'Round the Sphere: Health Care Renewal Rebuffed by In the Pipeline on Avandia

Seems like Derek Lowe over at In the Pipeline and a few other people as well are detecting a hidden "agenda" at the Healthcare Renewal blog.

It started with PharmaGossip recommending an article on Avandia at the Health Care Renewal site, calling it "essential reading". The article in question is "Expanded Avandia Story Now Echoes Familiar Themes."

In the article, the author, Roy M. Poses MD, compares the Avandia case to the Vioxx case and cites these "familiar themes":

• Early warnings from at least one whistle-blower were apparently ignored.
• The pharmaceutical promoted the drug enthusiastically, apparently again in a way designed to distract attention from particular adverse effects.
• Just to muddy the water, the whistle-blower had financial relationships to manufacturers of competing drugs, possibly leading to questions about whether his whistle-blowing may have been influenced by them.

I also warned that GSK may be following the same path as did Merck (see GSK May "Step Into the [DTC] Void" to Defend Avandia and Advice to GSK on Handling the Avandia Avalanche: Don't Do What Merck Did). Peter Rost went so far as to call me "stupid" for giving GSK free advice, but I know he meant that in the nicest possible way.

Anyway, Derek had this to say:

"[The] article has some good points in it, but to my ear they're phrased oddly. For example, it advocates a skeptical attitude toward the marketing claims made by drug companies, which is very good advice. But that's very good advice for evaluating the marketing claims of companies in every other industry, too. They're trying to sell you something. They will present their product in the most favorable light possible, whether that product is a car, a diabetes drug, or a burrito.

"...one of the things that I dislike about the Health Care Renewal piece is the hand-rubbing now-we've-got-'em tone that I detect in it. You don't have to go far to find it from plenty of other sources, either, which is why people like me are perhaps too touchy on the subject."

[You can find Derek's complete post here: More Avandia, And More on Marketing]

What I found disturbing about the Health Care Renewal piece is the following claim that Dr. Poses made:

"Once again, it appears that a drug company was pushing one its products beyond what the clinical research evidence supported."

The way I interpret this is that GSK made efficacy (benefit) claims beyond what the evidence supports. This is different than saying it tried to gloss over the adverse side effects, which is what the FDA warning letters (mentioned in the NYT article) say. The FDA never, to my knowledge, claimed that GSK was making unsubstantiated benefit claims.

This is an important distinction, because any decision by the FDA to request that Avandia be taken off the market will be based on how the risks stack up against the benefits. Other commentators -- including Bob Ehrlich -- also point out that the benefits of Avandia may outweigh the risks:

"In my view, here is another useful drug accused of being dangerous in the unrealistic desire for risk free medications...Properly warned, patients and their physicians need to weigh the risk and benefits of any drug. In some of those carefully considered cases, patients will still die because of a reaction to a drug intended to make them better. That has and always will be the case. Those deaths pale in comparison to lives saved. That part of the story gets lost because 'greedy uncaring drug company' makes better copy." [DTC Perspectives Issue 262]

I am not sure that Avandia's risks outweigh its benefits, but if intelligent bloggers -- and MDs to boot! -- can't get it right, then God help patients who need to make a decision!

'Round the Sphere With Christiane Truelove

PharmaLive's e-newsletter "Pharma Blogs: Week in Review" edited by Christiane Truelove offers a roundup of what bloggers in the Pharma Blogosphere^TM are writing about recently. To read it, you need to subscribe here.

Topics covered this week include:

• The two Peters (Pitts and Rost) on the issue of drug re-importation.

Pitts is the anti-Peter, whereas Rost if the pro-Peter, viz-a-viz allowing re-importation. You may recall that this was the issue that first brought Rost to worldwide attention via his 60 minutes interview. Back then Peter did not have a blog and would send out email missives. "Get a Blog already," I said (see "Rost to Roost in Blogosphere"). The rest, as they say, is history. Pitts, on the other hand, used to work for the FDA. Funny how many former FDAers now lobby, do PR, or otherwise consult for the drug industry.

• Jim Edwards (Brandweek) on the failed DTC moratorium provision

Truelove says "In response to comments made by Democratic Iowa Senator Tom Harkin in the Star-Ledger, Mr. Edwards says, 'We've had 10 years of DTC. Either it's fine the way it is or it needs to be reined in. If it needed reining in, then this was the chance to do it. And you balked. No one believes that Congress will ever again take serious action to change DTC rules.'" (see "Senate to Big Pharma on DTC: 'Never Mind!'")

Of course, some people, like Robert Corn-Revere, think Congress has the right to limit DTC only by eliminating the first amendment (see this screed from the Media Institute).

• Derek Lowe (In the Pipeline) on more power to the FDA to monitor drug safety

"We know just as much about toxicology as we did yesterday -- a lot, from one perspective, but not nearly enough, from another," Dr. Lowe says.

No legislation will correct the FDA's blind eye, which was turned towards years and years of Purdue's perfidy re: off-label promotion of OxyContin. According to an article in the New York Times, "when the painkiller was first approved, F.D.A. officials allowed Purdue Pharma to state that the time-release of a narcotic like OxyContin 'is believed to reduce' its potential to be abused." Where was the FDA when Purdue Pharma went further? They can have all the power in the world, but it doesn't mean they will use it. After all, there are post-FDA career decisions to consider.

Frosting occurs over pink cupcakes
Of course, Truelove mentions the Pink Cupcake Caper and the "kitty fight" that briefly pitted her against Black Kitty. I'm not going to get into that here, but Truelove handles the whole thing very professionally and distills from it the lesson I promulgated: pharmaceutical sales reps need to have some guidance about what is and what is not appropriate food to be handing out to patients in waiting rooms (see my Guidelines for Gifts to Patients).

Truelove then relates her own personal story about an inappropriate gift from a pharma rep that she still cherishes -- a chocolate bar wrapped in a drug logo-emblazoned wrapper (you'll have to read the newsletter to find out what drug and what pharma company -- hint: it ends with "zeneca"). It must be way moldy by now! Yewwww!

There's more, but I've got to get on with making a living. I suppose you should too!

Survey Finds Blogs Critical of Drug Industry Are Most Credible

I will be in Las Vegas this Monday and Tuesday where I am speaking at the Healthcare Blogging Summit. I will be participating on the panel, "Blog Search, Distribution, Measurement & Reputation Management", along with Fard Johnmar (HealthcareVOX blog), Tom Eng, Healia (medical blog search), and Constantin Basturea, Converseon (a Web 2.0 communications agency).

At this meeting, I will present the details of the Pharma Blogosphere Reader Survey. Below is the press release, which highlights some of the findings from that survey, which I hope stimulates some discussion at the meeting.

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First Ever Pharma Blogosphere™ Reader Survey Reveals That Blogs Critical of the Pharmaceutical Industry are Viewed More Credible than Blogs Supportive of the Industry

Results of the First Ever Reader Survey of the Pharma Blogosphere™ Presented at the Healthcare Blogging Summit in Las Vegas

Survey sheds light on the credibility and bias of over 20 blogs devoted to various aspects of the pharmaceutical industry

Las Vegas, NV – April 30, 2007 – A new survey of pharma blog readers presented today at the Healthcare Blogging Summit by VirSci Corporation, publisher of Pharma Marketing News newsletter, reveals that four of the TOP FIVE credible pharmaceutical-related blogs are "industry critics," as rated by industry and non-industry readers alike.

According to industry readers, the TOP FIVE credible blogs, in rank order, are In the Pipeline, Pharmalot, Pharma Marketing Blog, BrandweekNRX, and PharmaGossip. In the Pipeline blog is the only "industry supporter" in the group (see TABLE, below).

Non-industry readers also considered critical blogs more credible, although the list of blogs in this group is somewhat different (see TABLE, below).

Pharma Rag, PharmaGossip, Question Authority, and Pharma Giles were considered the most critical of the industry by all 143 survey respondents, whereas On Pharma, In the Pipeline, Drug Wonks, and Eye On FDA were considered most supportive.

Aside from bias for or against the industry and credibility, respondents rated blogs according to readability (layout, ease of reading and finding information) and usefulness (for keeping readers aware of the issues).

"Top Honors" overall went to In the Pipeline, Pharmalot, BrandweekNRX, PharmaGossip, and Pharma Marketing Blog.

Thirty percent (30%) of respondents read 2 to 9 pharmaceutical-related blogs more than once a week. Eighty-six percent (86%) read pharma blogs to keep up to date with industry news and gossip; 69% to learn more about industry business practices, regulations, etc.; and 22% to "snoop" in order to see what bloggers may be saying about their companies or blogs.

The most frequently read blogs are Pharma Marketing Blog, PharmaGossip, Pharmalot, Question Authority (Dr. Peter Rost), In the Pipeline, and Eye On FDA.

"Both the drug industry and its supporters seem to have fallen into the same credibility gap," said John Mack, publisher of Pharma Marketing News and author of Pharma Marketing Blog and Pharma Blogosphere™ blog. "The results of this survey are a wake-up call to blogs that support the industry. They must do a better job convincing readers—most of whom are likely skeptical of the industry to begin with—that the information in their blogs is credible."

VirSci Corporation's survey was featured in the April issue of Pharma Marketing News. A reprint of the article "How Readable, Credible & Useful are Pharma Blogs? can be found on the Pharma Marketing Network website and purchased for $9.95. It’s free to subscribers of the newsletter (subscribe here).

TABLE: TOP FIVE credible blogs according to industry respondents (left 2 columns) vs. non-industry respondents (right 2 columns), based on the percentage of responses in the "Top 2 boxes" (Superior/Excellent). N (industry)=43 (excluding respondents who “never” or “rarely” read the blog); n>5 (includes only blogs having more than 5 responses); N (non-industry)=100 (not Never/Rarely); n>10. Excludes Pharma Watch blog because it is now closed to the public. *In the Pipeline is the only “industry supportive” blog in this group, as judged by respondents.

About the Survey
One hundred forty three (143) respondents to the survey ranked 22 pharmaceutical-related blogs according to readability (layout, ease of reading and finding information), usefulness (for keeping readers aware of the issues), and credibility (accuracy of information). The survey was hosted online between February 3, 2007 and February 28, 2007. VirSci Corporation acknowledges with appreciation Chris Pounds at Myriad Pharmaceuticals for help with survey design and analysis.

About VirSci Corporation
VirSci Corporation (www.virsci.com) publishes Pharma Marketing News and owns Pharma Marketing Network, which brings together pharmaceutical marketing professionals from manufacturers, communications companies, and marketing service providers for wide ranging discussions and education on a multitude of current topics. Pharma Marketing Network & Pharma Marketing News provide executive-level content coupled with permission-based e-marketing opportunities.

Media Contact
John Mack, VirSci Corporation
Phone: 215-504-4164
Cell: 215-431-0859
E-mail: johnmack@virsci.com

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Who Loves Ya Baby? The TOP 5 Blogs According to Industry Readers

As many readers of the Pharma Blogosphere^TM blog know, back in February we hosted the First Ever Pharma Blogosphere reader survey. A sampling of results of this survey have already been published on this blog (see "Industry Bias in the Pharma Blogosphere" and "Pharma Blogosphere Survey Results - Who and Why?").

The full results of the survey will be published in the April, 2007 issue of Pharma Marketing News and presented at the Spring 2007 Healthcare Blogging Summit 2007 being held in Las Vegas on April 29. (I better get my ass in gear to get ready for that!).

In this installment I present some data showing the top 5 pharma blogs ranked by survey respondents who said they were employed at pharmaceutical companies. Recall that blogs were ranked according to Readability (layout, ease of reading and finding information), Usefulness (for keeping readers aware of the issues), and Credibility (accuracy of information). The results are shown in the following slide.

Note: N=43 industry readers; shows top five blogs in each category; only blogs with more than 5 respondent ratings were considered.

Some Take-aways
Only three blogs -- In the Pipeline, EyeOnFDA, and Pharma Marketing Blog -- made the "Industry Top 5" in each category. Props to In the Pipeline for being #1 in Usefulness and Credibility, and #2 in Readability!

Surprisingly, Drug Wonks was considered the most readable, but did not make the Top 5 in either of the other 2 categories. I reveal more about that in the upcoming Pharma Marketing News article.

Sorry, Peter, Question Authority -- popular as it might be among all readers -- did not make the "Industry Top 5" in any category! But I will say this: Industry readers thought that Question Authority was more supportive of the industry than did non-industry readers! In fact, it was second on that list (behind Pharma Marketing Blog) of blogs that the industry thought supportive. Perhaps if the survey was done over again today, industry respondents would have a different opinion! Perhaps more closely aligned with a view expressed on CafePharma; namely, "This Rost guy is a Michael Moore crony that is an industry and medical community outcast that has nothing better to do then sit at his computer all day long blogging about things he knows little about, blowing things out of proportion, and surfing porn."

Caveats
Kind in mind that this survey covered only 22 blogs. Today the field is much bigger! Also, several blogs were very new when the survey was run and, consequently, may not have had enough history to be properly judged.

There will be another Pharma Blogosphere Reader survey in the Fall. Stay tuned!