Naked Medicine

Let's Face It: Medicine is Business

Category: Business of Medicine

Big Pharma Shilling and WebMD.com MayoClinic.com Smack-Down

New York Times Online is likening WebMD’s “information” as “using the meretricious voice of a pharmaceutical rep”.

I don’t know… I never found WebMD’s interface “apparently attractive” but I suppose some people like all the flashy stuff. I mean, I find the ads on NakedMedicine.com mildly annoying, but these only go toward keeping the site alive and paying for the internet connection. If I had to start paying staff writers and “physician experts”, I can see how I may need to squeeze ads onto every available white space on a website.

The few times when I did look at WebMD there are so many different ads for so many different things (often unrelated to the topic on the page) that it’s no wonder WebMD brings in over $500M revenues a year. The only time I recall seeing an ad-free page on WebMD is on their “CME” topics… and I do wonder who is paying for those (and for how much!) to keep those pages ad-free. Someone’s paying for these.

But I personally like MayoClinic.com if only for the ease of getting at the information I was looking for without having to block a gazillion ads.

I think Ms. Heffernan is seeing more of the truth in the relationships between the members of the American Medical Association and the drug industry through what she sees on WebMD.com . Maybe in the doctors’ offices we get to see a sprinkling of drug “detail pieces” and miss the piles that are thrown away or hidden (I’ve always wondered why drug companies don’t just stop leaving these behind because they’re the biggest waste of trees). The real goodies are often hidden away – in the form of shadowy monetary compensation that the feds have caught up on.

After all, when you get a world famous oncologist bragging about how many thousands of dollars he can get drug companies to pay him “per patient” in a clinical study, what’s a drug company to do?

OIG’s Top 10 Most Wanted Fugitives

John Walsh probably isn’t going to be featuring these on his “Most Wanted” show, but these criminals are on OIG’s Most Wanted for defrauding the government (and tax payers like you and me) out of millions of dollars by submitting false claims for services or goods (motorized wheelchairs seem to be a popular vehicle).

These people look like very unhappy people, maybe all that stealing and defrauding make one a sour puss in life. Not to mention in prison.

Read more from the Washington Post: Health care fraud: Not a faceless crime any longer.

Johnson&Johnson: Don’t Just Cite Your Credo, APPLY IT.

When I used to consult in the pharma world, I notice that J&J employers love their company credo. It makes a deep impression on them. They believe truly that they’re joining a company that takes pride in their history and reputation. There’s this feeling of “pedigree” for being part of the Johnson & Johnson family.

But times have changed and I suppose companies too, and the people who run these companies have forgotten that credos don’t do much good as engraved paper weights and for recital purposes only. Credos are supposed to be applied.

http://www.nytimes.com/2011/01/16/business/16johnson-and-johnson.html

http://deniscollins.tumblr.com/post/2780912540/can-johnson-johnson-get-its-act-together

http://managementhelp.org/blogs/business-ethics/2011/01/16/jj-dig-deeper/

Pharmacy and McDonald’s: Strange Bedfellows that Aren’t so Strange

My friend Natalie Bourre saw my post about the non-biodegradable Happy Meal photo-essay and told me about a Canadian Pharmacy that had, as part of its weekly promotion, a coupon for McDonald’s.

This promotion is no longer on the corporate website, so you will have to visit Nat’s blog to see the screenshot she captured when those coupons were prominently displayed at the “CLICK ME NOW!”-eye-level.

Here’s what we DO have for this week’s promotion, however. A special offer for seniors who spend $50 or more with the drug store:

And here’s why I think it’s not so strange that a pharmacy should accept advertising from McDonald’s, and why an establishment advocating for better consumer health would not be a strange bedfellow with a fast food company:

If we are all more responsible with our health and become epitomes of good prevention and healthy lifestyle choices, pharmacies would go out of business. Or at least struggle a bit in the pharmacy business.

Don’t get me wrong, we’ll always need drugs and stuff that pharmacies dispense, by the mere reality that we are mortal and therefore subject to the systematic and gradual deterioration called “aging”. But people who don’t have serious health issues requiring chronic medication and healthcare intervention aren’t going to be frequenting drug stores. Healthy people who don’t need medication are not that great for the long term robustness of a drug dispensing business.

Let’s also not forget that when we’re at the drug store waiting for our prescription filled, we also get to wander around the aisles for some impulse purchase, as well as doing some shopping for toothpaste or shampoo or laundry detergent or Halloween costumes (drug stores these days are almost like departmental stores, offering things you’d normally not associate with drug stores)! It’s not just the drugs dispensed, but all the opportunistic non-medical drug store purchases that contribute to the bottom line.

The way I see it, promoting McDonald’s now may help create new customers for tomorrow.

Teva Canadian MS Community: No Win for the Company

Teva is closing its community forum from its Canadian multiple sclerosis education website because of Canadian healthcare regulations around dissemination of information relating to prescription drugs.

You’ll read the explanation if you visit the Teva MS website, but keep reading for the crux of the situation:

I have to agree with Teva’s decision because it becomes a no-win for Teva. If Teva were to hire someone to conform to regulations and actively monitor the site, the patients could claim that Teva would allow only favorable comments when it may in …fact be a perception issue. Teva could be allowing only approved/indicated usage discussions posted, rather than removing unfavorable comments to Teva.

On the other hand, Teva stands to be liable for any damages claimed by patients who said they tried something because of what they had in a Teva-hosted discussion forum even if it was not sanctioned by Teva and even if Teva could have disclaimers abound. If I were a company I would not allow a truly “free” discussion forum, other than one that deals specifically with the approved indication of its drug, and even then would question the utility of this over an actual conversation with a licensed healthcare provider.

I see this as a case of controlling information not for restricting its availability but for the sake of responsibility of how that information is used. Drug information can be used out of context and inadvertently harm patients.

On the other hand, non-profit patient advocacy sites will host these discussion forums, and they appear to legally be able to do so. It would be interesting to see how these associations deal with legal situations that could potentially arise from patients being injured or harmed by information shared on the site that may not be accurate or even safe for others. This is a delicate balance of sharing information to help while keeping that Hippocratic “do not harm” oath in mind. Even if the intention is good, injury can occur because of misuse (and that misuse does not have to be intentional, either, it could be accidental).

But the reality is, drug companies are more likely to get sued than non-profits!

First heard from: Nat Bourre

Advil PM v. Tylenol PM Ad is Misleading

This has been bugging me for a long time, but recently I saw another one of these “advil PM versus tylenol PM” commercials, so I am going to finally write about it!

First of all, the commercial is basically a “why Advil PM is so much better” ad. It talks about how the person taking tylenol PM isn’t getting as good of a sleep as the person taking advil PM, and it shows the person on tylenol tossing and turning while the advil taker snoozing peacefully.


What’s wrong with this picture? Several:

1. They are different drugs. Advil is ibuprofen, an NSAID. Tylenol is acetaminophen, which works on pain by a different pathway. Both work for pain, and both have their advantages and disadvantages as pain killers.

2. But is Advil focusing on this fact – PAIN? NO! Advil is now talking about sleep! All right then, let’s look at the ingredients for sleep. It is basically the same ingredient as Benadryl. The exact same ingredient in both. But I thought I was watching a commercial for a pain killer drug. And instead of focusing on the key indication (pain), the Advil ad focuses on the side indication (sleep).

3. Fine. So why does Tylenol’s sleep aid work less better than Advil’s sleep aid even when both offer THE SAME SLEEP AID? Simple answer: Advil puts more Benadryl (38 mg) in its combo med. OK more accurately, “the active ingredient in Benadryl”.

So it’s not because Tylenol’s sleep drug is less effective, it’s not because Tylenol PM uses an inferior or less effective sleep drug than Advil.

It’s because Tylenol has less (25 mg) of the same sleep drug as Advil.

[On a personal note, Benadryl’s regular dosage is 25 mg, which already makes me feel completely drowsy and dried up. I don’t need an extra 13 mg of antihistamine to make me sleepier!]

This commercial annoys me because it exemplifies what is wrong with many commercials on TV relating to meds. They dupe consumers by playing with words and making apples-to-oranges comparisons, instead of true head-to-head comparisons.

Come on, Pfizer (maker of Advil), you can spend millions of bucks on a better commercial!

Top 10 healthcare social media predictions

3 of my predictions appeared here:

Industry consultant and entrepreneur Jane Chin (@janechin) goes even further, alleging that next year PhRMA will appoint its first ever ‘Chief Tweeting Officer.’

Jane Chin (@janechin) thinks social media will spur new approaches to customer care and technology, as “cutting edge pharma …companies will experiment with a blend of continuing medical education and cloud-based user-generated content for CME 2.0.”

Jane Chin (@janechin) emphasizes sound strategic judgment and an eye on the needs of a targeted audience for specific, relevant content by warning that “pharma will realize, once again too late, that data dumping fails both in real life and in social media.” [Thanks @skypen!]

Which Side Are You Really On, Jane Chin?!

I received what is probably the most passionate email from a reader of this blog that I’ve ever gotten since creating NakedMedicine.com in 2006. The email concludes with this:

I can’t figure out what your agenda is Ms Chin. Are siding with the poor hard working physicians who are fighting a losing battle with their idiot patient’s lifestyles? Are you siding with the tirelessly industrious pharmaceutical scientists who are selflessly dedicating their efforts to cure our ills? Are you siding with the poor neglected suffering individuals who are bravely pushing onward in their lives, struggling with disease, possible disease, possible pandemics, or just plain plainness requiring cosmetic medicine? Doctors, business, persons, for whom are you advocating?

I was shocked by the email, because this reader “hit the nail on the head”! He can’t figure out what my agenda is, because my agenda is in NONE of those sides he described. In other words, if I were guilty of picking “a side”, it wasn’t part of the “usual suspects”.

Here’s my very long response to my reader, to whom I’m grateful, because he took the time and effort to share with me this question that obviously is frustrating him.

******

You wrote what you felt, and I don’t fault you for that. I can sense a real feeling of frustration from you, and I don’t blame you for feeling frustrated about the healthcare system that seems to be broken in many ways.

I want to address specific points you brought up – first one being ‘cures’. I genuinely don’t think that the drug industry is prevented from, or are resistant to, discovering cures for diseases. It’s not about ‘cure’ versus ‘not the cure’ that is the problem. It is often the economy of scale that is the problem, and a very understandable one when you consider that the drug industry is – and has to run like a business – in order to remain in business. I have no doubt that the drug industry would love to find a cure – because they can charge for the price of a ‘cure’ and be justified in charging such a price.

The problem on the one hand is that many times we simply cannot find ONE underlying factor of a disease, especially the chronic diseases like diabetes and heart disease (in fact, many diabetics die of a heart attack and don’t live long enough to die of diabetes complications, especially those consuming a western diet). It is not like a bacterial infection where we can pinpoint ONE origin of the disease and target that specifically, the way we can target an infecting bacteria with an antibiotic and ‘cure’ the patient.

The other problem is about the number of people with a certain disease. For example, there may be fewer companies willing to research rare diseases that may be ‘repaired’ let alone ‘cured’, simply because the companies need to get the money somehow to do all the experiments and clinical trials necessary to jump through regulatory hurdles to even get the drug approved. When i was a graduate student, doing what are pretty simple experiments (and not even in people – i worked off the petri dishes), i was often using reagents that cost my employer thousands of dollars to purchase from reagent companies. Each of my experiments has to cost at least a thousand bucks, and many of my experiments failed and produced no result.

These prices are nothing compared to the amount of money it costs to run a clinical trial at the scale required by the FDA. Now the drug companies have to pay for the drugs, the cost of mountains of paperwork needed to get the clinical trials started, the doctors who do the clinical trials (and some doctors get really snobby and brag to each other about how much $ they can muscle out of drug companies “per patient” to enroll in the drug companies’ trials), not to mention the “overhead” that the academic institutions charge the drug companies because their doctors work there (and these overhead costs can mean more than 50% of the total study budget).

And then most of the drugs end up not passing the FDA’s requirements and fail to get approved. So if you’re running a company, you will tend to want to go into areas where you will likely have more customers – heart disease for example – just so you stand a better chance of keeping your company operating should it succeed in getting a drug treating that disease approved. This is also why the government has to create incentives for companies that are willing to go into rare or “orphan” diseases – for example, Gaucher’s disease is a rare lysosomal storage disease affecting maybe 1 in 40,000 people. A drug company that competes in this market will be happy selling 1 prescription every 3 months.

I honestly do not view drug companies as entities that profit from the suffering of others, because of the logic of this assumption: If drug companies are creating diseases in people in order to make drugs for the very diseases they created, then that to me qualifies for the statement. However, drug companies happen to offer the tools to treat the disease, not unlike device companies making scalpels and surgical tools to allow doctors to cut us open should our illnesses demand it. It seems illogical to me to accuse device companies for profiting from people having tumors that require scalpels to operate and excise the tumors – unless we’re also implying that the scalpel companies are putting tumors in people that only their brand of scalpel can remove.

Additionally, I have observed that for the most part, people in our society today tend to prefer that we “have a pill to treat XYZ”, so that they do not have to do the hard work required to get their own health back on track. And then you add to the fire media agencies that charge pharma companies millions of dollars to come up with brainless gimmicky advertisements, and it is no wonder why many people feel like the drug companies are “profiteers of suffering.” Some years ago, there was a government funded study that shows that rigorous diet and exercise will help reduce diabetes risk at a very real level – in fact – the study patients who had diet and exercise regimen did as well in reducing their diabetes symptoms as study patients who took an anti-diabetic drug.

But why hasn’t the government or the doctors (not the drug companies – their responsibility is in making drugs) done anything about this amazing result? Because the of costs involved to the clinics in order to make “diet and exercise” possible in patients at a therapeutic level. Clinics would need to hire case workers and nurses whose job is to counsel and support and follow each and every single patient who opts for this “natural and effective” treatment. OK then, how about asking patients themselves to do this? Seriously, if you are a patient at risk for diabetes (i.e. risk factors are there, but patient is still “pre-diabetic” and not yet requiring drugs to control their blood sugars), you have everything you need at your disposal to go for the natural and effective (and less expensive than prescription drugs) cure! why aren’t patients doing this? because willpower and discipline are key – and you’re going to need both for a lifetime to prolong the onset of disease.

I can share this true experience – my husband had prediabetic blood work results some years ago when I urged him to see an endocrinologist, because his side of the family also suffers from diabetes. the endocrinologist told him that because he was so young (not yet 40 at the time), she preferred that he try the old fashioned diet and exercise, and see if he could get the risk factors down, before she put him on a drug. He happens to have a level of willpower and discipline that even I don’t have – and he altered his lifestyle dramatically – and it was enormously difficult. 6 weeks later he went back and the endocrinologist was so impressed with his results that she told him that most of his blood work results were approaching normal numbers. But she also told us that not every patient she sees can make this happen – and often she is forced to give the patient drugs to make sure that the patient doesn’t end up with uncontrolled diabetes symptoms (resulting in all sorts of nasty things including death).

I see drugs as exactly what you said you wished to see – repairs and cures. However, the reality is, few are truly cures because of the complexities of most diseases, and repairs don’t always “fix” things without creating new problems (called side effects) EXACTLY because of the complexities of most diseases.

The doctors’ hands are tied not by pharma companies, but by insurance companies as well as their own malpractice lawsuit concerns. Your average primary care doctor has to track how many patients he sees everyday because he needs to make sure he breaks even. That’s not the drug companies doing, but the insurance companies that capitate how much doctors are paid for doing what. So you also have a system that don’t reward doctors for spending more time with patients – in fact – you’re making it very bad business for the doctor to spend too much time because then he’ll lose money that day – and this does not do well to cultivate trust with patients who then need to heed the doctors’ advice about doing the hard things they need to do to steer their health status back on track.

I hope my email begins to help you understand where I am coming from – perhaps I can’t take any sides because I don’t think there are any sides that I can reasonably take without acknowledging that there are other entities that also need to be held accountable. the healthcare ‘system” is truly a “system” and a staggering, complex one at that. the best I can do is to help the consumers – people like you and me – to think for ourselves about what is being “sold” to us whether it’s from the drug companies, insurance companies, the government, the doctors, even patient groups. If I am guilty of siding with anything, it will be on the side of “critical thinking” about the system of healthcare with all of its players.

Best wishes,
Jane Chin

Pharma Offering Lifestyle Drugs – Power will Shift to Patient Customers

You’ve probably seen it coming – smelled hints of it on TV – pharmaceutical companies are getting into what we call “lifestyle drugs”; products that focus on “enhancing” your life rather than “extending” it.

Yes, there is a big difference, and you may think that “extending” life pays big, “enhancing” life may pay even BIGGER. (just ask the Botox people.)

It’s only a matter of time before pharmaceutical companies shift their focus from “therapeutic intervention” to “lifestyle / recreation” because they now deal with a ready-and-willing customer base who are willing to pay.

This also creates a more dramatic shift: one of bargaining power from the physicians to the patients. Eventually, pharma’s customers will become the patients more directly than before, with doctors becoming more of a “broker” – the people who writes the drugs but apart from that having no real power. Doctors are already complaining about patients leaving them if they don’t do what they’re told by the patients – “if you don’t write me this drug, I’ll go to someone else who will!”

There’s a bit of theatrical irony if this happens, because doctors will get a taste of what pharma sales reps have dealt with for years: being punted to the position of a measly “order taker” or “human sample dropper”. How about doctors eventually becoming “order takers” and “human Rx writers”?

Pharma Industry’s Job is NOT Disease Prevention. THAT’S YOUR JOB.

I’ve heard the argument, so have you.

“Those evil pharma companies aren’t interested in prevention! They want people to get sick and stay sick because that’s how they make their money! On the drugs!”

Recently I had railed against the pharma companies that are capitalizing on increasing trends of people using certain prescription drugs as “lifestyle drugs” – not to mention appearing on the Wall Street Journal this past Friday to rail against pharma companies that abuse the role of medical science liaisons, so I have my own pet peeves and criticisms with pharma. What irks me is when a criticism about any industry is not based on a fundamental flaw in that industry, but is simply born of politicking sensationalizing this-is-how-I-get-more-readers/viewers tactic.

Most of these people have taken a basic science class at some point in their lives and learned about a phenomenon called “entropy”. How things in a system tend to go toward disorder, and to halt this “natural” occurrence from occurring, you have to add in a great deal of energy, and even that won’t ultimately stop the inevitable.

Kind of like the idea of life and death, which is relevant to the assessment of this dimension of our hostility towards the pharmaceutical industry.

Obviously, pharma companies want you to stay alive, preferably as long as possible. This is not so they can capitalize on you dying (a dead person is no longer a customer)! The pharmaceutical industry is a business that capitalizes on your DESIRE to PROLONG YOUR LIFE AND MINIMIZE PHYSICAL PAIN AND SUFFERING. If you aren’t interested in prolonging life and minimizing physical pain and suffering, the pharma industry ain’t gonna benefit from YOU since you’re not a customer to begin with!

Let’s say you are sick from complications of heart disease.

Pharma companies that are in the heart disease business is not responsible for PREVENTING YOU from getting heart disease. YOU ARE RESPONSIBLE for making sure you do what you’re supposed to do to reduce your risk of getting heart disease, unless somehow you have signed the claim to your physical existence over to another person who is legally responsible for your physical survival and health.

Your family doctor may have a responsibility to educate you on mitigating the risks of getting heart disease, so those who want to rant about prevention may want to point their antennae to the medical profession, but ultimately YOU are STILL RESPONSIBLE for the behaviors and actions YOU TAKE that lead to the result of heart disease or no-heart disease. Your doctors can be the best doctors they can be and even give you a diet and exercise regimen that will lower your cholesterol, reduce your blood pressure, and take down your diabetes risk factors a few notches – but if you DON’T DO WHAT YOU’RE SUPPOSED TO, then you will end up with the health consequences. Actually, this is EXACTLY what happens in many obesity and heart disease cases today. Doctors themselves will admit that many of their patients won’t heed their advice, and most will lack the discipline required to stick with a rigorous healthy lifestyle to make a lifesaving change.

Are we saying that it’s the pharma industry’s job to PREVENT us from assuming behaviors that will put our health at risk? If there’s a pill for stopping us from risky behaviors, and pharma makes it commercially available, then we’ll simply turn around and say “now pharma wants to control our thoughts and actions!” (I think we already have those kind of pills, and there are activists and lawyers jumping on that bandwagon.)

Seriously, if you take care of your body, do everything healthy like you’re inundated by all media outlets to do (don’t drink, don’t smoke, don’t go out in the sun without wearing sunscreen, eat more fruits and vegetables, exercise at least 30 minutes a day, etc…), then you’re probably not going to need all those pharmaceuticals until the inevitable process of aging occurs, where your cells can’t care less what you’ve done because they’re all getting old and breaking down as a natural part of the decline of “life” in your physical human existence.

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