Ghostwriters in the sky
Francis Collins, the new Director of the National Institutes of Health said on C-Span that he is shocked by the apparent conflicts of interest between Big Pharma and scientists. He was talking about scientific studies regarding pharmaceuticals.
We do not see the representatives of Big Pharma much anymore, but when one of them does show up, I will do what I have done since the early 1980s. I refuse to take any paper they want to give me and tell them, “I will not read anything. What I want from you is to answer three questions. WHAT DOES THIS DO? WHAT ARE THE DANGERS and WHY IS IT BETTER THAN THE OTHER GUY’S?
Some younger argue and hold up the paper, “It’s all here?” The older guys don’t bother. They know that it is at least 50% a popularity game. If I like them, I will listen longer.
In 1983, when I was the manager of a pharmacy in Pittsburg, California, it was 100% a popularity game for Merck. She was 30-something, gorgeous and small. For me, she was the equivalent of fried Twinkies at a bikers’ rally. Her energy seeped from her pores. Men are attracted by energy. You single women, more cheerleader WORKS.
This Merck girl was the only Big Pharma Detail Person allowed in the pharmacy. She knew right where to go. The stool, beside the sink, at the far end of the pharmacy, counter was her web. She could not be seen from the front. My ashtray was there. Food was usually abundant. The coffeepot was pushed back under the shelves.
I always smoked a cigarette, sipped stale coffee and listened intently to her “detail”. Never more than five minutes. I refused to take any study she was waving around. I was in love with an idea that included her naked. The testosterone surged and my head was definitely in the game.
This darling girl (why are they always 10 years younger?) would always smoke her cigarette and make my pharmacy her hideout for a half hour, forty-five minutes.
Finally, she put me on the expense account and took me to lunch. It was on a day off. We met at a restaurant on Yganico Valley Road in Walnut Creek. The lunch was long. We drank wine. The crescent booth was rich red and black leather. The lights were dim. The music soft, low. She suggested Hennessy after we ate. She extended her hand and held mine for a few seconds. Her eyes were wet and I was lost. I really fell in love………AGAIN.
“You are a married man,” she said, “I can’t.” She let go of my hand.
“I shouldn’t,” I said, and it was over. Her visits after that were five minutes. She never again sat on the stool. She continued to try to peddle Merck’s studies. I refused to take them. Ah life, it has offered so many tastes that I was allowed to chew but not swallow.
All of that was meant to entertain you before I report about ghost-written papers that are signed by NIH scientists as the authors when they have been written by writers employed by Big Pharma.
You and I have suspected this for a long time. How can one study on Cozaar tell us that Avapro is inferior and a study the next week tells us how bad Cozaar is. You notice how the detail person will always lead with a prominent paragraph criticizing the others guy’s drug?
Direct to Consumer Advertising is marginalizing you, my friend. We are getting farther and farther out of the loop. That must change, but it is up to you. I have other windmills. Put down the beer, turn off the game, go to the Internet. There are politicians championing the end of DTC ads. Ask yourself, “Is it worth three phone calls to my Representative and Senators to get this stopped?” Direct to Consumer advertising is the engine that is running our profession straight to the dump. The voices of pharmacists have to carry weight with the legislators.
Anyway, you can see the NIH Chief on C-Span’s NEWSMAKERS show this Sunday (12-27) at 10:00 AM or 6:00 PM ET. With the anything-to-help Big Pharma Bush years behind us, there is a “Proposed Rule” that would require disclosure of financial connections between medical firms and NIH funded scientists. The rule would forbid “ghostwritten” studies WRITTEN BY DRUG FIRMS but attributed to researchers. Pathetic that this went on for decades. Why hasn’t the NIH busted this up a long time ago? You can answer that one.
The NIH Director, Francis Gibson, said he was SHOCKED by some reported conflicts. The years 2000 thru 2008 almost put us under. “The Have Mores” prospered while you guys were held hostage by the PBMs.
Now, who was the smart one? I didn’t know that the studies contained bullshit. I refused to accept them because I SUSPECTED that they contained bullshit.
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I graduated the first time in late ’80’s. I had no suspicion that we were touting fluff. After years of one course per semester I ‘learned’ basic statistics (took me three times, with first course at community college). Then, part of the part of the PharmD curriculum was Drug Information. Believe me, when you’re paying cash for classes, you make the time you spend in school worth it. Drug Information, as a class, opened my eyes to what was going on.
As students we rigorously dissected drug studies and presented articles in Journal Club. I told the orthopedic surgeon I was shadowing that of the anti-inflammatories, Bextra was going to be tolerated better than Vioxx if the patient had one underlying illness than another. I made him a little table (similar to what might of been in Facts & Comparisons) comparing the adverse effects. He listened and prescribed in light of an unbiased opinion. Two years later, one was yanked from the market, then the other. The information was in the package insert and in the drug studies, but not interpreted accurately and certainly never mentioned by reps.
Several years away from that second degree, with no access to bibliographic research capabilities, I rely on my free copy to Pharmacy Times, Drug Topics, Hospital Pharmacy, etc. and to a certain degree on drug reps. They present new drug information about chemo drugs I’m not familiar as well as new pharmaceutical science. For example, the rep that sets up sales for some vaccines e.g. Cervarix, says his company’s product is ‘better’ than Gardasil because it covers more viral variants, and its novel excipient provides longer duration of effect. He gave me the lowdown on why FDA recently approved indication in males (genital warts, remember when we compounded products from podophyllin resin?) I’m not proud. Now, that I have a little statistical reasoning under my belt, I’ll take information from wherever I can get it, drug reps, stories from the manufacturer, etc.
That was one reason I got into pharmacy, that when people started slathering on the highfalutin talk, at least I would be familiar with anatomy and chemistry. I don’t think that direct-to-consumer should be considered anything more than snake oil to the masses, based on what I hear when I work retail, and even in the hospital setting by those without more in-depth nursing, etc.
Forgive the manly man reference, Cathy, but you are an absolute STUD!!!! After the years I put in, I will not even pretend that I care that much. I am not going to work at this. They have to get me with a compelling headline. They have to give me the information in a concise digestible form and they have to give it to me quick. That includes advertising in MY magazine (after 21 years, I feel a proprietary inclination) and all of the other magazines. Quick, to the point and answer my three questions. I admire your attitude, Cathy. I hope that your holiday is fulfilling and that you end the day satisfied.. JP