The Skeptical Cardiologist

Should I Get My Info On Expensive New Drugs at a Drug-sponsored Dinner?

Beginning around the time I started this blog  in 2013 I made a decision to try to avoid all drug-sponsored information.
This meant, among other things, not participating in the lunches that various pharmaceutical reps sponsored in our office and not going to drug-sponsored dinners.
I consider this part of a healthy skepticism and I wrote in a previous post

” I realized that any time I spent listening to a heavily biased pharmaceutical representative promoting their product was replacing and/or competing in my brain with information about medications and diseases from unbiased sources. In subtle ways, even to the most ethical doctors, this has been shown to effect prescribing practice. If it didn’t, these companies would not be spending billions promoting their drugs directly to doctors.”

Today, I’m looking at a typical flier that was put on my desk for a “Program” at Stoney River Legendary Steaks in Chesterfield and pondering if I should attend.
I shall lay out the specifics and let my readers decide via a poll.

Topic of the Program: Expensive New Cholesterol Lowering Drug

The topic is “Praluent (alirocumab) Injection: Achieving Further LDL-C Control With two different doses.”
Praluent is one of two new cholesterol lowering drugs that are being very heavily promoted to physicians right now.

Advertisements for Repatha stuck on to the front of multiple cardiology journals, including the flagship journal of the American College of Cardiology and the news journal of that organization .

I have found it nearly impossible to avoid print advertisements for Repatha, the other new cholesterol lowering drug as large print advertisements often cover the scientific journals that I read.
Both of these drugs are made from mouse antibodies, require injections either monthly or twice monthly and work on the PCSK9 receptors (I touched on this on one of my posts from the ACC meeting in March) to lower LDL or bad cholesterol by 60%.
Both are going to be really expensive and are expected to boost dramatically revenues from the companies making them.  Amgen, the company selling Repatha will charge 14,000$ per year and Sanofi/Regeneron the companies marketing Praluent will be in the same range.
I’ve been reading about them and talking to a few patients who I thought would be good candidates since they were approved earlier this year.
However, I’ve scrupulously tried to avoid having my brain filled with information provided by pharmaceutical representatives or articles written by physicians heavily under the sway of the companies making these drugs.
I want to make my treatment decisions based totally on unbiased information, preferably the original studies which establish efficacy.

The Inherent Bias of Drug-Sponsored Dinner Talks

I’ve been to a lot of these drug-sponsored dinner talks prior to 2013 and I know that the information presented is very biased. The allure for physicians is a free dinner at a fancy steakhouse with unlimited glasses of good wine. While we are chowing down we get to hear information on a new drug presented by a physician who is typically being paid thousands of dollars by the drug company to give a 45 minute presentation of slides that were created by the drug company.
Said physician may have absolutely no special expertise in the area being discussed but has usually been to “speaker-training”  meetings sponsored by the drug company where he/she undergoes  intense training on the condition being treated and the drug’s effects and side effects. Typically the physician is paid several thousand dollars for attending these meetings with all expenses covered.
Dr. Bernard McGuire, an internist at Mercy Hospital here in St. Louis will be presenting the slides. You can check out his prescribing profile (or any doctor for that matter) here,
You can also enter his name in to Pro Publica’s “Dollars for Docs” database here. If you do you will discover that between August 2013 and December 2014 he received $60,000 dollars from Pfizer for giving talks about the new anticoagulant Eliquis.
He received between $1100 and $2500 dollars for each one of these talks.
(You can also enter my name in and see that I have been reported as receiving $227 dollars from drug or device companies. I maintain this is an error since I haven’t participated in the drug sponsored lunches in my office they are listing).

The End Result

As a physician I feel compelled to keep up to date on the latest developments in medicine that have the potential to help my patients. This certainly includes learning about new medications.
The information presented at drug-sponsored dinners is generally accurate and most physicians feel that they are not biased by attending these functions.
However, the combination of all of the insidious ways that drug companies bombard physicians with information about new drugs likely leads to over prescribing and irrational exuberance about their safety and effectiveness.
Should the skeptical cardiologist keep up his purist stance on avoiding drug-sponsored drug information or should he savor the steak and fine red wine while soaking  up potentially biased but possibly life-saving information?
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