Provenge is a "controversial and innovative Provenge prostate cancer vaccine" that Pharmalot says is experiencing problems because "many doctors, particularly those in smaller settings, were slow to adopt the $93,000 vaccine since they had to wait for reimbursement." Pharmalot interviewed one such doctor -- Leonard Liang, a Los Angeles urologist -- who gave his personal experience regarding reimbursement issues.
Of interest to me were the comments to the post in which "zuppy" accused Dr. Liang of bias because he owns stock in Dendreon, the company that manufactures and markets provenge. "zuppy" stated:
"I think it should be noted that Dr. Liang has a record of contributions to the Investor Village DNDN Message Board, that clearly demonstrates his shareholding interests in Dendreon. As for the YouTube video released 1 August, 2011, I found it inappropriate that a practicising Urologist with a public display of shareholder interest in Dendreon, would create and put on YouTube a video featuring one of his patients being treated with Dendreon’s Provenge."Dr. Liang admits he owns stock and said "I have never not disclosed this." However, Dr. Liang does NOT disclose this in his video, which you can see below (while it's still available):
It's a rather long video, but informative. In it, Dr. Liang makes a very good case for Provenge. I especially like how he describes what is meant by mean survival rates of Provenge (25.8 months) vs. placebo (21.7 months). "Another way to look at the data," says Dr. Liang, " is that your 3-year survival rate is going to be a lot better."
Basically, Dr. Liang paints a rosy picture in his video, emphasizing the positive and adequately explaining the risks, which are mainly "flu-like symptoms that go away." Is Dr. Liang biased because he owns stock in Dendreon? Who knows. But he certainly is promoting his infusion business -- his YouTube channel (here) links to his web site, which promotes his practice.
Dr. Liang, however, is not the only doctor who has produced a Provenge YouTube video. Another doctor -- Gerald Chodak -- has a prostate cancer YouTube channel (here) that includes the following video about Provenge:
I don't know if Dr. Chodak owns stock in Dendreon, but he points out one very important problem with Provenge that sheds further light on the reimbursement problem:
"One of the things that is unusual about this treatment," says Dr. Chodak, "is that it has no effect on the PSA results and it has no effect on whether the cancer may progress to other parts of the body...And that can make it a little difficult to determine if a man is getting a good response or not."The point is that if it can be figured out who is NOT responding during treatment, the expensive Provenge infusions ($31,000 per pop) can be halted and other treatments tried. Obviously, payers are reluctant to pay for something that may not be working.
Anyway, I find it interesting that doctors like Dr. Liang and Dr. Chodak are producing videos that promote specific brand name products. My questions are:
- Can/should Provenge sales reps of Dendreon marketers provide urologists with links to these videos? Would FDA have a problem with that?
- And which video do you think Dendreon sales reps would choose to share with their potential clients? Dr. Liang's of Dr. Chodak's?