theme or did you modify it yourself? Anyway
    keep up the nice quality writing, it is rare to see a great blog like this one these days.

  65. Aw, this was an incredibly nice post. Spending some time and
    actual effort to create a very good article… but what can I say… I
    procrastinate a whole lot and never manage to get anything
    done.

  66. Hey there just wanted to give you a quick heads up.

    The text in your post seem to be running off the screen in Safari.

    I’m not sure if this is a formatting issue or something to do with internet browser compatibility but I thought I’d post to
    let you know. The style and design look great though!
    Hope you get the issue resolved soon. Many thanks

  67. The pumps are “very cumbersome and clumsy,” Bivalacqua says.
    Despite reliably producing erections, pumps have the lowest satisfaction rate of any erectile
    dysfunction treatments. “In my practice, most men who try it will
    say, ‘Not for me,’ ” he adds. asgenviagria.com
    does viagra lower blood pressure

  68. is viagra for women available 2016
    youtube viagra commercial 2015 actresses
    viagra generic name mycoxafloppin