OCTOBER 16, 2008

Before You Take That Pill, Read This Letter from Vexed Former Pharma Exec

Still reading your book. The HTN [hypertension] chapter now. Way to go discussing the ALLHAT trial. [see note below.] I was selling an ARB [angiotensin receptor blocker] when the results were released, and was glad actually what the results were from that trial, which was funded by the NIH (I was a pharma critic even then). Sampling generics would solve many issues with the cost of prescribing, but that would be beneficial for the patient, so, of course, that will not happen.

ALLHAT was never actualized because of both intentional lack of media attention, journals and other forms, as well as copious amounts of branded HTN med samples left often with all who prescribe, as the prescriber ignores deliberately the reality of appropriate treatment.

Samples are the number one influencer of your prescribing habits. I'd have 20 cases of Cozaar in my possession when that study came out to dispense aggressively. That amounts to tens of thousands of pills of Cozaar. I'd increase market share of Cozaar without ever knowing or meeting a doctor who would reflect this growth by leaving samples only. UPS in a suit, my friend.

Kickbacks are in second place. It's unfortunate. I'd spend close to 100 grand a year directly to doctors very creatively, and similar to money laundering. And was coerced to do this for no reason other than speculated reciprocity, and this act which would metamorphasize in various ways, yet was always tacit and secretive.

My writing is atonement, in a way. Mea Culpa remains intrinsically, however, within me.

Finally, I belong to some advocacy groups such as www.npalliance.org, www.communitycatalyst.org, and others. Some are for doctors only. Might want to check such sites out, as you would benefit their missions, I believe.

Thanks for reading this long note from a vexed ex pharma exec.

Postscript: There are also some interesting comments from marketing execs writing on this topic anonymously on pharmalot.com here.

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Doug Bremner wrote on October 17, 2008

Note: Diuretic medications [the "old"] medications were shown to be safer than the "new" angiotension converting enzyme (ACE) inhibitors and calcium channel blockers in the ALLHAT study.

ALLHAT (2002): Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). Journal of the American Medical Association 288:2981-2997.

ALLHAT

ALLHAT. JAMA 2002;288(23):2981-2997. *lisinopril (Prinivil)-angiotensin converting enzyme inhibitor or ACEI; >chlorthalidone (Hygroton)-diuretic, p<0.05; ** lisinopril and amlodipine (Norvasc) – Calcium channel blocker, or CACB >chlorthalidone, p<.05); doxazasin (alpha receptor blocker) stopped early (CHF)