Ethical Blinders

Good evening, class!

Book report project
Today we start off with an assignment for a new book that doesn't quite cast the drug company in such demonic lights, as have our previous assignments. It's more illustrative of the powerful personalities who dwell at the summit of medical research and business. Mild personalities simply don't reach these spectacular heights, which explains why we are plugging away at this blog anonymously, while we should be doing other mundane tasks.

Such a clash is illustrated in a new book, reviewed here in the Times, describing how one alleged scandal over drug safety morphed into an altogether different affair surrounding the principal investigator for a Canadian drug, Nancy Olivieri (described as "charismatic"), her attempts to whistleblow the company supporting her, and why it may have all been smoke and mirrors. Not available in the US yet, so far as we can tell.

Pill splitting backed by insurers
The Associated Press has a interesting story, found in today's Philadelphia Inquirer, about how pill splitting to save money is being encouraged by insurers. If multiple dose forms are priced similarly, and there are no issues with instability or coat-core formulations, why not get a higher prescription strength Lipitor than you need, and cut it in half?

Ethical blinders?
It was the last sentence in this article that grabbed our attention. We got most of the way through this thinking that a CME "wall of separation" between pharmas and docs may be possible someday, if these trends continue. But then the Cephalon spokeswoman has to go ahead and say something stupid like "...it's an opportunity for us as a company to start building a presence in psychiatry" while discussing the psychiatry course they are underwriting.

If she's reading this (hah!), she probably has no idea what we are objecting to. Therein lies the problem.

We've had many a conversation with sales folks (who have a much more difficult job than we) about influence over physician prescribing habits. VERY little is required to make one person feel some kind of indebtedness to another, when it comes to gift giving. Pharmas know that well. Even the merest office trinkets, or under $25 "lunch and learns" can influence a doc to mke a decision they would not ordinarily make. See this link for the statistics involved. The reps we have known talk about building their relationship with physicians, often becoming quite chummy. And the kicker - they honestly, in their gut, think that is perfectly OK. Why not? Salesmen from other industries certainly get that way with clients.

Do we need to write more, or are you getting it? Would you like to know all of the factors that went into the decision for your doc to write you an Rx for drug xyz? And would you be comfortable knowing that the sales "relationship" was a factor, however background it may be?

The reps, the Cephalon spokesbabe, the docs - all with moral blinders. Is it immoral when they don't even see the conflict? Why is anything besides science guiding medical decision-making here? After all, every company claims that each of their products is the superior product for clinical reasons. Let's make them back that up without the relationships.

Tomorrow: The article that almost brought us out of retirement last February.