Rx-ky business

Well, AFM called me up on the Insight post for painting my town¹ a little too apologetic for our phriends in Pharma (possibly due to some comments I made on this post of his, and these over at The Scientist, and also just today on Flickr…) .

So I guess I should make some self-apologetics, that my point has *not* been that Pharma is cute and cuddly and can always be trusted – c’mon they are industry – the wonderful Merck saga unfolds beyond just deceptive journals – this sort of awful ‘hit list’ language to “neutralise” and worse, “discredit”, critical doctors makes me cringe (and if you’re sick of hearing about Vioxx, you can get upset at Lilly’s innapropriate off-label Zyprexa marketing instead). There is nothing I can concoct to attempt to downplay the totally unethical nature of that sort of behaviour, to me it is indefensible. There are bad elements out there. Even if we rule the Vioxx shenanigans as an exceptional exception (which is the closest I can get to a defence) just take a look at the US statistics on Pharma fines and settlements made by over the last 9 years (and that just to the government, does not include private parties, class actions etc.)

Pharmaceutical companies are corporations. And yes, they are motivated by making money. And AFM is right, some guy in marketing will try to put that goal ahead of making quality medicines. But let’s remember that’s also what these companies are about making medicines. Medicines that help people. People do not get into this industry because they want to hurt people.

And that is where I start to get annoyed by anti-Pharma movements.

Free drugs: Just say no?

“Everybody likes something free.” I don’t think anyone is going to disagree with Chimonas and Kassirer there.

Drugs are expensive. And even if in a country like Australia, universal insurance may mean that vital medicines are cheap for the end-consumer, somewhere someone has pay the full price (i.e. the government).

Because drugs are so expensive, many drug companies – particularly when releasing a new product, will offer “free samples”. Now these aren’t quite like a give-away taste-test counter like at the local deli – the drugs still need to be prescribed by the doctor to a sick patient – but the principle is the same. You try it, and if it works, hopefully you’ll buy the real deal.

Sounds great! Hospitals get free medicines. Doctors learn about new treatments. Patient receives expensive treatment cheaply. And Pharma makes a friend. Everyone is a winner! What’s not to love?

Well… turns out it’s not quite the rosy picture we’d pictured. PLoS Medicine carries an investigative essay on the ramifications of free drug samples on the health care system.

Summarised points below:

Back in the 80s in medical marketing

This bit of commentary by ‘pharmacy insider’ Simon Burrow at the Croakey health blog really should have been filed under humour.

Now this may have been the story, even as close as the early 90′s, but I would just love to see someone try and slip cruise ship tour past Medicines Australia.

Now, quite possibly, Burrow could be talking about the non-prescription pharmacy market – all the front-of-store goodies including a lucrative boom of complementary and alternative supplements. And that is worrying – because these are still marketed as health products – and pharmacies are community health professionals that should take professional pride and responsibility to ensure that the products they supply are based on evidence-based claims of efficacy, not who took them to Cairns for the weekend.

The lesson I’d like to impart from this is just how well regulated the prescription medicines industry in Australia is compared to some other industries. It’s not perfect - people are always trying to push the boundaries - but there are well-intentioned guidelines put in place to protect to all stakeholders – industry, health care professionals and the patient/consumer from exploitation.

More than medicine

Hot on the heels of discussions about Pharma and digital media – GSK has recently launched a corporate blog More Than Medicine. They aren’t the first Big Pharma to do so, Johnson & Johnson is also present in the blogosphere with JNJ BTW.

The idea behind the blogs is to create a more comfortable dialogue between these large overarching organisations and the end-product consumers (i.e. you and me).

J&J: “Everyone else is talking about our company, so why can’t we?“

GSK: “Our goal is to encourage an open, productive discussion about a range of topics .. that doesn’t sound like it’s written in ‘legalese’.“

Already GSK has been called out for having pseudonymous bloggers – but while it might somewhat detract from their claim to broad openness, it’s hardly a rare thing amongst bloggers (ummm… does yours truly qualify?*) Relationships don’t have to be built up on a first name basis.

Already the two blogs have very different styles, and showcase positive ways in which Pharma can successfully harness this new media.

Baker drug deals

There will be more medical marketing musings over this week. There are few more articles in my backlog as I’ve been trying to work out what is and is not okay to do when engaging medical education activities.

But the final post today will be a little lazy. This was so obviously wrong.

The very recent Baker-Sanofi Plavix deal, which can be followed at Croakey.

Just a reminder, or is it?

The decision on what medicines you are prescribed can be a matter of life or death. These decisions need to be based purely on what is best for you, the patient, not on who has the flashiest marketing campaign.

Medicines Australia, the national self-regulatory body for the pharmaceutical industry, is in the process of revising its Code of Conduct for 2010. The code is based mostly on ensuring that any marketing its members engage in is based primarily on accurately educating health-care professionals, and that their activities will withstand professional scrutiny and not bring the industry into disrepute.

The new code is expected to heavily crack down on the use of once ubiquitous Brand Name Reminder – all those free give-aways brand logos emblazoned on them. All brand name reminders will be expected to cost less than $20 and be directly relevant to the clinical setting – an umbrella or coffe mug is definite no, but this might also cover generic office equipment – like USB sticks, mousepads, sticky notes and pens.

Is this ban based on evidence? Sadly, yes. And even items under $20 may still cause some influence. And Research published in the Archives of Internal Medicine suggest the mere presence of logos can influence how a doctor thinks about what he prescribes. But that influence may be a good thing. It depends on how he was educated.