Love, share, learn

As seems to always be the case, as soon as I decide to take a short blog break, people link to me.

Greg did it twice. Hat-tipping me for that cool UK Swine Flu video I spotted – and also featuring some of my flu posts on this month’s Scientia Pro Publica – a collection of awesome science blogging written for the people – this month’s theme: OMG … Science is Everywhere! You can read more about SciProPub at Grrl Scientist.

I have also been quoted (and named, with my real name!) at BNET Pharma industry blog. I do have to agree with the sentiment. It would be a lot easier to sound sane if when I try to defend Pharma against claims of unethical practices if the industry I am trying to defend would just kindly stop engaging in them…

Your internet has a drugs

Whiz Kids: Alec & Shanna and The Computer That Said NO To Drugs!

Computers and drugs, do they mix?

So the last post didn’t quite Pharm me all out as it was supposed to, so here’s a few remaining links in my medical marketing and related sturf I’d like to purge from my chest before they become totally irrelevant:

1. Dose of Digital has a Top 10 marketing ideas for Pharma. I wonder if the critics agree with any of these (such as doing away with branded websites)
2. Tips for using Twitter as a pain log (also advice on when to ignore your doctor)
3. The UK National Health Service (NHS) has engaged the community online with a remarkably well done website. Not only does it provide health advice, contact details and news – it also responsibly examines health claims made by the UK media and lets you know the real story between red meat and sperm.
4. The U.S. FDA has made steps towards global domination: In January it set up its first permanent base in Costa Rica
5. A bit more technical, an article on establishing standards in biomarkers research. Biomarkers are molecular tests used to type diseases like cancers to determine which treatments are the best for you.

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.

Who is testing cancer vaccines?

As I wrap up my “Pharma is your Phriend” series, lets take a look at some more research.

This is a very interesting analysis of cancer vaccine trials using data mining from Open Access journal, Immunome Research.

The authors have taken advantage of there being quite a lot of publicly available information on clinical trials these days (yes, it is there, if you know where to look¹) to amass a whole host of information on cancer vaccine clinical trials for a type of analysis known as data mining.

There own summary of the results reads:

This application enables rapid extraction of information about institutions, diseases, clinical approaches, clinical trials dates, predominant cancer types in the trials, clinical opportunities and pharmaceutical market coverage. Presentation of results is facilitated by visualization tools that summarize the landscape of ongoing and completed cancer vaccine trials. Our summaries show the number of clinical vaccine trials per cancer type, over time, by phase, by lead sponsors, as well as trial activity relative to cancer type and survival data. We also have identified cancers that are neglected in the cancer vaccine field: bladder, liver, pancreatic, stomach, esophageal, and all of the low-incidence cancers.

Two cool things I learned from the paper were: Vaccines for cancers have been in development since the 1970s, and melanoma has been the cancer studied most for a vaccine, even though the first ones out to market have been for cervical cancer (expect melanoma vaccines in the next 1-5 years?).

But as we are looking to shift this discussion towards the pharmaceutical industry, let’s look at who runs clinical trials (Pop up: Figure 2a).

Insight into Australian medical marketing

Insight on SBS ran a televised forum on medical marketing practices in Australia about a month ago, but I’ve only just caught up and watched it – it’s still available online. The forum involved proponents from within the industry, key watchdog figures, specialists, general practitioners, medical students and a few patients/consumers.

The key thing everyone seems to want is transparency - including the pharmaceutical industry, if only to appease public concerns.

Unregulated pharmaceutical advertising looks like this

It was good to see a discussion that focused well on the situation here in Australia (i.e. no direct-to-consumer advertising, subsidised universal healthcare, and a strict marketing code of conduct by an industry body enforced by an independent review panel). The best points I feel were made by the professor who pointed out that there is no problem with transparency, but why are we singling out the medical profession and pharmaceutical industry? Why are we not as concerned about the links the industry has to politicians, or pharmacists*, or the influence created by sponsorship of mining, agricultural, tourism and other industries on their respective providers?

No industry is as regulated and scrutinised as our medicines industry. Yet, it continues to be criticised as not doing enough. Sure, the system is by no means perfect, breaches occur – but they are pulled up on breaches, punished, and those breaches are publicised (and as the Pfizer representative said, that hurts their public  image much more than any fine). I would not like to silence the critics, as that is the only way we can improve this system. They made good points that I’ve already blogged about recently drug samples don’t help, and brand name reminders (no matter their value) influence doctors.

Some concerns though seem a bit silly. What is wrong with bringing doctors from overseas to talk about medical advances? And just as odd, what is wrong with a mere 3% of doctors being sponsored to go overseas to learn about medical advances? Do they think Australia should develop it’s medical knowledge in isolation from our neighbours and field leaders in the US and Europe?

And some were just based on pure inability to comprehend how industry works, or anti-industry sentiment. I’m sure one person brought up the low cost of medicine manufacturing per pill compared to per pill costs to the consumer (because that is the only cost the industry faces ever?).

Some things I would have liked to have seen discussed more (or at all):

• Spokespersons from either medical education or advertising companies – the people who actually produce the marketing materials?
• Education in university medical courses – are medical students in Australia trained to deal with industry?
• Training given to industry representatives regarding the code of practice – why do breaches still occur if everyone knows the rules?
• Those industry marketers not participating in the MA, who watches them?
• More scrutiny on those outside of the industry – pharmacists, consumer products, CAM and others who make spurious health claims  and marketing incentives outside of regulatory bodies?
• The ghost writing issue (this was probably avoided due to the legalities surrounding the Merck/Elsevier case, or SBS just didn’t know about it)

*The “chemists” the crusie ship guy were on about, were more than likely street-pharmacists, or even pharmacy assistants, regarding sales of alternative medicines, vitamins and/or consumer medicines – absolutely nothing to do with prescription medicines. I wonder if they’ll do a similar special with the Pharmacy Guild?

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.

Drug-fuelled psycho-textbooks unleashed in hospitals

Thus reads the tabloid headlines.

Okay. Okay. Not quite.

Wall Street Journal blog actually states:

The Boston Globe got wind of the study, which found that among 20 authors of the guidelines for treatment of depression, dipolar disorder and schizophrenia, 18 had at least one financial tie to a drug maker, and 12 had ties in at least three categories, such as consulting, research grants, speaking fees or stock ownership.

It still sounds like an expose on the sinister Big Pharma Conspiracy.

Is this really worrying? Is it even surprising?

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.

Internet socks on drugs

The Scientist has a piece about “asthma” becoming your friend on facebook.

It reminded me about an Australian Prescriber that has been sitting in “to post” box. Melissa Sweet (who also does Croakey) wrote about how Pharma is/can capitalise on new digital media.

The big issue with the internet and health marketing is lack of regulation. I mentioned in my previous post how marketing drugs is *very serious business* – encouraging the innapropriate drugs and treatments can hurt and kill people (that’s why we hate CAM, but that’s a story for another day).

While in Australia, it’s illegal to promote prescription products to patients and consumers, there aren’t such laws in the USA – so Pharma just needs to put information on their US website. They can’t be blamed if someone googles their options, can they?

It’s also sometimes difficult to work out where drug information is actually coming from. Melissa points in particular to a youtube account that has been accused of being a sock-puppet for a sleeping pill manufacturer.

Making it more difficult can be outdated guidelines that have yet to address modern internet communication tools (namely social media like facebook/myspace/twitter) – hopefully the 16th MA Code will expand on what is and isn’t permitted.

Photo: Team Puppet by o2b (Creative Commons)

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.

Do you feel special?

Via Biology in Science Fiction.