Often I’ll put a movie on my Netflix queue, then go immediately to Wikipedia to read the plot summary. And I just might take that DVD, watch the final scene, then view the movie from the beginning. Why? Well, I like surprises and plot twists and all, but I just find it more enjoyable to know the “end” so that I can better understand and more enjoy the “means”.

I got thinking about how this peculiar behavior relates to reading journal articles after seeing Teresa Rogstad’s recent AMWA Journal feature (2009;24(4):176-181), “Judging the Quality of Medical Literature.” In a succinct review, she lays out the key things (eg, study design, bias, sample size) to assess in determining the “methodologic strength” and “application usefulness” of published research. Now on my burgeoning “must-read” list for nonscientists in Pharma, her article might be of value to even the most CONSORT-literate folks.

Consumers of scientific literature might well combine my contradictory movie habit and Rogstad’s criteria by approaching their next scientific article as follows:

• Read the Abstract (plot) to help assess the quality and direction of the study.
• Read the Discussion section (ending) to understand the research implications.
• Read the entire article to understand the data’s finer points and full meaning. As with a film, this method can help maximize the reader’s use—and dare I say, enjoyment—of the “story” that the writer and researcher(s) have crafted.

We at SRMC believe this assessment of the quality of the research “story” is crucial to the most effective use of published clinical data. And it’s one of the many capabilities that we offer to help clients who want to optimize the impact of the research articles they use to support their products.

So if you’ve ever asked yourself—Is this/that journal article good? or Should I cite this study?—we can help you find the answer. And if you have questions about how the movie ends, we can answer those, too.

Ted J. Slowik, PhD

Director, Scientific Information, S+R Medical Communications
teds@srmedcom.com

At the risk of sounding like my own father, I have concluded that doing business today is a lot like that now-famous Oldsmobile campaign.  Doing business today is not based on the practices I was taught to honor, respect and hold sacred.  In fact, today’s business world is quite like the Wild West—plenty of outlaws, snake-oil peddlers and people looking to be the “biggest gun in town”.

The first difference I find is the ability to take people at their word.  With all the muttered promises, downright lies and “handshake” deals that frankly are not worth a damn, you simply can’t do that anymore.  Could it be a generational gap? New generational values? Or am I becoming an old fart?  It almost doesn’t matter, because when you are unable to trust people to do what they say, something is wrong.  Taking people at their word should mean that there is an understanding between two people that certain expectations will be met.

The second difference is a growing inability to conduct business on a face-to-face basis.  As I compose this blog on my computer, check my smart phone for text, e-mail messages, check my voice-mail and find comfort and safety behind my computer screen, I understand where some of the problem resides.  The ability to engage people in a “live conversation”, either face-to-face, via the phone or via virtual meeting technology is increasingly more difficult.  But I simply can’t think of many successful personal or business relationships I have had where I wasn’t able to interact with people “live”.  Really, how can you build trust and understanding when you have to submit proposals and information via a “blinded web portal”?

The final difference is the “it ain’t grown here” mentality.  My business, in great part, depends on selling ideas, creativity and high-quality implementation of those ideas.  Yet it often feels like that is not what our clients really want.  The typical interaction with our clients is often very one-sided: the client says, “We want an electronic sales program that looks like this and says this, and we need a price for that by tomorrow afternoon.”  Now, some of you reading this might ask, “What’s wrong with that?”

What’s wrong is that it may not be true that an electronic sales program is the correct solution to the problem they are trying to solve.  What has been lost is the long-term strategy (translation: today’s stock share-price) that’s critical to the process and driven by the following key questions: What do your client’s customers really want?  How should you create messages and images that ensure your customers understand and accept your brand?  What media will best reach the demographics of your target audience?

If the above are, in fact, the hallmarks of business practices in the future, so be it.  I personally don’t agree with doing business in these ways—but then everyone has their own opinion (and orifice).  It’s just that when you can’t trust people, interact with them on a face-to-face basis and expect them to have an open mind on how they manage their business, it, doesn’t bode well for the future.

So, with that in mind and that said, I think I will change my Depends, wipe the drool from my chin, sit on the front porch of the assisted-living center and try to find some Oldsmobile ads in the magazine I am reading.

David H. Recht

CEO North State Resources
Holding company for S+R Medical Communications

Of the five industries about which the poll inquired, soft drinks had the highest “most trustworthy” vote (34 percent) and the lowest “least trustworthy” score (4 percent). Fast food was the runner-up in both respects (22 percent “most trustworthy,” 10 percent “least trustworthy”).

Each of the polls’ other three ad categories had more negative than positive votes. Pharmaceuticals was ranked “most trustworthy” by 18 percent and “least trustworthy” by 29 percent. The automotive industry fared a bit better, at 14 percent “most trustworthy” and 19 percent “least trustworthy.” Financial services did worst of all, at 13 percent “most trustworthy” and 38 percent “least trustworthy.”

Want to weigh in on the conversation? Check out the full article here at Adweek.

Source:Minyanville

The pharmaceutical industry is going through a transformation — not only has it been consolidating with mega-mergers like the one between Merck (MRK) and Schering-Plough, but it’s facing a major patent cliff as the revenues from the blockbuster drugs of the 1990s fall prey to generic competition.

Yet, these larger changes have led to shifts in other parts of the industry, too. Since Big Pharma can no longer rely on new blockbuster drugs to pad their top line, these companies now have to transform how they do business to include the biotech model of finding drugs for diseases with smaller patient populations. This also means a major overhaul of how the industry sells its product to the masses.

Pharmaceutical sales reps will be the first to tell you that the industry is scaling down. Once plentiful — there were more than 100,000 reps in 2005 — the drug sales rep is quickly becoming part of the past. A recent report by Deloitte proclaimed to the industry to change its sales models or bust.

An article in the Indianapolis Star this week shows just how much sales rep are despised by the very doctors they’re supposed to woo. Doctors have been pushing for sales reps to make appointments and cut down their pitch time. In some cases, doctors are asking to ban their presence altogether (one in four doctors now refuses to meet with reps, according to the Deloitte report).

But doctors’ dislike of this incredibly aggressive and confident class of individuals isn’t the only reason that the sales rep is becoming extinct. Doctors are no longer the key decision makers when it comes to what drugs are being prescribed. That decision now rests heavily with consumers (who are highly affected by direct-to-consumer advertising), and even more so with insurers who are the primary payers for the often over-priced drugs being pushed by the pharma companies.

Pharmaceutical companies aren’t blind to the problem. The past year has been a bloodbath for pharmaceutical peddlers. AstraZeneca (AZN) said in 2007 that it would cut 7,600 people by 2013; it later upped that number to 15,000. The company didn’t say where those jobs would come from, but the sales force was offered the buyout first. Sepracor, wholly-owned subsidiary of Japan’s Dainippon Sumitomo Pharma, reduced its number by 530 in 2009, bringing its sales force to 1,325 people. King Pharmaceuticals (KG) eliminated 380 field sales positions last year, bringing its total number of reps down to 720 and Sanofi-Aventis (SNY) cut 750 people from its sales roster.

Jump to 2010: Pfizer (PFE) cut 556 sales reps as part of its broader layoffs due to its merger with Wyeth last year. Earlier in the month, Merck eliminated 400 positions from the Schering-Plough headquarters in New Jersey with a majority coming from the sales team. This is on top of the 1,000 sales reps that Schering laid off in 2008 before its merge.

So how will the new pharmaceutical sales landscape look?

It’s likely that insurance companies are going to be playing an even bigger role in which prescriptions become the drugs of choice. Meanwhile, Big Pharma will likely look to outsourced sales rep to educate those same insurance companies. As a plus for doctors, their knowledge will likely have to come more from medical journals and other non-biased sources.

“Pharma’s challenges require a detailed understanding of each stakeholder’s role and contribution to value,” says W. Scott Evangelista, principal at Deloitte. “By better understanding every stakeholder’s unique needs and motivators, a pharma company would be better equipped to improve its internal capabilities — e.g., knowledge, skills, tools — to interact more effectively with each constituent.”

I didn’t want to hear from them, and I haven’t since. I avoid lectures and meetings that drug companies sponsor, and I use no drug company pens or notepads. The longer I avoid direct contact with drug company reps, the better I feel about it. The further removed I am from these things the more I realize I was getting a lot of my information about medications from company reps who had vested interests in my using their product. I realized that I don’t need samples, because the companies give samples only of their newest products, and those don’t have the research or track records that the older products have. Furthermore, the older products are now available as generics, which ultimately save my patients far more money than they save by taking a few free samples and then paying for the priciest, newest product.

Obviously, this is the opinion of one physician, but the points Dr. Fink brings up about her disdain for pharmaceutical marketing tactics have been echoed more than once lately. So if not from pharma companies, where would physicians get their information about products? According to Dr. Fink,”That isn’t to say I don’t keep informed and try new products that are appropriate for certain patients, but I do so based on research and my patients’ needs, not who bought me lunch last week.”

Samples, proper medical education, and other informative materials should be needed to help improve patient outcomes. But physicians seem to be turning their heads the other way.  If pharma doesn’t heal the wounds and restore the trust with physicians, credibility will be the least of its problems. What do you think?

Read Dr. Fink’s post here.

Source: Med Ad News

Recognizing the erosion of trust physicians have in the information they receive from the pharmaceutical industry, the healthcare advertising agency S&R Communications Group has recently re-engineered into two specialized companies, S+R Medical Communications and Friday Morning. Friday Morning will provide insight on a project basis into what physicians will and will not respond to as promotion. Meanwhile, S+R Medical Communications will provide educational vehicles that brands need to rebuild trust and help physicians and patients make better, more informed choices in healthcare.

To learn more about the need for credible branded medical education, Med Ad News spoke with Dave Recht, CEO of North State Resources – the holding company for S+R Medical Communications and Friday Morning– along with Kelli Soare, senior program supervisor, and Ed Leon, senior program director, both of S+R Medical Communications.

Dave Recht: The trust issue has crossed the boarders of promotional strategies in a pretty pervasive way. It’s not just the advertising. It’s not just the sales rep, but there’s also the trust issue in the whole area of medical education. Part of that stems from the fact that there are cases in which physicians look at any of the information that’s coming from the pharmaceutical industry and they’re very skeptical about it.

I’ll also say, immediately 180 degrees to the opposite, that one of the areas that continue to be described, at least to us, and other reports we’ve seen is that they do want education.

If you start out with the mission that pharmaceutical companies, aside from their discovery and development and marketing component, have an obligation to educate their physician and patient audiences. If you accept that as a basic plank of responsibility for the pharmaceutical industry, what that demands is the physicians are saying, we give you that you guys have the most knowledge and the most insight and the most information about the products that you’re marketing, there’s not a dispute that we don’t think those products can be valuable, but we need to know the information that you have and that we need to know to make informed decisions about which of those products are right for which patients.

If you take that perspective, physicians really do want to be educated. But I think they want to be educated now in a way that they can take that information along with information that they’re getting from a number of other sources – Internet, their colleagues, symposia, publications – and use their brains to filter through what are the best opportunities to treat their patients.

There clearly is a demand and a need for branded medical education.

Med Ad News: Is there a problem with the way branded medical education is being presented? Are they getting what they need?

Dave Recht: There’s some things that need to change. We’ve always taken the perspective on the branded side, or the medical information side, within labeling, that education has a set point, and that is to deliver information that helps somebody better understand and better make treatment decisions. Whether it’s certified education or whether it’s educational information within labeling, we really don’t distinguish that in the sense of one type of education being better than the other type. It is education across the board.

So, if you take that premise and you say to yourself, okay, the first thing about education is it has to be need-based. To go into a speaker bureau or some other educational program in which you’re talking about cough cold products, unless there’s a new revelation and high-powered product, nobody is going to pay attention. So, it has to be based on the educational needs of the doctor in terms of helping he or she make their treatment decisions.

Then, if you base it on need, the second thing that has to happen is it has to be credible. What are the hallmarks of credibility? It’s people whom you choose to associate with in developing the educational material, so your thought leaders and KOLs. They’re respected. They’re well grounded. They have good clinical application and perspective on how a product should be used. Not just the theory of it.

Then the information needs to be transparent. There needs to be a way in which physicians can look at the data that is provided as support for the particular product, and physicians need to be able to see the whole truth and nothing but the truth. That’s another plank of what good education is about. And unfortunately, it isn’t getting delivered as frequently as we might like it to be in today’s world.

Then to me the final point of it is how do you present that information? What is it you choose to do in terms of the different types of mediums? The graphic design. The language you use.

And by the way, when we develop our educational programs, we always look at key principles of adult learning. What are some of those key principles and how do we apply those to the educational process and the programs we’re putting together for an audience?

So, the end of this whole thing becomes a process by which physicians who get an educational event from us … that education should be meaningful, worthy, credible, applicable from a clinical perspective, and it needs to be presented in a way that the physician receiver can easily understand the information and gain knowledge very quickly.

Ed Leon: A lot of clients probably don’t accept the reality that the way doctors get information has changed quite a bit, and it’s changing rapidly. Just like consumers and patients, doctors are active seekers of information much more than they were 10 or 20 years ago. They’re not just passive recipients. You have to meet the doctors where they are, where they’re seeking information. It’s very rare that a doctor is going to sit in his office and just wait for a sales rep to come in and get his first piece of information about a therapeutic area or a product.

Read the rest of the interview here.

The EMR possibilities for the Mac Tablet  have been covered in depth through an article at Softwareadvice.

“The Ultimate EMR User Interface
An Apple tablet would be the ultimate UI for electronic medical records. With a touch-screen display like the iPhone, using the EMR during an encounter would be simplified. For example, selecting an evaluation and management (E&M) code could be as easy as “dialing in” the code with a swipe of a finger…”

But are EMRs really making life for physicians easier? And will the Mac Tablet help? This video begs to differ.

Swine flu, health reform and restrictions on industry gifts to doctors are among the top 10 health stories identified by the Harvard Health Letter in its annual list.

The Harvard University publication develops a top 10 list each year with help from doctors on its editorial board.

Among the top stories of 2009 is the national effort to curb healthcare costs via reform legislation, mandated coverage and tighter regulation of health insurers. “Chances are that legislation, if it does become law, won’t do nearly enough to control costs,” the list’s authors said.

Healthcare organizations faced additional challenges this year as a result of the H1N1 flu pandemic. “Measured public health response” and “plenty of information” helped keep the pandemic in perspective, the editors said, and despite the oncoming flu season, they expect that H1N1 will likely remain manageable.

The Harvard Health Letter‘s full list of top 2009 health stories is as follows:

• H1N1 flu
• Healthcare reform
• Screening tests
• An alternative to warfarin?
• New findings about “good” and “bad” body fat
• Restrictions on industry gifts to doctors (TRANSPARENCY)
  
• MicroRNA-based treatment
• Changes in blood sugar goals for patients in intensive care
• Testing for C-reactive protein
• Social networks as conduits for health and disease

What about Pfizer? They must be on the ‘pharma’ list.

Check out the Wall Street Journal’s top 10 here.

During the first few weeks of the pilot, the number of health facilities with stock-outs in one district alone, was reduced by over 75 percent. The early success of the SMS for Life pilot project has the Tanzanian authorities interested in implementing the solution across the rest of the country. Tanzania has around 5,000 clinics, hospitals and dispensaries, but at any one time, as many as half could potentially be out of stock of anti-malarial drugs.

Kudos to all those involved for making this happen. We can only hope that other drug companies continue to think of new and innovative ways  technology can improve patient outcomes.

Full press release below via IBM.

LONDON - 14 Dec 2009: A new solution developed by IBM (NYSE: IBM), Novartis and Vodafone with the Roll Back Malaria Partnership, is helping to save lives using everyday technology to improve the availability of anti-malarial drugs in remote areas of Tanzania

Called “SMS for Life,” the initiative uses a combination of mobile phones, SMS (Short Messaging Service) technologies and intuitive web sites to track and manage the supply of Artemisinin-based Combination Therapy (ACT) drugs and Quinine injectables, both of which are key to reducing the number of deaths from malaria.

The mosquito-borne disease causes nearly one million deaths in Africa each year, mostly among pregnant women and young children, and many people die because they simply lack quick access to vital medication.

Tanzanian child helped by SMS for life program and IBM LotusLive.com cloud computing (Click on photo for print-quality version).

The concept of using text messaging to improve stock management of life-saving medicines was developed by pharmaceutical company Novartis and a team of international students taking part in IBM’s internship program, Extreme Blue. The team came up with SMS for Life, as it relies on simple technology and fosters self-sufficiency. IBM was tasked with managing the overall project and Vodafone was invited to develop and manage a system based on simple SMS messaging that would help ensure dispensaries did not run out of vital stock.

After visits to clinics, hospitals and dispensaries across Tanzania, IBM, Novartis and Vodafone initiated a five-month pilot of the SMS for Life solution, covering 135 villages and over a million people in different geographic locations across Tanzania.

Vodafone, together with its technology partner MatsSoft, developed a system in which healthcare staff at each facility receives automated SMS messages, which prompt them to check the remaining stock of anti-malarial drugs each week. Using toll-free numbers, staff reply with an SMS to a central database system hosted in the United Kingdom, providing details of stock levels, and deliveries can be made before supplies run out at local health centres.

“This is an example of a truly innovative solution helping solve a humanitarian problem,” says Peter Ward of IBM, SMS for Life Project Manager. “After spending time on the ground, we created a project plan, developed the application with Vodafone and Novartis and established the best way to deliver the pilot, working with the Tanzanian Ministry of Health. We expect other countries will also be able to benefit in the future.”

“Vodafone has worked closely with IBM, Novartis and MatsSoft, to develop a simple, robust and innovative system that is able to deliver even in the most remote African communities,” said Dr. Dianne Sullivan, Scientific Adviser, Mobile Health, of Vodafone. “The SMS for Life solution shows the tremendous potential of mobile technology to deliver social good through lateral thinking by helping to ensure supplies of life-saving drugs.”

During the first few weeks of the pilot, the number of health facilities with stock-outs in one district alone, was reduced by over 75 percent. The early success of the SMS for Life pilot project has the Tanzanian authorities interested in implementing the solution across the rest of the country. Tanzania has around 5,000 clinics, hospitals and dispensaries, but at any one time, as many as half could potentially be out of stock of anti-malarial drugs.

“The SMS for Life program has already had a positive effect in Tanzania,” says Senior Health Officer with Ministry of Health and Social Welfare, Tanzania, Winfred Mwafongo. “I’ve seen district medical officers ordering urgent stock replacements for various health facilities. During a visit to 19 rural health facilities in one district alone, I saw huge improvements in their inventory management systems. I’m very impressed with the results so far and look forward to following the rest of the pilot through to completion.”

“Collaboration is critical to tackle health problems of the developing world, and we are proud to be part of the SMS for Life partnership, a project that will reduce stock-outs, and ensure that mothers and their young children in Africa have access to life-saving anti-malarial medicines,” says Silvio Gabriel, Executive Vice President and Head of the Malaria Initiatives at Novartis.

Designed as a public and private partnership leveraging the skills and resources of several companies, SMS for Life could have far-reaching implications for existing health systems worldwide. Several other African states are already keen to introduce the project.

Malaria Clinic in Tanzania helped by SMS for Life and IBM LotusLive.com cloud computing.  Copyright: Olympia Wereko-Brobby. Click on photo for print-quality version.

About the RBM Global Partnership
The RBM Partnership is the global coordinator of the fight against malaria. RBM draws its strength and experience from hundreds of partners from malaria endemic countries, country donors, companies, non-governmental and community organisations, foundations and research and academic institutions. RBM partners’ collective aim is to reduce annual malaria deaths from around one million to virtually zero by 2015 through the implementation of the Global Malaria Action Plan (GMAP). This outlines RBM’s vision for a substantial and sustained reduction in the burden of malaria in the near and mid-term, and the eventual global eradication of malaria in the long term with the introduction of new tools. www.rollbackmalaria.org

About IBM
For more information about IBM, please visit www.ibm.com.

About Novartis
Novartis provides healthcare solutions that address the evolving needs of patients and societies. Focused solely on healthcare, Novartis offers a diversified portfolio to best meet these needs: innovative medicines, cost-saving generic pharmaceuticals, preventive vaccines, diagnostic tools and consumer health products. Novartis is the only company with leading positions in each of these areas. In 2008, the Group’s continuing operations achieved net sales of USD 41.5 billion and net income of USD 8.2 billion. Approximately USD 7.2 billion was invested in R&D activities throughout the Group. Headquartered in Basel, Switzerland, Novartis Group companies employ approximately 99,000 full-time-equivalent associates and operate in more than 140 countries around the world. For more information, please visit http://www.novartis.com.

About Vodafone
Vodafone is the world’s leading international mobile communications group with approximately 323 million proportionate customers as at 30 September 2009. Vodafone currently has equity interests in 31 countries across five continents and around 40 partner networks worldwide. For more information, please visit www.vodafone.com.

The report, an update of a 2005 analysis by Cochrane Collaboration, excluded eight studies funded by Roche that haven’t been published and whose full data wasn’t given to the researchers. The exclusion reversed the group’s earlier finding that Tamiflu protects against complications.

The report raises questions about how drugs are reviewed, approved and distributed, Fiona Godlee, the British journal’s editor in chief, wrote in an editorial. The studies originally used to establish the benefits of Tamiflu were written by Roche employees and paid consultants, under-reported serious side effects and failed to clearly identify all the authors, she wrote. In at least one case, a study was attributed to a researcher who disavowed any involvement to the journal, Godlee wrote.

Follow the story here:

Bloomberg

Gaurdian

Financial Times

Reuters