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DBL%20Hendrix%20small.png College chemistry, 1983

Derek Lowe The 2002 Model

Dbl%20new%20portrait%20B%26W.png After 10 years of blogging. . .

Derek Lowe, an Arkansan by birth, got his BA from Hendrix College and his PhD in organic chemistry from Duke before spending time in Germany on a Humboldt Fellowship on his post-doc. He's worked for several major pharmaceutical companies since 1989 on drug discovery projects against schizophrenia, Alzheimer's, diabetes, osteoporosis and other diseases. To contact Derek email him directly: Twitter: Dereklowe

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May 24, 2011

How Others See Us (And How We See Them)

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Posted by Derek

Via Matt Herper, here (PDF) is an interesting survey from Quintiles, the large clinical outsourcing company, on how different groups perceive the value of new drugs.

The first problem is that not everyone can agree on what's valuable. Surveying managed-care people and physicians, the number one factor mentioned is cost. Biopharma respondents mentioned cost, but were more weighted toward outcomes (which, for example, was a factor in only 10% of the physician responses). Patients. . .well, patients mentioned cost, but not as much as the doctors or insurance people, and they hardly noted outcomes at all (single digits). "Not sure" was a front-runner.

When things were asked in a less free-form way, though, with a list of answers to choose from, patient outcomes and safety were always the top two factors among all four groups - followed by quality of life, followed by cost. An interesting discrepancy, I have to say. When asked if they agree with the statement that "All in all, the money patients spend on prescription medication is worth it", 84% of the biopharma people agree, as do 80% of the patients. Doctors were 70/30, but managed care people were 56/44. (These are all mixtures of "somewhat agree" and "strong agree", by the way).

And when asked to rank various groups according to how much value they add to health care, doctors and medical staff come out number one, no matter who's asked. "Scientists and medical researchers" come in second - except in the case of the physicians, it's a very distant second indeed. (They rank themselves so highly that there's very little left over for anyone else: 81% versus a bunch of single digits). But, interestingly, "Biopharmaceutical companies" get ranked at 11% by people in biopharma, 5% by patients, and at 1% by physicians and managed care.

So where do all these scientists and medical researchers, who are ranked much higher, actually work? Why, at pure, untainted institutes, one guesses - in spotless white coats, their minds on higher things, somewhere far away from the business of actually making and selling drugs. . .

Comments (15) + TrackBacks (0) | Category: Why Everyone Loves Us


1. John Schilling on May 24, 2011 12:50 PM writes...

Conceivably the respondents could believe that the scientists and medical researchers are adding great value, and that the biopharma companies are then taking that value away...

More plausibly, given the way the choices are laid out, "value added by biopharmaceutical companies" is being interpreted to mean value added by biopharma companies exclusive of the value already added by scientists and researchers.

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2. Nerd 27 on May 24, 2011 1:33 PM writes...

I suspect that there might be some "psychological distancing" by some of the respondents to "Evil Big Pharma." You can blame the politicians for that. In this current political climate, almost ANY industry that turns a profit (except movie production companies) are looked at as evil.

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3. Anonymous on May 24, 2011 2:21 PM writes...

Seriously? Nobody has a problem with a profit or the science half of the business. Maybe it's the total lack of morals (as implied by billions of dollars in fines for illegal activity) that is the problem. When getting caught and paying a fine for illegal activity is considered "the cost of doing business" what do you expect. I'm embarrassed for our industry on so many levels it's ridiculous.

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4. SteveM on May 24, 2011 2:31 PM writes...

Physicians may say Cost is the number 1 factor, but their prescribing practices belie that claim. Me-too branded drugs make tons of money, even when clinically similar generics or even OTC meds are on the market. E.g., Nexium versus Prilosec versus OTC Omeprezole. To say nothing of the huge fish oil rip-off Lovaza:

Only doctors who are wildly indifferent to cost would write those scripts as first line treatments.

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5. mari mansfield on May 24, 2011 3:14 PM writes...

Derek – thank you for your insight into the New Health Report. I want to clarify that although all groups were asked to define the value of ‘healthcare’ in their own terms, the follow-up question was asked specific to the value of prescription medications. (This is what you referenced in your second paragraph, above.) Patient outcomes and safety were indeed selected by most groups as the most important factor in determining the value of prescription medications, but these responses can’t be compared to the previous question which was geared more toward healthcare in general. A third question presented a holistic definition of value in healthcare which included both cost and outcome language and asked whether respondents agreed with it. A large majority in all groups did.

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6. WB on May 24, 2011 10:16 PM writes...

It's rather sad that pharma is seen as 'evil pharma' these days. Is there any way to fix this poor perception? Unfortunately the press reports seem to add to the "evil" perception. It's easy to blame all the marketing and sales people on the board of these companies for the lack of morals and lack of progress of most pharma companies. And I think it's probably the real reason too.

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7. cliffintokyo on May 25, 2011 4:30 AM writes...

Blame the MBAs for the BioPharma image problem.
Their one-size-fits-all approach to marketing medicines in the same way as consumer products marks all of us who work in big pharma as equal evil exploiters of sick people in the public perception. Proof? I didn't see much sympathy for the tens of thousands of research scientists who were *let go* in the last 2-3 years.
Biopharma marketing should be about explaining the advantages of new approved products and encouraging docs to use them and tell us how they evaluate them.
There should be no pharma sales force mentality and none of the quotas, bonuses, dirty tricks, etc associated with selling (harmless) consumer products.
Do ALL MBA courses teach the same mantra, that all products can be sold in just the same way? If so, its no wonder that we end up with a load of money-lusting morons. And what a bunch of sharks who charge fat fees for teaching students such garbage.

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8. jackpratt1 on May 25, 2011 6:10 AM writes...

Healthcare is not subject to normal market forces! Anything that you have to buy at any random moment in order not to die is not something to which a rational supply/demand calculus can apply. Check out "Penny Health Insurance" articles on how to reduce the cost of insurance.

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9. sepisp on May 25, 2011 6:59 AM writes...

Haha, this is such a pie in the face for physicians. First (p. 5), 30% of physicians mention neither cost nor outcomes, and 70% fail to mention patient outcomes. Sounds like a major fraction of physicians come to work only to collect pay, forgetting the primary mission of curing and treating patients. Second (p. 9 upper), physicians have a self-approval rating (81%) far above other groups (46-63%), and they place a low value on medical research, only half of that given by others. Physicians seem to prescribe whatever feels best, usually what the insurance company dictates (p. 19), and complain mainly about cost rather than new treatments (p. 15). Regardless, all groups seem to consistently like physicians (p. 9 lower). It seems that medical school seems to attract individuals for other reasons than desire to help people; a stable high-paying job and ability to manipulate come to mind reading this data.

There is also a result in the study that inspires hope: 96% patients are well-informed about their condition, and get the information not from sensational news but from the right sources (p. 12-13). Everyone knows the horror stories about how informed somebody's grandma was (I've seen one drink cough medicine like it was whisky), but this is an exception, not the rule.

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10. Jnich on May 25, 2011 8:41 AM writes...

As a PI at one of these "pristine institutes", I guess I'm glad that we're not viewed upon so poorly. While I will never defend the denialism that accompanies some of the animosity toward big bio/pharma, there is a difference, and people do recognize it.

This blog is, apart from it's very interesting commentary on a range of issues, seemingly somewhat of a catharsis den for industry folks who (rightfully) feel that they are unfairly attacked for being part of a very much for-profit enterprise. Are the scientists at these places more interested in marketing and profit than human health? Obviously not. How about the administrators and the leadership? Let's just say it's not so obvious. This is what is being reflected in the latter part of the poll.

I'm no stranger to the constant reiteration here that academia is just as ethically corrupted as industry... or that industry is a far more necessary part of discovery... or that academia acts so holier than though, but actually accomplishes little in comparison (this reminds me of the sickening old adage "those who can, do... those who can't, teach"). But these sentiments often seem like overkill and overcompensation for the nagging feeling that biopharma does exhibit some questionable morals.

I think we should be done with the ends justify the means mentality. And its definitely time to do away with the implicit threat to society from big pharma that states "if we're not allowed to rake in these kinds of profits and operate the way we want, then we're going to take our ball and go home, and then you'll be sorry." My guess is that sort of shift would go a long way to changing perceptions, and even reality.

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11. Rick on May 25, 2011 8:55 AM writes...

There's a glaring omission from this report. Two overwhelmingly influential stakeholders were not surveyed: board members and investors (including investment analysts). They have more influence than the four groups that were surveyed combined. I suspect their responses would differ much more significantly from the four groups that were surveyed than the four groups differ between themselves. Those differences could be very enlightening. These are such obviously important constituencies that it seems as if Quintiles deliberately chose to exclude them and I have to wonder why...

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12. victor on May 25, 2011 5:13 PM writes...

What I find interesting is the difference of opinion between the patients and the other three (realistic) stake holders with respect to future treatment options (p 17).

What I find frightening is the physicians pessimistic 10 year outlook on the quality of health care (p 15).

The former is clearly an issue of education, but what is the cause of the latter, more pessimistic outlook?

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13. sepisp on May 26, 2011 1:49 AM writes...

#12: Have you been living in a barrel since birth? It's the increasingly limited access to healthcare and the approaching collapse of funding for the U.S. healthcare system. When the accelerating increase in monthly health insurance payments / hospital bills outruns the average households' income, healthcare will again be accessible only to the rich. Just as it was in the 19th century. Ever wonder why there are so many witchdoctors in Africa? That's because there are no real doctors.

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14. er on May 26, 2011 2:24 PM writes...

I have to agree with SteveM as I have seen the same thing. However where I practice our pt base is solidly poor. I was trained and still follow the path of ignore cost until you get to the tx plan--So after all is said and done I check the code to see if they are self pay, free care, fed or state and then figure out how best to write my script for the cheapest ride for the pt.
If they need something I can't hook them up with through our clinic pharm program like narcotics or specialized tradenames or Walmart so be it---they have to pony up somehow. But I thank God that there are some drugs I can offer some of them even if they are very expensive. It is not my job to live their life for them or take those decisions out of their hands.
Just my perspective.

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15. oleginger on June 3, 2011 1:44 AM writes...

There is another interesting report that fits nicely the "How Others See Us" headline:
High marks on systematic med chem but otherwise the old academia vs. industry tune.

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