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Selling Sickness

EBM Session on "Evidence and Drug companies- what to watch out for"

Michelle Howard and David Chan

Objectives:
- introduce the concept of "Selling Sickness" by pharmaceutical industries
- illustrate common examples:


Video clips to stimulate discussion:

Might be fun to do something about pharmaceutical companies: http://australianscreen.com.au/titles/selling-sickness/


This clip describes how "opinion leaders" are groomed to do presentations to their colleagues- basically they are sales reps themselves (1 min 25 sec).

http://www.bmj.com/cgi/content/full/336/7658/1402?ijkey=914vdwBBxz8uGID&keytype=ref


10 min by David Suzuki (same documentary as the australian one above- talks about how the industry creates 'syndromes' like social anxiety to sell Paxil)
http://www.youtube.com/watch?v=v5Q1MkDbVEU

http://zinzin.us/view-type-Yt-p-1-q-pharmaceutical-code-nj0LZZzrcrs-title-Zyprexa-Drug-Rep--.html- this 5 minute clip talks about how stats are presented (RRR vs ARR issue)

http://zinzin.us/view-type-Yt-p-1-q-pharmaceutical-code-AazObF_pHSU-title-Pharma-Not-in-Business-of-Health,-Healing,-Cures,-Wellness.html 7 minute clip on objectives of industry to create life-long conditions that need drug therapy and the little discussed serious side effects

http://zinzin.us/view-type-Yt-p-1-q-pharmaceutical-code-kOW8LNU2hFE-title-Ex-Drug-Rep----Manipulating-Doctors--.html 9 minute clip describes psych drug industry and how side effect information is presented and manipulated.


Discussion point and practical take home messages:

 

Checklist for evaluating information provided by a drug company BMJ 1997;315:480-483 (23 August)

l     Does this material cover a subject which interests me and is clinically important in my practice?

l     Has this material been published in independent peer reviewed journals? Has any significant evidence been omitted from this presentation or withheld from publication?

l     Does the material include high-level evidence such as systematic reviews, meta-analyses, or double-blind randomised controlled trials against the drug's closest competitor given at optimal dosage?

l     Have the trials or reviews addressed a clearly focused, important and answerable clinical question which reflects a problem of relevance to patients? Do they provide evidence on safety, tolerability, efficacy and price?

l     Has each trial or meta-analysis defined the condition to be treated, the patients to be included, the interventions to be compared and the outcomes to be examined?

l     Does the material provide direct evidence that the drug will help my patients live a longer, healthier, more productive, and symptom-free life?

l     If a surrogate outcome measure has been used, what is the evidence that it is reliable, reproducible, sensitive, specific, a true predictor of disease, and rapidly reflects the response to therapy?

l     Do trial results indicate whether (and how) the effectiveness of the treatments differed and whether there was a difference in the type or frequency of adverse reactions? Are the results expressed in terms of numbers needed to treat, and are they clinically as well as statistically significant?

If large amounts of material have been provided by the representative, which three papers provide the strongest evidence for the company's claims?

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