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United States of Pharma: Why Drug Marketing Rules American Healthcare

I often hear medical and pharmacy directors at public and private health plans express frustration over how physicians prescribe. These payers feel forced to use prior authorization to combat irrational prescribing. ”Why,” they ask, “do doctors ignore the evidence? Why don’t they follow guidelines?” Read more → →

Spare the Rod, Spoil the Child – How the Prescription Pad Replaced the Paddle.

child getting paddledFifty years ago, if a child misbehaved, he got a good paddling. Today, society frowns on slapping and spanking kids, with corporeal punishment outlawed in all but 19 states.

While RxBalance is happy that our society no longer sees spanking as an appropriate response to misbehavior, we are concerned that Americans seem so at ease with drugging kids who are irritating, moody and temperamental. Sadly, there are children so destructive to themselves and others that medication is necessary. We are not addressing children such as these in this blog. Read more → →

Why Falling Cholesterol Trumps Cancer Rising – The Galileo Factor and Pharma Marketing

Today, we take it for granted that high cholesterol is a risk factor for coronary heart disease. This medical wisdom is so pervasive that USA statin sales were $14.5 billion in 2008, according to IMS.

I don’t plan to use this blog to debate cholesterol risks or statin benefits. However, based on my experience, the pharmaceutical industry was a contributing factor to the worldview that believes high (LDL) cholesterol is bad regardless of age, sex, race, and/or personal or family medical history. Read more → →

In Brain Chemistry We Trust – The Gospel According to Pharma

The rise of the biopsychiatric model of mental illness

If anyone has doubts about America’s faith in a Higher Power, all you need to do is to take a look at how we have come to worship the biomedical model of mental illness. This biomedical model is so entrenched in our culture that it has become gospel. Please note, however, that RxBalance is not saying that antidepressants don’t work or that brain chemistry and genetics do not contribute to mood disorders. Quite the contrary – psych meds have a role in treatment . We also respect the pharmaceutical industry’s role in helping to destigmatize mental health disorders like schizophrenia, depression and bipolar disorder. Read more → →

All that Glitas is Not Gold – Musings on Pharma Marketing & Type 2 Diabetes

In the past several years, the second-generation glitazones Avandia (rosiglitazone) and Actos (pioglitazone) – once touted as breakthroughs that could reduce cardiovascular mortality in patients with type 2 diabetes – have been tarnished by controversy. The story of the glitazones (also known as thiazolidinediones or TZDs) reflects everything that is good, bad and ugly about the pharmaceutical industry. Read more → →

Playing With Fire –The State of Pediatric Mental Health in America

Shire Pharmaceuticals recently introduced the first selective FDA-approved alpha-2A adrenergic receptor agonist for treatment of ADHD (attention deficit hyperactivity disorder) in children. Intuniv (guanfacine) is thought to stimulate receptors in the pre-frontal cortex. Shire initially positioned the drug for children with ADHD who displayed a subset of symptoms that included “arguing with adults, deliberately annoying others, losing one’s temper, and being easily frustrated or irritable.” Shire eventually received a FDA warning letter for implying that Intuniv treated individual behaviors (which were manifested by behaviors at home like  “bedtime blowups”, “toothbrushing tantrums” and “dinnertime defiance”.  In response, Shire modified all their marketing materials for Intuniv. However, you can view screenshots from the original DTC  consumer website here, at a site that archives web content. Read more → →

Risky Business – How Buying a Ford Explorer is Like Taking Zometa

Last week, Peggy Stevens, a woman in Missoula, Montana who developed osteonecrosis of the jaw (ONJ) while being treated for lymphoma, was awarded $3.2 million. The settlement was based on Ms. Stevens’claim that Novartis did not disclose risks associated with the bisphosphonate, Zometa (zoledronic acid).

Imagine this scenario.

You walk into your local Ford dealership intending to buy a Ford Explorer for your daughter’s 17th birthday. The salesman says he’s happy to help. With this scenario in mind, which of the following questions do you think the salesman is least likely to ask?

  • How much do you want to spend?
  • What options are you looking for?
  • Did you know that Ford Explorers are notorious for overturning at low speeds, that SUV rollovers account for 33% of passenger vehicle fatalities and that close to 10,000 people died in SUV rollover crashes in 2002 alone?
Read more → →

Altered Reality – Are Declining Cardiac Death Rates Attributable to Drugs?

Sometimes I feel like I live in an alternative reality. This seems particularly true when promoting certain drugs for asthma, hypertension or high cholesterol. What do these chronic conditions have in common?  For all, there is ‘big buck’ value to providing medications to people who are sick.

Reality depends on which side of the fence you stand on.  If a pharmaceutical client markets an ACE inhibitor, the medical writer’s reality is that ACE inhibitors are ‘knights in shining armor’ that protect people with hypertension from heart disease, kidney failure and death. However, if my client markets an ARB,  I am waving the flag that calls for the’death’ of ACE inhibitors, suggesting to providers that their patient’s chance of survival will increase if they take an angiotensin receptor blocker. And of course, telling doctors over and over again about the “high incidence” of cough reported in patients taking ACE inhibitors. Read more → →

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 → →