Category Archives: Science and Research

GSK Trading Sluggish on Avandia Saga

2013-06-10 11.31 AM105 Around ASCO time GSK was a promising stock being touted by life science investors as one of those undervalued stock that you can go both long and short. Even with the Avandia scandal going on, you’d think that GSK is almost invincible.

Except it isn’t.

Headlines around Avandia still dominates investor consciousness and even though GSK is more than Avandia, this goes to show that a little bit of bad news that lingers on too long can hurt investor confidence and such ambivalence has been playing out in GSK stock price these past couple of weeks.

$GSK needs to get close to $52.50 and break past this to regain investor confidence. The stock price seems tentative about it, teasing that $52 threshold.

The Bigger the Marketing Machine The Smaller the Cause Relevance

I saw this post from my friend Casey Quinlan about the Susan G. Komen foundation canceling various events across the U.S. due to public backlash of what the public perceives as the foundation’s foray into political stances:

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I don’t know what’s happened with Komen but the corporate good will seems to have declined the bigger it’s gotten. Maybe Susan G. Komen foundation needed to stay more a corpus supporting grass roots level chapters as opposed to this major corporation painting everything pink.

What was ironic was that the pink ribbon concept was created by the late Ms. Lauder of Breast Cancer Research Foundation. I did not know that BCRF was the originator of the pink ribbon concept! I thought it came from Komen because this organization pops up *everywhere* I see breast cancer. What a pity that BCRF isn’t getting more recognition and activity about its work — but this also speaks to the formation of public consciousness: the better marketing machines gets the credit even when they may not have come up with the innovation.

Large “cause-based” organizations that consume 80%+ funds for overhead will run into this type of PR problem. Instead of funding research, education, outreach, even scholarships (think: children whose parents have passed due to cancer) — the infrastructure gobbles up the raised funds. This is also what causes frustration and resentment in consumers.

How marketers over-leverage Neuro-Bunk to sell you stuff.

I worked in the cancer field and around this time (ASCO conference) I’d start seeing attention grabbing headlines like, “ginger kills cancer cells!” and then I start seeing ginger candies popping out all over supermarkets — not just in Asian markets where I used to find them, but everywhere. This is one of those “cancer bunks” where the preclinical researcher observed that high doses of an ingredient in ginger kills cancer cells on a petri dish. And suddenly… ginger kills cancer cells. I was furious why this scientist let the flames be fueled by gross extrapolation of science that hasn’t been tested in humans.

My favorite part is when she calls herself Dr. Strangelove in juxtaposition to Dr. Love, who has been on TED selling Oxytocin as the moral molecule. Crockett says there are scientific studies that have shown Oxytocin increasing envy, gloating, selective assocation with one’s own group (clique behavior, exclusionary behavior) — so she can easily say that Oxytocin is the immoral molecule.

People may say, oh this type of bunk can’t harm anyone — but then you are talking about vulnerable population (patients who suffer from conditions that may be labeled “incurable” “irreversible” “terminal” — and they are willing to try anything and everything at their own expense (non approved treatments aren’t paid for by insurance companies).

As for Dr. Love’s Oxytocin-love, Tell “oh this can’t harm anyone” to the children whose parents are trying to purchase oxytocin to dose their “ills”.

Danger of Safety Deafness to Pharma DTC Ads

Pharma ads are a relatively “new” phenomenon. In the late 1990s, the FDA allowed pharma companies to advertise directly to consumers (DTC). These DTC campaigns were reviled by physicians who believe that the ads would create pressure on them from the patients and disrupt that physician patient relationship.

Pharma companies do not have “free speech” because they operate under “commercial speech”. They are therefore dictated by the Food and Drug Administration (FDA) on what they are allowed to say and they are required to provide the information about the safety of the drug as part of “fair-balance”.

This is why you will see the disclaimers built into the ad, as the narrator smoothly go from talking about how the drug works and to ask your doctor about the drug to the standard —

“…WonderDrug is not for everyone. Women who are pregnant or nursing should not take WonderDrug. Your doctor may do routine liver testing when you are on WonderDrug. Do not take WonderDrug if you are also taking IncrediblePill. Patients who experience big toe palpitations should stop WonderDrug immediately and call their doctor….”

From an industry perspective, one of the arguments *for* DTC is that diseases and conditions become educational opportunities.

For example, depression is a stigmatized condition — then Pfizers happy little marshmallow cartoon (or pill? or cloud? I don’t know what that Zoloft character was meant to be) showed up on screen and it was a way to encourage consumers to talk to their doctors about conditions they may otherwise not discuss. For erectile dysfunction, it used to be an uncomfortable topic, but it is one of the side effects of diabetes and patients care about sexual function (compliance on meds) — so you have ads that break the ice of conversation that patients need to have so that doctors can work with them on adhering with medication regimen for best outcomes.

So there are definitely positives as a result of DTC.

On the other hand, when a DTC for restless leg syndrome came out, I didn’t like that campaign very much. I felt this was such a specialized population of patients, that having a DTC campaign may cause patients to start diagnosing themselves, erroneously, based on seconds of soundbite.

In the past when pharma companies have been sued for not disclosing safety risks and full side effect profile, their DTC ads have usually been part of the lawsuit where the charges would be that patients have not been properly informed of the full risks of the drug and that the time spent on effectiveness tips the fair balance to make the drug appear “safer than it should appear”.

Image by http://www.sxc.hu/profile/StillSearcOne of the concerns I have is that over time, patients may begin to ignore those safety statements. This can be a real danger.

It’s not unlike how many of us have grown “blind” to online ads. We go to the website and our eyes are hit by ads all over the place, but we’ve trained ourselves to selectively ignore them. Ad-blindness is a real phenomenon and internet marketers talk about this and how to bypass or overcome them.

In pharma DTC, we may become so used to those safety disclaimers that we may become selectively deaf to those statements. Many of those statements are also repetitive and similar — such that we may begin to downplay the real risks that “need for liver monitoring” may pose.

Here’s an example from real life:

We’ve all seen various statin drug commercials — these are widely used blockbuster drugs. There are always safety statements about muscle weakness — sign of serious adverse event that can result in death.

One of my relatives was on a statin drug and he watches a lot of TV, he no doubt has seen ads for these statin drug commercials including the one he was taking. One afternoon when he visited and we were sitting at a picnic table he casually mentioned that he had trouble walking very far because he seems to have very low energy.

I knew he must be on a statin drug but he’s been on several drugs for several years: this person is a chronic smoker who still wouldn’t give up smoking or horrible fat-laden diet after multiple surgeries including a quadruple bypass (I am not kidding! Quadruple bypass! One of the most serious heart surgeries you can get). He’s always complaining of aches and pains — but still:

I asked him if he had switched meds recently and sure enough, he had been taken off an old statin in favor of “a newer” statin. I told him that he needed to call his doctor immediately and make sure that his “weakness” isn’t due to a serious adverse event like rhabdomyolysis, which can cause fatalities because of kidney over-burden.

He called his doctor and was taken off that statin to another statin and his “weakness” improved dramatically.

In other words, patients who are watching these commercials may grow deaf to these statements that sound very clinical but they don’t know what this looks like in real life. We aren’t thinking “oh I’m feeling this way because the drug is causing my muscle fibers to massively break down” — we think “I’m feeling really weak.”

“I saw a nurse – Where’s the doctor?”

You went to see the doctor and then realized that you talked to the nurse practitioner who ordered some tests — but you never saw the doctor! What’s going on?

In some states, a nurse practitioner (NP) has the same prescribing authority as the doctor, and may even act as a patient’s primary care “doctor” — thus I wouldn’t rule this out as a case of negligence, but more a prevailing norm of healthcare in a particular geographic area.

That said, you should absolutely be comfortable with the care you are receiving. If you want to see an MD instead of an NP, that is within your right as a patient!

I’ve heard of patients complain about their doctors not scheduling enough tests to rule out possible conditions associated with their complaint, so “test ordering” may depend on the context of the appointment. Often, physicians are not financially rewarded for ordering tests (costs the insurance companies too much) when compared to prescribing a drug (cheaper for insurance companies to pay for pills than an expensive scan).

For example, I had an acquaintance whose doctor was writing prescription drugs for her diabetic elderly father without doing any blood tests or monitoring. Her father began vomiting on a regular basis, and this doctor simply switched to writing other prescription drugs without figuring out why the patient was vomiting and becoming increasingly lethargic. She took her father to another doctor, who promptly ordered a series of tests to look at what was happening, and determined that the vomiting was mostly likely a serious adverse reaction to one of the diabetes medication. This doctor used the results of the tests to make a more informed clinical decision on which drug may keep the patient’s diabetes under control while minimizing the side effects that would prevent the patient from taking the drug regularly to keep symptoms at bay.