Physician Empathy vs. Pre-Launch Marketing

A recent article in the Boston Globe about pharmaceutical companies "pitching empathy" to doctors focused on an exhibit at the American Academy of Neurology meeting that "claimed it could create, in a perfectly healthy person, the disorienting symptoms of multiple sclerosis."

"The machine, commissioned for the meeting by Cambridge drug maker Biogen Idec Inc. and Elan Pharmaceuticals Inc., drew a line of doctors ... who were curious to experience how it might feel to have a perplexing disease known for its random, debilitating attacks on the brain and spine. With a video, headphones, and two wobbly treadmill tracks, the machine attempted to mimic the lack of coordination, blurred vision, and other signs of an attack.

"The marketing theory behind the simulator is that a more empathetic doctor is more likely to treat patients aggressively, which means prescribing more drugs. O'Leary [the founder of the marketing company that designed the MS and other simulators] said one survey showed that the strategy seems to work: Doctors emerged from the anemia simulator measurably more interested in treating patients' symptoms." (See "MS drug makers try a new pitch: empathy.")

[I spoke to the reporter who wrote this story and I was quoted in the article (see "Mack Quoted in Boston Globe Story About Pharma's Empathy Pitch to Physicians").]

What is the real goal of the "MS simulator"? Is it really to increase physician empathy and thereby increase scripts? Do specialists who see MS patients every day for years need to learn to emphasize with their patients? Is there actually a causative link between increased empathy and more prescriptions? Or is there something else at work here?

As I said in the article regarding a congestive heart failure (CHF) simulator designed by the same company that designed the MS simulator, a cardiologist with a lot of experience treating congestive heart failure probably knows all there is to know about being empathetic. Similarly for neurologists who treat MS patients.

So, I question the need for "old" doctors to acquire "new" empathy in order to better treat their patients, despite what doctors purportedly said in a survey as they left the Biogen Idec booth (it is well-known that what people, including doctors, say and what they DO are often two different things).

On the Road, Again
"Young," inexperienced, doctors are another matter altogether. If the MS simulator is anything like its CHF counterpart, it will be making the rounds at teaching hospitals in a tractor trailer like the one shown on the left. It is at these locations that new doctors will be drawn into the marketing web, often encouraged by the hospital or medical school itself.

Whenever the mobile unit is scheduled to visit a medical center, the center's PR department gleefully rehashes the sponsor's press release to announce the coming as in this introduction to a Allegneny Hospital newsletter article:

"On June 29th and 30th, healthcare professionals at Allegheny General Hospital (AGH) will have the unique opportunity to walk in the footsteps of a patient with congestive heart failure by way of a state-of-the-art simulation technology developed by pharmaceutical company AstraZeneca...AstraZeneca's Heart FXPod is an innovative multi-sensory, interactive technology designed to provide physicians, nurses and other clinical professionals with a first-hand experience of what heart failure patients suffer on a daily basis."

And a medical center that has a "no drug rep" policy inside its doors, probably would not object to allowing an "educational" mobile unit chock full of reps to park in its neighborhood or parking lot. Indeed, if the mobile unit is parked in a public area nearby, the medical school cannot object.

Thus, the anticipated mobile version of the MS simulator, just like the CHF simulator, is a door-opener to "new" physicians with NO experience with MS or with Biogen's MS treatment.

That brings me to another point about the goal of the MS simulator in an exhibit at a scientific meeting. New doctors without MS treatment experience are not likely to attend such a meeting. And many of them will already be familiar with Biogen's drug, Avonex, which is approved for treatment of MS.

What these doctors may NOT know, however, is that Biogen is currently testing another drug, Rituxin, for MS. According to a Reuters news story, these clinical trials demonstrate that Rituxin "proved highly effective against multiple sclerosis ... signaling a potentially more effective way of treating the progressive neurological disease."

This is "just a small Phase II trial," according to Dr. Stephen Hauser, the study's lead researcher and chairman of neurology at the University of California at San Francisco. Based on this thin evidence, Hauser claimed that the "data suggest Rituxan is twice as effective in preventing relapses as the most widely used current treatments [including Avonex]."

Is it a coincidence that the MS simulator debuted at a medical conference at which results from this "small Phase II trial" were presented?

Avonex currently competes with Betaseron by Berlex Labs. Berlex had a booth at the Boston Neurology meeting also, but it was merely some kind of Merry-go-Round ride through a simulated brain of an MS sufferer being treated by Betaseron. Biogen's MS simulator was a bit of one-upmanship in terms of Exhibit marketing.

Avonex faces patent expiry in 2011 and it is important that Biogen maintains the loyalty of physicians who currently prescribe Avonex for MS. THESE are the physicians that the MS simulator is designed to reach and bring into the Biogen booth where they will learn about the Rituxin MS trial.

Although Biogen and its sales reps at the booth cannot initiate conversations about off-label use of Rixtuxin for MS, there are ways to point out that a presentation will be made at the conference about a "new treatment" option that is twice as effective as Avonex. Perhaps Dr. Hauser will be at the booth shaking hands, discussing the trial, and introducing docs to sales reps who have all the reprints in one hand and cup cakes in the other.

So, let's not think that the pharmaceutical industry is attempting to improve physician-patient interaction through technical simulations. Gadgets and entertainment are always good ways to attract physicians into the marketing lair and that is the real goal of pharma companies. Of course, I am stating the obvious, but sometimes you need do that to cut through all the hype.

It's just too bad that pharmaceutical companies have to go through all this to make physicians aware of new studies for their drugs. Imagine all the money they would save -- which might make the drugs cheaper -- if pharma companies could freely distribute published clinical trial information to physicians without going through all this smoke and mirrors! But, then again, think of all the "creative" marketing companies that would be out of business.