Tuesday, November 27, 2007

'Round the Sphere: True Confessions and Omissions

Dr. Carlat's (author of The Carlat Psychiatry Blog) confession of a past stint as a paid drug industry "consultant" was first sighted by me in the Wall Street Journal Health Blog here.

[BTW, kudos for to the WSJ Health Blog for attaining the #6 position in eDrugSearch's list of Top 100 health Blogs. This beats Pharmalot, which has dropped back to #42. Pharma Marketing Blog, however, is close behind WSJ in the #11 position!]

Howard Brody over at Hooked on Ethics blog pointed out a few things Dr. Carlat omitted ini his confession and suggested that the $30,000 Dr. Carlat received as "honoraria" was actually a bribe to prescribe more Effexor ER (see Carlat's 'Dr. Drug Rep'--Some Further Possibilities). He also suggested that the same is true for the other 199,999 physician "consultants."

I dunno. The math just doesn't work for me. $30,000 is a lot to get maybe 25 or so new patients on the drug, which is probably the extent that Dr. Carlat to increase his NRx for Effexor ER. I offered a different ROI analysis in my post on the topic (see "Dr. Carlat's True Confession: 199,999 More to Go").

My conception of the conversation Dr. Carlat had with the Wyeth sales manager the day after he was less than a stellar spokesperson for Effexor ER (see here for the back story).

You might also want to read the comments posted to Carlat's own blog here. One comment posted by a psychiatrist in private practice in NYC included this confession, demonstrating once again how naive physicians claim to be:
"I was particularly struck, okay, terrified, by your description of the way the AMA sells information, and that that, and purchasing prescribing information from pharmacies aren't illegal. Everyone's so conscious of HIPAA laws, you'd think there would be some corresponding protection for physician privacy."
Carlat also claimed to be "astonished" at the level of information drug companies have about the prescribing habits of physicians. As if that were some kind of state secret!

As for "physician privacy," imagine if the prescribing habits of physicians were really considered private information that the public had no right to see! How would we hold them accountable? As a matter of fact, the government (eg, HHS) should spend some dough getting their hands on these data and see if physicians really are prescribing the right drugs for patients and link Rx behavior with patient outcomes. O yeah, forgot. That would require universal electronic medical records -- a pipe dream long forgotten by the current administration!

1 comment:

esilverman said...

Hi John,

For the record, Pharmalot posted mention of Danny Carlat's piece in the NY Times magazine two full days before my friends at the WSJ Health Blog. Here's the link...

http://www.pharmalot.com/2007/11/guilty-pleasure-the-doctor-as-drug-rep/

I may be too ugly to win the beauty contest over at eDrugSearch, and the WSJ team certainly gets its share of great posts and the like, but I'd appreciate credit where it's due - if you're going to bother to track that sort of thing in the first place.

Cheers
ed at Pharmalot