Monday, August 14, 2006

Hybrid: But who will take Big Pharma's temperature?

According to a recent Marketplace report, there is a new kind of health care professional on the block these days - the pharma-nurse. From the transcript of the story, here is a succinct description:
Pharmaceutical company Berlex pays [Corey] Wisnieski and 79 other registered nurses to help people with multiple sclerosis take a drug called Betaseron. Other MS drug makers as well as companies that make diabetes medications do the same. The goal: to teach patients how to give themselves shots and manage the side effects.
Do I detect a subtle hint of pharma double-speak? Maybe it is my six years of industry experience talking, but I just can't seem to see this in such an altruistic light.

At first, the situation sounds like a win-win. The patient gets care. The pharma makes money. The doctors keep an eye on things.
But physicians who oversee patients don't necessarily have a vested interest in a particular drug. Sylvia Lucas, a neurologist at the Western Multiple Sclerosis Center in Seattle, says pharma nurses are a Godsend:

SYLVIA LUCAS: The bottom line is that if this drug is not working, we know that. If there's progression of disease, we're gonna change the drug.
Change it, sure. But what induces doctors to try treatments in the first place? How could something that someone describes as a Godsend not influence which drug gets prescribed?

This article talks about a similar program for users of Lilly products:
Even so, the patient programs are offered only for patients who use the company's product, which can be an incentive for doctors to prescribe the drug in order to tap the free educational benefits being dangled by the companies for their patients.

"I don't want to call it pressure. But the expectation is they have to be on a Lilly product" in order to receive the free training, said Terry D. Ridge, a nurse practitioner who works with diabetic patients for an American Health Network doctor's office on Indianapolis' Westside.
And it makes sense. Why would pharms invest that kind of money - after all, health care is expensive! - if they weren't getting a return on their investment?

Back to Dr. Lucas for a moment, this is how she describes her experience to Marketplace:
I would love it to have two hours to spend with each patient, saying this is where you inject, these are the side effects you should expect. This isn't a cure, but it really is supposed to prevent picking up disease down the line. You know, it's almost like insurance.
Almost. Wow. Does it disturb anyone else that Dr. Lucas doesn't have time to describe medication side-effects to her patients? I can't say it better than Blue Lily did early - healthcare in the US is just plain broken.

Thinking about this shortage of doctor-patient time, I happened to find this tidbit, in a Businessweek article on the pharma-nurse phenomenon (bolds mine):
Academics who study this sector are especially critical of sales pitches that drug companies make directly to consumers. That includes promoting drugs for complaints that can often be treated without prescription medicines.

Even as these moves have come under a microscope, however, drugmakers must discover new ways to boost sales. Simply adding more sales reps won't fly. They are already so numerous that physicians are now holding sales visits down to an average of 90 seconds.

In such a context, the nursing programs are attractive to the drugmakers because they help hold patients to the recommended drug regimen.
Context, yes. It wouldn't have occurred to me to draw the line quite so directly between sales calls and the uptick in the number of pharma-nurses. Which means that not only is healthcare being outsourced, as Marketplace reported, but advertising is tagging along for the ride. So much for indutry regulating itself.

Unless and until the FDA steps in, I suppose it is business as usual in American healthcare: patient beware.