Monday, August 08, 2011

Two Doctor-Created Provenge YouTube Videos: Which One Would Dendreon Reps Prefer to Show Their Docs?

I read with interest today a Pharmalot post about Provenge after seeing this tweet from @jackbilson3: "Outstanding article & comments about Provenge from @pharmalot".

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?


  1. Anonymous11:28 AM

    Would it get that far? Doubtful the reps would (officially) share anything unless their own pharma legal/regulatory teams had signed off on it? Doubtful they would..

  2. I wonder, however, if pharma companies have specific written SOPs regarding recommending YouTube videos and other doctor-generated content not officially endorsed by the company?

  3. Leonard Liang4:25 PM

    Dear Mr. Mack ("PharmaGuy"),

    I'm glad you took the time to watch my video. However, please keep in mind that the video isn't really made for the pharma industry or wall street. The YouTube video I made is for patient education. That is, men or family or men with metastatic prostate cancer who may find it helpful to have Provenge explained to them in "layman's" language. I doubt that for these people, 13 minutes for the video is too long.

    It is interesting that you chose to quote some anonymous "basher" named "zuppy." It is clear from the comments section that there are anonymous people who choose to post false and negative comments for reasons that cannot be for "the good of society" or for "truth" as they purport.

    It would be unethical for me to give Provenge to someone who is not a proper candidate for Provenge. It is not unethical for me to be a shareholder of Dendreon or to make an educational video. Should I "disclose" to a patient if I am a Pfizer shareholder before I write a script for Viagra? Should I "disclose" to patients every time I do a kidney transplant that I actually get paid for the service? Should I tell patients exactly how much I get paid for surgeries and office visits? Where does it end? Sometimes you have to trust that your doctor is going to do the right thing. That's what I try to do for my patients ... the right thing.

    When a patient sees me I go through a much more detailed and frank explanation. I'm sorry if you think the video is too "rosy."

    If you took the time, you would be able to figure out that Dr. Chodak has a whole library of urological educational YouTube videos. He is to be commended for that.

    I do not have any plans to "take down" the video. Why should I? It is helping patients understand a new and complex thing. Immune therapy for cancer is a relatively new thing in medicine. For example, you should be aware that there are many chemotherapies that have a measurable effect (lowering PSA) but that have failed approval. Why? Because they have not had a survival benefit. At the end of the day, the standard for efficacy for a cancer treatment is survival benefit. Provenge has that and is well tolerated. For patients with advanced cancer, living longer with few noxious side effects is a very good thing.

    Warm regards,
    Dr. Leonard Liang

  4. Dr. Liang,

    Thanks for your comments.

    I am entitled to my opinions about your video and merely point out some issues regarding doctor-generated content that it illustrates and to contrast the content of your video with that of Dr. Chodak's. His video speaks more to the problem of why Provenge is not doing as well as expected. In contrast to that, your presentation is indeed "rosy."

  5. It is not unethical for me to be a shareholder of Dendreon or to make an educational video. Should I "disclose" to a patient if I am a Pfizer shareholder before I write a script for Viagra? Should I "disclose" to patients every time I do a kidney transplant that I actually get paid for the service?

    Cliff Merchant MD

  6. Cliff,

    Thanks for your comments. I am not making any judgement regarding the ethics with regard to whether or not physicians should reveal stock ownership or make product videos. I am more interested in whether or not drug companies should use this kind of content surreptitiously during sales calls.


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