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If you're a physician, you know Medscape. A division of that internet health care behemoth, WebMD, Medscape pounds our inboxes daily with offers of free CME. Much of the CME is industry-sponsored, which is not exactly a news item for most of us. But what you may not be aware of is that Medscape sells its disease-specific "resource centers" to the highest bidder. For example, the ADHD Resource Center is purchased by Shire, the Bipolar Disorder Resource Center is owned by GlaxoSmithKline, and the Pharmacological Management of Pain Resource Center is now the property of Cephalon.
How much do companies pay in order to take control of what doctors learn? Good luck extracting this information from Medscape, but rumor has it that about $500,000 gets you a sort of "base package" which includes four articles. The sponsoring company gets to specify the topics and the authors, of course. There is a menu of extras, so if you really want to saturate the medical mind with your marketing message, you can presumably part with well over a million. And this doesn't include income from the advertising banners that appear to populate each and every web page on the site.
Yes, doctors know Medscape. And Medscape knows money.
What began as an embarrassment of Eli Lilly, PV Updates, and PRMS is gradually becoming a full-fledged scandal. The Indianapolis Star picked up the story last weekend (read it here), and psychiatrist David Port, M.D. wrote me a letter alerting me to an expanding crisis of trust in psychiatry. Here is an excerpt:
"Whatever Lilly's justification for sponsoring a course ostensibly to help the psychiatrist to better deal with professional liability risks, I am outraged that PRMS has accepted money from Lilly and has chosen to offer its authority and reputation toward this Lilly effort. PRMS is the American Psychiatric Association-endorsed entity which directs APA members to a selected malpractice insurance agency. PRMS is thus the agency many or most of us psychiatrists turn to for guidance and direction as to liability exposure and malpractice coverage. For PRMS to work for Eli Lilly is a glaring conflict of interest between their psychiatrist clients and a pharmaceutical corporation whose interests do not necessarily coincide with those of the psychiatrists with whom they have a professional relationship. This is analogous to the same law firm representing two individuals opposing one another in a law suit; in that situation we assume that there cannot be fair representation of either client, and we may imagine that the client with an attorney who has more clout in the law firm may well prevail in the action. How can we trust PRMS, or the APA for that matter, to provide us with the best liability support? David Port, M.D."
Yes, it's true. PRMS runs The Psychiatrist's Program, a malpractice carrier that is officially endorsed by the APA.
I know, it can get very confusing. Let's follow the money. Eli Lilly gives the APA at least $1.3 million in 2007 (so far) for industry-supported symposia and fellowships. Lilly then gives PRMS a bunch of money (Lilly refused to tell John Russell at the Indy Star how much) to produce a web-based slide show teaching psychiatrists how to prescribe potentially toxic medications like Zyprexa without being sued. The APA officially endorses PRMS' psychiatry malpractice insurance for its members. Does APA receive any type of kickback for this endorsement? I assume that would be illegal, but who knows?
Look, I get as annoyed by conspiracy theorists as the next guy. But the web of money and influence here is so murky and repugnant that it leaves me wondering what's going on. I officially invite both the APA and PRMS to respond. And I'd love another diplomatic letter from Eli Lilly!
"Dear Dr. Carlat - We are sorry that you misunderstood the purpose and the message of the risk management program that Lilly supported.
The underlying message of this program is that the best way for psychiatrists – and all physicians – to manage their risk of litigation, happens to be to do what’s also best for their patients – provide good clinical care, be informed, communicate and document the care.
With the barrage of plaintiffs’ lawyer advertising – against Lilly medicines and numerous products made by other pharmaceutical companies – we know that there is misunderstanding and anxiety in the psychiatric community about the risk of litigation and malpractice. For example, Lilly and the National Council for Community Behavioral Healthcare announced in June, 2007, the results of a survey of 400 psychiatrists that showed that more than half had patients who stopped taking antipsychotic medication or reduced their dosages based upon fears raised by law firm advertising. We believe that any information that can help a physician reduce this anxiety and uncertainty will also help return his or her focus to good patient care, which is what is most important.
This program is an attempt to provide helpful, independent, non-product-specific information to psychiatrists to keep the risk of litigation in perspective and to understand what they can appropriately do to reduce that risk.
Initial feedback from psychiatrists who have participated in the program has been overwhelmingly positive.
Please don't hesitate to contact me if you have additional questions.
Marni LemonsGlobal Product CommunicationsEli Lilly and Company"
What's that in the air? Ahhh, the sweet smell of damage control.
Although Eli Lilly's Zyprexa is an effective antipsychotic, it causes more weight gain, hyperglycemia, hyperlipidemia, and overall metabolic havoc than just about any other medication known to medicine. Because of this, Lilly has been sued by patient groups, and recently settled with 18,000 patients who alleged they were never properly warned about Zyprexa's side effects.
Now Lilly's fighting back. Its weapon: educating doctors about risk management. I recently received this flyer in the mail. Published by PV Updates, a medical education company favored by Lilly, the title of this educational activity is "GET THE FACTS: Understanding Professional Liability Risk Associated with Prescribing Medications." You can watch the slide show here.
Here's the bottom line educational message: You can prescribe whatever medication you want, no matter how toxic, as long as you clearly document your rationale. So go ahead, prescribe Zyprexa--you won't be sued.
This strikes me as one of the more devious drug marketing campaigns in recent memory.
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