A Dispatch from the Front
11/11/06 08:24 AM
Although the format of this essay is fictional, every item reported and every vignette is true and documented. Stories about patients are altered only to protect privacy, but are verifiable with the patients’ permission.
From: Retinal Field Agent Supervisor, North American Office
To: The Corporate Pharm Central Command
RE: Current Harvest Update
I am pleased to make this report to the Central Pharm Command. We are making excellent progress on all assignments: Research and Marketing Coordination, Education and Infomercialism, and Decision Support/Mind Control. We have had particular progress from our Thought Leaders, which provides a clear indication that our increased recruitment and Thought Leader Liaison efforts are paying off. Although the Retinal Field represents only a small portion of the overall Medical Pharm, it controls an important crop. Vision is more important to patients than any other bodily faculty other than life itself. The Retinal Field comprises two of the most threatening conditions threatening the growing population of seniors in our region, and to paraphrase the old saying, “When you’ve got ‘em by the eyes, their minds and hearts are soon to follow.
I would like to separate this progress report into our three main projects: Education/Infomercials, Research and New Product Promotion, and Clinical Mind Control.
Education/Informercialism-
We are making great strides in this area. This is of course closely tied with our research and new product promotion efforts, but even on its own merits, education control has become an invaluable tool for controlling retinal therapy. At the time that we set the historic paradigm of expensive treatment regardless of utility (The glorious “PDT revolution”), we were in control of barely one-fourth of educational programs. I am very proud to announce that at the last annual meeting of the American Society of Retinal Specialists meeting in Cannes, France (an opulent venue that was only possible with our financial support), of the 123 speakers listed in the program, only two had no corporate financial relationships. Furthermore, although our doctors are required to disclose financial relationships, we have continued to successfully conceal the details and extent of those relationships. Although we have succeeded in making many influential Thought Leaders very “grateful”, they are (amazingly) still able to claim academic “independence”. Since we have been recruiting more rank and file docs to quasi-research activities, our audience is finding it convenient to accept these claims. Although there is still an irritating cadre of docs who object to this system, they have for the most part kept quiet, perhaps feeling overwhelmed by our relentless efforts. We think this insurgency may be in its last throes. We have also had excellent success with our peripheral seminar programs. The Avastin “stumbling block” has posed a real threat to our plans by shattering the paradigm that there is no safe, effective, and cost effective AMD treatment. Still, even in this environment, we have sponsored many successful promotions of our expensive, ineffective alternatives by setting up “expert panels” to talk about promotional “studies” as if they were real science. Even when we present legitimate data on moot questions, it is accepted as if the information was necessary. It’s amazing. We had a very well attended Macugen Seminar in Las Vegas, which went off very well. We really think we can milk more blood out of this turnip if we can just continue to discredit the enormous safety data on Avastin. Fortunately, it has so far eluded the gullible that it is illogical to suspect a stroke risk for a milligram or less of Avastin or Lucentis when oncologists use 1000 mg or more with no such concerns. The uncritical acceptance of Thought Leader messages such as this continues to amaze us, but we are happy nonetheless.
In addition to the traditional meeting format, we are thriving in the paid vacation market. Through our ever tightening liaison with societies, smaller physician groups, and our own users groups, we are hosting innumerable meetings at exotic locations. Each issue of the “throwaway journals” contains too many testimonies of our success in this area to even count.
Research/New Product Promotion-
We are truly enjoying “Perfect Storm” conditions with our research efforts. The coincidental development of governmental budget restraints and the era of retinal pharmaceuticals could not have come at a better time for us. As government research money has become scarcer, we have been able to step in and, in effect, purchase the loyalty of entire departments. We have even been able to fund entire professorships for some of our more loyal promoters. Furthermore as personal incomes for academic and private doctors has come under pressure, they have eagerly welcomed our offers of income replacement without all of the requirements of documentation and performance verification that they are faced with in actual patient care. Many, especially community researchers who have signed on to our various “research by numbers” programs actually seem relieved when we demand to retain and control their data. The brilliant idea to usurp IRB functions is especially attractive to our less experienced recruits.
The sheer volume of these activities is promising for two reasons. With one of our newer projects, we have been able recruit well over 200 “research centers”. This has created a true win-win. The centers, which are completely under our control, are able to create the illusion of research activity for their local marketing efforts. We are able to control data with a research “team” that is too large to ever organize in any way that could threaten our goals, and we have a built-in critical mass of practices that will use our products regardless of what the data may show.
There is no great risk there, because we can control “what the data may show”. This is simply due to the fact that we have been able to take over the design process of the studies on our products. We have created an environment where approval does not require that we show, or even know, everything about our products. We merely have to collect enough data to say something nice about them. We can even control what “nice” means! With the Visudyne study, we redefined success to include three lines of visual failure. We also elected not to look at early OCT data, so we were able to disregard toxicity data that, unfortunately, is now well documented in the literature and in medical experience.
We have also had wonderful success with Lucentis. This was made possible by simply proposing that the already safety-tested, approved, and priced parent drug would not work. We have taken the “me-too” drug phenomenon to a glorious new level. By justifying the development of Lucentis without even considering the parent, we were able to bring the “me-too” fragment out for a new indication and effectively enjoy the revenue burst on the same drug twice! It has been a miracle. We have largely survived a significant threat to our plan when Avastin was independently “discovered”, and we were able to maintain the illusion of need well enough to secure expedited FDA approval for Lucentis. Even though our revenue on Lucentis is only 1/5th what we had hoped so far, we have been able to redirect almost a billion dollars from the CMS eye care budget directly into our coffers. This is over 20% of the CMS budget, but fortunately that is not our problem. Perhaps if Medicare becomes insolvent, we will be able to replace conventional independent physician compensation altogether.
Clinical Mind Control-
We are making real progress with our mind control program. Of course the loaded CME programs and carefully directed research designs are instrumental in this, but we are also making real headway in the trenches as well. A few examples follow:
We have had significant success lately in deflecting Avastin usage toward Lucentis. We make over $15,000,000.00 for a volume of Lucentis the size of a soda can, so we can well afford to provide free product for any study willing to “go our way”. Among these projects are studies of Lucentis on various retinal vascular diseases that already unequivocally respond to Avastin. Although the following is the story of “one that got away”, there is a message of hope hiding within. We had a recent account of a patient in one of our practices with a simple vein occlusion, readily treatable with either laser or Avastin. Our guy successfully disparaged these options and withheld them in favor of waiting for an expensive trial of Lucentis. This would have all gone well for the benefit of our doctor and us, but the patient, a truck driver who needed his vision, grew impatient. He went over to a “dark side” practice that has resisted our efforts and received Avastin and a limited grid laser. One month later, he had improved from 20/200 to 20/25, good enough to resume driving. Although this one got away, it provides clear evidence that our phase IV efforts on Lucentis may allow us to recover some of the revenue we lost due to the unfortunate Avastin discovery.
Just today, we had a report of a patient who was seen by a general ophthalmologist, who had taken one of our luxury junkets for the quickie Lucentis how-to courses designed to circumvent actual retinal specialists. Well the doc was just itching to play retina doc because, as we’ve pointed out, you can make a lot of money injecting Lucentis. Mind you, the patient didn’t even have macular degeneration, but that is part of the point of marketing to non-retinal specialists and directly to the public. Actually, she had just popped a retinal capillary BLOWING HER NOSE! She was already getting better, but the doc was going to commit her to Lucentis at $2000.00 a shot every 4 weeks for two years. $54, 000.00 to treat something she didn’t even have, all because we are succeeding in incentivizing unqualified docs to use our stuff. It’s simply glorious. Although this one also got away to a real retina doc, it shows the great potential to increase our business even beyond the needs of real disease!
We also received word from a field operative about a patient being treated by a mere community retina doctor for AMD. The patient innocently assumed that the AMD book being marketed by John Hancock University (name changed to protect the culpable) would be a reliable resource. You are well aware of our long and fruitful relationships there, and we were pleased enough to send the booklet filled with kind words for our older products. The institution was also kind enough to supply this patient’s name and information to our Direct to Patient marketing people, and we have been inundating him with mind control materials ever since. Unfortunately, he did find out about our connection with this university because they misspelled his name, and of course all of our materials then contained the same odd misspelling. We need to correct this problem, but it is evidence of the tight marketing relationship we have with one of our flagship institutions.
Conclusion-
Yes, the future is bright indeed. There are annoying watchdog groups such as The National Physician’s Alliance, but we have alliances of our own, and we have more money. We have excellent buy-in from the major Society “players”. There are rumblings on Capitol Hill about flushing us out of our covey, but we have nurtured an unprecedented level of alliance at the NIH, the FDA, and among several friends on the Hill and in the Whitehouse. The corporate elite is alive and well. We just need to stay vigilant about these quaint populist groups. We will keep all of you at Central Command posted on events in the months ahead. In the meantime we will keep to our motto:
“Bringing the Science of Marketing to the Marketing of Science”
