Monday, June 2, 2008

Another failure to communicate with Doctors

In a Wall Street Journal Blog, Jacob Goldstein talks about Anemia drugs sold by Amgen and J&J (Aranesp, Procrit and Epogen) that may stimulate the growth of tumors in some cancer patients. Research suggests a genetic link that could potentially be used as a biomarker to figure which patients should and should not receive those drugs.

At the end of the WSJ article, Goldstein quotes Tony Blau, the lead researcher who said that “The definitive answer to this question lies locked in the files of pathologists’ offices.”

What a shame.

If drug companies had better communications with doctors, research on what works and what does not could be significantly enhanced. performed a February 2008 online physician survey of oncologists and hematologists on the subject of Aranesp, Procrit and Epogen prescribing practices. See detailed survey and results.

65.6% of doctors agreed that certain dosages of these drugs resulted in more rapid growth of certain cancers and a decreased cancer survival rate. Consequently, about 66% of doctors have either reduced the dosages they prescribe, or reduced the number of patients they prescribe the drugs to, or reduced drug usage in certain cancer patients.

Amgen and Johnson & Johnson should do more prompt research on this issue and get answers as quickly as possible since many doctors are clearly nervous about using these drugs. Ironically, the answers are probably "locked in the files of pathologists’ offices."

The longer doctors are kept uninformed, the more likely they will be influenced by media reports as opposed to science, as occurred in the Vytorin debacle. See Analysis of Vytorin Surveys.

Failure to communicate promptly and effectively with physicians will certainly cause further erosion of sales of these drugs, as is occurring with Vytorin.

Robert Cykiert, M.D.

Yogurt for everyone except doctors

As a sign of our times, the Wall Street Journal blog
noted that Eli Lilly had a white sign at their Oncology meeting in Chicago with the following message:

Food, beverages and/or meals will not be provided by Eli Lilly and Company for the following parties:

* Physicians and individuals with prescribing authority in Minnesota in order to comply with Minnesota statutes

* Government employees in New York (both city and state) in order to comply with New York statutes

Particularly tempting was the frozen yogurt that everyone could have except Minnesota doctors and NY government employees.

Lilly’s sign prohibiting free frozen yogurt to MN doctors is a clever way to make a point, tongue in cheek. Free pizza, and other trinkets have no effect whatsoever on physician prescribing patterns since doctors receive the “gifts” from all the companies. Therefore, no one company has an advantage. If you ban all trinkets by all companies in all states then the pharmaceutical companies will simply divert those marketing funds to things like DTC, eDetailing, and online sponsorship of CME courses. A much better way to deal with pharma gifts to doctors is to require all medical companies to post all gifts on their public web sites. The transparency will keep everyone honest. performed a December 2007 online physician survey of 290 doctors in various specialties to determine their views on medical company marketing to doctors. Click to view survey.

While 40.5% of doctors agreed that medical companies shouldn’t give any gifts, 71.6% said that doctors are not influenced by these small gift items. It seems like detailed public posting of all gifts with specification of doctor recipients would keep everyone honest. I checked Lilly’s web site--don’t see the frozen yogurt listed there yet.

Our publicly posted surveys are performed on randomly selected physicians, the doctors fill them out voluntarily and are not identifiable, and are completely anonymous. Therefore, the doctors have no incentive or advantage to give false or misleading answers in the survey. Doctors then read our publicly posted surveys to see what their colleagues are thinking on major issues in healthcare. It’s one of the few effective ways that doctors can take the pulse of their colleagues on controversial issues that affect their livelihoods and affect patient care.