Monday, June 28, 2010

Keep the ‘Samples’ Coming

A few words on the how-much-did-Pfizer-spend-on-free-samples article in the Wall Street Journal:
Do you know anyone who has ever refused those free samples?
What’s your first reaction when you get a free sample? Is it: “Oh cool, thanks, Doctor. Now I don’t have to hit the pharmacy until later.” Or is it: “This is great. Let’s see how they work. Maybe I won’t need that higher dose.” Or is it: “Wow, thank you. I just don’t have the money right now.” 

Did anyone ever say, “No, that’s okay, doctor. Give them to somebody else.”

maybe that’s exactly what industry should do. Maybe the smart thing to do is for industry to continue spending this money on “samples” but only for new patients and those that remain adherent. Reward those who take care of themselves. Doctors could give these drugs to their patients who are taking their prescribed medicines. And not just a week’s worth – enough to see improved health outcomes, enough for patients to appreciate what being adherent means.

Patients adhere to the prescribed medication regimen less than 50% of the time, especially for disorders that may not have symptoms. We see this a lot in patients who are on anti-hypertensives and cholesterol lowering medicines. How many people do you know who've gotten a 10-day script for antibiotics, only to stop taking them after 3 days because they felt better? Their reasoning: Save them for the next time, save a trip to the doctor's. If improving adherence is about educating these patients, then the learning should come with the experience.

Patients will assume more responsibility for their own healthcare in the future. The delicate balance of providing care for those who need help versus those who do not appreciate help or care to change their behavior is always an issue. Drug samples are not currency in trade, they are a tool. Patients need to have that tool available through their physicians to improve their own well being. Maybe doctors should ask more patients if they want that drug sample -- especially from those people who continually suggest that drug samples do not benefit patients!

And about that $2.7 billion Pfizer spent on free samples – let’s keep it in perspective. Pfizer made more than $19 billion in 2007, $52 billion in revenues. We believe they are dedicating a large amount of that to new research -- which is what they are in business to do.

Friday, June 25, 2010

Medtronic and Transparency: Well Said, Mr. Hawkins

Recently, Medtronic announced that it too, would begin posting online the dollar amounts, above $5,000, that it pays its physician-consultants, joining the ranks of other medical industries that have begun listing their KOL payments. The new health care reform law will require Medtronic to do this in 2013, but Medtronic is smart to do it now.

What caught our attention is how succinct Medtronic Chairman and Chief Executive Bill Hawkins put the need for KOL involvement in product development, whether it’s medical devices or a drug. He told the Wall Street Journal that his field is very technical and highly dependent on collaboration between Medtronic engineers and outside consultants.

"I'm hard-pressed to think of any innovation we've had that didn't come from Medtronic working with physicians,” he said. 

Industry, while acknowledging that transparency has its place, needs to stress the value of industry-physician collaboration, and the good that has come of it.

We certainly believe that the two need to exist, and now even some journal editors believe that too. We think these arrangements can be appropriately structured to ensure the transparency everyone requires while not going overboard by gutting private investment in medical science.

Tuesday, June 22, 2010

Transparency and the Advertising $$$ Free-Fall

The transparency trend is firmly in place now, and its impact is beginning to be felt. One significant tremor: Industry spending on advertising revenue in medical journals. The WSJ Blog reported recently that those dollars plummeted to $626 million last year, from $865 million in 2005.

To refresh your memories: A March article in Medical Marketing and Media said only one journal, NEJM, had an increase in pages – a whopping .9%, for 2009. JAMA was down 12.8%.

The WSJ article, which focused its piece on industry revenues lost by the American Psychiatric Association, ($7.5 million over the past year), said that industry is cutting back from advertising in the APA’s journals, “in part because the industry faces its own pressures to avoid potential conflicts of interest.” 

The impact of this lost revenue and a bad economy are impacting everyone.  But what do less articles published, less research presented at conferences, less private investment in health really mean?

Did anyone think of the unintended consequences this push for transparency would bring?

Up until this point, physicians and KOLs have been fairly quiet about the COI turmoil. But recently, some medical association heavy hitters took a stand.

That's what this issue has lacked all along: A real conversation between physicians who think there is a conflict of interest in earning a living from industry, and those who don't. Maybe they can make sense of all this, and establish workable rules that make real sense.

We'd like to believe the pendulum is swinging the other way and industry's model of interacting with healthcare professionals will continue to change.  We hope for the overall improvement in healthcare, but we also know we are a long way from really knowing.  In the meantime, the economy is affecting all of us.  Make sure your CV/Resume is up to date. 

Friday, June 18, 2010

Can we learn something from other Countries with constrained resources?

For those being challenged to come up with new ways of delivering effective but less expensive health care, we have a suggestion: stop trying to think outside the box. Imagine that there was never a box to begin with. (For those who need reminding, the rate of healthcare cost has increased about 8% each of the last three years.)

Researchers at the McKinsey Quarterly found innovators in many places, including Mexico, Mali, India and New York City, who were coming up with no-box-ideas of treating patients in affordable but valuable ways. For example, in New York City, chronically ill patients are being remotely monitored, significantly reducing hospital admission rates. In Mexico, families can subscribe to a $5-a-month advice and triage service. In Pakistan, a chain of retail outlets sells condoms and provides health services for women and children. And so on.

Industry members should be able to see themselves fitting into these various scenarios. In Mexico, for example, subscribers with chronic diseases should be alerted when prescriptions need to be refilled; in Pakistan, they can provide counsel and advice on antibiotics. And so on.

The authors of the McKinsey article said that in the emerging markets, these entrepreneurs “face fewer constraints…so they can bypass Western models and forge new solutions.”

What an opportunity for learning and helping. We hope both sides are smart enough to recognize it.

Thursday, June 17, 2010

Should T-Mobile jump into the medication adherence space?

One thing that’s so fascinating about watching various businesses and groups try and solve the problem of medication adherence is that they are so diverse – if you need convincing, pick up Monday’s New York Times.

One business that is exploring whether it wants to enter the market is T-Mobile. It already has a name for its product; the product itself is developed; T-Mobile even showed an advertisement of its product at a mobile health fair last month at Stanford University.

So why isn’t the cell phone company ready to launch its product? As the mobihealthnews article points out, T-Mobile has its marketing channel in place, so what is it waiting for? According to the article, T-Mobile execs are concerned about “liability issues” and whether they “know the space.”

Know the space? Why should T-Mobile be different than anybody else? Jump on in, boys, the water is just fine!

Monday, June 14, 2010

Publishers want more transparency of HCP's potential conflicts

Seems that our cousins on the other side of the Atlantic are upset about transparency, too.

BMJ wants the head of Margaret Chan, secretary-general of the WHO, who’s being accused of sheltering some members of an important “emergency” committee with alleged ties to industry. This committee made the decision on when to announce the H1N1 pandemic, and BMJ, among others, wants to know if committee members’ decisions helped put money in industry members’ pockets, namely Roche and GSK.

According to BMJ, industry makers profited handsomely because the committee wrongly predicted how large the pandemic would be, and so countries stockpiled antivirals. Even by industry standards, it’s serious money – about $7 billion total, according to BMJ, quoting JP Morgan.

The names of the 16 committee members are only known to the World Health Organization (WHO). WHO has said it won’t release the names until the committee’s work is finished. One committee member, according to BMJ, was consulting with Roche at the same time this person authored work on the “use of antivirals in a pandemic.”

Dr. Chan, in a MedPage today article, acknowledged the need for stricter transparency regulations, but denied that the committee made any decisions to help industry. "The bottom line, however, is that decisions to raise the level of pandemic alert were based on clearly defined virological and epidemiological criteria. It is hard to bend these criteria, no matter what the motive."

Industry can help here. The antivirals have a decent shelf life – a few years -- so Roche and GSK should consider buying some of the Tamiflu and Relenza back. Considering the financial situation that Europe finds itself in right now, that would be welcomed good will.

As for those committee members, face it – you are guilty until you prove yourself innocent. It’s galling, absolutely, but the sooner you declare yourself, the sooner you’ll be left alone.

Friday, June 11, 2010

Google Health's PHR-Is it a sign or will they be back?

It's amusing that some bloggers are taking swipes at Google, more specifically, Google Health.  We think it’s okay for the king of the hill to get a stone in his shoe every once in a while.

Should the rumors of Google Health’s possible demise be true, isn’t it possible that Google is acting on what the rest of us suspect -- that the business model for the personal health platform needs to be reconsidered?Relying on patients to find their own way here is not proving to be the most efficient way to get patient records online.

Chilmark Research says Google Health has “struggled to be relevant.” Maybe that’s true. But if you’re not sure which way the rain is falling, it’s hard to know in which direction to hold the umbrella. 

Maybe what needs to happen at this point is for some forward-thinking group to study the models that are already out there – who’s doing them, who the patient population is, and so on – and then study the outcomes.

Maybe this is what Google Health is already doing: Retreating, regrouping, rethinking, and then planning to reissue its new personal health platform model.

Tuesday, June 8, 2010

The Transparency Band Wagon Gets More Crowded

As more medical professionals jump on the conflict of interest band wagon – the Council of Medical Specialty Societies (as reported in Fierce Pharma) being the latest – maybe it’s time to be less myopic and examine this situation from 30,000 feet up.

So far, the exam yields nothing but questions.
  • What will be the effect of all this transparency?
  • Should the separatists, (those who believe that industry money is too much of a lure to keep physician consultants honest), get most of what they want, then what will happen to real research and development?
  • Can anyone deny that collaboration has not yielded excellent results?
  • What will be the effect of all this finger-pointing on physician and student education? Will all presenters be looked upon with mistrust? What about CME? Will it survive? Who will pay for it?
  • Will physicians avoid becoming NIH researchers, not wanting to see their name on a Web site?
  • Will physicians stop working with industry, for the same reason?
All of this seems to suggest that healthcare professionals working with industry are guilty until proven innocent!  It is clear that the former model must change and adapt; our message is that some may be trying to throw the baby out with the bathwater. Good, clearly structured contracts can help make this process more organized and disciplined -- which is what many are really saying anyway.

Friday, June 4, 2010

The future of drug development: Is this it?

The irony cannot be lost here.

Can Steve Nissen, the cardiologist industry loves to demonize, show Pharma how to shorten the length of a clinical trial, save money on it as well and --- on top of all that – prove to the world that KOLs continue to have an indispensable place in the future of medicine?

Nissen, the department chair of cardiovascular medicine at the Cleveland Clinic in Ohio, and an FDA adviser, is lending his considerable clout to an ambitious trial that is teaming up Pfizer’s Lipitor with a version of a thyroid hormone that, when given together, reduces cholesterol levels as reported on

This hormone, created by the Swedish pharmaceutical company Karo Bio AB, is called eprotirome, and according to Bloomberg, works in such a way that the FDA will require that it undergoes extensive testing. Who will make the key management decisions; how will this compound be developed differently than products of the past? Will Dr. Nissen talk publicly about his relationship with this company? The media apparently hasn't asked this question yet. But even more important, has drug development gotten so expensive that it might not be able to be completed without significant cost?

These studies will still take considerable time and money, both of which Karo doesn’t have – Karo has no products on the market, Bloomberg says. What Nissen and Karo are talking about is testing the combination on massive numbers of people, with the trial lasting about three years. Imagine the cost of such a trial. "If regulators clear Karo’s limited scope for research, it will still cost $300 million or more," said Erik Hultgard, an analyst at Handelsbanken Capital Markets in Stockholm. Is this the future of drug development for small- and medium-sized companies? We certainly believe that the development model needs to change. Should a shorter, more evidence-based approach to drug development be used?

Let us all hope that Nissen and Karo are successful, as everybody wins here.

Wednesday, June 2, 2010

Gentle Nudges Work to Get People Exercising -

Gentle Nudges Work to Get People Exercising -

This is a really great article that has real application to adherence. Does it mean that social networking could work to help motivate adherence?  We think so and when combined with technology like SMS and IVR, it can often help bridge gaps in care between office visits for patients.

We are aware of several pilots that are focused in this area.  But who is really responsible for Medication adherence.  Are patient's themselves really the ones?  How much responsibility does a Healthcare Professional have to make sure a patient follows their prescriptive treatment?  All these are weighty topics that suggest we are early on in this part of the debate.  Stay tuned, but we encourage people to get out and exercise, in fact, its time for my daily walk too!