Pharma Needs to Think Carefully How They Wish to Interact with Patients

Just discovered that my Pecha Kucha presentation given at the e-Patient Connections conference in Philadelphia last September 2010 was indeed posted online. Thanks Kevin Kru.

The title of the talk was "Through the Looking Glass - A Patient's View of Interacting with Pharma." It was given in a very organized fashion. Only 20 slides which were each displayed for 20 seconds. At the end of the last slide, the presentation was complete.



Gotta admit - doesn't look/sound too shabby.

Is Pharma Paying Your Doctor?

[Note: Majority of the information below was pasted from an email announcement and one other source online.  I just fixed some of the links.]

An historic piece of journalism was published today. Six news organizations partnered on the "Dollars for Docs" project - ProPublica, NPR, PBS's Nightly Business Report, the Chicago Tribune, Boston Globe and Consumer Reports. They examined $258 million in payments by seven drug companies in 2009 and 2010 to about 17,700 health care practitioners nationwide for speaking, consulting and other tasks.  The project offers details on the seven pharma companies, the top earners and a chart of the number of doctors in each state, their professional backgrounds and what they did on behalf of the drug companies.

In a major investigation of pharmaceutical company payments to doctors, ProPublica and our partners found that hundreds of the doctors who are being paid to promote drugs have been accused of professional misconduct, were disciplined by state boards or lacked credentials as specialists.  A sidebar piece examines lawsuits brought by former pharma employees who alleged their companies illegally marketed brand-name drugs.

Today, NPR will feature interviews with Charles Ornstein on Morning Edition and Tracy Weber on All Things Considered and next week NPR's Alix Spiegel will have an in-depth piece.  The Boston Globe and Chicago Tribune published their own related stories, while the Nightly Business Report will run features on their program on Tuesday and Wednesday.  And Consumer Reports published a survey of patient attitudes toward pharma payments to doctors.

Ornstein and Weber won a Pulitzer Prize for their King/Drew medical series in the Los Angeles Times in 2005 and they were finalists for the award this year for their coverage of health care issues for ProPublica.  Both are available to do interviews to discuss this new investigation.  The reporters will also host a conference call this Thursday, October 21st at 3pm Eastern to explain how other reporters can follow up on their work and do their own local investigations (details to follow soon).  We hope you will join us by writing, blogging, tweeting or republishing it for your audience.  Please feel free to contact us with any questions at all.

Best regards,
Mike Webb & Quadia Muhammad
ProPublica
917-512-0233

ePatient Connections: A Patient's View of Interacting with Pharma

Earlier this week, I traveled to Philadelphia to speak at and attend the 2010 ePatient Connections Conference. This was the 2nd year of the conference, organized by Kevin Kruse and Kru Research, bringing together lifescience companies, marketers, digital and healthcare companies, physicians and patients to discuss better ways to work together to "improve patient outcomes." 

I had submitted or pitched my own story to share at the conference many months ago and was pleased when Kevin Kruse invited me to give a special presentation.  I must admit that I felt some pride knowing that no company pushed to get me scheduled and that as an individual, I was given an equal opportunity to contribute.

As you can see from a few of these photos, my presentation focused on the interaction of pharma companies and patients online.  Engagement is a big buzz word right now and so I used that as a jumping off point.  As MS patients, we frequently see short-term projects come and go online.  Often these initiatives exist merely to provide leads for the companies.  I know that, you know that, we should all go ahead and admit it.  The companies want our contact information.  They ultimately want to sell us something.

However, sometimes the projects will provide a good service...do something good for somebody.  I know that many of my readers were sorely disappointed that I agreed to participate in the "HowIFightMS" unbranded initiative.  It was my hope that folks looking for real-life stories of people living with MS would find our videos and dig further to find our blogs.  I know it that did happen on occasion because I received emails from folks across the country in response to the project.  I was also thanked many times for creating the videos.  Made me feel good about it all.

My talk included 20 slides and not nearly all of them were photographed.  I have included the ones which were in this post.  There are a few slides which I wish had been photographed during the talk.  If they were, they didn't make it onto the flickr stream from which these photos came.

Those slides included tidbits which became the popular soundbites and recommendations from my speech. Who knew that my words would even turn into soundbites... I didn't.

Some quotes from my talk:

"Stop selling and start supporting."

"Don't fear monger or condescend."

"Trust: Build it or destroy it - your choice."

"Abandon your patient or customer group and you destroy trust in the entire pharma industry."

"Listen, talk with me, be honest and transparent, stop trying to sell me, ask what I want and give me more than I expect."

"Do good for others and patients will notice; that's the best marketing of all."

Do I Need You?

There is so much more to be shared regarding what I learned during the conference, but this is it for now.  The topic of empowered patients and the influence of ePatients online have been growing in recent years.  It is good that our voices are being represented at some of these health-related conferences. 

It was a great opportunity to connect with some influential patient leaders whom I follow online.  Fortunately, we'll have another chance to connect and discuss important topics in less than two weeks at BlogWorldExpo2010.   Las Vegas, here I come.  :)

Pay no Attention to that Man behind the Curtain

Prescription Project has an entertaining post on their blog, PostScript:
"The way to a legislator's heart? Caterers give it a try"

Here's a brief excerpt:

We know that pharma has long found ways to get what it wants by talking through others – physicians, say, or advisors for the FDA. But a tip to the letter-writers of the world: if you don’t want to look like you were put up to something, don’t parrot information you probably couldn’t get doing your job.

The petitioner from RestaurantstoYou moves quickly from entreating to indignant: “How could we think “the most educated people in the world, Doctors, could be manipulated by the offer of a ham sandwich and chips from a pharmaceutical or medical device company sales agent? Instead, the opposite is true. Doctors routinely ask these reps to go do more research for them, at no cost to the doctor, so that they can have additional information for their individual analysis that they will use to make decisions regarding their patients.”

Abt knows this because he says to better understand his clients, he has watched from the back of the room in admiration as the reps performed their lunch and learns. Fine.

But if you are the one making the sandwiches, do you really want to sound like you are reading off the same talking points as the state policy director for the PhRMA trade association? PostScript has been to enough hearings to know those talking points when we hear them. Sales reps with no background in science are providing valuable information about drugs that physicians can’t get anywhere else? And pasta salad.

Yep.

I recommend you go read the full post, especially if you need a little chuckle.

Warning: Steroid-induced Annoyance Ahead

In January, I learned that Montel Williams is honoring Billy Tauzin at this year's The Montel Williams MS Foundation Gala & Pro Celebrity Poker Challenge. It is no secret that Montel has a very chummy relationship with Big Pharma and PhRMA (Pharmaceutical Research and Manufacturers of America) more specifically, of which Tauzin is the CEO.

This being MS Awareness Week and all, it seems like an appropriate time for Montel to hold his little soiree. But I gotta tell ya, this little tidbit of information just made me want to puke (or maybe that's the heartburn from day 5 of Solumedrol.) Tomorrow, you too can 'join in the fun' by signing up for the online Pay-Per-View event, just $9.95. Here's the Press Release regarding the live-streaming event and information regarding a Podcast interview with Montel himself.

So, please while the star-gazing, poker-frenzy folks out there in cyberspace pretend to pony-up to the table and hob-nob with the Big Pharma guys, I can only hope that my thighs continue to remember why they exist, my fingers continue to respond to the big great mind I've got in my little ol' head, the elephant continues to retreat from standing on my face, the growing tinglies ALL OVER which are revealing unknown numbnesses continue to go through their stages, my balance stops leaning to the right, and I survive another day without chewing off somebody's head or eating cardboard right out of the box.

Needless to say, I won't be watching the Poker Game.

Drink Up, Drug Up, Read Up

I simply love the reaction to the MS Blogger Project which is continuing to reach out over the globe. So many kind folks have reposted the long list of links to bloggers out there who just happen to be touched by MS in one way or another. In fact, I'm still tracking down folks who I initially missed in the round up. So please, if you know of others not included, do let me know. And if you are reluctant to post the entire list, please consider sending folks here to Brass and Ivory to check it out.

Also, just a reminder that submissions for this week's Carnival of MS Bloggers are due tomorrow. Please submit a post (via blogcarnival or email) from your blog of which you are particularly proud, or which you simply want to share, by noon on Tuesday, March 11, 2008.

Now on to the business of this brief post regarding levels of pharmaceuticals found in drinking water. As you may have read, the Associated Press released information regarding investigations into the level of pharmaceuticals found in our drinking water.

Here is a little of what is being said today around the blogosphere:

AP Probe Finds Drugs in Drinking Water - Associated Press Writers
Big Pharma Is in the Water - Sarah Rubenstein of the WSJ Health Blog
Drugs in the Water Supply - Dr. Val Jones of Revolution Health Blog
Until You Get Your Metabolism in Line, We Will Never Have Clean Drinking Water - PharmaFraud Blog
PhRMA Statement on Pharmaceuticals in the Environment - Ken Johnson

Normally, I would never flush drugs down the toilet, but considering that tomorrow will be the fourth of a 5-day IV Solumedrol treatment, I guess I don't really have a choice in the matter. What goes in must come out...

What difference does $165,776,833 make?

Did you know that in 2007, the pharmaceutical and health care products industries spent $165,776,833 on Congressional lobbying activities?


PhRMA: $22.7 million for political lobbying in 2007
By Lynne Taylor
25 February 2008

The Pharmaceutical Research and Manufacturers of America (PhRMA) spent a total of $22,733,400 last year on Congressional lobbying activities, an increase of around 25% on 2006’s figure, according to disclosure forms posted with Congressional public records services and publicised by the Center for Responsive Politics (CRP).

PhRMA spent more on lobbying last year than any other industry group, ahead of the US Chamber of Commerce, which was next with a spend of $21,160,000. Individual drugmakers making it into last year’s top 20 for spending on lobbying were Roche - $11,352,038; Amgen - $9,080,000; Sanofi-Aventis - $7,770,000; and Pfizer - $7,220,000.

PhRMA spent $12 million during the second half of 2007 alone, the Center also reports. The industry group has said that most of the big rise in spending last year was to fund efforts to get Congress to reauthorise the State Children’s Health Insurance Program. However, the group also lobbied successfully against other legislative proposals including: permitting imports of cheaper prescription medicines from Canada and elsewhere; moves to empower the federal government to negotiate prices with drugmakers for medicines supplied to Medicare enrollees; and restrictions on direct-to-consumer advertising contained within the Food and Drug Administration reform bill, which became law last September.

In total, the pharmaceutical and health care products industries spent $165,776,833 on lobbying activities last year, according to the records, which are filed with the Secretary of the Senate and the Clerk of the House. Among the industry’s other big spenders were: AstraZeneca Pharmaceuticals - $4,080,000 plus $280,000 from an affiliate; Abbott Laboratories, at $2,380,000 plus a further $280,000 spent by its Ross Products affiliate; Bayer Corp $3,868,550; the Biotechnology Industry Organization (BIO) - $3,600,000; Boehringer Ingelheim - $4,285,164; Bristol-Myers Squibb -$2,840,000 plus $340,000 from its Convatec affiliate; Eli Lilly - $1,960,000; GlaxoSmithKline - $3,620,000; Johnson & Johnson - $3,820,000 plus $320,000 from an affiliate company; The Medicines Company - $2,510,000; Merck & Co - $2,300,000 plus $1,020,000 from Merck Serono; Novartis - $3,540,000 plus $465,000 from affiliates; Schering-Plough - $2,160,000; Teva -$2,140,000; and Wyeth $1,820,000 plus $520,000 from an affiliate.

Presidential election donations so far
Meantime, the industry’s contributions to candidates for this year’s US presidential election currently stand at $9,123,768, with 51% going to the Democrats and 49% to the Republicans, says the latest data from the Center. Industry contributions for the whole of 2006’s Presidential election cycle totalled $19,598,807, of which 31% went to Democrats and 67% to the Republicans, it adds.

By Lynne Taylor
Source: PharmaTimes


I previously wrote about pharmaceutical lobbying expenditures during the first half of 2007.

Billy Tauzin to be honored at Montel Williams MS Foundation Gala

So today, I heard the news today (h/t Pharma Marketing Blog) that The Montel Williams Show will be no more. According to the AP report, the show will cease production after this the 17th season while stations will be offered 52 weeks of the 'best of Montel' reruns.

Then just yesterday, I was alerted to the fact that The Montel Williams MS Foundation Gala & Pro Celebrity Poker Challenge to be held on March 13, 2008 will be honoring none other than Billy Tauzin, former Louisiana congressman and current $2 million-a-year CEO of the lobby group Pharmaceutical Research and Manufacturers of America (PhRMA).

As President and CEO of PhRMA, which represents the country’s leading pharmaceutical research and biotechnology companies, Billy – himself a proud cancer survivor – works to ensure that patients everywhere continue to have access to the miracles of medicines. As part of PhRMA’s mission, Billy Tauzin helps ensure that innovative biopharmaceutical research – including vital research for the treatment of MS –thrives, improving and saving lives everywhere. Under Billy’s leadership, PhRMA is also the official sponsor and driving force behind the Partnership for Prescription Assistance (PPA), which is designed to help un-insured and under-insured Americans get the prescriptions they need to survive. Montel Williams is proud to serve as the national spokesperson for this critically important ongoing initiative.

Ok, I'm like a broken record. The Partnership for Prescription Assistance (PPA) does not, I repeat, does not provide medication to patients. It is a big PR machine to help polish up Big Pharma's image.

Now, it looks like Big Pharma and Montel are going to rubbing each other's backs at this little fundraiser...all in the name of Multiple Sclerosis research. Doesn't that make you feel all warm and fuzzy, just like 'Sharing Miracles'?

Hey, Big Pharma!! My Doctor's Visit is Private, Stay Out!!

Yesterday, Dr.Rich pointed to an article in the Philadelphia Inquirer which induced copious amounts of moaning and ranting within my living room.

Here's a brief excerpt [emphasis mine]:

When Zaccary Newsham-Quinn, 4, visits his pediatrician in Levittown, the doctor, Nathan Zankman, asks if he would be willing to have their conversation recorded for use in medical research.

Zaccary's mother, Danielle, agrees, and signs a consent form, and the doctor turns on a small digital recorder that captures every word between the physician and patient behind the examining-room door.

Later, Zankman sends the recording via computer, along with others he made that day, to a Fort Washington start-up technology company, Verilogue Inc.

Verilogue has software that analyzes the real-time patient-physician interactions, compiles a verbatim transcript, and puts the recording and transcript in a database that Verilogue clients in the health-care industry will use to learn what doctors and patients actually say to each other about diseases and medicines.

So what kind of medical research is being done here?

Capturing real physician-patient interactions is new to pharmaceutical market research. The idea came from Verilogue's two young founders, Jeff Kozloff and Jamison Barnett, both 31, who had worked in pharmaceutical market research, and who saw a need to go beyond traditional recall methods, such as focus groups and interviews based on memory after the fact.

"The idea is, by increasing access to information where it's truly happening, at the point of practice, you are increasing knowledge, and will be able to come up with better support and communication materials for physicians and patients because they shared their experience," said Kozloff, Verilogue's president and chief executive officer.

The research will lead to improved marketing materials...aaah. So far Verilogue has nine large (unidentified) pharmaceutical clients and "a network of participating physicians nationwide."

Doctors record their interactions with patients during two days each month, and are paid what Verilogue said is a nominal fee for their time.

The Inquirer reports that Dr. Zankman has been recording patient visits a couple days a month in the three months since he signed up with Verilogue. Zankman says that he has concentrated on four medical conditions chosen by Verilogue which are fairly common in pediatrics: allergic rhinitis, asthma, persisitent asthma in a child less than 4 years, and ADHD.

When Zankman asked Danielle Newsham, 29, if she would be willing for Zaccary's office appointment to be audio-recorded and used for research by companies, she quickly said yes.

"We're here quite frequently. I look at it as helping medical research," said Newsham. [...]

"I'm a firm believer in science and technology. If companies could learn something from conversations about my son's condition, maybe it could help someone else."

But it doesn't sound like Verilogue's service is aimed to boost science and technology. It is aimed at the marketing efforts of pharmaceutical and biotech companies who desire to "get a glimpse of the patient's state of mind, progression of disease, and what is said about the company's medications - or a competitor's drug."

Regarding the nominal fee paid to participating physicians, the company said "the fee is similar to stipends paid to medical investigators in other clinical research."

"We are not the next Google, but we are revolutionizing our own segment in the industry," Kozloff said. "The physician-patient conversation behind closed doors is the epicenter. The long-term value of what we are doing has tremendous upside potential for everyone in the health-care continuum."

I agree that the physician-patient relationship is the epicenter of healthcare, or at least it should be. But it is a confidential, privileged relationship and should not be infringed upon by those seeking to tweak a marketing message. I find it disappointing that physicians would agree to this "research" in exchange for a stipend. And what about the extra time it takes to obtain the agreement from the patient or even explaining what the "research" is about. Time is money and time is limited in a doctor's visit.

Beyond the issues of coersion, the waste of precious doctor-patient face time, and the misinformation regarding the true nature of the research, Dr.Rich made a wonderful point regarding compensation for the study.

This is a purely commercial endeavor; it has nothing whatever to do with scientific or medical advancement, and everything to do with marketing advancement (specifically, to tailor marketing messages in order to optimize drug sales). So at the end of the day the patient and her little son were unwittingly drafted into a particularly sophisticated focus group.

Traditionally, participants in market research focus groups are paid for their efforts. Since in this case the patient is at least as much a participant in the generation of marketable data as is the doctor, the patient undeniably deserves his/her fair share of the proceeds. The cut should be at least a 50%, or preferably more since it is the patient whose personal medical information is being risked in a private, for-sale-to-whomever, corporate-controlled database. There’s no indication that the patients are being informed that this is a money-generating endeavor, let alone being offered their fair share in compensation for their participation and their personal risk.

I've participated in a focus group here in DC and was compensated generously for my time. But my experience was much different than if I had arrived at my doctor's office and was asked on the spot to allow my visit to be recorded for "research."

If I choose to respond to an invitation aimed at market research, then that is my perogative. If my doctor is paid to ask me to participate in market research, then a conflict of interest has arisen. This goes byond the drug rep trinkets and gifts which are increasingly becoming unwelcome in the physician's office and in various healthcare settings.

My message to Big Pharma and their marketing teams...stay out of my doctor's office!!! You are not welcome there, at least while I'm talking.

Remove Financial Disincentives and Increase Prescription Compliance

Don't you enjoy reading something and going...."Yes! Of course!"

Besides the 'well, duh' reaction to a study published in the January/February issue of Health Affairs, I think those interested in healthcare reform should examine what exactly is being measured here.

The study was led by researchers at University of Michigan and Harvard University. The study was funded by GlaxoSmithKline and Pfizer, and was conducted in part by ActiveHealth, an Aetna subsidiary that designs the kind of plans discussed.

At the University of Michigan, the Center for Value-Based Insurance Design was established in 2005 "to develop, evaluate, and promote value-based insurance initiatives that achieve improvements in health outcomes and contain health care costs."

Value-based insurance design offers a potential solution to the health care financing crisis. Value – the clinical benefit achieved for the money spent – is absent from the current dialogue on how to solve the health care dilemma. Instead, the dialogue focuses on two trends in benefit design – cost containment and quality improvement – which create a conflict of incentives for patients.

Money is a huge motivator in American society. We work for money, we worry about money, we manage our money, we spend our money, we save our money, we fight over money, we often measure something's importance by it's monetary value. Money, money, money....

Insurance companies and large employers are spending increasing amounts of money in disease management services, in part, to help them limit future costs and ultimately save money.

The study in question sought to measure the impact of offering lower drug co-payments to people with diabetes, high blood pressure and other chronic diseases on the increased use of preventive medicines. Higher co-pays are frequently used by American employers to cope with the rising costs of health insurance and require workers and retirees to pay more out of their own pockets. But does this is ultimately help patients and save money for the employer in the long run?

Proper treatment for a number of chronic illnesses can be very effective at preventing complications of disease and can help patients stay physically active and productive employees. But that treatment is only as good as when the patient stays compliant with therapy. That means the patients needs to take the recommended medication on the recommended dosing schedule.

The study compared two companies, one of which cut employees’ co-payments on a few key drugs, such as statins for cholesterol and beta blockers for high blood pressure. Generics were free to employees, and the co-pays for branded drugs were cut in half. Cutting co-pays reduced non-adherence by 7-14%.

[E]mployers increasingly enroll beneficiaries in expensive disease management programs designed to improve patient self-management, often by intervening to enhance compliance with specific medications. However, at the same time, rising copayments and greater cost-sharing create financial barriers that discourage the use of recommended services. When patients are required to pay more for their health care, it is well known that they buy less – of both essential and excessive therapies alike.

"All research to this point has shown that individuals will not buy important medical services even if there's a small financial barrier: $5 or even $2," senior study author Dr. Mark Fendrick, of the University of Michigan Medical School and School of Public Health, said in a prepared statement. "This study showed that when you remove those barriers, people started using these high-value services significantly more. These results bolster the idea that health insurance benefits should be designed in ways that produce the most health per dollar spent."

Many companies are already paying for disease management programs to help patients with chronic diseases such as diabetes. So why not encourage people to take the medicines they need. You “pay a nurse $65 an hour to call call a diabetic [employee] and say, ‘Take a beta blocker.’ And the employee says ‘I know it’s important, why did you raise my copay from $15 to $30,” Fendrick says. “It’s a classic example of the misalignment of incentives in the U.S. health care system.”

In response to the report on the WSJ Health Blog, I commented:

Lower copays is a nice idea, but how about requiring insurance companies to cover disease-modifying meds under major medical instead of pharmacy benefits. Or not allowing insurance companies, such as the local Carefirst BCBS in DC, to establish an annual $1500 limit for drug benefits in their individual policies. The Carefirst policy I’ve had for over 7 years has maintained the same $1500 cap for drug benefits. However, the initial wording of my policy implied that a 10% coinsurance would apply after the limit was reached, but that has not not been the case. $1500 covers only 3.5 weeks (25 days) of my MS med, much less any other of the meds I take for Rheumatoid Arthritis or Hypothyroidism, each drug which works to limit damage and allow me to stay active. Preventing further damage and staying active seem pretty important to me. It’s just unfortunate that my copays for meds end up being about $25,000 each year after insurance has paid their ’share.’

And reader Tom responded:

Lisa’s case typifies what really needs repairing in the health care system. This incidentally, is why there is public outrage directed at pharmaceutical companies that is totally unjustified. The culprit is and has been insurance companies. Remember, they are the entity that the Federal Government uses to administrate Medicare. Employers and employees pay for their coverage, it is not gratuitous. The companies then “decide” what they will pay for. Does the term “racket” edge to the forefront? Give us all your money, but we really don’t want to pay anything out. THIS is the mantra that needs addressed.

After a lively discussion, reader CR concluded:

…getting back to the actual article to which this exchange is attached… I would simply point out that, while Fendrick’s mother is right about the “duh” factor in his studies, the notion of aligning co-payments to achieve treatment objectives is a benefit design innovation. Further, it’s important to note that it was not an innovation that came out of academia or the government, but large employers. Pitney Bowes took the lead in creating, evaluating and reporting results of this value-driven approach, which was first given wide report in WSJ in May of 2004. Fueled by ongoing additional research efforts by Fendrick and others, the concept continues to be refined. Point is, employers–seeking better value from the health care supply chain–innovate solutions that would never be conceived of by bureaucrats.

The innovative idea of connecting copays to compliance and health outcomes is a smart benefit design. If only patients were valued not by their costs to the system, but by their positive health outcomes contributing to the overall economic system.

And finally Peter Pitts commented on his blog : Treating chronic disease via appropriate pharmaceutical intervention saves both money and lives -- benefiting both the public purse and the public health. And isn't that what health care is all about.

Amen Peter.

'Sharing Miracles' brought to you by PhRMA

PhRMA is ready to unwrap their 'Sharing Miracles' campaign.

I'll let you in on a little secret. Big Pharma has a tainted reputation.

Oh, you didn't know that? Shocking, isn't it.

Public Affairs TV

Last October, The Hill reported, in Lights, camera, PhRMA, that the drug industry's powerful lobby group had launched their own 30-minute TV show 'Healthcare Campfire with Billy Tauzin' on the local Washington WDCA, a Fox-owned channel and MyNetworkTV affiliate.

The episodes, broadcast as paid advertisements but billed as public affairs programs, borrow the format of talk shows such as NBC’s “Today.” When Tauzin took the helm at PhRMA after retiring from Congress and surviving a bout with cancer, he promised to turn around public opinion about the industry.

“They look like a news story you would see at a local news station,” PhRMA Senior Vice President Ken Johnson said. Johnson had a 20-year career in TV, including stints as a news anchor and director, prior to working for Tauzin on Capitol Hill.

Buffeted by bad press resulting from the recalls of drugs like Vioxx, public bitterness over high drug prices and angry political rhetoric about the industry’s clout in Washington, the drug industry has sought to shift the emphasis to its role in developing medicines to treat serious and deadly diseases.

PhRMA’s desire to take more control over how the drug industry is perceived led to the idea for the TV show.

Tauzin’s interviewees [in addition to PPA spokesman Montel Williams and selected patients] include other well-known figures, such as former White House Press Secretary Tony Snow and motivational speaker Sean Swarner, who survived two fights against cancer and has since scaled the world’s tallest mountains.

The interview segments are interspersed with reports by PhRMA staff on new medicines under development or other healthcare topics.

The idea of 'fake news' stories addressing healthcare, medicine, and pharmaceuticals is disturbing and self-serving at best. Consider the MedLinkTV programs which are going to be shown, whether you like it or not, in the waiting rooms of several New York doctors. Fortunately when you are at home, nobody forces you to watch a 30-minute paid advertisement, promoted as a public affiairs programing, or to buy-into whatever it is they are pushing.

The drug industry’s foray into television is the product of a more than $1 million investment in a state-of-the-art, all-digital, all-high-definition studio and control room that probably rivals most TV stations’. The set is complete with teleprompters and a “green screen,” allowing any image to be digitally added in post-production as a backdrop for interviews.

The group also uses the studio and the booth for media training sessions for its staff and for interviews between broadcasters and PhRMA executives. “There’s such an advantage to being able to go live 24 hours a day, anywhere in the world,” Johnson said.

“Billy’s a natural at this,” Johnson said. On the day of a taping attended by The Hill, Tauzin worked off a teleprompter without having seen the script in advance. There was briefly a problem as crew members tried to position the ex-lawmaker so the flag on the photo of Capitol wasn’t visible (it looked too obviously fake), but Tauzin handled his hosting duties with aplomb.

At the taping, Tauzin showed the Cajun charm that’s one of his trademarks. Greeting Swarner, the mountaineer, before the cameras switched on, Tauzin shook his hand and joked, “Did you take the elevator or did you climb the stairs?”

PhRMA has posted some of the interviews on YouTube, probably to test-drive them a bit and developed a blogspot website, sharingmiracles.com, which is supposedly an "interactive forum for people to relate their own personal stories of hope and survival." There you will find a few video clips of interviews and photo stills obviously from PhRMA's new TV studio.

Public Relations for PhRMA

I first discovered the Sharing Miracles site after looking into Montel Williams, the Partnership for Prescription Assistance, and PhRMA at the beginning of December after Montel threatened a high-school intern in Savannah, Georgia. I noticed the Sharing Miracles link at the bottom of a press release, which was unrelated to the controversial incident.

I wrote about the incident in Is Montel Williams Disturbed by Big Pharma? I have nothing against Montel personally and am glad that he is open about his MS and supports MS research abroad. What bothers me is that he uses, or allows to be used, his persona to represent a PR concoction of PhRMA to shift the drug industry's image into a caring, generous lot.
See PhRMA and PPArx: How much are they really helping patients in need?
The day after I wrote about Montel and had perused the Sharing Miracles site, an interesting thing happened. The traffic on my blog shot up considerably. Somebody from Edelman seemed to read almost everything I had written, followed by visits from several pharmaceutical companies. For those who don't know who Edelman is, this PR firm was responsible for the fakery, undercover, 'grassroots' bloggers who left messages on Wal-Mart websites in 2006.

Now this wasn't the first time I had noticed visits from companies who had briefly been mentioned in a post. After writing about APCO who has worked for PhRMA in PR, somebody within their DC offices using a company computer read my blog. This is monitoring social media, keeping abreast of what is being said about your company or your clients. Indeed, this post will probably draw in various PR monitors.

As an individual, consumer, and potential patient, you should be aware that the internet has become a place where companies want to sell you their wares. Drug companies have been slow to adopt that model and have been clumsy in their attempts, but they are getting better at it.

Just today at the World of DTC Marketing Blog, the use of video on the web as a way to reach your customers is discussed. An idea which is gaining popularity is to offer an opportunity for an individual to share their story or experience with the owners of the website. The last time I visited PPArx's site, I saw that same opportunity but noticed that once you submitted your story, it became theirs to edit without any further agreements necessary from you. Editing someone else's statement or story is a clever way to say what you really want to be said.

I don't know this for certain, mostly because I didn't bother to ask, but I suspect that a number of the individuals featured on the Sharing Miracles blogsite may have been folks who agreed to submit their stories about PPArx. Why do I think this? Well, because almost half of the stories so far reference prescription assistance as part of their personal 'miracle.'

Addendum: Further investigation reveils that Qorvis, a strategic communications/PR firm right here in Northern Virginia, is responsible for the Sharing Miracles website and its' unconvincing fake forum.

Now, I think the term miracle is overused. Apparently, so does blogger Orac over at Respectful Insolence - "Resolved 2008: Let's not use the word 'miracle' to describe unexpected survival." There are very few occurrences which might warrant being called a miracle. I believe my brother's experience 20 years ago falls under this category.

The Miracle in My Family

When my brother was 11 or 12 he loved to dirt bike, that is ride a zippy little motor bike over dirt trails with lots of hills, ditches, and various obstacles. After being caught skipping band class (which was expected of him to participate in because all other family members were musicians), he was forced to make a deal with our parents. In order to continue riding his dirt bike, he had to stay in band....but he could switch to any instrument he really wanted to play. So my brother chose to switch to tuba as, with one instrument at home and one at school, he only needed to transport his mouthpiece to and from school. Very clever decision.

The summer my brother was 13, our father took him to the dirt track area at the nearby lake, maintained and monitored by the park rangers. This was a Saturday morning trip just as common as any other. However, this time the 1968 Volkswagen Bug which was used to haul the bike trailer wouldn't start. Engine trouble. My dad found the ranger's station, but it was locked and unattended. A simple lesson without any real significance it would appear.

The summer my brother was 14, he went dirt biking and brought along our 13 year old cousin who was not an experienced biker. They had a great time riding the tracks and took a second go around. But this time something unexpected happened. My cousin didn't notice that after jumping a particularly large hill and ditch, my brother didn't visibly come up over the other side. Our cousin jumped the same hill, ending up running over my brother who was caught under his bike. My brother was unconscious and wasn't moving. Cousin quickly rode to my dad who was waiting at the car and they retrieved my brother.

Here's fortune #1. Since my dad already knew that the ranger's station would not be manned, he didn't waste time trying to get help (days before cell phones). They brought my brother to the VW Bug while he was unconscious and bleeding out of the mouth.

Fortune #2. The front seat of the VW Bug no longer reclined although my father tried to make it recline to no avail. If he had succeeded in this attempt, the doctors say my brother would have drowned in his own blood before reaching the hospital.

Fortune #3. The surgeon most skilled in the type of surgery necessary happened to be at the hospital and available the moment my father arrived. He has since written case studies about my brother's experience and recovery.

Fortune #4. The type of injuries my brother sustained, detached lung and blown open trachea, usually are accompanied by other severe injuries occurring in a car accident. The surgeons removed a rib, using the muscle to rebuild his trachea/bronchial area, reattached the two lobes of his lung which were detached by the force of the accident, and even used felt patches to hold things together.

Recovery from these types of injuries is not guaranteed. Being placed in ICU for two weeks, it was interesting to be able to see the tire tracks across my brother's body. I think it was over a week before anyone even attempted to clean the dirt out from under his fingernails as the pain was so severe that it might put him into shock. He almost died three times in ICU before beginning his journey of healing.

Fortune #5. He was a strong athletic individual who had tremendous respiratory strength, partically attributed to his experience playing tuba. It takes alot of lung power to play the larger brass instruments especially. His doctors said that this was some of the best therapy his could have had before his accident to prepare him for the difficult recovery road ahead.

Indeed that school year is a big blur to my brother. He missed alot of school, took lots of pain medication, and worked hard at therapy (an expensive Schwinn exercycle rather than attending babysat physical therapy sessions). Then he had to stay out of trouble and not get rough-housed, because if someone accidentally hit him or threw something into his chest, there was the risk of undoing the surgical repairs which really took a long time to truly heal.

Surviving several bouts of pneumonia and other respiratory distress sending him back into the hospital, my brother survived that first year to become a rare survivor. He was asked at least once by his surgeon to visit a fellow high-schooler who had been in a car accident suffering similar injuries to his own. This young girl was scared of dying and needed to know that survival and recovery was possible. She died the next week.

Over the years, my brother's scars have brought him attention. I think he has jokingly claimed that the scar which curves along his back and around to his side (where the rib was removed for access and use of muscle tissue) was from a shark attack. The scar is somewhat jagged and spreads about two inches wide. The scar from his chesttube looks like a bullet wound. I think he has claimed the bullet's still in there. :)

Sharing Miracles on TV and Online

Consider each of the little things which had to occur, even a full year in advance, to prepare the way for my brother's survival. Very few of the stories shared on Sharing Miracles will rival this. You will read about medications to treat chronic illnesses, such as diabetes, high cholesterol, high blood pressure, heart disease, arthritis, depression, and asthma. You will read about clinical trials and cancer treatments. You may even find stories which include references to carpal tunnel syndrome, sleep apnea, allergies, and irritable bowel syndrome.

How do I know this? I read each and every story on the website which has to be pre-approved by PhRMA for inclusion.

At first in September and early October, a few folks left comments on each entry but this must have started to look contrived (which it was.) Now PhRMA wants the public to start commenting and sharing their stories of inspiration and gratitude to the generosity of the Partnership for Prescription Assistance which is not really a program that doles out prescription assistance. Their service is kinda like a phone directory, but one which takes credit for helping anyone who opens it up and conducts a search, regardless of the final outcome or connection to a desired party. As such, PPA now claims to have helped over 5 million individuals find assistance.

So PhRMA has a press release ready to announce that the ‘Sharing Miracles’ Television Program Extends Reach Across America: First Episode Features Former White House Press Secretary Tony Snow (January 7, 2008). I note that the program will now air on WUSA-TV (CBS) in the Washington, DC area, on Sundays at 11:30am-12:00am which happens to be the same timeslot and station where I was witness to the infomercial starring Hugh Downs discussing the Health Secrets book just a few weeks ago.

Beginning in January, Sharing Miracles – a 30-minute public
affairs television program about health care that features compelling and inspirational stories told by patients – will begin airing each Sunday in 17 cities around the country.

Hosted by former Congressman and cancer survivor Billy Tauzin, now the president and CEO of the Pharmaceutical Research and Manufacturers of America (PhRMA), Sharing Miracles is designed to raise awareness about medical advances that improve the quality of people’s lives. Sharing Miracles is produced by PhRMA’s Communications & Public Affairs Department.

The new show will also help to spread the word about the Partnership for Prescription Assistance, a program sponsored by America’s pharmaceutical research companies to help uninsured and underinsured Americans find access to the medicines they need for free or nearly free. The Partnership for Prescription Assistance has already helped nearly 5 million Americans.

The first episode features former White House Press Secretary Tony Snow, who is battling colon cancer. Future programs will highlight two-time cancer survivor and motivational speaker Sean Swarner, who has climbed the tallest mountains on each of the seven continents in memory of cancer victims; “Leave it to Beaver” television star Jerry Mathers, who is fighting diabetes; North Carolina State University Hall of Fame basketball coach and breast cancer patient Kay Yow; syndicated television talk show host Montel Williams, a multiple sclerosis sufferer; Telemundo personality Mayte Prida, a breast cancer survivor; and pop icon and Broadway star Deborah Gibson, who has suffered from depression.

In this month’s show, Snow explains how “sickness stretches your soul, opens your eyes, and introduces you to a world of unimagined grandeur, possibility and joy. You realize what life’s blessings are. Everything that is wonderful becomes more intensely wonderful and all the things that you love, you more intensely love.”

Each show features lively discussions that are informative and that convey messages of hope to patients around the country – and to their family members and friends – who must confront debilitating medical conditions every day.

The show’s corresponding Web site, http://www.sharingmiracles.com/, is an interactive forum for people to relate their own personal stories of hope and survival. Every patient's battle is unique, but the collective power of shared experiences can offer great help and courage to others who are fighting for their lives.

PhRMA, please give the intelligent citizens of this country a break and stop pouring money into efforts to polish the reputation of profit-driven pharmaceutical companies. Granted there are some companies who are taking risks in research, but the quickly approaching lack of innovative drugs in the overall pipeline is evidence to the need for more research and less marketing/lobbying/public relations.

Do a good job and you will be recognized for it. People are not dumb.

PhRMA Prefers No "Second-Guessing Motives" When Discussing Pharmaceutical Sampling

Yesterday, a joint study conducted by Harvard Medical School and Cambridge Health Alliance was released in the American Journal of Public Health addressing the demographics of those patients most likely to receive pharmaceutical drug samples.

The study will be published in February 2008, but you can read the abstract here - "Characteristics of Recipients of Free Prescription Drug Samples: A Nationally Representative Analysis."

Not surprisingly, the big pharma lobbying group, Pharmaceutical Research and Manufacturers Association (PhRMA), was not pleased with the conclusions of the study and released a statement in response. However, you may notice that the link is no longer good, because the statement was revised and re-released today here.

I wonder how many people actually had an opportunity to read the original? I did. My comments are emphasized below.

PhRMA Defends Distribution of Pharmaceutical Samples;
New Study Fatally Flawed, 2003 Figures Outdated

Washington, D.C. (January 3, 2008) — Pharmaceutical Research and Manufacturers of America (PhRMA) Senior Vice President Ken Johnson issued the following statement regarding the Jan. 2 American Journal of Public Health study on distribution of free pharmaceutical samples:

“Distribution of free samples by technically-trained pharmaceutical research company representatives – many of whom are healthcare professionals themselves – plays a critical role in improving patient care and fostering the appropriate use of medicines. Providing physicians with free samples of pharmaceuticals clearly benefits patients and advances healthcare throughout the United States.

So free samples improve patient care? Those research company reps who provide physicians with free samples serve to advance healthcare (ie. provides a way to extend the post-marketing review of new name-brand medicines.)

“Instead of second-guessing motives, Harvard researchers would better serve patients by examining health outcomes. Clearly, free samples often lead to improved quality of life for millions of Americans, regardless of their income.

Is that free samples which improve quality of life? I thought that PhRMA's mantra was that drug research and miracle medicines improve the quality of life for millions of Americans.

“Free pharmaceutical samples can give physicians valuable first-hand experience with new treatment options. And free samples can help patients begin treatment sooner, find the right medicine, and offer an option for those who have difficulty affording their medicines.

Notice how the term 'free' has been used six times already?

“As the study authors note, when patients were seen by practitioners in their offices, uninsured patients ‘appear more likely to receive a free sample than do insured persons.’

“According to the study authors, this suggests that office-based
practitioners make a ‘sincere effort’ to use free samples to help needy patients.

“Likewise, insured patients who lacked prescription drug coverage also were more likely to receive a free sample.

So PhRMA wants to remind the reader that 'free' (3 more times) samples are used to address the lack of prescription coverage for some patients and the neediness of others.

“Indeed, a recent Henry J. Kaiser Family Foundation survey found that 75 percent of physicians frequently or sometimes give free samples to assist patients with their out-of-pocket costs. An earlier survey examining key factors influencing physicians’ decisions to distribute free samples found the ‘patient’s financial situation’ was a considerable or strong influence 86 percent of the time.

'free' 2x more

"That said, the study released Jan. 2, which was conducted by Harvard Medical School and Cambridge Health Alliance researchers, was fatally flawed.

Here it comes... the official PhRMA mantra... the Partnership for Prescription Assistance is here to help. I've discussed PPArx before here, here, and here.

“The study, which relies on 2003 data, ignores significant outreach efforts in recent years, including the 2005 launch of the Partnership for Prescription Assistance (PPA), a program sponsored by America’s pharmaceutical research companies to help uninsured and underinsured patients.

“Our member companies recognize that, unfortunately, many uninsured and underinsured patients do not receive their medical care from office-based practitioners.

So does that mean that lack of medical care from office-based practitioners is to blame for the failings of pharmaceutical samples as an effective safety-net for uninsured and underinsured patients?

“And, as important as free pharmaceutical samples are in improving healthcare, they represent one – not the only – option for patients in need.

“As a consequence, over and above the billions of dollars in free samples that pharmaceutical research companies distribute to physicians, our companies have provided medicines worth more than $10 billion, in wholesale value, to nearly 5 million struggling Americans since PPA was launched.

“Additionally, we have hand-delivered information about accessing free or nearly free medicines to clinics and hospitals nationwide that serve low-income Americans. And we have connected more than 200,000 patients with clinics and healthcare providers in their communities.

'free' 4x more

“PPA is a clearinghouse for more than 475 public and private patient assistance programs. More than 2,500 brand-name and generic prescription medicines are available through the participating programs.

Please note that some of the participating programs are simply discount cards which may, or may not, give the holder as little as 0% off the retail price of their medication.

Patients who need help should call...where trained operators field calls in more than 150 languages...

Too bad the trained operator I spoke with last summer could not speak English.

Here's part of PhRMA's press release which was edited out:

"The most troubling facet of the study is that it relies on data from 2003 to present a picture that could be markedly out-of-date, relative to what is occurring during physician visits today.

“In addition, the samples distributed during the study period tended to be pharmaceuticals to treat chronic conditions. Thus, it is predictable – not surprising ­­– that there would be a strong linkage between patients’ age and receiving free pharmaceutical samples. Patient age strongly correlates to such medical conditions as arthritis, and uncontrolled cholesterol and blood pressure levels.

"The pharmaceutical samples that were distributed to those patients were new to the market and, at that time, were perceived by physicians to offer benefits to patients with uncontrolled disease.

So what's the big deal with that omission you ask?

Drug samples raise patient safety concerns, according to author Dr. Sarah Cutrona, a physician at Cambridge Health Alliance and an Instructor of Medicine at Harvard. (via Cambridge)

"The distribution of free samples has become very controversial. Evidence shows that free samples may influence physicians' prescribing behavior and cause safety problems. For instance, we found that the most widely distributed sample in 2002 was Vioxx, with Celebrex being number 3. These drugs turned out to have lethal side effects. While many doctors still view samples as a safety net for their neediest patients, our study shows that samples are potentially dangerous, and do little for the needy."

I guess PhRMA didn't really want to bring attention to the fact that some newly-approved, most-promising, blockbuster medications may have undiscovered lethal side-effects.

The Cambridge/Harvard study is the first to look at free drug samples nationally and found that most free drug samples go to wealthy and insured patients and are not used to ease the burden of the poorest nor the uninsured.

Dr. David Himmelstein, senior author of the study, a physician at Cambridge Health Alliance and an Associate Professor of Medicine at Harvard adds: (via Cambridge)

"We know that many doctors try to get free samples to needy patients when those patients come into the office. We found that such efforts do not counter society-wide factors that determine access to care and selectively direct free samples to the affluent. Our findings strongly suggest that free drug samples serve as a marketing tool, not as a safety net."

And if there is any doubt about that, just look to the controversy surrounding the proposed licensing of drug reps in Washington, D.C. and other jurisdictions in the country. It is widely accepted that drug reps are basically salespeople who go office-to-office to try to get physicians to prescribe more of their brand-name drug.

Please keep in mind that...

"Free drug samples are not the solution to the disproportionately low amount of health care resources going to the poor and uninsured; they are part of the problem," said Dr. Steffie Woolhandler, a physician at Cambridge Health Alliance, Associate Professor of Medicine at Harvard, and study co-author.

(h/t WSJ Health Blog "Poor Get Short Shrift on Drug Samples.")

Is Pfizer guilty of being a "Constant Gardener" in Nigeria?

The WSJ Health Blog discusses details of Nigeria's legal case against Pfizer.
AP reports:

The now-controversial trials for the antibiotic Trovan [by Pfizer] were conducted in Kano [Nigeria] on 200 children during a meningitis epidemic in 1996. Nigeria alleges Pfizer conducted the trials illegally, without the full knowledge and consent of the government and the parents, causing the death of 11 children and injury to dozens of others.
A message left with Pfizer headquarters in New York was not immediately returned Tuesday, but Pfizer has always denied any wrongdoing, insisting the drug saved lives.

Nigeria's Kano state and the federal government have instituted separate civil and criminal cases against Pfizer. The federal authorities demand $7 billion in damages.

Judge Atiku, who is presiding over the civil case in Kano, postponed further hearing to Jan. 29, 2008.

The Health Blog concludes:

The cases are an extreme example of the ongoing tensions between multinational drug companies and the developing world, and some industry-watchers are waiting to see whether other developing countries follow with their own legal actions.

While I don't agree with opaque tactics which the 'big pharma' drug industry may employ to justify spurious testing, I do find myself appreciating one comment left on the Health Blog by "An Observing Pharmacist."

The kids who received Trovan (taken as a pill) did just as well as the kids who took an IV antibiotic. Pills are easier to distribute and administer than an IV, so the hope was to treat more kids and people effectively.

Nigeria is reaching into the deep pocket [of Pfizer] hoping to pull out some cash.

Testing methods of delivery of a particular pharmaceutical is at the heart of 'evidence-based medicine' where assumptions must only be made in creating a hypothesis to be scientifically proven or disproven.

Last year a trial conducted as part of the search for an effective oral formulation of an existing MS disease-modifying drug failed miserably. There was hope that an oral pill would become available for MS sufferers who are currently only offered self-injectible or IV delivered drugs to curb the progression of the disease. Once an effective oral drug is available, the blockbuster status of current MS drugs will diminish dramatically as will the pharmacy costs to the patient and their insurance companies.

I don't know if Pfizer is guilty of misbehavior in this case. I certainly hope not. But it does appear that Nigeria is looking to reap some considerable financial benefits at the ultimate expense of the number of patients who must pay for the resultant increased costs of current and future Pfizer medications.

It's unfortunate that the government of Nigeria is looking to the American model of 'sue, sue, sue' to punish Pfizer for being their "Constant Gardener."

DC Council takes first step to clipping the wings of the pharmaceutical industry

Today's Washington Post reports a bold move by the D.C. Council to regulate pharma reps who peddle drugs to District physicians and hospitals. The SafeRx Act of 2007 breaks new ground in the effort to reel in the multibillion-dollar prescription drug trade. Below are highlights from the must-read article.

The D.C. Council voted 7 to 6 yesterday to give initial approval to legislation that would make the District the first jurisdiction in the country to license pharmaceutical sales representatives, a major blow to the prescription drug industry and one that could have national implications if states follow the District's lead.

"For too long, we have allowed profit and paternalism to be our guide for patient safety," said Council member David A. Catania (I-At Large), who has become known in national health circles as an industry watchdog. "The truth is, no one is minding the store."

After the vote, Ken Johnson, senior vice president of Pharmaceutical Research and Manufacturers of America, issued a statement through spokesman Jeff Trewhitt.

"We regret that the council voted in favor of legislation that creates unnecessary financial burdens for the District of Columbia at a time when the money would be better spent addressing a wide array of health care challenges confronting the city including HIV/AIDS, diabetes and heart disease," the
statement said. "The bill passed by the council puts the city into a regulatory arena that has been effectively addressed by federal laws and federal government agencies for years."

Under the bill, salespeople would have to be licensed and sign a code of ethics and would be regulated by a pharmacy board. To qualify for a license, the representatives, dubbed "detailers" in industry lingo, would have to be college graduates. They would also have to refrain from using titles that would give the impression that they are licensed to practice pharmacy, nursing or medicine.

The bill, which has several parts, also would ban pharmaceutical manufacturers from engaging in a practice called "data mining," when doctors' prescription data are used for marketing purposes without their knowledge and consent.

Critics say the information trickles down to detailers who can then target a doctor for a particular drug by looking at his or her prescribing habits. District doctors could opt in to the program to allow firms to get their prescription data from pharmacies.

New Hampshire, Maine and Vermont, which have passed similar legislation, are in court with data collection companies and manufacturers fighting the new laws. New Hampshire is appealing the decision of a U.S. District Court judge to block the state from enforcing its new data mining law on the grounds that it restricts commercial free speech.

The District could face the same fight, council members said.

Catania said that is to be expected. "They are taking their playbook from the tobacco industry," he said. "Sue, sue, sue."

Yesterday's vote, however, will not end the debate. The council must vote again Jan. 8 on final approval of the legislation.

Big Pharma and Bad Press Go Hand-in Hand?

Can't the Big Bad Drug Industry do anything right?

Today I came across a PharmaFraud article - The Old "Two Sets of Books" Scam - which discusses a little provision buried within the Medicare Modernization Act (MMA) which Big Pharma helped to get passed. This little item allowed Pharma Manufacturers to send one set of drug price data to the federal government, and another set to the States.

The MMA requires Pharma Manufacturers to report average drug prices to the Federal Government, but the Federal Government is not allowed to give this pricing information to the States. There is only one reason that Big Pharma pushed through such a ridiculous clause; to defraud the government.

Big Pharma sends false drug prices to the federal government, the States send utilization data to the federal government, and the federal government verifies the URA (Unit Rebate Amount), calculated by the Manufacturers; a calculation that is based on the Pharma Manufacturers phony prices.

A recent document made public in Re: Pharma Industry AWP Litigation, reveals Abbott's use of "two sets of books" (For additional background, review PF's post; The Five Sets of Books Methodology for Covering-up Fraud and Hiding Drug Diversion). Recently, the DOJ issued a subpoena seeking unit, price, and rebate data for several drugs made by Abbott. The State of Texas had previously served Abbott with a subpoena in which they requested and received the same data. But guess what; Abbott sent one set of data to Texas, and a different set of data to the Feds.

Humm...doesn't sound too good for Abbott.

Then, I find an announcement which PhRMA released today regarding the wonderful goodwill which the pharmaceutical companies are providing to those in need.

The Pharmaceutical Industry provides Relief to Mexican Flood Victims

The pharmaceutical industry has quickly come to the aid of over one million people who have been affected by the flooding caused by Tropical Storm Noel in late October and early November in the Tabasco and Chiapas regions of southern Mexico.“The flooding in Mexico has caused serious damage to the Chiapas and Tabasco regions, which puts the many people who live there in danger,” said Pharmaceutical Research and Manufacturers of America (PhRMA) President and CEO Billy Tauzin. “Our member companies are supporting the aid workers in their fight against potential diseases and other health related problems that could arise as a result of the flood.”PhRMA member company contributions have included:

Abbott’s donation consists of 28,000 boxes of antibiotics, 94,000 bottles of serum, 7,000 packages of infant formula, 46,000 nutritional supplements, and 100 glucose meters with 10,000 reactive strips. In addition, Abbott has donated the resources for HIV and Hepatitis A, B and C exams and
blood tests. It has also provided the materials to reactivate the operation of the blood bank that services several hospitals in Villahermosa.

GlaxoSmithKline (GSK) has made a donation of medicines and OTC products valued at more than $580,000. The contribution comprises quantities of Ceftin and Bactroban, which is valued at around $100,000, as well as Septrin, Amoxil, Zentel, Virlix and Zovira. GSK will be working with its donations partner, AmeriCares, and its in-country partners, the Mexican Order of Malta, to distribute the products.

Johnson & Johnson is distributing OTC drugs, antibiotics, wound care products, and food and water through its disaster relief partner, AmeriCares. It also guarantees that any U.S. based employee of Johnson & Johnson will have their contributions to the flood victims matched 2-for-1
through their Matching Gifts Program.

Merck is donating $50,000 in cash to the American Red Cross and working closely with their partners on the ground to assess the situation and provide any medicine and support that will be requested in the future.

Pfizer contributed $17,000 from its disaster relief fund which was matched by Corporate Affairs Mexico for a sum total of $34,000 allocated for reconstruction works. It also donated drinking water as well as other needed supplies and contributed medicines worth $80,000 channeled through the Ministry of Health. To its Tobasco based peers, Pfizer donated a sum total of $17,000.

Schering-Plough is distributing to its colleagues in Mexico cash donations and medicines for adults and children, such as antibiotics, antifungals, pain medicines, and treatments for colds and flu. Moreover, it is delivering supplies such as groceries medical supplies, cleaning agents, house
wares, as well as other items.

Wyeth is donating 18,600 units of nutritional products (SMA, Promil and Progres), as part of a national “United for Them” relief initiative, which includes other major companies as well as Televisa, Mexico’s main TV network.

If I'm not mistaken, aren't these the same Big Pharma companies which have been getting a lot of bad press and are just a little in trouble with the feds right now?

But hey, at least that may actually be helping some folks who need the help right now.

I'm glad for that.

Is Montel Williams disturbed by Big Pharma?

Controversial behavior by Montel Williams, spokesman for PhRMA's Partnership for Prescription Assistance, may bring unwanted attention to Big Pharma's great PR machine. (h/t Cary Byrd at eDrugSearch Blog)

As reported, the 'Help is Here Express' blew through Savannah Georgia to promote the hope of 'free or nearly free' drugs to qualified individuals. This Orange Bus travels the country promising that it's program helps to save lives...by providing medications to uninsured patients.

Montel Williams has multiple sclerosis, as do I, and has been the visible image of PPArx since . Now I've got my own opinions as to the quality of assistance which Billy Tauzin and his Orange Bus purport to provide needy individuals. [see PhRMA and PPArx: How much are they really helping patients in need?]

Previously, I've given Williams the benefit of the doubt regarding the use of his image to promote a glossed-over PR concoction. I have no doubt wondered as to the level of compensation the Big Pharma lobby may be providing him, but I've let it go.

Last Friday, Courtney Scott, a high school intern at the Savannah Morning News, interviewed Williams for the paper. But apparently her 2nd question touched a raw nerve.

Excerpt from Savannah Morning News online:

Before the rally in Johnson Square, Williams stood for an interview with Scott.

With her second question she asked, "Do you think pharmaceutical companies would be discouraged from research and development if their profits were restricted?"

It was a question she came up with after discussing the issue with her Advanced Placement English teacher.

Williams bristled.

"I'm trying to figure out exactly why you are here and what the interview is about," he replied.

He asked if she suffered from any illness, to which she answered no.

"I'm here as a patient advocate talking about the fact that medications available today are saving people's lives, that's what saving mine and after that, this interview is done."

He snapped his fingers, said thanks and walked away.

"That's an absolutely fair question to someone who represents the pharmaceutical industry," said Savannah Morning News Executive Editor Susan Catron.

Ken Johnson, senior vice president for the Pharmaceutical Research and Manufacturers of America, said the question would have been better directed to himself because he represents the drug industry, and Williams is paid to raise awareness of the drug program.

Yup, that's it. A paid endorser is not in any way responsible for having an opinion on the item being endorsed. However, I believe that any paid spokesperson should be educated and well versed on the subject of that endorsement. Williams could have simply responded that the question presented be directed to the individuals representing Big Pharma itself, not to the star of the Orange Bus Circus.

Later that day, Scott was at the Westin Hotel preparing for an unrelated interview when Williams approached her and delivered a threat. MSNBC reports Montel threatens to 'blow up' teen reporter. Savannah Morning News says Montel 'blows up' at local reporters. My favorite is from eDrugSearch Blog Big Pharma Flack Montel Williams can't take the heat -- from a high school interrogator!

But I guess that all should be excused as Williams offers On-Air Apology to Teen Reporter (AP Press). Scott may take the offer, but she should be prepared to face numerous slick-talking representatives of PhRMA. And representatives are numerous indeed as Big Money is being spent by Big Pharma to represent and educate many of us, including our lawmakers in Congress.

As far as PhRMA's Partnership for Prescription Assistance goes, here's a brief rundown of my personal experience, excerpted from a previous post - Rx Outreach Rocks!

I have spoken before about PPArx and not much has changed.

When I called their number this summer, I was 'assisted' by a man who didn't really speak English at all. In fact, we had to resort to spelling everything in 'alpha, beta, charlie, echo' lingo. Now just think about most medications....that's extremely tedious at best.

Then I waited....and waited...and waited...and finally received their specially-prepared 'package' almost two months later. Ironically, the 'package' omitted applications for programs which I knew were available (I was instructed to contact the program directly for more information) and included applications to programs for which I knew I was not even remotely eligible.

What a waste of time, energy, and resources.

Perhaps PhRMA and Montel Williams need to lower their perceived risk of personal attack by actually doing a better job of providing the information and services which they are promoting.

And to the companies and lobbyists of Big Pharma, please use your resources for real R & D and stop spending so much money, time and energy on 'educating' and 'selling' us of your wonderful intentions, products, and services. We'd all be better off for it.

UPDATE: Prescription Access Litigation discussed Montel and PhRMA on their own blog, sharing my views. Expert below:

So why was Montel so angered by this question, a question which arguably invited a stock answer that PhRMA reps repeat dozens of times a day? It’s not as if the reporter asked “Why doesn’t the pharmaceutical industry make its Guiding Principles on Drug Advertising mandatory and enforceable?” And it’s not as if the reporter asked some obscure question on some obtuse point of, say, patent law or the issue of follow-on biologic drugs. It’s surprising that the industry’s main spokesperson for its patient assistance program was so poorly prepared to answer such an easy question.

But perhaps all this is beside the point. Does it ultimately matter if Montel Williams answers questions about the industry’s priorities and policies, or any questions beyond the mechanics of this patient assistance program?

The answer is, yes, it does. Montel Williams has become one of the most visible spokespeople for the industry. He lends his name and his credibility to the cause of burnishing the image of America’s pharmaceutical companies, and is paid (presumably handsomely) to do so. So it’s entirely fair that he be asked questions about the industry. Although perhaps Ken Johnson, PhRMA’s Senior Vice President of Communications, is the better person to ask this kind of question, Montel is fair game as well — by accepting the industry’s money, and acting as his spokesperson, he has to take what comes with that — including fair questions about the industry’s misplaced priorities.

Doctors are Human Too

How much influence does the pharmaceutical industry have over your doctor's prescribing habits?

Not only are we (patients) supposed to ask our doctors about such-and-such drug for such-and-such condition, drug reps are attempting to convince your doctor to prescribe such-and-such drug for such-and-such condition because it is supposedly more effective than the other such-and-such drug commonly used.

Today's New York Times Magazine has a wonderful article, "Dr. Drug Rep," written by Dr. Daniel Carlat. During a year of being paid to give talks to doctors about an antidepressant, a psychiatrist comes to terms with the fact that taking pharmaceutical money can cloud your judgment.
(via Over My Med Body!)

On a blustery fall New England day in 2001, a friendly representative from Wyeth Pharmaceuticals came into my office in Newburyport, Mass., and made me an offer I found hard to refuse. He asked me if I’d like to give talks to other doctors about using Effexor XR for treating depression.
[...]
How many doctors speak for drug companies? We don’t know for sure, but one recent study indicates that at least 25 percent of all doctors in the United States receive drug money for lecturing to physicians or for helping to market drugs in other ways. This meant that I was about to join some 200,000 American physicians who are being paid by companies to promote their drugs. I felt quite flattered to have been recruited, and I assumed that the rep had picked me because of some special personal or professional quality.
[...]
Regardless of how I preferred to think of myself (an educator, a psychiatrist, a consultant), I was now classified as one facet of a lunch helping to pitch a drug, a convincing sidekick to help the sales rep.
[...]
One of my most uncomfortable moments came when I gave a presentation to a large group of psychiatrists. I was in the midst of wrapping up my talk with some information about Effexor and blood pressure. Referring to a large study paid for by Wyeth, I reported that patients are liable to develop hypertension only if they are taking Effexor at doses higher than 300 milligrams per day.

“Really?” one psychiatrist in the room said. “I’ve seen hypertension at lower doses in my patients.”

“I suppose it can happen, but it’s rare at doses that are commonly used for depression.”

He looked at me, frowned and shook his head. “That hasn’t been my experience.”

I felt rattled. That psychiatrist’s frown stayed with me — a mixture of skepticism and contempt. I wondered if he saw me for what I feared I had become — a drug rep with an M.D. I began to think that the money was affecting my critical judgement. I was willing to dance around the truth in order to make the drug reps happy. Receiving $750 checks for chatting with some doctors during a lunch break was such easy money that it left me giddy. Like an addiction, it was very hard to give up.
[...]
I still allow drug reps to visit my office and give me their pitches. While these visits are short on useful medical information, they do allow me to keep up with trends in drug marketing.

Rx Outreach Rocks! Great Assistance Program for Generic Medication; PhRMA's Billy Tauzin at it again

Rx Outreach -- "A Safe, Affordable, and Easy Way to Get the Medicines You Need"

I just have to say that Rx Outreach truly does provide a valuable and easy service to patients, unlike some other more highly promoted programs (ie. PPArx).

After being denied a request for additional assistance in receiving my MS medication last summer (2006), I began an extensive search of prescription assistance programs and trudged through the lengthy application process. At the time, a number of my other medications were not yet available in generic form, but they are now.

With the increased availability and use of generic medications, patients' options have been expanding and innovative programs have been cropping up to serve those patients. Wal-Mart's $4 Live Better Prescription Program has sparked competition in other large retail stores including Target which has established it's own $4 Prescription Program.

To date, none of my generic medications are included on the $4 lists at Wal-Mart or Target, but they are available through Rx Outreach with a reasonable handling fee. Rx Outreach, a program of Express Scripts Specialty Distribution Services, Inc., currently provides 129 generic medications to eligible patients (income below 250% FPL) with an easy-to-complete application form.

According to the customer service agent I spoke with this summer (2007), the program was established in 2005 to assist uninsured and underinsured patients. Since many of the patients they help are elderly, Rx Outreach has designed an extremely easy application process. Amazingly, the only proof required for income eligibility is YOUR WORD.

Imagine that...an assistance program which honors the "honor system."

The refill process is simple. I received a Refill Reminder letter in the mail.
"We are sending you this letter to let you know that it is time to refill the following medication(s)." If you choose to refill by phone, an automated system is available 24/7 and customer service is available monday-friday. To refill by mail, simply use the form provided and include payment in the enclosed envelope (no need to add postage.)

Throughout the process, each customer service agent I have spoken with has been friendly and helpful. I am extremely please with their service.

Rx Outreach is managed by Express Scripts Specialty Distribution Services, Inc. (ESSDS), a fully licensed mail order pharmacy that is committed to making the use of prescription drugs safer and more affordable. It is not an Internet pharmacy. ESSDS manages more than 55 patient assistance programs (PAPs) for major pharmaceutical companies, serving millions of individuals.

ESSDS developed Rx Outreach to provide a safe, affordable, and easy way for people of all ages to get medicines they need. The program offers prescription medicines to uninsured individuals and families, as well as those who have limited prescription drug coverage.

On a slightly related topic:

I think that it is disgusting that Pharmaceutical Research and Manufacturers of America (PhRMA) is using the tragedy of the California wildfires to promote their sham of a service, Partnership for Prescription Assistance (PPArx). I have spoken before about PPArx and not much has changed.

When I called their number this summer, I was 'assisted' by a man who didn't really speak English at all. In fact, we had to resort to spelling everything in 'alpha, beta, charlie, echo' lingo. Now just think about most medications....that's extremely tedious at best.

Then I waited....and waited...and waited...and finally received their specially-prepared 'package' almost two months later. Ironically, the 'package' omitted applications for programs which I knew were available (I was instructed to contact the program directly for more information) and included applications to programs for which I knew I was not even remotely eligible.

What a waste of time, energy, and resources.

Here's PhRMA's recent press release:

Help For California Fire Evacuees Possible
Through Partnership for Prescription Assistance

Washington, D.C. (October 23, 2007) — Pharmaceutical Research and Manufacturers of America (PhRMA) President and CEO Billy Tauzin issued the following statement regarding the California wildfires:

“Californians who have been affected by the recent wildfires -- and who are uninsured or underinsured -- should know that help getting the medicines they need may be available through the Partnership for Prescription Assistance. The PPA, sponsored by America’s pharmaceutical research companies, is dedicated to helping Americans who lack adequate health care coverage. Now, as residents of southern California face the destruction being caused by these wildfires, the PPA is offering to help qualified patients get assistance even faster.

“Struggling Californians who are having trouble getting the medicines they need may find expedited help through PPA’s disaster relief program by calling the PPA’s toll-free number [info redacted]

“Since April 2005, the PPA has helped more than 4.3 million uninsured or underinsured Americans – including 250,000 in California – find programs that provide prescription medicines for free or nearly free. It helps patients in need obtain access to more than 475 public and private patient assistance programs, including 180 programs offered by pharmaceutical companies. The PPA can also help Californians find out about programs offered by the state, such as Medi-Cal, Healthy Families and Access for Infants and Mothers.

“In addition, the PPA provides information on nearly 10,000 free healthcare clinics and has connected more than 163,340 patients with clinics and healthcare providers in their communities.

“Through the PPA, America’s pharmaceutical research companies are continuing to make tremendous inroads by assisting struggling Americans who need it most, and this is especially true during California’s time of need.”

More than 1,300 national and local organizations, including the American Academy of Family Physicians, American Cancer Society, Easter Seals, National Urban League and the National Association of Chain Drug Stores, are working with America’s pharmaceutical research companies to help spread the word about the PPA.