Friday, November 30, 2007

Counter Detailing -- Pissing into the Wind or Profitable Endeavor?

Pissing into the Wind: Engaging in a pointless activity.

That's how I see Dr. Dan Carlat's new focus on redeeming himself by engaging in some freelance "counter detailing" in his home state of Massachusetts.

You'll recall that Carlat recently wrote a true confession of how he earned $30,000 as an MD shill for Wyeth a few years ago (see "Dr. Carlat's True Confession: 199,999 More to Go").

Many people called for him to give the $30,000 to charity or back to Wyeth, but Carlat demured.

Carlat explained on his blog and in an interview with Ed Silverman over at Pharmalot that "I'll be doing the opposite of what I did with Effexor, which was to give drug talks. Instead, I’ll be visiting different doctors, different practitioners in different places in the area and try to educate them about direct-to-consumer advertising, evidence-based medicine and treatment options."

He will do this on his own time, but only "until my 30K runs out." If he "bills" himself for his time at the same $450 per visit rate he did for Wyeth, he would have to visit about 67 docs. That's assuming he gets past the receptionist every time he tries, which is not likely because he vows that free lunch is not included. Will he bill his failed calls at the same rate as his completed calls? Real pharma detailers do -- ie, pharma reps are paid whether they see the doc or not.

Let's say 50% of physicians let him in. That means Carlat will end up speaking to only about 33 physicians.

While Carlat is "counter detailing," actual pharma reps are out there detailing and offering many goodies to docs that counter detailers like Carlat can't offer -- eg, free samples. Detailers can also offer glossy reprints of medical articles, pens, calendars, free CME, and, of course, free lunch. With these incentives, many Wyeth reps claim they do not have a problem accessing physicians and I am sure their success rate is greater than 50%.

How many detailers are out there in Carlat's territory? Let's just focus on the Wyeth reps and assume there are 5,000 of these in the US that visit psychiatrists. There's bound to be several hundred just in Carlat's territory competing with him.

Let's also not forget the 199,999 other physicians hired by the drug industry as consultants. Wyeth could easily deploy some of these to counter Carlat's counter-detailing effort.

Who knows, Wyeth may even try some "stealth counter-counter detailing" by sending out docs to visit other docs on their own, claiming to be counter detailers with outcomes data that are favorable to Effexor.

Even though I am not serious about the stealth stuff, the thought leads me to ask what credibility does Carlat have as a counter detailer? He doesn't seem to plan to work within an organization like the Alliance for Human Research Protection, which funds Dr. Jerome Avorn's counter detailing project in PA (see "Counter-Detailing Anti-drug Reps Coming to Educate Doctors"). He's a lone wolf counter detailer!

The Book
Here's what I think. Dr. Carlat is working on his tell-all book. His true confession AND his counter detailing mea culpa will offer some great feedback and experiences to write about. From this I expect Carlat to reap a hell of a lot more than $30,000!

If true, then Carlat's counter-detailing stream has an associated rainbow.

P.S. Carlat IS a member of the National Physician's Alliance, whose mission he describes in his blog:
"By the way, several physicians at the National Physician's Alliance (NPA) are available for free talks on pharmaceutical industry influence, and they span the specialties, offering counter-detailing on treatments in internal medicine, cardiology, pediatrics, etc.... And join NPA while you're on their site. Unlike the AMA, they will never sell your name to drug companies."

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