Envisioning 2.0

Dr. Daniel Carlat, who writes a blog focusing on psychiatry and the pharmaceutical industry, has written a mini-confessional about his days as a paid speaker for Wyeth Pharmaceuticals. In his article, published in the New York Times magazine, he discusses how he felt getting paid to produce talks for Wyeth caused him to downplay the bad and highlight the good about the antidepressant Effexor.

His article has generated a lot of commentary throughout the blogosphere – for and against him. However, one comment, posted on the Wall Street Journal’s Health Blog from a physician currently speaking on behalf of a drug company struck me. He said:

“As a long time speaker myself for Wyeth, I read with much interest Dr. Carlat’s article. I too have been to many speaker’s seminars being updated on the lastest studies regarding Wyeth’s drug Enbrel as I am a rheumatologist. I too have given many talks to local physicians regarding the reasons to use Enbrel for people suffering from Rheumatoid Arthritis, Psoriatic Arthritis, and Ankylosing Spondylitis.I too have accepted honorariums for my time and travel expenses. But unlike Dr. Carlat

I truly believe in the drug that I am supporting in my talks to local primary physicians. I truly believe in the benefits of Enbrel and how this agent has made a huge difference in the lives of thousands with severe arthritis even with the known risks of this agent.As a physician one makes these decisions on a daily basis. And to the cynics who ask if I would also do talks for free, the answer is yes becuase I have also done many talks for the Arthritis Foundation. my local hospitals and arthritis support groups, gratis. As in so much of life, proper balance is of utmost importance.”

In a fascinating interview published on Maggie Mahar’s Health Beat Blog, Robert Blendon, professor of health policy and political analysis at Harvard’s Kennedy School of Government, had some sobering words for those seeking radical reform of the health system.  Blendon is well-known in health policy circles for tapping into the American mindset regarding reform.

First, Blendon looked at the current status of Massachusetts’ plan to cover the uninsured.  Policymakers hoped that more than 220 thousand uninsured citizens would sign up for a heatlh plan.  To date, only 15,000 have enrolled despite the threat of a fine.  Blendon described the Massachusetts effort as “the canary in the coal mine,” . . . if it’s not breathing in 2009, people won’t go in that mine.”

Following are a few excerpts from his interview, which I believe are instructive.

Include All Relevant Stakeholders In The Conversation

“Reformers need to ask ‘what are the points that are absolutely critical to various interest groups if we want them to find reform acceptable?’  You want many people to feel that they have had a major say. Then they should develop a very general plan.”

Don’t Try To Be Perfect The First Time

“The very best plan for reform would be polarizing . . . Every interest group would oppose it, and it would never pass. What reformers need to do is to decide which groups they can bargain with. In Massachusetts they decided they could make a deal with the insurers. But reformers will need to work quietly behind the scenes . . . finding concessions they can live with—or fix later.”

Remember, Middle Income People With Insurance Are Risk Adverse

“Middle-income people with insurance are risk adverse . . . Legislators need to be very careful about how they try to re-arrange coverage for the middle-class. Even if these people say they are dissatisfied with the present system, they think they have a lot to lose—especially if they haven’t been seriously sick and tried to actually use their insurance.”

Maher’s post has ignited quite a debate and is fascinating reading.

This morning, John Mack, author of Pharma Marketing Blog, wrote an interesting post focusing on Eli Lilly and Company executive Diedre Connelly’s recent statements about the drug industry-focused online forum CafePharma. According to Medical Marketing and Media Editor-in-Chief James Chase:

“Lilly USA president Deirdre Connelly yesterday took a swipe at online forums that attract disgruntled, venting sales reps, describing sites like CafePharma.com as ‘outlets for people who don’t have the courage to speak out with their ideas’ for improving their roles and the performance of their companies.”

Connelly’s view of CafePharma’s users reflects the view of other executives who feel that the forum is an outlet for unproductive anonymous venting.

Despite Connelly’s opinion, human resources and corporate communications executives at the company might want to read this post (and responses to it) highlighted by Mack regarding diversity at Eli Lilly. The post, (published in May) points the finger at minority employees for Lilly’s recent sub par performance:

“As a long term employee, it absolutely kills me to see what diversity has done to Lilly. Over the last 10 years or so, the increase in diversity (read blacks and females - not thought) has been inversely proportional to the effectiveness of the company. It looks like it will only get worse with the quotas we have at every level of the company.”

Interestingly, the online debate about diversity at Eli Lilly coincides with a growing class action lawsuit filed by minority employees alleging that the company discriminated against black employees.

The lawsuit and CafePharma post reveal some employees do not view Lilly’s efforts to improve its track record on diversity equally. On the one hand, certain executives believe that Lilly is promoting and grooming under-qualified minorities. Other the other, those filing the suit think the company is not doing enough.

From a communications perspective, these two pieces of diametrically opposed data indicate that company executives may to adjust how how they communicate about diversity within and without the company. Key questions to answer include:

-How do we ensure that diverse stakeholders view our hiring/promotional practices as equitable?

-How can we combat the perception that Lilly is hiring under-qualified minorities?

-What can we be doing to demonstrate our commitment to an appropriately diverse and well-functioning workforce to potential minority recruits who may decide not to work at Lilly because of the lawsuit?

I don’t have enough information about Lilly’s situation to appropriately answer these questions. However, company executives should consider monitoring (and taking seriously) commentary published on CafePharma and forums like it. After all, the truth often comes out when people feel they are protected by the mask of anonymity.

As readers of this blog are aware, I’ve been following the progress of Vertex’s hepatitis C drug (Telaprevir or VX-950 ) over the past year or so. I initially wrote about it from a communications perspective, saying that the drug was promising. However, there were signs that company leadership may have overstated its potential.

Today, we learn why it is always a good idea to exercise caution when communicating about a drug early on. According to Reuters:

“Vertex Pharmaceuticals Inc (VRTX.O: Quote, Profile, Research) released data on Friday showing its experimental hepatitis C drug is more effective than existing treatments and works in half the time, but causes significantly more side effects.”

The side effect issue is a big deal. In one Vertex trial, PROVE 1, 13% of patients stopped taking the drug in the first 12 weeks of the study because of side effects. In addition, “65 percent of patients who took part in the 24-week treatment regime . . . saw the virus eradicated and stay eradicated after three months.”

The results were a disappointment to investors who sent Vertex stock tumbling. Vertex’s product becomes a much tougher sell because its efficacy profile may not be enough to overcome its toxicity. If patients are not continuing therapy because of side effects, physicians will be less likely to prescribe it to patients. This is especially true if there is another – equally effective – therapy with fewer adverse events.

Now we wait for the FDA’s decision on the drug. Observers think it will be approved, but we’ll see how physicians react once it is on the market.