In my last post, I wrote about how the pharmaceutical industry funds half of the continuing medical education (CME) of doctors, and the risk this may pose for bias in what doctors learn. The influence of industry money on health education goes far beyond this, though. In 2004 I learned first-hand how insidious this influence can be.
I’ve been an educator my whole career, and was immediately enthused by this opportunity. It was sponsored by my hospital, the Mental Health Association of San Francisco, and a public relations firm I had not heard of, Porter Novelli. Although I was wary of drug companies using such talks as marketing tools, there was no apparent industry connection. I agreed to do it, and asked the caller for any written materials they had to clarify the format.
A number of weeks passed. It may have been only a week before the talk when I received a press release, an outline of the event, and a promotional flyer headlined “Life Beyond Depression: Delta Burke Speaks Out.” I learned that San Francisco was the fourth stop of a national tour called “GOAL! (Go On And Live!)” featuring Ms. Burke. Her message was that, “… it is possible to virtually eliminate the emotional and physical symptoms of depression and go on and live.”
I, too, was listed as a speaker on the press release. It said I would “discuss the warning signs of depression, highlight treatment options, and explain why the virtual elimination of symptoms is the goal of treatment.”
The repetition of this “virtual elimination” phrase made me suspicious. I went to the GOAL website (now defunct). It looked like an innocuous public education effort about depression. There was no mention of any specific antidepressant, although “virtual elimination” was mentioned there, too. Then I saw that the site was copyrighted by Wyeth Pharmaceuticals, makers of the antidepressant Effexor. It all started to make sense: Effexor’s advertising campaign at the time touted the drug’s ability to lower scores on the Hamilton Depression Rating Scale to near-normal levels, i.e., to “virtually eliminate” symptoms.
I explored the Porter Novelli website until I found a page that described their public relations efforts on behalf of their client Wyeth and its product Effexor, including the GOAL website and the series of talks by Ms. Burke. (Although that page is now gone, this blog entry from 2002 clearly links Wyeth, Porter Novelli, the “virtual elimination” phrase — and even Dr. Nemeroff, who was the lead investigator of the study that triggered Wyeth’s promotional campaign. A 2002 Wyeth press release documents the campaign as well.)
I felt I had been duped. I imagined turning the tables by standing at the lectern in the Grand Hyatt ballroom, and instead of giving a talk crafted by Wyeth’s PR firm, I would instead astonish everyone by revealing the subterfuge. I would declare that the audience and I were lured there under false pretenses, as a crass marketing ploy. My denouncement would make the papers.
Of course, it didn’t happen that way. I told the Community Health Resource Center I refused to participate in a veiled pharmaceutical promotion, and suggested they follow suit. Instead they called my chairman to find a last-minute replacement, while someone from GOAL called and pleaded with me to reconsider. My chairman opined with some irritation that our department was obliged to provide someone. And so he did the talk himself, presumably extolling the “virtual elimination” of symptoms just as Wyeth and their PR firm had planned.
My chairman and the Community Health Resource Center, and perhaps the city’s Mental Health Association as well, saw this event as constructive public outreach despite the commercial overtones. I could not. It concerns me when education for the public, or CME for physicians, conceals a disguised ulterior motive. For me, this experience underscored how easy it is to re-brand product promotion as education, and how vigilant we doctors must remain in order to avoid unwitting enlistment in those commercial efforts.
Doctor: Did you say, San Francisco?
That makes you an oddball devoid of credibility. I still do not understand why you threw such a tantrum. You were just asked to describe screening, diagnosis, and general treatment. You were not asked to promote anything, except general clinical information.
Despite the “oddball” name-calling, I thought the above comment was worth publishing and worth a response. “Supremacy Claus” shares the position taken by my department chairman, and presumably by my hospital and the Mental Health Association. Maybe it’s the most straightforward way of looking at it: If I don’t mention Effexor, I’m not promoting it.
I disagree, but it’s obviously a matter of opinion. By setting the terms and catch-phrases of the presentation — and supplying me with an approved set of slides, which I failed to mention in my original post, and only learned about when I received the press release and other material — the organizers put my “general clinical information” in a promotional context. To me this seems very much like the cameo appearance of a doctor on a TV drug ad who says, “Tell your doctor if you have fever, weight loss, or unexplained cramps, as this may be a sign of a serious reaction.” The doctor is certainly involved in product promotion, even if he/she doesn’t literally say “use this!”
It is ironic that the left wing government lawyer intimidates companies by fining them $400 million in lawyer gotcha for off label promotion, in violation of the First Amendment and of the Commerce Clause.
Then the left wing doctor is offended that the company has to have all slides approved by its lawyers to avoid massive fines.
This excessive sensitivity and punctiliousness is a masking ideology for left wing bias.
The maker of the medication has saved many 1000’s of lives by preventing suicide. It has restored millions of lives. The doctor lacks any basis for any moral superiority.
To give credit to Dr. Reidbord, he has the courage to address remarks. Other left wing ideologues respond with only shunning and censorship.
While I welcome respectful disagreement, I will not publish name-calling or ad hominem attacks from “Supremacy Claus” or anyone else in the future.
Issues surrounding off-label promotion are complex and interesting, and relate to the roles of the FDA and physicians as gatekeepers in a society with decidedly mixed feelings about state paternalism. I will explore some of this in my next post.
If I am the “left wing doctor” mentioned above, I was not offended by Wyeth’s lawyers vetting their slides. I was offended by their lack of transparency — the plan to feed the public a sales pitch under false pretenses, and to enlist me without my knowledge or consent.
Wyeth and other pharmaceutical companies create lifesaving products. I claim no moral superiority. Nonetheless, everyone has room to reflect on the ethics of their attitudes and behaviors.