Pharma gets the yellow card

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 Maxine Vaccine, blogger with attitude, takes a look at some key issues affecting the pharma industry – this week, the potential impact of minor side-effects on a drug’s sales.

Let’s consider a hypothetical case. A male patient has chronic disease A, which requires careful monitoring and treatment with drug Z. Because of the risks of developing co-morbidities, he is also put on statin Y and anti-hypertensive X. So far so good.

But Z has digestive side-effect B, which is socially embarrassing, while Y causes dysfunction C, which affects his private life. His GP prescribes famous drug W (or rather, its generic equivalent) for the latter condition. The patient’s girlfriend notes the improvement, but W also causes the patient to suffer headaches, insomnia and loss of peripheral sensation, which detracts from the point of the drug (for him at least).

This conflict of interests, combined with the untreated side-effect B, results in the girlfriend packing her bags. As a result, the patient develops affective disorder D, for which he is prescribed famous drug V (or rather, its generic equivalent).

By now, the patient is beginning to feel his life is an exercise in product placement. And in generic equivalents – but let’s not dwell on that. Before he develops carpal tunnel syndrome and the two ends of the alphabet converge, let’s ask why this is happening.

Some of you may recall the classic Flanders and Swann song ‘The Gasman Cometh’, in which a gasman carrying out a domestic repair creates a new problem that requires a plumber, who in turn creates the need for an electrician, and so on. Do pharma reps invariably create business for other pharma reps, regardless of company?

Of course not, you’ll reply. All side-effects are duly listed in the product literature, and they only affect a minority of patients anyway. That’s true – but only major side-effects are reliably reported. Many persistent symptoms may not be reported due to denial or embarrassment – or, once reported, they may not be recognised as side-effects. After all, when you’ve got lots of things wrong with you, who knows the precise cause of a symptom? Does it even matter?

Yes, it does. We’re moving rapidly towards a model of community-based prevention and treatment of chronic diseases through long-term medication. Patients need to recognise, understand and deal with the side-effects of these drugs. The same patients are increasingly aware of, and able to choose from, the range of treatment options available. They are sharing their experiences via the Internet (as are GPs). And when they give a drug a bad name, you can bet that it always sticks.

Many patients and their GPs are surprised and confused by the side-effects of medication. By raising their awareness of these side-effects and the best ways of dealing with them, you’re providing a patient-focused solution rather than just a product. You’re also helping to improve patient compliance. In the era of personalised medicine, that’s the best route to customer loyalty.

If you ignore the yellow card, the red card may follow.

Maxine Vaccine is keen to receive your feedback on these and other pharma industry issues. Be nice (but don’t be NICE)!