Monday, November 26, 2007

Is it Medical Education, or is it Pharmaceutical Marketing? - the Case of "Dr Drug Rep"

Even though many other bloggers have commented on it, I must note an article just published in the New York Times Magazine by Dr Daniel Carlat, editor of the Carlat Psychiatry Report and blogger on the Carlat Psychiatry Blog.

Dr Carlat recounts what inspired him to produce a newsletter on psychiatry treatment that is supported by no pharmaceutical company money, and to blog acerbically about the influence of vested interests on medical education.

It seems that in 2001, he became, as the article is entitled, "Dr Drug Rep." One of the local drug reps enticed him into giving "educational" lectures, over drug company supplied lunches, to physicians and others in their offices. The lectures, of course, were mainly positive about the drug company's product (a serotonin and norepinephrine reuptake inhibitor used to treat depression, venlafaxine, Effexor by Wyeth).

Dr Carlat described the lavish meeting at which he was prepared for his new part-time job. He was provided with a "slide deck" of company approved slides, and heard lectures by famous psychiatrists who, of course, found little not to like about Effexor. Dr Carlat gradually began to realize that the evidence which he was taught to provide in support of Effexor was not as convincing as it first appeared. He became concerned about how much drug reps knew about other physicians' prescribing, and the degree to which his own lectures were being monitored by drug reps. After encountering some skeptical physicians in his audiences, he began to realize that he was not as convinced about what he came to be selling as when he started. Finally, when he modified his presentation to be more honest about the benefits and harms of the drug, the local district manager for the pharmaceutical company inquired, "have you been sick?" That is when he quit his part-time Dr Drug Rep job.

The extent that pharmaceutical manufacturers (and other companies such as biotechnology firms and device manufacturers) disguise marketing as "education," and recruit physicians and academics to do marketing in their guises as "thought leaders" should come as no surprise to readers of Health Care Renewal and some of the other blogs listed on our side-bar. However, this topic is addressed not as often as it should be in the medical and health care literature, and in medical school and house staff training. Furthermore, the public hears far more from the corporate marketers and those who work for them than from the skeptics like Dr Carlat.

That this clearly written and entertaining article appeared in an outlet with the circulation and prestige of the New York Times Magazine means that we really are making progress in making the public aware how deception, dishonesty, and unethical behavior in general may be responsible for much of the current health care crisis. Kudos to Dr Carlat.

See also discussion on the Carlat Psychiatry Blog, the Clinical Psychology and Psychiatry Blog, the Health Care Organizational Ethics blog, the PharmaGossip blog, the PharmaLot blog, and the Retired Doc's Thoughts blog.


Anonymous said...

It is amazing how much clearer things become when money is not involved.

I recently read that due to a minor rule change, Minnesota is having a major impact on pharmaceutical marketing in that state. Apparently a new state official decided to interpret an existing law differently from his predecessor. Now drug companies are only allowed to give physicians no more than $50 worth of food in any given year.

Since the rule change, suddenly facilities are banning drug reps from their premises, and reps are dropping like flies. It is easy to have integrity when there is no money involved.

Anonymous said...

yeah good point on your blog post, it is easy to understand, thanks for sharing, keep it up…

Sadness Addicted said...

Antidepressant advertising is directly targeted at manipulating normal healthy women to want to be medicated. Women must stand up to big pharma’s bullying them to over-medicate with antidepressants washing out their emotions & personalities and interfering being mothers, sisters, brothers, daughters, partners and lovers.. Women are targeted for antidepressants by big Pharma in the same way that tobacco companies targeted us 70 years ago. Drug companies are so effective at selling unhappiness to women that women take more than twice as many antidepressants as men. Like effexor Wyeth/Pfizer plans on using modern marketing techniques and direct payments to doctors to have Pristiq over prescribed instead of used based on evidence based diagnosis.