How to Outsmart Big Pharma - Part II
Don Draper could sell you Vioxx. (Source)
tl;dr - Assume that everything you read about a drug is somewhere between slightly misleading and complete bullshit.
Welcome back to Part II of this gripping saga on how to bulletproof yourself against drug company nonsense. In Part I, we looked at some of the tricky wording and fantasy data used in clinical studies and package inserts.
In Part II, we're going to look at shady marketing practices. Both to health care professionals like yourself and to consumers.
Anyway, let's get into it.
"Educating" The Gatekeepers
New drugs are getting approved at record paces by the FDA. It's impossible to read all of the studies to keep afloat with just the drugs in your field. You need some way to stay on top of updates.
Drug companies know this. And they know that health care professionals are the gatekeepers. They are the ones who ultimately decide whether a treatment gets used or not. And so the sales and marketing department plays a big role in whatever "educational" pieces make their way to you.
Everything about this screams 'educational'.
Have you ever been to a CE dinner? A drug company will rent out a nice place like Ruth's Chris or Fogo de Chao. They provide an expensive meal (often including drinks). And an MD will go through the wonderful data for some new drug. And you get a free CE to boot! #Winning
That CE is carefully picked over by the marketing department before it sees the light of day. The data presented is there to put the product in the best light possible. It's not trying to provide a fair and unbiased picture. I read a report once that talked about a CE "Individualizing ADHD Pharmacotherapy with Disruptive Behavioral Disorders" that was taught by a Johnson & Johnson funded MD. Risperidone was mentioned 13 times. Not surprising.
Lest you think our profession is immune, it's not. I recently got an email from one of our national pharmacy organizations. The opening sentence?
“Dear Pharmacist,
Every now and then, medications come along that make you question the status quo and redefine expectations...”
It's almost laughable. The fine print reads "This is communication from the [insert organization here], developed under the direction and sponsorship of Novartis Pharmaceuticals Corporation."
Translation: "We paid [insert organization here] lots of ca$h to send this to you."
I'm not calling out the national organization here. They have bills to pay and they need to keep the lights on. I'm just sayin...
Typical setting for allergy medication advertising.
Then there's Ghostwriting. What's that? It's exactly what it sounds like. No, it's not about that lovable '90s TV show. (Warning: If you click the preceding link, good luck getting that song out of your head. "Ghostwriter...WORD!")
With Ghostwriting, medical writers paid by drug companies write a study or publication under the name of a "researching" MD.
Guess what the conclusion normally is?
This one is seriously sketchy. Because these "studies" look like legit primary literature. And many journals don't have an official policy against ghostwriting. So just because you're reading a prestigious journal doesn't mean you're reading an unbiased article.
Do a quick a google search for "ghostwriting in medical literature" and enjoy the rabbit hole that you're about to go down.
Last but not least, there is the good ole Advertorial. These look like editorials, but act like advertisements. You might also heard of them called "native ads". Scroll the front page of most syndicated pages (BuzzFeed, Huffington Post, etc) and you'll see a ton of these.
Go to Medscape and you'll read informative articles with fine print that reads "This post sponsored by Amgen." They're usually articles that discreetly 'educate' consumers and healthcare professionals about some disease. And of course the sponsoring company happens to have a magic pill to solve the problem.
This is probably most common with health information on the internet.
"Educating" the Consumer
If I take a PPI, I can has all the foods.
In the US, drug companies also advertise directly to consumers. It's interesting to note that New Zealand is the only other country in the world that allows this.
These are the Cialis commercials you see on your TV. Or the ones that really piss me off: Prilosec and Larry the Cable Guy. Really, you mean to say I should go ahead and eat everything I want to?
It's not just drug commercials. There's a new thing going on with direct to consumer advertising. Sponsored webpages for the disease (not the drug itself) are popping up everywhere.
An example is OIC Is Different. I first saw this gem during the Superbowl this year. What's tricky here is that both the TV commercial and the website appear to just be about opioid-induced constipation. They tell you how opioids (wait for it)...
...induce constipation. About how you're not alone in your suffering. At first flush, it looks more like a disease awareness campaign.
Then they mention a prescription treatment option to talk to your doctor about. This takes you to a website for Movantik, a new medication for opioid-induced constipation. It's about $300 for a month's supply.
Do you know what OIC Is Different doesn't tell you about? All of the other stuff you can try. You know. Things like movement. Water. Dietary fiber. Coffee. Metamucil. Docusate. Senna. Docustate + Senna. Dulcolax. Miralax. Magnesium citrate. Milk of magnesia.
Do you know what doesn't cost $300 per month? All of the things listed above. Combined. You could take all of the things above in combination for a month and still not get to $300.
Look, OIC is a serious issue. I've seen patients get admitted to the hospital and need surgery for it. Drugs like Movantik and Relistor definitely have a place in therapy.
But that place is usually after trying everything else. The commercial won't tell you that.
The recently approved sleep medication Belsomra used a similar tactic. Really, this is just starting to become standard practice. Back door disease "awareness" campaigns that are started months before the drug even hits the market.
What's the lesson in all of this?
Everything except unicorn poop is bullshit. (Source)
Simple. Assume that everything is bullshit.
Start from "bullshit," and let the data win you over. Let the drug work it's way up. Make it earn your trust. That's the whole point of science. The goal is to DISPROVE the hypothesis (or to 'fail to reject the null' for you stats wizards).
The goal of science is not to make sensational headlines.
There's a lot of money to be made in Big Pharma. Any tactic that gives a drug even a slight edge can be worth millions. That's not an evil thing. But you don't have to play into that game either.