Sunovion Offers Psychiatrists Free Trips to Miami to Promote Latuda

Talk about chutzpah. You'd think that after all the recent revelations of psychiatrists selling themselves out to the highest bidders, a drug company would think twice before waving wads of cash in front of their faces. And you’d hope that the psychiatrists would be slightly reluctant leap up and grab the loot.

Not so on both counts. Sunovion, maker of the latest atypical antipsychotic to be approved by the FDA, Latuda (Lurasidone), recently sent out a round of emails to psychiatrists offering free winter trips to Miami, Dallas and Scottsdale.

Oddly, I was one of the recipients—and in order to find out more details I played investigative journalist, pretending I was interested in the offer. Here’s what I found out.

I received the first e-mail on November 4, 2010:

“On behalf of Sunovion Pharmaceuticals Inc., Health and Wellness Partners (HWP) is pleased to invite you to participate in a Latuda^® (lurasidone HCI) tablets Speakers’ Bureau Meeting entitled A New Atypical Antipsychotic Agent for the Treatment of Schizophrenia. The purpose of the Speaker Training Meetings is to train and educate psychiatrists about Latuda and schizophrenia, who in turn will educate other health care professionals in peer to peer meetings....If you wish to attend the meeting, please click the button below to proceed to the registration page where you will indicate your first, second and third choices for date/location by November 8, 2010. Registration will be on a first come, first served basis so please be sure to register early.”

For some background on Latuda, see my earlier post in which I briefly reviewed the pros and cons of the drug. Essentially, it appears to be as effective as most antipsychotics, less effective than Zyprexa, causes little if any weight gain or metabolic problems (just like Abilify, Fanapt, Geodon, and Trilafon), but causes plenty of troublesome side effects like sedation and a severe form of restlessness called akathisia. Since it provides no clear advantages over existing options, why don't we just re-name the drug “Metooda.”

At any rate, I went ahead and started the online registration process, and immediately received the following:

“Thank you for completing the Save the Date for the Speaker Training Meeting. To initiate the process and your Speaker Agreement, please forward a copy of your CV immediately. You can e-mail it to registration@hwpnj.com or fax it to 201-661-5580. Since registration is on a first come, first served basis, we urge you to respond quickly…. Please indicate your preference of first, second and third choice of which meeting you would like to attend.:

Friday, December 10 – Saturday, December 11, 2010 in Miami, FL,

Friday, January 7 – Saturday, January 8, 2011 in Dallas, TX,

Friday, January 14 – Saturday, January 15, 2011 in Scottsdale, AZ”

While I had no intention of actually going to any of these tempting locales (at least not on their dime), I chose Miami in the hopes of getting the ball rolling more quickly. A week later, on November 11, I got this response:

“On behalf of Sunovion Pharmaceuticals Inc., we are pleased to confirm your participation in the Latuda® (lurasidone HCI) tablets Speakers' Bureau Meeting, A New Atypical Antipsychotic Agent for the Treatment of Schizophrenia on Friday, December 10 - Saturday, December 11, 2010 in Miami, FL.
We will be sending you additional registration details shortly.
If you have any questions regarding the meeting, please contact Health and Wellness Partners at registration@hwpnj.com, or call 551-579-6980. Your call will be returned within 24 hours.”

But then, on November 23, my dreams of a pharma-funded junket were quashed:

“Dear Doctor:

Thank you for your interest in the LATUDA (lurasidone HCl) tablets Speakers’ Bureau Meeting. Due to the overwhelming response to this meeting the registration site unfortunately accepted more registrants than there were spots available, and we are unable to accept your registration at this time. We apologize for any inconvenience this may have caused you, and again, thank you for your interest.”

Of course, I have no way of knowing if I was rejected because they finally googled me, or because there truly was an "overwhelming response." If they were telling me the truth, I suppose I should not be surprised, since according to the largest existing database of hired guns by ProPublica, psychiatrists top the lists of doctors vying for drug company cash (see Medscape's coverage of this dubious distinction here). If they were lying, my feeling’s aren’t hurt, particularly since I myself was being sneaky in pretending that I was interested in taking them up on their offer.

At any rate, over the next few weeks, I’m sure I’ll hear more from various colleagues about how lavish the resorts are, about the amount of the “honorarium” that goes along with the trip (I’m guessing around $1500), and about whether these doctors have to promise to actually do anything in return for the trip. In the past, speaker’s bureau meetings were little more than bribes to get doctors to listen to “key opinion leaders” expound on a new drug. The return on that investment could then be measured by local drug reps using prescription data-mining technology.

As befits a me-too drug, Sunovion is using the same old me-too strategies to manipulate medical opinion. Cash, pools, and room service work every time.

Stephen Stahl + Lurasidone: The Hired Guns Come to Town

Just when you thought we had reached the point of antipsychotic supersaturation, yet another me-too drug is edging its way into this $20 billion market. The drug is Lurasidone, and the company is Sunovion (formerly Sepracor). FDA approval is likely by the end of this year, and in anticipation Sunovion has begun a marketing blitz, tossing so much money at hired guns that it looks like confetti. And where there is drug company money to be had, Stephen Stahl is never far behind.

Lurasidone is simply another antipsychotic—no more, no less. The two major clinical trials (Pearl 1 and Pearl 2) have shown inconsistent efficacy results, high rates of side effects such as akathisia (restlessness), parkinsonism (tremor and stiffness), and sedation, and apparent inferiority to Zyprexa. Like several of the newer antipsychotics (such as Ability, Geodon, and Fanapt), Lurasidone causes little weight gain and few metabolic abnormalities. With no clear advantages over its many competitors, Lurasidone will succeed or fail based purely on the strength of its promotional campaign.

Which is why Sunovion has hired the impresario of drug company-funded education, Stephen Stahl, as their chief hired gun.

Stahl is the driving force behind a road show of Sunovion-funded “programs” entitled “Schizophrenia: Building Awareness—Advancing Understanding.” I first started receiving flyers for these lectures in July, and I get a new one every week or so. I’ve scanned some of them into my computer and have posted them on Evernote here.

The most recent promo piece came a couple of days ago, in the form of an email from Stephen Stahl himself. It started this way:

"To my fellow Boston area Psychopharmacologists:

Just a head's up about a local educational program I hope you can attend related to schizophrenia. The content is based both upon my textbook, Stahls Essential Psychopharmacology, and two cases from my private practice.”

Obviously aware of the increasing skepticism about pharma funding of physician education, Stahl addresses the issue head on: “ Although supported by Pharma and not CME (a new company Sunovion with a drug in the pipeline is the sponsor), there is no mention of any product here, just information on disease state, what I think is a very a cool update (understandable) on genomics, neuroimaging and the prodrome related to schizophrenia, and illustrated after the first didactic lecture with two cases taken from my practice.”

While I applaud Stahl’s transparency, I think he misunderstands the problem with pharma-funded programs. Their deficiency has nothing to do with the fact that they mention their drug, or any other drug. Why would a busy psychiatrist attend a half-day program on antipsychotics in which “there is no mention of any product”? In fact, we want to hear plenty about products. We look to experts like Stahl (and others on this tour, such as Leslie Citrome, Henry Nasrallah, Andrew Cutler, and Steve Potkin) to help us navigate the increasingly confusing terrain of antipsychotics.

We want them to talk about products, and we want specific recommendations. What is their first choice of antipsychotics and why? What are their second and third choices? What do they think about the increasing popularity of conventional antipsychotics? In their heart of hearts, do they really think that Lurasidone is worth choosing over its competitors? Shouldn’t we be hesitant to try me-too medications, when others of equal efficacy have long track records and clinical experience?

I predict that none of these experts will address these painfully obvious questions. Because if they did, they might let it slip that risperidone is their drug of choice. Or Abilify. Or Trilafon. Or Some Other Drug That Is Not Lurasidone.

Instead, audience members will hear about purely hypothetical mechanisms of action, many of which will be presented in such a way that Lurasidone will appear to have a "potential" advantage over its competitors.

This, after all, is the marketing strategy that Stahl has pioneered. Keep the audience mesmerized with colorful cartoons of fancy mechanisms of action that have no proven connection to the drug’s clinical action. Then say that because of these mechanisms of action, the sponsored drug “might” or “should” or “could potentially” or “will theoretically” be the best thing since Fridays.

Yesterday, Stahl’s CME company, NEI, sent me a free booklet, “Psychosis and Schizophrenia: Thinking It Through.” Like his road show, this book is funded by Sunovion, and it contains a coyly phrased endorsement of Lurasidone that is vintage Stahl: “Actions at 5HT7 and 5HT1A receptors suggest potential antidepressant and pro-cognitive actions, but this requires confirmation in clinical trials and real world clinical experience” (page 43).

Sorry for the poor review, Steve. But as Randy Jackson says on American Idol, “I’m just tryin’ to keep it real, dog.”