This is a heartrending story, both because of the deceptive opposition Hoffmann LaRoche and some of Dr. Bremner’s colleagues exercised against him once he discovered that Accutane was a source of depression and thus unsafe, and because of Dr. Bremner’s grief over his mother, who died when he was only four and a half years old.

After discovering the link between Accutane and depression, the drug was not immediately taken off the market. Instead, Roche mounted a campaign, including a long and grueling series of court depositions, to try to discredit Dr. Bremner’s findings however they could. They also accused him of fraud in a journal article he had published.

Woven throughout the story is Dr. Bremner’s search for information about his mother. He began his genealogical search online, tracking down relatives, anyone who might have known his mother. His unresolved grief and suppressed memories of his mother emerged as the stressful Roche-related events in his life unfolded. He was unsure if his career in academic psychiatry would continue to advance. Then, his marriage and family life were also affected by the stress caused by the depositions and his simultaneous search for his mother’s family and her grave.

Admitting that he was never one to rock the boat or be confrontational, as the story unfolds, Dr. Bremner finds his courage to see both trials through, though not without significant pain and suffering. By confronting his own painful memories, he is able to overcome every obstacle that would have derailed his quest for justice.

Through Dr. Bremner’s quest for his mother’s history, he is able to find her grave and hold a family memorial service. Around the same time, Roche takes Accutane off the market and his published article is found to be free of any alleged fraud. By seeing the injustice in Roche’s actions and being able to relate them to the injustice of not being permitted, as a child, to grieve for his mother, he was able to finally integrate that loss and honor his mother.

The story ends happily for Dr. Bremner and his family, including his wife Viola, who knitted him a scarf from wool taken from the sheep at his family’s former house in the state of Washington. This was the house where he lived until his mother died, and that he and his own family recently visited. The story is not only one of personal growth and tremendous courage, but also of how cautious patients should be concerning medication. Roche’s denial of the depression and suicide problem for the sake of maintaining their profit is a disgrace. Because of Dr. Bremner, at least one harmful drug is now off the market. The book is a powerful warning to become knowledgeable about other medicines and not to naively trust whatever Pharma may try to market – to you or your doctor. It is also a powerful testament to human courage, strength and love in the face of fear and pain and loss.

Review by Louise Gordon posted on Amazon here.

Part 1

Part 2

Part 3

Part 4

Part 5

The Australian Journal of Boneheads and Joint Medicine, which was published by Extracta Moneya, a division of Dutch scientific publishing juggernaut Greed-Elsleazier, also contained little in the way of advertisements apart from ads for Formonimax, a Phoni drug for osteoporosis, and Viletoxx, Phoni’s controversial pain-killer.

In a statement provided last week to The Scientist, an eminent Australian physician and long-time member of the World Association of Medical Editors reviewed four issues of the journal that were published from 2003-2004.

“An average reader, such as a doctor, could easily mistake the publication for a genuine peer reviewed medical journal”, he said. “Only close inspection of the journals, along with knowledge of medical journals and publishing conventions, enabled me to determine that the Journal was not, in fact, a peer reviewed medical journal, but instead a marketing publication for Phoni.”

“They’ve done a heck of good job, and it was only when I noticed that some of the names of the so-called “honorary editorial board” appeared to be made up that I became suspicious,” the reviewer admitted.

“Professor Phil. I. Daftwhoofing appears to be an anagram of “Ripping Off Fools Who Read This,” for example. Similarly, Dr. Leon Theophuleet is an anagram of “Pulled The Other One”. And “Gill Ripcheap” seems to be an anagram of Rich Pillager, who I believe is Phoni’s Head of Global Marketing…”

A spokesperson for Elsleazier, however, told The Scientist, “All of our journals are thoroughly peer-reviewed prior to publication, by our accountants. Our company would never publish a journal unless it was guaranteed to make us lots of money. After all, our publications are well-known for the standards they deliver – standards of living for our publishing executives, that is…”

Disclosure of Phoni’s funding of the journal was not mentioned anywhere in the copies of issues obtained by The Scientist. Elsleazier acknowledged that Phoni had sponsored the publication, but did not disclose the amount the drug company paid.

The spokesperson added that Elsleazier had no plans to look further into the matter. “The high prices of subscriptions to our journals are a guarantee of their quality,” he said. “After all, everyone recognises the quality of Australian scientific publications, in the same way that American diplomacy journals or Nigerian accountancy and banking magazines are regarded…”

One of the genuine members of the Australian Journal of Boneheads and Joint Medicine’s “Honorary Editorial Board,” Dr. Táké Bakhandar, a rheumatologist in Australia, said he was delighted to serve on the board, however. Dr. Bakhandar has been on Phoni’s Asian Pacific and international advisory boards since the mid 1990s, as well as the advisory boards of other pharmaceutical companies, including Pfizer and Amgen.

“You get involved in a whole bunch of things at this level,” he said, adding that he had put his name on “quite a few advertorials” for pharmaceutical companies in the past 10 years. “I’m delighted to be able to promote the life-enhancing products of the pharmaceutical industry,” Dr. Bakhandar said.

His colleague and fellow member of the Australian Journal of Boneheads and Joint Medicine’s Honorary Editorial Board, Dr. Pádme Baksheesh, agreed. “My own observations conclusively show that there is a direct relationship between the number of products I plug for pharmaceutical companies, and the degree to which my life is enhanced,” he said.

Rich Pillager, Head of Global Marketing for Phoni Pharm. Inc. was also unrepentant.

“The Australian Journal of Boneheads and Joint Medicine” is an important tool in Phoni’s CME (Continuing Medical Education) programme,” he said.

“After all, we’ve been putting out advertorials for years. Everyone remembers our series of children’s books that were designed to promote the use of Phoni’s SSRI Saloadatat in children, for example,” Pillager notes, referring to the controversial “Mr. Bipolar” book based on the UK “Mr. Men” franchise.

“Our competitors have been doing exactly the same thing, only we’re aiming our latest fairy tales at the adult market. I can’t see what the problem is,” he frothed rabidly.

[this was a spoof piece but unfortunately the quote
"You get involved in a whole bunch of things at this level,"
was real, and the fake journal was real as well]

For more of Pharma Giles work see his hilarious children’s book ‘The Story of Modern Medicine’.
[via pharmagossip and scientific misconduct blogs. Hat tip to Dan Abshear]

It all started that night in my office. There I was sitting in the dark, leaning back in my chair, my legs propped up on the desk. If there was one thing better than having a phone that never rang, it was having two phones that never rang.

The smoke from the cigarettes was floating around my head and the whiskey was tasting better with each swallow. On the radio Sinatra was crooning “I’ve Got The World On A String.” Yeah!

I hadn’t had a case in weeks and I was seriously thinking about getting a new line of work. Being a pharmaceutical litigation consultant just wasn’t paying the bills.

I like the good things in life. Like liquor, women, reading, chess and working alone. I’m educated enough to speak English if I’m required to. I used to work for the Big P, but was fired for insubordination, thus starting a cliche that still hasn’t run out of steam. But I’m all done with hating them. It’s all washed out of me. I hate pharmaceutical companies hard, but I don’t hate them very long. How many ex-marketing VPs are there out there that have become litigation consultants? Not many.

I needed a drink. I needed a lot of life insurance. I needed a vacation, I needed a home in the country. What I had was a coat, a hat and an overdraft.

So here I am in 2008. I’ve turned fifty and what do I have to show for it? A second floor office (that doubles as my abode since I was booted out of my apartment) above a two-bit saloon in downtown Peapack NJ that serves watered down drinks and has a neon sign that is driving me wacky. A ’05 Lincoln Continental that I bought with my last pay check pay from the Big P in 2005. A black suit with two pair of pants, and a broken computer from one of the many working overs it’s taken since I became a Hard Boiled Blogger.

Yeah, I’ve got the world on a string all right…

Then came the knock at the door.

I could see through the frosted window on the door into the lighted hallway that it was a dame. And boy, what a dame! The outline of her body looked like an hourglass with a head on it.

“Come in,” I said. As she started into the room I reached for the desk lamp.

“No,” she drawls in a Mae West voice, “I prefer the dark side.”

As she walked closer to me I could see her face, lit by the flashing neon light shining through the window. She had long brown hair that hung to her shoulders. Her green eyes sparkled from the flashing light. Her full lips were covered with ruby red lipstick, smiling a smile that hit me smack in the libido. She must have greased up real good to fit into that dress.

“Are you the one they call, ‘the Doc’?” she purred, interrupting my inventory of her.

“Yeah,” I replied. I felt like that wolf in those Tex Avery cartoons, with my tongue hanging to the floor and my eyes popped out of my head a foot. “Have a seat,” I managed to say.

“No thank you, I prefer to stand. My name is Linda. But you can call me Mrs. Robinson. Tell me Doc, just what do you want most out of life?” she asked.

I was in luck. Philosophy was my long suite. “A thousand a day, plus expenses,” I told her.

Without batting an eye, she reached into her big black purse and pulled out a big wedge of smackers. She then threw it on the desk in front of me. “Ten days, in advance,” she said.

Well, here’s to you, Mrs. Robinson. I just love it when women talk dirty. And this broad spoke my language.

“So, what’s the case?” I asked.

“You are,” she said.

“Case solved,” I replied. “That’ll only cost you five thousand bucks.”

“No,” she said, “you don’t understand. My clients are a little concerned about your Chinese friend. They want you to call her off.”

I only had one Chinese-sounding friend. A little lady called Qui Tam. And I wasn’t about to sell her down the Suwannee, even for the Abe Lincoln picture collection that was lying on my desk right now.

“So just who are your clients?” I asked. I was getting wary of this dame. She was the kind who lied just to keep in practice.

“Is that any of your business?” she replied sweetly, her smile playing a rumba on my nether regions.

”I could make it my business,” I replied.

”I could make your business mine” she countered.

”Oh, you wouldn’t like it,” I told her. “The pay’s too small.”

Sure, the dame was sharp, but not sharp enough to cut the baloney. I knew I could end up making small talk all evening if I wasn’t careful. Talking to her was like trying to open a sardine can after you’d broke off the metal lip.

“So what’s a smart dame like you doing working for a bunch of crooks like the Big P?” I asked, hoping to make some headway.

She smiled. It hit me in the hip pocket. “It’s a long story and it’s not pretty,” she replied.

”I got lots of time and I’m not squeamish,” I shrugged.

Mrs Robinson sighed. My heart played hoopla in my chest. “Why do you bother with Qui Tam?” she pleaded. You know she’s no good for you.” She gestured to the greenbacks on my desk. “Why not take the money and give up on her? Why do you have to go on?”

It was a good question, and one that I’d often asked on those long lonely nights when sleep itself seems like a dream too good to be true.

“Because too many people have told me to stop,” I replied. “Trouble is, I’m a romantic at heart, see? I hear voices crying in the night and I go to see what’s the matter. I know I don’t make a dime that way. There’s no percentage in it at all. But it’s just something I do.”

It was all beginning to make sense, in a screwy sort of a way. I get dragged in and get money shoved at me. I get pushed out and get money shoved at me. Everybody pushes me in, everybody pushes me out. Nobody wants me to DO anything. Okay, put a check in the mail. I cost a lot not to do anything. I get restless. Throw in a trip to Mexico.

“I hadn’t supposed there were enough whistleblowers these days to make litigation consultancy very attractive to a man like you.” she sneered.

”I stir up trouble on the side.”

“You know, I think you’re nuts. You go barging around without a very clear idea of what you’re doing. Everybody bats you down, smacks you over the head, fills you full of stuff and you keep right on hitting between tackle and end. I don’t think you even know which SIDE you’re on.”

”I don’t know which side anybody’s on. I don’t even know who’s playing today. I had more careers than you’ve had lovers, sweetheart, and they’ve gone just the same way. Don’t try and ask me why.”

“I’m afraid I don’t like your manners.”

“Yeah, I’ve had complaints about them, but they keep getting worse. I grieve over them on long winter evenings.”

Mrs. Robinson finally turned off the megawatt smile. My libido breathed easy.

“I think we’re done talking, Doc,” she said. “I’m at the Courtyard Marriot, Basking Ridge, New Jersey, room 108. Let me know if you change your mind.”

She turned and walked out of the office. “I’ll be waiting,” she purred.

I couldn’t keep my eyes off her swaying hips as she walked towards the stairway and disappeared down the steps. The smell of her perfume lingered on after she left. I could hear the radio again now that she was gone, although it was playing the whole time she was here, Eddie Fisher was singing “I’m Walking Behind You,” and in my mind I was walking behind Mrs. Robinson.

I got up and looked out the window just in time to see her getting into a big red Caddy. Holding the door for her was the biggest guy in the world, at least 6’6″ and 400 pounds. As she was getting into the car, she glanced up at me with a look that could melt your heart.

“Tiny” also looked up at me. His stare could have melted iron. As they drove away, I couldn’t get her out of my head.

But I couldn’t give up on Qui Tam. She was all I had lived for these past two years. I had put in too much to get out. It was a matter of pride. But pride doesn’t pay the rent. I walked over to the coach and laid down. I tried to get some shut-eye but all I could do was think of Mrs. Robinson. And her client’s money.

[via Peter Rost MD blog]

Read more Pharma Giles here.

As I have written about before, sociologists know that there is a group of innovators, early adaptors, and then the “herd” that follows along (see “Diffusion of Innovations in Service Organizations” or “Disseminating Innovations in Healthcare“). It is true for farmers in Costa Rica adopting a new type of grain seed, or for psychiatrists prescribing a new brand of antipsychotic.

Although a new and superior kind of seed was introduced in 1925 it took another 10 years for all farmers to adopt it.

Doctors don’t “read” the literature and then go out there and make a decision about what they should do. They look to their “mentors” or the early innovators, in this case their professors from medical school, or their surrogates.

Human behavior dictates that a few early adopters are looked to for guidance by most

Most look to the early adopters defined as ”experts” in the medical field, who are often branded as such at national professional meetings with the support of the pharmaceutical industry, who have coined the term “key opinion leader” or KOL. They, unfortunately, are often heavily subsidized by the pharmaceutical industry.

Qform is a business, and they are not developing a list of KOLs in every city and speciality for their own amusement, or to help people find doctors. They are doing it because they can make money by selling the lists to others who can make money by identifying the KOLs. They are selling influence. To see another particularly egregious example, take a look at the company called kolonline, where they openly boast on the internet about their ability to “manage” your kol for you (their words, not mine). I couldn’t believe it either when I first saw this.

So I guess that would make kolonline... what?

From their website:

As our name implies, we are a company devoted to providing Key Opinion Leader software and Key Opinion Leader Management services for pharmaceutical, biotechnology and device companies. We have invented two (2) world-class proprietary web-based applications for managing and developing relationships with KOLs (some have described them as ‘knowledge management systems’). More importantly, because we have actual real-world experience from working in the Pharma industry we provide unparalleled service and consulting. We have held positions in medical/scientific affairs, medical science liaisons, medical education, drug information, sales training, strategic marketing, product management and field sales.

The principals in KOL, L.L.C. have deep experience in cardiology, anti-infective, pain management, diabetes, gastroenterology, urology, women’s health and central nervous system products. As such, we have developed personal relationships with many KOLs.

We are “The Key to Opinion Leader Development™”.

Sidebar reads:

We have developed a “validation tool” which provides a systematic, unbiased ranking of all the KOLs in OLms or ISCP.

We can manage your key opinion leaders (KOLs) for you

And let’s not forget their handy software, the Opinion Leader Management Service (OLms), a “web-based application with accompanying on-going services designed to help pharmaceutical and biotechnology companies:”

• Manage and develop KOLs
• Demonstrate value to their organization (ROI)
• Showcase MSL activities
• Build and Monitor KOL Development Plans, Goals and Activities

OLms provides:

• Convenient, secure, confidential, web-based access (24/7/365) to information about your KOLs, including their contact information, publications, presentations, trials, society memberships, etc (the KOL ‘Knowledge Capital’) and links their activities to your core scientific concepts
• KOL identification
• KOL validation – provides an unbiased ranking of KOLs based on predetermined criteria to ensure consistency and avoid favoritism
• Effective communication system – users can enter notes and insights
• Thousands of reports – KOL contact info, KOL Development Plan goals and activities, compliance (consulting/confidentiality agreements), MSL monthly reports, etc
• Service – we build the records of each KOL and continually update them
• Cost-effective KOL management – our pricing is reasonable and OLms is designed to demonstrate a return on your investment (ROI)

How about their demo?

As you can appreciate, for confidentiality reasons, we can not take you to any of our client sites; however we do have two (2) demonstration sites with generic, non-confidential information which will provide you an overview of the kind of information and service we provide. Because these demo sites are web-based, you and your colleagues can view from your office while we are in ours. Then, if we appear to be the “right wrench for the job”, we are happy to come to your office for a formal presentation. A demo normally takes about 30 minutes on line.

Do you think this wrench will work?