Re: Question For Dr. Pilcher

May 25, 2002

> I'm not sure if Marjorie, as an emergency clinician, has much direct

> contact with pharmaceutical companies trying to sell her their

> products...

Are you kidding me, englishtexvet? Any doctor, any nurse, any

specialty -- we're all honey to the drug rep bees.

> Forgive us our scepticism Dr. Pilcher, but you are part of an

industry

> that has proven itself to be morally corrupt. Your job is to sell

> product. You are not governed by a strict code of professional

ethics,

> as Marjorie and myself are. It is OUR job to protect patients from

> misleading research (not easy in these days of direct marketing to

the

> consumer by drug companies)...

I agree with you in spirit, but -- incredibly -- I'm about to come to

the defense of drug reps (which, incidently, Dr. Pilcher is not, in

that his job description is not to sell products. That's not to say

he doesn't want to put his products in the best possible light for

the public -- why would we expect him to do otherwise? And that's why

skepticism is important here.)

It's true that the public (appropriately) expects health care

professionals to aspire to the highest professional ethics, higher

than other professionals, and in my experience most of us honestly

strive to hit the mark. But there are too many examples of health

care professionals who sadly betray that trust -- the OB-GYN who last

year carved his initials in the belly of the woman he just performed

a Cesarean section on, and the pharmacist who diluted his patients'

chemotherapy meds to pocket a fortune, immediately come to mind. Not

to mention other less dramatic but equally corrupt examples.

And I've met some pretty sharp and honorable drug reps. It's easy to

identify them -- spend a few minutes explaining your concerns about a

product and/or how it is marketed, then sit back and listen to their

response. Of course, most don't know enough about their products to

answer intelligently, and others continue to try to snow you. But the

good ones appreciate the honest feedback, answer your questions even

if they aren't favorable to the company, and reward you in the future

with only the best studies and product information. Like all jobs,

some people do it well, and seek good relationships with all their

clients.

Plus, the literature has examples of excellent, even landmark drug-

supported studies. For example, while others may disagree, I believe

Genetech supported unbiased research on its clot-buster TPA in the

mid 80s. Of course, it's easy to take the high road when your product

is so good -- TPA literally revolutionized the treatment of acute

heart attacks. But Genetech didn't falter when some studies showed

cheaper alternatives worked just as well. Instead, they helped

physicians identify when cheaper thrombolytics were as or more

appropriate than TPA, and when the reverse was true. More recently,

with the trend towards emergency cardiac cath rather than TPA for

acute heart attacks, I didn't notice Genetech trying to sway the data

to favor their product, but again tried to clarify which patients do

best with what treatment.

But like you, I totally believe in heightened skepticism regarding

statements made by drug (OTC or prescription, small start-up or large

corporations, traditional or alterative therapies) companies, and

results from drug company-supported studies. More than most are

thinly veiled marketing ploys -- which is not to say they aren't

making truthful claims or promote valuable products, but that these

studies are usually not the vehicles with which to discover that.

And I agree, it's so easy for us to catch the tricks drug companies

and others use when presenting their products directly to the public.

Often, they are just dumbed down versions of the same tricks they try

on our professions.

Another poster, while praising Cutanix, asked why some of this

group's favorite OTC and Internet products haven't provided the same

kind of research. I know nothing about most of the products

mentioned, but sometimes being honest and honorable to one's

customers means NOT " blinding them with science. "

> and it appears to me that Marjorie is

> doing an excellent job of it.

Thanks. (Gee, who would have guessed that we'd so frequently agree

with one another. )

Marjorie

Marjorie Lazoff, MD

May 25, 2002