Healthy Skepticism Library item: 17411

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: Electronic Source

Herper M
Medicine's Dance With The Devil
The Science Business (Forbes Blog) 2010 Mar 18
http://blogs.forbes.com/sciencebiz/2010/03/medicines-dance-with-the-devil/

Full text:

In a small, darkened room at the American College of Cardiology’s annual convention, a debate between two top cardiologists turned into a brouhaha involving academic researchers, industry executives and representatives of the ACC and the American Heart Association over whether or not industry money should be used to pay to teach doctors about the latest medical advances.

Drug and medical device companies fund $1 billion of continuing medical education (CME), most of it run by small companies that have made a cottage industry of preparing presentations for doctors.

Robert Harrington of Duke University was listed as a defender of the CME system, but he spent most of his presentation attacking industry-funded CME. His catalog of pharma malfeasance: a 1999 AstraZeneca e-mail openly talked of intentionally burying trial results; academics have been caught signing their names to ghostwritten papers; companies have paid fines of up to $800 million for off-label marketing practices that included unethical CME. “We need to take a stand about what’s right and what’s appropriate,” Harrington said.

But Harrington maintained that new checks and balances could make things better, including having companies pool their money and prohibiting companies from choosing lecture topics. “If we’re willing to be manipulated there are a lot of people who want to manipulate us,” he said.

This problem has been around for decades. He quoted an ad executive from 1963: “The drug business is today, and will be tomorrow, what the doctors cause it to be. Drug advertising too.”

Harrington’s opponent was Steven Nissen of the Cleveland Clinic, famous for his role in the Vioxx and Avandia scandals. He started with a video clip of Jack Nicholson screaming, “You want the truth? You can’t handle the truth!” and argued that there is no way any combination of checks and balances will ever keep CME from just being “commercial marketing efforts.”

The very fact that drug companies keep sponsoring medical education, he said, means that the CME must be subtly accomplishing their marketing goals and perverting medical practice. “If we did a good job with industry-sponsored CME, I believe that the money would dry up,” Nissen said.

Even CME that barely mentions a drug can help prime the market for it by talking about the science in a way that will whet doctors’ appetites, Nissen argued. He pointed to a Merck presentation that ran on the ACC Web site, in which the science and need for a heart failure drug that helps the kidneys was talked up. Merck had an experimental drug, rolofylline, that was nearing the market at the time. It failed.

Talking up the science before a drug’s launch can certainly boost demand. That kind of promotion helped make Celebrex and Vioxx into big sellers. Amgen is currently running medical journal ads to promote the molecular pathway hit by its experimental bone cancer drug. But doctors also get excited about new stuff on their own—they were interested in rolofylline. It can be hard to tell honest enthusiasm from drug-company driven hype.

Is there any way to inform doctors on the industry’s dime without turning education into marketing? ACC chief executive Jack Lewin argued from the audience that there’s no other way to pay for educating doctors as the body of medical knowledge explodes. “If we don’t manage these relationships we’re going to stifle innovation and we’re going to stifle the progression of science,” Lewin said.

A big test of this idea will come in November, at the next annual meeting of the AHA. As an experiment, industry-sponsored lectures will be funded by a pool of companies, instead of a single drugmaker. Top physicians, not the companies, will pick the topics.

Nissen lost the debate on a technical knockout. He accused the American Heart Association of issuing scientific statements that defended sugary sodas because it was getting money from Coca-Cola to fund a “Red Dress” campaign to raise awareness of the danger of heart disease in women.

Wrong red dress. Clyde Yancy, the president of the AHA, got up and said his organization hadn’t gotten any Coke cash. The Diet Coke brand underwrote red dress promotional activities for the National Heart, Lung and Blood Institute, according to Coca-Cola and the NHLBI.