SRxA’s Word on Health: 2012 in review

As we wait for the ball to drop on 2013, we’ve been reviewing our own performance over the last year.

Here’s an excerpt from our Annual Report:

About 55,000 tourists visit Liechtenstein every year. SRxA’s Word on Health was viewed more than  173,000 times in 2012. If it were Liechtenstein, it would take about 3 years for that many people to see it.  In other words, this blog had more visitors than a small European country !

In 2012, we posted 162 new posts, growing the total archive of this blog to 474 posts.  Not bad, considering we’re less than 3 years old!

The busiest day this year was December 6th with 1,850 views.

While the majority of our visitors were from the US (with Canada and the UK not far behind) …our little  blog was viewed by people from 196 countries. That’s ONE HUNDRED AND NINETY SIX!!!


So, whether you’re from Afghanistan or Zimbabwe, or anywhere in-between, thank you for reading, for following, for your support. None of this would be possible without you.

See you in 2013.  Happy New Year!

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The Doctor Won’t See You Now

US Pharma reps think they have it bad?  Then they should spare are thought for their poor beleaguered colleagues on the other side of the Pond!

According to an article in the industry journal PM Live,  time-pressured doctors in the UK are increasingly refusing to see pharmaceutical sales reps altogether.

A study undertaken by in April 2012 surveyed more than 1,000 General Practitioner’s (GPs). They found that 52% of GPs did not see any pharmaceutical sales representatives in a typical week, while 26% saw only one pharma sales rep during that period.

Lack of time was the most common reason cited by GPs for not seeing pharma sales reps (38%). Other reasons included a practice “no-see” policy and a perceived lack of reps’ impartiality.

At the same time, they learned that doctors are turning to digital channels for independent product information. Nearly a quarter (23%) of the GPs surveyed said they preferred to find their own product information via independent online resources. said its findings follow earlier studies it conducted that show only 3% of doctors think online pharma resources are credible. Worse still 42% said they never visit pharmaceutical websites.

This research would appear to be in line with other trends among healthcare professionals.  European doctors’ use of iPads and other mobile devices is increasing and US pharma execs expect to increase their future spending on digital marketing channels.

SRxA can help Pharma companies to navigate the promotional maze and get the best bang for those pharma dollar bucks. Contact us today to find out more.

Abbott Gets a Shellacking

Last week, the -a leading online provider of financial news, commentary, analysis, ratings, business and investment content- took a major swipe at Big Pharma, in general, and Abbott, in particular. Under the headline ‘Abbott Helps Big Pharma Look Even Worse’ author Vince Crew, lambasts the drugmaker for its past marketing practices and warns that unless Pharma adheres to a zero tolerance policy for illegal practices, the industry’s reputation will be doomed forever. Here’s a verbatim copy of what he had to say – On May 7, Abbott reached an agreement with the federal and nearly all state governments to pay $1.6 billion in connection with its illegal marketing of the anti-seizure drug Depakote.

And yes, it’s even more despicable because it represents the unfortunate, illegal, unethical, typical temptation of off-label marketing — promoting a product for usage contrary to its approval.

Someone(s) at Abbott thought it a good idea, according to the Justice Department confirmation, to have a “specialized sales force” market Depakote in nursing homes to dementia patients, even though there was no evidence that it was safe and effective for such use. By the way, in the spirit of “someone will always tell,” several employees blew the whistle on the pharma behemoth. No doubt the settlement has caused Abbott investors, stakeholders, competitors and the industry in general, to pause. Before you think Abbott is doomed because of a reprehensible thing like this, 11 days following this settlement, Abbott Laboratories reported better-than-expected earnings as sales surged on its injectable arthritis drug, Humira. So, no tears for Abbott, unless they regard ongoing settlements as business as usual and don’t actively adhere to a zero tolerance policy for illegal practices. In that case, we should weep for the industry as a whole. Time will tell.”

Abbott, has a very different story to tell. In their mia culpa press release regarding the settlement, Laura J Schumacher, Executive Vice President, General Counsel and Secretary says, “The company takes its responsibilities to patients and healthcare providers seriously and has established robust compliance programs to ensure its marketing programs meet the needs of health care providers and legal requirements.” As Mr. Crew says, time will indeed tell. However, everyone would do well to heed the warning. According to Deputy Attorney General James M. Cole, “Today’s settlement shows further evidence of our deep commitment to public health and our determination to hold accountable those who commit fraud. We are resolute in stopping this type of activity and today’s settlement sends a strong message to other companies.”

In the meantime, if any pharmaceutical companies are looking for help to ensure that their marketing practices are compliant, please remember SRxA is here to help.

Pharma-Physician Interactions Perceived Positively

According to a survey released last week, nearly eight out of 10 physicians view pharmaceutical research companies and their sales representatives as useful sources of information on prescription medicines.

That’s good news for pharmaceutical marketers who spent $24 billion between October 2009 and September 2010 on physician-targeted promotional spending, and an additional $1 billion on continuing medical education.

The telephone survey of more than 500 American Medical Association members found that physicians consider a range of sources useful for staying informed about medicines. In addition to sales reps and company-sponsored peer education programs, doctors also rated continuing medical education (CME) courses, peer-reviewed medical journals, and their fellow physicians as useful sources of information.

The survey also found that physicians consider a broad range of factors in making their prescribing decisions, with almost all respondents relying on their clinical knowledge and experience as well as a patient’s response to a particular medicine. More than 80% reported that they take into consideration a patient’s insurance factors, such as formulary and prior authorization requirements, with just under 70% using information provided by pharmaceutical company representatives

The survey, which was supported by PhRMA, also looked closely at how physician respondents view their interactions with pharmaceutical company representatives.

More than 90% responded that interactions with representatives allow them to learn about new indications for approved medicines, potential side effects of medicines, and both emerging benefits and risks of medicines.  In addition, 84% of physicians said that interactions with representatives allow them the opportunity to provide feedback to a pharmaceutical company about their experiences with a specific medicine.  Large majorities also found information from company representatives to be up-to-date and timely (94 %), useful (92%), and reliable (84%).

The survey also included several questions about company-sponsored peer education programs, in which physicians present to their peers. Nearly 9 out of 10 of physicians who reported attending these programs said the information was up-to-date, useful and reliable.

Physicians attending peer education programs reported gaining a range of information, including: improved clinical knowledge (98%), potential side effects of medicines (97% ), new uses of medicines (97%), the range of treatment options (97%), and emerging drug risks (95%). Importantly, 94% said the programs strengthened their ability to care for patients.

Peer education programs allow physicians to have important dialogues with their expert colleagues. This sharing of information ultimately benefits the patients they treat,” said PhRMA’s John Castellani.

SRxA and its team of independent Clinical Advisors specializes in providing support to the pharmaceutical industry and has developed a number of highly successful and unique peer-to-peer education programs. For more information, contact us today.

Pediatric Wheezers not such Wizards with Puffers

Regular readers of SRxA’s  Word on Health already know that asthma is the most common chronic childhood disease in the U.S. Direct asthma-related healthcare costs are upwards of $ 6 billion a year and lost productivity costs associated with working parents caring for children who miss school, costs a further billion. Given this huge financial burden we were shocked to learn that fewer than one in 10 children with asthma use their inhalers correctly.

While children have more success with newer inhaler designs, at best, only one child in four gets it completely right, according to the findings published in the journal Pediatrics.

Researchers from the University of North Carolina at Chapel Hill, Eshelman School of Pharmacy studied 296 patients aged 8 to 16 years old who used four different devices to manage their asthma.

The devices were:

  • metered-dose inhaler (commonly called a puffer)
  • diskus, (a dry-powder inhaler delivering Advair)
  • turbuhaler (a dry-powder inhaler delivering Pulmicort or Symbicort)
  • peak-flow meter, which does not deliver a drug but is used to measure lung function to determine if medicine is needed

Only 8% of children in the study performed all of the metered-dose inhaler steps correctly. Older children were more likely than younger children to get more of the metered-dose inhaler steps correct. With a diskus, 22% of children performed all steps correctly, and 15.6% performed all of the turbuhaler steps correctly. Children using a peak-flow meter did so correctly 24% of the time.

The researchers also found that the majority of health-care providers who participated in the study did not demonstrate or assess children’s use of the four devices during pediatric asthma visits.

It is crucial that health-care providers not only show a child how to use an inhaler correctly but also have the child demonstrate the device in front of a physician or pharmacist,” said lead investigator Betsy Sleath Ph.D. “Pediatric practices are extremely busy places so we need innovative ways to demonstrate and assess device technique among asthmatic children.”

Improper use of inhalers and other asthma medication devices can lead to poor control of the condition, more hospitalizations and increased health-care costs.

SRxA’s team of leading asthma experts can help design programs to teach healthcare professionals how to teach patients about their asthma therapy.  These validated programs have been shown to dramatically increase compliance and adherence.  Contact us today to learn more.

World Exclusive – Preview of NARAC Knows

Last month, SRxA’s Word on Health bloggers attended the inaugural North American Rhinology and Allergy Conference (NARAC) in Puerto Rico.

NARAC was designed to bring together practicing allergists and otolaryngologists (ENT’s), to share the most up-to-date information regarding diseases of the nose and airways.  And it succeeded.

The Scientific Committee brought together an outstanding faculty representing the Who’s Who of allergy and ENT.  Over 160 delegates from three countries and 37 US states attended and enjoyed a mix of plenary sessions, Problem Based Learning breakouts and industry-sponsored symposia.  The interactive, multi-specialty format provided attendees with both state-of-the-art science and the opportunity to translate it into best clinical practice for their patient s through peer-to-peer discussion.

The scientific proceedings of this meeting will be published in the American Journal of Rhinology and Allergy later this year.  In the meantime however, the conference organizers recognized the need for a Rapid Response e-Newsletter to be disseminated to both attendees and those allergists and otolaryngologists not fortunate enough to have been there.

Based upon recommendations from our independent clinical advisors, the NARAC Course Directors asked SRxA to develop the e-Newsletter on their behalf. The brief was to provide an entertaining and engaging mix of:

  • Meeting Highlights
  • Session Reviews
  • Key Takeaway Messages
  • Pro-Con Discussions
  • Attendee Surveys
  • News from the Exhibit Hall

In the three weeks since the conference, together with our talented team of designers and NARAC’s own editorial review committee, we have done just that.

And now….with much fanfare and drum rolls… we are proud to bring you, our Word on Health readers, the exclusive first edition of NARAC Knows.

In the coming days the e-Newsletter will be distributed to 20,000 clinicians across the US.

NARAC Knows was supported by unrestricted grants from Dey Pharma L.P., Sunovion, and ViroPharma Inc.

If you are planning a medical meeting or conference and would like to have the same type of coverage for your event we’d love to hear from you.

Improving Asthma Adherence

A new study, published in the Journal of Allergy and Clinical Immunology, shows that patients who are more confident about the benefits of their asthma controller therapies tend to report higher levels of adherence.

The Trial of Asthma Patient Education (TAPE) study examined the effect of an educational program aimed at increasing expectations of treatment benefit on medication adherence.

Patients with sub-optimally controlled asthma were randomized to either placebo or the active drug – montelukast (Singulair) in conjunction with an interactive computer-based multimedia educational presentation that was either neutral or designed to increase outcome expectancy.

The enhanced presentation was specifically designed to increase the expectation that the drug would adequately control asthma symptoms, while the neutral presentation included information on asthma care and management but without active promotion of the benefits of medication. The presentations were shown before the study drugs were dispensed, and again 2 weeks into the study.

Adherence was monitored electronically over 4 weeks and was defined as ≥80% use of prescribed doses. Medication adherence was measured electronically using devices fitted onto the medication bottles to record the date and time of each bottle opening.

Outcome expectancy, peak expiratory flow, prebronchodilator FEV1, asthma control (Juniper asthma control questionnaire), and asthma-related quality of life were assessed at baseline and at the 4-week follow-up.

Results showed that the enhanced presentation mode was associated with improved adherence to active drug. Additionally, when a patient expected a higher benefit from treatment, their breathing test scores improved and self-reported asthma control scores tended to be higher. There was also an accompanying trend for improvement in asthma-specific quality of life.

These results suggest that the manner in which medications are introduced to patients may not only affect their expectations about the potential benefits of the therapy, but may also impact their level of adherence and sense of improved health. The authors dubbed this The Madison Avenue effect.

This study further supports the results of work undertaken by SRxA’s Health Outcomes Advisors:  Dr. Allan Luskin and Dr. Don Bukstein.  Together with SRxA, Drs Luskin and Bukstein, both world authorities on Health Outcomes, have developed fully integrated Practice Management programs to improve medication adherence and patient outcomes. These programs can be customized for almost any drug or treatment modality.  Pharmaceutical companies wanting to know more about these guaranteed result programs should contact us today.

Clinical Research under scrutiny?

If you watched the news at all over the past week you probably saw CNN‘s Sanjay Gupta‘s confrontation with disgraced doctor Andrew Wakefield.  He, as you may recall was the author of the 1998 study that linked autism to some childhood vaccines and set off a worldwide scare for parents.

In the intervening years there have been countless lawsuits against vaccine manufacturers and millions of children who, perhaps needlessly, have gone unvaccinated.  Recently,  an investigative report published in the British Medical Journal called the original study an elaborate fraud.

So, is Dr Wakefield alone in manipulating clinical trial data?  Can we rely on other clinical studies to provide us with the truth?

No, not according to researchers at Johns Hopkins.  In a report published January 4th in the Annals of Internal Medicine the authors concluded that the vast majority of published clinical trials of a given drug, device or procedure are routinely ignored by scientists conducting new research on the same topic.

Trials being done may not be justified, because researchers are not looking at or at least not reporting what is already known.  In some cases, patients who volunteer for clinical trials may be getting a placebo for a medication that a previous researcher has already determined works or may be getting a treatment that another researcher has shown is of no value. In rare instances, patients have suffered severe side effects and even died in studies because researchers were not aware of previous studies documenting a treatment’s dangers.

Not surprising then that they go on to say, “the failure to consider existing evidence is both unscientific and unethical.”

The report argues that these omissions potentially skew scientific results, waste taxpayer money on redundant studies and involve patients in unnecessary research.

Conducting an analysis of published studies, the Johns Hopkins team concludes that researchers, on average, cited less than 21% of previously published, relevant studies in their papers. For papers with at least five prior publications available for citation, one-quarter cited only one previous trial, while another quarter cited no other previous trials on the topic. Those statistics stayed roughly the same even as the number of papers available for citation increased. Larger studies were no more likely to be cited than smaller ones.

The extent of the discrepancy between the existing evidence and what was cited is pretty large and pretty striking,” said Karen Robinson, Ph.D., co-director of the Evidence Based Practice Center (EPIC) at the Johns Hopkins University School of Medicine and co-author of the research.  “It’s like listening to one witness as opposed to the other 12 witnesses in a criminal trial and making a decision without all the evidence. Clinical trials should not be started — and cannot be interpreted — without a full accounting of the existing evidence.”

The Hopkins researchers could not say why prior trials failed to be cited, but Robinson says one reason for the omissions could be the self-interest of researchers trying to get ahead.

Want to make sure that your clinical trials stay on track and that your publications are evidence-based?

Contact SRxA for more details.

Pharmaceutical Marketing – new year, new challenges, new solutions?

As each week passes, regulations governing prescriber-sales rep interactions seem to tighten and as a result fewer and fewer physicians are admitting reps to their offices. In parallel more and more doctors are looking on line for the information they need about the drugs they prescribe and products they use.  It’s not surprising, then, that so many pharmaceutical companies have pared down their field sales force.

Increasingly the pharma rep is being replaced by internet based customer-centric strategies, portable technology and other forms of closed-loop marketing.  This seismic shift in pharmaceutical sales and marketing means there are fewer face-to-face meetings and that doctors have relatively limited opportunities to interact and share knowledge with their peers.

However, a recent survey undertaken by SRxA, shows this is precisely what doctors want.

Because the traditional pharma sponsored dinner is no longer acceptable in today’s heighted era of regulatory scrutiny, SRxA has worked with its team of clinical advisors to develop a number of exciting new and compliant approaches. Healthcare professionals from all specialties who have participated in these events have unanimously rated the programs as “excellent” and our clients are delighted with their return on investment.

Undoubtedly, healthcare marketing is a much tougher business than it was just a few years ago. Rising costs, increased regulatory pressure, and shrinking sales forces, mean it’s harder than ever to reach physicians and patients. To succeed, you need to tailor your marketing strategies to the changing times.

Our team of pharmaceutical marketing experts and clinical advisors will work closely with you to:

  • Identify gaps and opportunities in your current strategy
  • Build enduring relationships with consumers and healthcare professionals through targeted, effective multi-channel programs

To find out more about the SRxA survey, the “for physicians – by physicians” programs, and how SRxA can help you meet your marketing objectives, contact us today.

Infectious Disease Guidelines: A Matter of Opinion!

In recent years, a deluge of publications addressing nearly every aspect of patient care has enhanced clinical decision making, However, some feel it may also have encumbered it, owing to the tremendous volume of new and often conflicting information.

Clinical practice guidelines were developed to aid clinicians in improving patient outcomes and streamlining health care delivery by analyzing and summarizing data from all relevant publications. Lately, these guidelines have also been used as tools for educational purposes, performance measures and policy making. They are also meant to assist in the delivery of patient care. Not surprising then, that both physicians and patients assume that following such guidelines means practicing evidence-based medicine.

However, according to a new study published in the Archives of Internal Medicine, more than half of recommendations included in infectious disease guidelines rely on low-quality evidence.

Researchers examined 41 guidelines published by the Infectious Diseases Society of America (IDSA) since 1994. Of the 4200 recommendations in those guidelines, only 14% were guided by randomized controlled trials (level I evidence) while 55% were supported by expert opinions only (level III evidence).

Five guidelines were updated during the study period. In these updates, the number of recommendations increased between 20% and 400%, but only two updates saw an increase in the number of recommendations based on high-quality evidence.

An accompanying editorial advises physicians to be wary of falling into the trap of ‘cookbook medicine.’ “Guidelines may provide a starting point for searching for information, but they are not the finish line.” said John H. Powers, MD of the National Institute of Allergy and Infectious Diseases.

Ultimately, the existence of guidelines is probably better than no guidelines, but clearly guidelines should never replace critical thinking in patient care and physicians should avoid  using guidelines as their only source when making clinical decisions.

For better critical thinking or to discuss the development of true evidence based guidelines for your brand, contact SRxA today. Learn how our teams of expert Advisors in Allergy, Pulmonology, ENT, Ocular Medicine and Surgery, Aesthetics, Reproductive Medicine and Behavioral Health can help you and your brand.