Tuesday, April 1, 2008

Epocrates + iPhone = Cooler, Richer CME Bias

Epocrates is the premier PDA-based medical software, extremely popular with doctors because the basic version is free. Of course, in a world of no free lunches, Epocrates comes with its own price, namely various drug ads offered in the guise of "doc alert" messages. All in all, not a bad product, and I gave it a pretty good review in this past article in The Carlat Psychiatry Report.

Now that Apple has opened up the iPhone software to third party developers, Epocrates has created an iPhone version. Unfortunately, Epocrates' CEO, in a recent interview with Pharmaceutical Executive Magazine, has tilted the company's hand, and it's all about pharmaceutical CME/advertising. To quote from the article:

"It's getting harder for sales reps to meet with doctors, and we provide a tool to establish a relationship with a physician and deliver messaging," Kirk Loevner, chairman and CEO of Epocrates, told Pharm Exec on Monday. Programs such as Doc Alerts transmit key pharma studies or journal articles straight to a physician's device. With the iPhone, pharma companies can also create richer mobile continuing-ed programs, including video and graphics branded with pharma messaging.

The company's inspiration, Socrates, once said, "The unexamined life is not worth living." I'm sure he would have had some wise counsel for Kirk Loevner, new champion of pharma messaging.


Supremacy Claus said...

Dan: I suggest you take a sponsored, free CME program in psychiatry. You choose one or let me.

Read it, take the quiz, get your credit.

Then, on this blog, list the content with which you disagree or that you feel is missing, i.e. errors of commission or omission.

Show us how sponsorship caused these. You will have given us an example of undue influence.

Next, show us how these errors could hypothetically harm a patient if followed by a family MD or psychiatrist.

Daniel Carlat said...

SC, I've taken innumerable free, sponsored CME programs in psychiatry. To read in detail the specific examples of bias detected, search this blog for "commercial bias." There are many, many examples, as this is very low-hanging fruit.

Daniel Carlat said...

The best way to find these articles is to choose "commercial bias" from the topic list on the right side.

Anonymous said...

Epocrates, unlike other health technology companies, was specifically created for pharma NOT physicians. This was Jeff Tangney's business plan at Stanford -- to give away a free product in order to get physicians hooked, then leverage this network for a promotional channel for pharma/biotech, med ed, and market research companies, and health plan formularies. In fact, 80% of their revenue comes from these groups.

Anonymous said...

is it just me, or isn't this intrusion by big pharma getting a bit obscene? What are they going to offer next: luxury rental car access to the office?

maybe no one is fully unbiased and objective in life, but the information that flows from the pharmaceutical industry is not close to this perspective. I don't understand what some people are accusing Dr C of allegedly selling here outside of what should be responsible and ethical behaviors RIGHTFULLY expected of physicians. Education should be unbiased and objective in the end.
It's about fact, not fiction.

The adage of TELL THE LIE ENOUGH AND IT BECOMES THE TRUTH won't fly here with me. You know whom I'm talking to with this comment!

Supremacy Claus said...

Dan: I took your suggestion. I found a list of criticisms of statements and omissions, representing the smallest fraction of the volume of sponsored CME. If what you cite is typical sampling, you may have an argument with 1 of 100 assertions.

This blog attacks its competition, with nit-picking gotchas. It does the same, leaving any adverse fact. It will cite only criticism.

My question goes past finding picayune gotchas.

Do you have evidence, these bad statements ever influenced a doctor?

If you find evidence of undue influence, do you have evidence a patient was harmed by getting a medication wrongly, or by not getting a treatment that would have been better?

This is important. You and the APA should make sure you have the facts lined up. You are disparaging two trades here, doctors and pharmaceutical companies. You should review any final publication with a good lawyer.

David Port, M.D. said...

I was interested to learn that Epocrates is provided "free" for PDA users and that it is paid for by pharma messages. I don't use a PDA but I have been using Epocrates "Premium" on-line, for which a modest annual subscription is required. It is commendably free of any ads or disguised commercial messages (I think) and it lists drugs by brand and generic names. I hope the remarks quoted by Epocrates' CEO doesn't portend commercial input on the subscribed site; so far it appears to be free of bias.

Anonymous said...

Dr. Carlat--

Thanks for the nice post, on target as usual.

I have stopped synching Epocrates, and while it complains that it's been awhile since you've synched, it still works.

This cuts down on the commercial messages quite nicely.

Michael Benjamin, M.D.