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

As I have been in all of my posts and e-mails to members of this

group and the group in total, I will answer all questions completely

up front and honestly. I appreciate all of your concerns and

skepticism regarding anything from companies. Obviously there have

been many before us claiming to have efficacy but without effect in

the general population following use. I understand why at this point

in time you cannot separate Cutanix from that group. But I do take a

huge exception to your lumping us in with those that are morally

corrupt. ly, you know nothing about me or anyone else that works

for the company. Be careful about making blanket statements about a

company that has yet to prove itself to the general public.

In answer to your direct question- Cutanix contracted with Dr.

Draelos' organization, Dermatology Consulting Services, to perform

each of our three clinical studies. In fact, we have contracted with

many other organizations just as we have with DCS- including Calvert

Preclinical Testing to determine if our lotion would sensitize or

irritate. Do you think we have some immoral objective by paying them

to perform our pre-clinical safety studies? To suggest that if we

were to obtain negative data we would immediately drop DCS is

preposterous. Look at the list of clients DCS performs clinical

studies for and you'll see that she has credentials that back her up.

If we obtained negative clinical results we would drop that lead

compound and move on to the next.

In short- Why would we want to launch a product that didn't work?

Keep in mind that this will be our only product offering, not one of

100s as is the case for big pharma.

As for your last point- nothing will convince you except your

personal experience with the product. I just hope you will give us a

chance.

> I saw no implication in Marjorie's posts that Dr. Draelos was

directly

> bribed into fraud, but was she not paid by your company to conduct

the

> " independent " study? I suspect you would be in no hurry to use her

> again if her findings were less than favourable.

>

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

> contact with pharmaceutical companies trying to sell her their

> products, but I assure you I have to deal with them daily. All of

> their representatives come armed to the teeth with " independent "

> research (financed by them) positively guaranteeing safety and

> efficacy. With an occasional exception, all the products turn out to

> be utterly useless, and in some cases dangerous.

>

> 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), and it appears to me that Marjorie is

> doing an excellent job of it.

>

> Like her, I would love to find that you have a safe and effective

> product. The point is: Nothing we have read so far convinces us!

May 25, 2002

I really don't need to " be careful " about any of my statements Dr.

Pilcher. I stated that your company is part of an industry that has

proven itself morally corrupt and I think that is self-evident.

I have no doubt that there are honourable used car salesmen out there

too, but I'm not sure that's justification for trusting everything

they tell me!

And to Marjorie: I'm really not naive enough to believe that those of

us that can have the ability to practice our professions taken away by

a board of our colleagues because of a breech of ethics are free from

dishonesty. In fact, I believe physicians have to face much more

temptation from this than veterinarians because they deal with 3rd

party payment so often. I simply meant that the Dr. Pilcher's job, at

root, is to sell product and that there was no code of ethics

governing his industry.

May 25, 2002

To Shane and all the others who feel my posts were too

confrontational, I make no apology whatsoever. The implication from

Dr. Pilcher's posts is that this study may be flawed, but that it was

the best his company could afford and that a poor investigation is

better than none at all.

I could not disagree more. If a product is introduced as a cosmetic

that trial and error is just fine, but if it is presented in a

scientific manner, and that science is poor, then it should not go

unchallenged.

This is no small philosophical detail. Good science is the pillar of

western society and the reason why ALL of the non-science based

nations have been left in the dust.

May 25, 2002

Sounds like a great idea to me. I will gladly receive information

about a new product that may offer some relief for this condition.

Unfortunately, there are those on this board who are overly myopic;

some who look only to traditional medicine for answers. Most on this

board fall somewhere in the middle of the spectrum, looking to both

traditional medicine and more homeopathic remedies.

This forum is quickly becoming a place for those with a medical

background to flaunt their knowledge and engage in serial

oneupmanship. We are all welcome to our own opinions and I see no

reason to attack someone for providing information about a new

product as Dr. Pilcher has been attacked. For those who place so much

stock in the success and method of clinic studies, please reference

clinical date Re the Metro products and explain why they have been

such a resounding flop in the actual rosacea community.

While I appreciate a degree of medical balance, I fear this board is

becoming overly " medical " in tone, much to its detriment. Seems to

me, many of the old regulars who posted about more homeopathic

remedies, which actually helped a great many of us, have been

silenced and intimidated in this process. The majority on this board

have been to dermatologists, wo we really don't need cyberdocs, since

doctors who have actually seen us have been of so little help.

We already know medicine has not provided satisfactory answers to

this condition, which is why there are so many who've looked to this

site for relief. If this board becomes just another podium to promote

the traditional medical approach, a mass exodus will undoubtedly take

place. I would hate to see that happen.

> How about we all just agree to get along

> and let the results of the product speak

> for itself?

>

> Shane

May 25, 2002