Personal Health

How Big Pharma Is Fooling You -- and Your Doctor -- with Junk Science

To the pharmaceutical industry, "research" is just a code-word for "smart-sounding marketing."
This article originally appeared on Health Beat.

It's no secret that the pharmaceutical industry trades in junk science. Prescription drug companies distort research, fudge measures of drug effectiveness and generally control our knowledge of what works in medication. Big Pharma's track record of shady science is a serious problem, especially considering the fact that recent discussions about creating a Comparative-Effectiveness Research Institute currently hold a place for prescription drug companies on the organization's board.

The obvious problem is that, to the pharmaceutical industry, "research" is just a code-word for "smart-sounding marketing." If you really want a sense of how deep this deception runs, consider the fact that the prescription drug industry relies on so-called "research" not just to shill its drugs, but also to argue that it has a vital role to play in shaping the doctor-patient relationship for the better.

This dubious claim comes in the June 2008 issue of PharmaVoice where Meaghan Onofrey from CommonHealth, a pharma marketing consulting firm, pens a piece arguing that coaching from the prescription drug industry can make sure that "physicians and patients speak the same language" so that "everyone wins." According to Onofrey, "one case study illustrates [how marketers can help physicians improve their communication]: by videotaping primary-care physicians, who were struggling to assess migraine prevention candidacy with their migraine patients." According to Onofrey, it turned out that the doctors were actually asking the wrong questions of their patients. In working with key opinion leaders and advocacy groups, a simple solution was formulated to address the issue. These same physicians were taught to ask a single question to help them more simply and clearly identify the patients' candidacy for migraine prevention."

You might be wondering what this oh-so-effective single question is -- and so am I. Even GlaxoSmithKline's online "headache quiz," which users can take to see if they might have migraines (and thus might be a good target for prescription drugs) asks eight separate questions of patients. When it comes to migraines, it's tough to imagine a silver bullet question.

Yet Onofrey provides no specifics about the "study," leaving the reader with a load of unanswered questions. Under what conditions was the study executed? What were the patient profiles? What was the patient-physician dialogue specifically like before and after the "single question" solution? All we get is some PR spin concluding that it's important to better identify "prevention candidates" (a.k.a. potential customers) through "leveraging ... dialogues."

CommonHealth's research is paradigmatic of pharmaceutical industry science: talk a big game, but ensure that there's enough ambiguity so that the really meaningful results are hidden. This is exactly what we get in direct-to-consumer (DTC) advertising. Ads for Pfizer's Lipitor, for example, claim that the drug reduces the risk of heart attacks by 36 percent because studies show that two patients out of every hundred on the drug get heart attacks, versus three out of every hundred on placebos (which is a difference of one patient, or about one-third of the heart attacks that would have happened without Lipitor). This data obscure the fact that the drug only helps one out of every one hundred people who take it.

But there's something particularly bald-faced about claiming that marketers can feed doctors a script for the benefit of all involved. As John Mack, publisher of the Pharma Marketing Newsletter, points out on his blog, "Although the research is billed as a way that pharmaceutical companies can help improve physician-patient communications by helping physicians and patients 'speak the same language,' it obviously may be more useful to CommonHealth's pharma clients, who can 'demonstrate value to physicians beyond just the benefit of the brand, potentially creating an unexpected, yet mutually beneficial relationship.' i.e., sell more drugs.

"So," Mack asks, "is this research or a sales tactic?"

Meanwhile, the pseudo-science here is just painful: Onofrey claims that CommonHealth's research is grounded in "sociolinguistics," which is ... wait for it ... the study of how people speak to each other in different contexts. Sounds flashy, but all it really means is that the 'researchers' tried to get physicians to speak differently.

This isn't the first -- or likely the last -- time that CommonHealth has twisted poorly-executed research to argue that pharma marketing practices are benign. Mack reports that back in 2006, CommonHealth undertook a study dedicated to proving that DTC advertising isn't nearly as bad as critics claim. In the press release for the study, CommonHealth gleefully announced that its results "challenge many of the assumptions of both academic and public policy critics of DTC."

First, here's CommonHealth's description of the study, which it called an "an exhaustive analysis of 440 transcripts of actual provider-patient interactions in community-practice settings. The transcripts were all recorded between 2001 and 2005, and examined the nature of patient medication requests, references to DTC in the dialogue, and the overall nature of the risk-benefit discussion in three therapeutic categories." Based on these transcripts, CommonHealth's team concluded that "patient-initiated prescription drug requests are not driven by DTC advertising." In fact, the press release reports that "DTC advertising was referenced by patients in just 0.6 percent of visits, and that "DTC advertising does not harm the balance of [discussions assessing the risks and benefits of a given medication], regardless of DTC spending in the given category."

According to Brad Davidson, the project's lead researcher, these findings supposedly confirm that "DTC does not have the negative impact on the actual dialogue that many people allege." John Kamp, executive director for the Coalition for Healthcare Communication, an association of medical marketers and advertisers, insists that "these facts will disappoint some who wish to restrict or ban DTC" and that "others who wish to improve DTC will be both better informed and challenged as they seek to better educate patients and improve the doctor-patient discussions that drive patient compliance with their healthcare regimens."

So what's wrong with this picture? First, Mack pointed out in 2006 that CommonHealth stone-walled him when he tried to get access to the study. Ultimately, Mack had to go to the FDA and submit a Freedom of Information Act request for the information. Once he got his hands on the study, Mack posted it on his blog and noted that it's little more than "a cover letter and a slide deck," far from the "raw data, multiple tables, and ... detail about methodology ... that a [supposedly] 'data-driven' agency like the FDA demands in medical research.

The real 'gotcha' moment comes in the following slide:

patientrx


Mack points out the problem: "Here, we can see that there were 585 mentions of a brand name drug either by the doctor or the patient during the 440 visits recorded. True, the doctor initiated the discussion in the vast majority of cases (455 or 78 percent of the mentions). Yet the patient mentioned a brand name drug first in 130 cases or 22 percent of the mentions. That's a far greater percentage than" the 0.6 percent that CommonHealth talks about in its press release.

That's because CommonHealth is hyper-selective in reporting its numbers: the 0.6 percent refers only to patients who specifically referenced advertising and asked for a medication. Joseph Gattuso, president of CommonHealth's MBS/Vox (Mind, Body, Spirit, and Voice) division -- which, according to its Web site, "specializes in 'reality-based' approaches to marketing insight based on dialogue between physicians and patients ... and other healthcare interactions" -- summed up the .6 percent number best, when he said that "it doesn't appear that a high percentage of patients are going to the doctor and directly [emphasis added] saying, 'I saw X brand on TV and that's what I want.'"

Would you tell your doctor you want a medication because you saw an ad on TV? Or would you say "I've heard about brand x -it sounds good." Either way, chances are, the only reason the patient knows and remembers the name of a new brand is because he saw an ad on television that was designed to plant the name in his memory.

As Mack explains: "Gattuso is not talking about how often discussions about brands take place in the doctor's office -- he's talking about whether or not the patient mentions seeing the brand advertised. In other words, CommonHealth is focusing only on how often DTC is mentioned in doctors' offices, not how often brands are mentioned."

Meanwhile a write-up about the study in Pharmaceutical Executive Magazine, willfully distorted the results, claiming that CommonHealth's study "sought to determine how often discussions about prescription brands were taking place ... " No, the study showed how often patient and doctor discussed television.

There's something uniquely unsettling about the fact that the pharmaceutical industry is ready, willing, and able to claim that its marketing is actually some perverse form of community service. It's one thing to claim that a drug works when it doesn't, but there's something especially weird about insisting that advertising can -- and should -- effectively structure patient-physician interactions. This point is all the more perverse because the same organization that's saying marketers should mold discussions is also claiming that DTC advertising doesn't do so. There's a disturbing undercurrent of social conditioning here that is played up or played down depending on what is most convenient for prescription drug companies.

This is all very audacious, even for Big Pharma. The lengths to which these marketers are willing to go to prove that their product is beneficial and desirable are stunning, and this drives home a point that health care reformers need to keep in mind: These are not the people we want involved in medical research. They have a deep interest in choosing spin over science and pursuing "research" in the service of marketing. These are not the priorities of a high quality health care system. The CommonHealth PR logic needs to be kept as far away from the proposed Comparative Effectiveness Institute -- and health care in general -- as possible.

Niko Karvounis is a Program Officer with The Century Foundation in New York City, where he works on issues of socioeconomic inequality and health care. He is a regular contributor to Health Beat, the Foundation's health care blog.
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