ArchivesWritten by Lydia Green

Scientific Publishing– Color Me Cynical

When it comes to scientific publishing, I am a true-blue cynic.

Medicine and marketing go hand and hand. Whether reading a published meta-analysis, systematic review or randomized clinical trial, bias is frequently interjected into journal articles because so much money rests on a favorable result appearing in the scientific literature.

The topic of publication bias has been covered extensively in the academic literature. If you want to read up on the topic, I suggest ‘Googling’ articles by Joel Lexchin (York University, Toronto, Ontario, Canada) and/or Lisa Bero at UCSF. Bottom line, if a drug company is in anyway involved in article development or placement, it is likely to color the content. Read more → →

The Thimble Theory

A doctor’s mind is like a thimble.

Like a thimble, we can only retain a certain amount of information. Once you go over that limit, the content of the thimble overflows, leaving the thimble with nothing in it. All marketers know this, which is why promotional materials focus on two or three salient points that are repeated over and over again. In fact, these “sound bytes” are repeated so often, that we all start to believe them whether they are true or not. Read more → →

Fight To the Finish – Why it Pays to Put on the Gloves

If you want to win the battle for doctors’ minds, stop complaining about – and start imitating– the pharmaceutical industry. Unless the healthcare and advertising industries suddenly collapse, you need to come to terms with the fact that drug companies are backed by an endless stream of resources, including marketing departments, advertising agencies, medical communication firms, public relation gurus and media firms.

Most drug companies spend 15% to 20% of sales on marketing. This adds up to a mindboggling amount of money. Lipitor sales were $7.8 billion dollars in 2008, so you do the math (IMS National Sales Perspectives™). You must accept that you do not have the same resources as the drug companies and never will. This doesn’t mean, however, that you have to take things lying down. Instead, I urge you to get in the ring and start fighting.

If you want to effectively deal with this formidable opponent (the pharmaceutical industry marketing machine), you may need to park your principles at the door. Your desire to inform, elucidate and educate physicians may be a valuable asset in the non-profit, academic and government worlds. Unfortunately, it will sink your ship when it comes to getting physicians to prescribe appropriately.

Most evidence-based technical reports and assessments start by asking key clinical questions. For example, a Drug Effectiveness Review Project (DERP) Report on drugs for schizophrenia might ask ‘do the atypical antipsychotic drugs differ in benefits (efficacy, effectiveness) or harms?’ If evidence based-medicine is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients”(Cochrane Collaboration), drug marketing is the judicious use of rhetorical devices such as innuendo and inference in order to persuade physicians to prescribe brand name drugs.

In other words, while the Good Guys (you) are asking ‘how do I impart knowledge to physicians so that they prescribe according to best practices’, the Advertising Guys are asking ‘how do I get physicians to write more prescriptions so that we increase our market share?” While imparting knowledge may be a noble cause, there is substantial evidence that increasing a doctor’s knowledge does not lead to improved prescribing. This is evident to anyone who analyzes prescribing data, reads the academic literature or interacts with doctors.

Therefore, if you want to win the battle for the doctor’s mind and get physicians to prescribe drugs more appropriately, focus on what you want doctors to do, not on what you want them to know. Unfortunately, there is an entire industry fighting to do the opposite. Keeping this in mind will help you do a better job in communicating with your physicians.

The Ties That Bind − Topical Psoriasis Marketplace

In the past few years, there have been some interesting developments in the topical psoriasis treatment marketplace. Are these developments, which occurred after a popular topical prescription medication went generic, interrelated or just a random series of events? Unlike a puzzle, where all the pieces fit together perfectly, there is no way to be sure.

Demonstrating the existence of questionable business practices is tough, especially since pharmaceutical companies rarely jump up and down to cheer their pursuit of the profit motive. Still, as a skeptic with years of experience witnessing how far the pharmaceutical industry will go to sell products, I sometimes find myself piecing together pieces of news that might seem unrelated to the casual reader. Read more → →

Something Smells Fishy − Prescription Drug Coupons

Last week there was a news story about Sanofi-Aventis SA overcharging state Medicaid programs by manipulating its “best price” for its anti-inflammatory nasal sprays. This got me thinking about why the Justice Department doesn’t go after pharmaceutical companies for issuing coupons and discount cards.

The details of these offers vary, but generally, the patient downloads a coupon for an expensive brand-name prescription medication and takes it to the pharmacy along with a prescription from their doctor. The consumer is happy with the price break. The programs appeal to physicians because their patients can afford to take their medications.

However, I have always found it fishy that these cards cannot be used by patients covered by Medicaid and Medicare. Call me skeptical; however, doesn’t this artificially inflate the price of drugs? Read more → →

Accentuate the Positive – Abilify

Drug companies rarely lie to doctors. They just hammer away at points that put their drug in an advantageous light. In their defense, drug companies pursue a popular adage that we learned as kids, ‘accentuate the positive, minimize the negative’.

In order to increase market share, drug companies invest large sums of money to shape and manage the clinical messages that are delivered about their drugs, whether in the form of advertising, CME, speaker presentations, clinical research, scientific publications, news stories, or clinical guidelines. They do this because it is a proven formula –when you control what’s communicated to doctors and consumers, you control what gets prescribed.

Unfortunately, drug company marketing often leaves out critical details. The details may appear in small print, but first impressions are what counts. Since pharmaceutical companies have a lot of money to spend on marketing, they do a superb job inundating physicians and consumers with positive messages that promote use of their drugs. As a result, we hear more about the side of the story that the drug company wants to tell than the more detailed accounts delivered in unbiased sources like Medical Letter, AHRQ Eisenberg Center Guides, Independent Drug Information Service or Consumer Reports Best Buy Drugs.

With that in mind, let’s take a look at the Abilify DTC Landing Page for Depression. If you were a patient with depression, you might be inspired to ask your primary care physician or psychiatrist for Abilify after seeing this. However, most folks’s enthusiasm for taking Abilify would wane considerably if the following important safety information, which appears in small print when one scrolls to the bottom of the page, were the size of the headline:

**Serious [Abilify] side effects may include: Abnormal or uncontrollable movements of face, tongue, or other parts of body. These may be signs of a serious condition called tardive dyskinesia (TD), which could become permanent

**Most common side effects (≥10%) from all clinical trials involving adults include: ADULTS: Nausea, vomiting, constipation, headache, dizziness, an inner sense of restlessness or need to move (akathisia), anxiety, insomnia, and restlessness

**It is important to contact your healthcare professional if you experience prolonged, abnormal muscle spasm or contraction which may be signs of a condition called dystonia.