Archive for the ‘Musings’ Category

Rant warning.

This stupid article appears in a Forbes blog: A Vaccine against Suicide?

Why do I consider it stupid? Not because of the problem it addresses (suicide is a major problem, and prevention is a good thing), but because they abuse the terms “disease” and “vaccine,” and over-medicalize a problem that primarily has other roots.

This article yaks on about public-health interventions targeting youth, with comments by an epidemiologist and a bunch of well-meaning but vaporous babble that doesn’t justify in the least the headline, or the approach being “offered.”

The best defense against suicide is a good family and social offense – a supportive environment which encourages accomplishment, rewards good behavior, discourages self-destructive behaviors, and puts the arm of love around kids. In other words, solid families, healthy neighborhoods, strong social ties – you know, all the common sense stuff we’ve always known.

Re-casting suicide as a disease and talking about vaccines while off-loading more responsibility to medical/psychological “experts” is stupid. It’s an analogy with undesirable consequences. I’m all for medical interventions when necessary, but let’s keep the primary focus where it belongs, and stop screwing around with the language.

It is our role to love kids. Not some “expert’s” role to vaccinate.

Rant over.


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forrecordIf you’ve read my posts and tweets over the years about the pharmaceutical industry, you could easily come to the conclusion – based on which ones you’ve read – that I’m either pro-pharma, anti-pharma, or deeply conflicted.

In case you’re wondering, the answer is Yes. All of the Above.

I emphatically do NOT sympathize with those who wish to portray the pharmaceutical industry as some sort of evil empire, a hopelessly degraded industry that only exists to rape the public, and a convenient whipping boy for opportunistic politicians and ignorant snake-oil promoters. I also strongly disagree with those who short-sightedly wish to ban pharmaceutical sales – as if this industry does not have a right to create and promote its products in the marketplace. If you ban pharma from “selling”, what is the next business you’ll put on the chopping block as unworthy of free-speech constitutional rights? Software companies (huge profit margins, by the way, and often defective products)? Sports teams (talk about inflated prices and corruption!) How about we start with tort lawyers? Hmmmm – OK, better stop there…

On the other hand, I seek to practice a very clear code of personal and professional ethics, and it grieves me whenever I see (in ANY industry, but I happen to have been involved in pharma/medical devices for 23 years) mindless greed, manipulation, lying, lack of transparency, and wasteful spending. There’s plenty of that in Pharma, and I despise it. But remember – there’s plenty of that EVERYWHERE (yes, including among politicians…). If you’re a pharma-hater, just step back and recognize that this is a human problem, not a pharma-specific issue.

Finally, for all the flaws and problems with the industry, there are life-changing products that come out of it. A smile comes to my face every time I think of the awesome efficacy of the cancer drug Gleevec. My children have an opportunity to know their grandmother (my mother) because of drugs that control her high blood pressure. And my own life has been transformed by use of an anti-depressant. So, if you wonder why at times I praise, excoriate, question, and seek to serve this industry, now you know – it’s because the pharma business is a flawed human endeavor JUST LIKE EVERY OTHER, and I’m a flawed human being just like every other. For the record…

(Image credit)

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A Tale of Two Shoes

I have wide feet. Not a big problem (I guess my balance is pretty good) – except when I have to buy shoes. Since I need to find shoes that are WWW, when I find something that fits, I’ll often buy two sets with different colors (say, black and cordovan) because it ain’t easy to find something comfortable.

This week, I had an early morning flight to Chicago. I’d packed up the night before, but floundered around a bit getting dressed in the early morning darkness, as my wife and I had just switched closets. I put on my comfortable work/travel loafers and headed out to Newark airport in plenty of time for my flight.

2shoes-smDoing the standard routine of piling all my stuff on the conveyor belt for passenger screening, I popped off my shoes to put in the plastic bin, and suddenly noticed, with bemused horror, that one shoe was black, and the other cordovan! They were a matched set all right, in style and fit – there was even a right and a left version. They just happened to be…umm, mismatched!

My first instinct was to look around in profound embarrassment at being such a bozo as to wear mismatched shoes. Then I realized that what I had done was a perfect illustration of what my work is all about helping clients with vendor selection. When you’re trying to find a match “in the dark,” there’s a pretty good chance you’ll end up with…well, something like what you see above! My role, in helping you find a vendor match, is to save you the lost time and (potentially) lost professional reputation by recommending a vendor that is the right size, fit, and style for you.

I was tempted to go in to see my client wearing these shoes as an example. But, professional propriety forced me stop off and do what many of you have had to do in the past – spend extra time and money making up for a mistake when selecting something without enough light. So, now I have a new pair of casual loafers that are pretty nice (but I don’t really need) and I get to drink my own Kool-Aid next time and make sure that I have the right “match” before starting out!

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I recently completed a six-part series (One Interface to Rule them All) on my StickyFigure marketing blog, regarding ideas I have for the “ideal” web interface. It generated a good bit of discussion in the marketing blogger/social media community. I’ll include a link here to post #1, which includes links to all the related posts.

Geek alert: this series will be most fully appreciated by those who enjoy thinking about software interfaces, and have some knowledge of web 2.0 stuff…

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Call me an idealist, but I think true professionals yearn to add value. There is no fulfillment in collecting a paycheck while being unproductive (except for the chronically pathetic “worker,” but that’s another post).

So, in your current role, what is your value-add? How are you making life better for customers? How is your company benefiting from your contributions?

One of the key indicators that it’s time to “move on” is that you begin to conclude – over the long-haul, not just during a bad week – that you are no longer adding significant value. Either you have changed, your company has changed, the business environment has changed, or some combination thereof…whatever the reason, you are not in an optimal role any longer.

Or, perhaps, the role was a mismatch to begin with. You read “First, Break all the Rules,” and “Now, Discover your Strengths” and you realize that your strongest abilities are not really being leveraged in your current role.

What to do? Find a way to move on. No-one wins when you’re not adding the kind of value that you could/should. Determine where your “gold” is – where you are most productive, gifted, and fulfilled; and then find the place that needs you.

I walked away from two professional positions (each after ~10 years) when I concluded that things had changed sufficiently that I could no longer provide optimal value. Amicably, with forethought and planning, I fired myself and embraced new opportunities that were a better fit. Had I become less capable or knowledgeable? To the contrary. It was just a matter of recognizing that I could no longer add value that way I needed to. And that’s OK.

Business conditions will continue to change rapidly. We needn’t assume that we’re going to be in one place forever, or that our contributions will be the same over time. One of my philosophical and practical goals in all areas of life is to create and build, get it established, then move on to new challenges. That’s how I add value – not by a lather-rinse-repeat cycle of repetitive tasks.

How do you add value? Are you prepared to take a clear-eyed look at your current role, ask yourself and others what your greatest strengths are, and look into new opportunities?

( Related post: Be Prepared – like right now! [networking] )

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It Stinks Around Here

As I drove down our street this morning, to drop my son off at school, my nostrils were assaulted by the evidence that one of God’s creatures was compelled – by imminent threat or by rapidly-revolving Goodyears – to let loose a malodorous expression of its displeasure.

skunk.jpgEven now, as I sit in my home office typing, the air quality has one overriding, pungent aspect to it…

It stinks around here.

No matter how many other pleasant scents, sounds, and scenes are outside, all are temporarily obscured by an overpowering odor that none can ignore.

Which brings me to this industry in which I work, and for which I have affection and concern.

It stinks around here.

The many contributions of the pharmaceutical industry to our overall health and well-being would be difficult to enumerate. Life-changing medicines have fundamentally altered the way we live; and for many, have given or restored life itself. But when it comes to many of the commercialization strategies, I’m afraid that the industry has shot itself in the foot.

The sales rep arms race. Spending-for-influence among doctors. Biased study results. Questionable DTC practices. Patenting incremental changes. The list could go on and on, but here’s the question: Why?

Here’s the answer: Commercialization strategies focus on maximum volume at maximum profit.

Now there’s a careful line we must tread here. All business focuses – legitimately – on growing volume and profit. That’s business; and if you don’t like it, go off in the woods and join a commune somewhere. But what should be the goal of a pharmaceutical company?

Let me propose a simple series of 5 statements:

    The right medicine,
    for the right people,
    at/for the right time,
    used in the right way,
    for the right reasons.

Who can argue with this overarching goal? What would you propose as an alternative – the wrong medicine, for the wrong people, for the wrong reasons?

Actually, yes – when your commercial strategy is to grow at any cost, that is exactly what will happen.

How would this simple set of 5 statements change the way we do business?

Here’s an example. Erectile dysfunction is a real medical condition. Pfizer, with Viagra, brought it to public awareness. Competitors followed on. But now the market must be grown – somehow. So all of a sudden, the conversation is changed to erection quality, and statistics are generated to try to expand the notion of prevalency, and ads morph away from medical emphases to recreational themes.

Now, put all that next to the touchstone of the 5 statements, and it becomes clear why something stinks around here. We’ve sacrificed right use for volume. A company’s commercial strategy exposes its true values. And everyone can see what the emperor is wearing for an outfit.

Off-label promotion is a violation of the entire set of statements. Neurontin was originally approved for epilepsy. However, the folks at Parke-Davis (later acquired by Pfizer) promoted it for a whole range of other uses, such that about 90% of the prescription volume was for non-epilepsy cases. Doctors are, of course, free to prescribe off-label, but companies operate under black-and-white rules about promotion, and Pfizer eventually paid huge fines for the stench of this kind of marketing.

Much of the commercialization stink has arisen because of a drive to get new prescriptions. But if we look carefully at the idea of patients getting the right medicines at/for the right time, that should drive companies to put far more effort into patient compliance/adherence. For many patients, taking their medicines for the right amount of time – sometimes, the rest of their lives – is the critical piece, and huge numbers simply do not follow through and continue their prescriptions. Better strategies to address this major health concern (and incidentally, huge potential source of profit for drug companies) would go a long way toward creating more good-will and encouraging responsible use of pharmaceutical products.

We could go on and on but you can fill in the blanks yourself with many other examples. Many good people and good companies operate under the cloud of stench produced by this self-inflicted spray of misguided commercial strategy. It’s a shame that it stinks around here. But let’s not point fingers elsewhere to find the cause.

Here is the challenge I present: Will any company take these 5 statements, post them in their boardrooms and front lobbies, and actually conduct business by them? What a breath of fresh air that would be – for employees, healthcare professionals, and patients alike!

It’s pretty simple, really – if you love the gold more than the Golden Rule, you’ll stink. No P.R. strategy or cover-up will save you. You’ll invite government regulation like flies attracted to…well, dead skunks. Come to think of it, I’ve got to go close the window now…

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The LA Times has been running a series of articles on the influence of drug companies on doctors. Whatever the merits of the articles may be, I found the opening of one of them to be particularly interesting. Here’s the spin:

    FOR many Americans, a doctor’s decision to prescribe medication is something of a sacred transaction. A physician considers the patient and symptoms and chooses the best drug for the job, drawing upon years of training and clinical experience. It is an exchange conducted in a hushed sanctuary, far from the heat and noise of the marketplace — a place where cool judgment reigns.
    That sanctuary has been breached. Today, drug manufacturers do everything in their considerable power to ensure that their brand-name prescription medications are on the lips of patients and in the minds of physicians every time the two meet across an exam table. A growing chorus of critics says their efforts have begun to rewrite the dialogue between patient and doctor, influence physicians’ judgments and open the act of prescribing to forces more profit-minded than sacred.

Now, perhaps my experience is different from most, but I simply don’t recall St. Peter being the receptionist at any of my recent doctor visits. I didn’t go through the pearly gates at the entrance, and the examining room certainly wasn’t a Garden of Eden.

So what we have here is an attempt to set up a straw man of some idealized past doctor-patient relationship, so that now drug companies can be portrayed as the serpents who invaded the garden.

Here’s my question: in truth, was a doctor’s decision to prescribe medicine really ever a “sacred transaction,” akin to some medical priest treating with us in the hushed confines of the exam room confessional? And if it was (and I have my doubts), what other factors besides drug company influence have changed the dynamic?

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Ed Silverman over at Pharmalot wrote up a quick post on the cost (to doctors) of spending time with drug reps.

You can read the full article here – the bottom line of the calculation was that, on average, a doc may save about 1 hour per week by not saving reps, thereby saving perhaps $6,000/year.

OK – 50 hours, 6K.

Now, let’s think about how much of a doctor’s time is flushed down the drain because of the ridiculous amount of paperwork, follow-up, and cost due to government regulation, HMO/insurance procedures, malpractice insurance, and all the other nonsense that sucks away the lifeblood of a physician’s practice.

Where’s the real threat to how we practice medicine? And how come there isn’t more outcry about Big Government and Big Tort Law? The lawyers don’t even give away free pens.

Just asking…

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I just wrote a post on this blog about the place of skepticism when reading news, or any other source of spin for that matter. Then I saw this news article, which really got me steamed.

As I mentioned in my prior post, everyone has an agenda. And here, you can see a dual agenda at work – bash-the-government for its stance on not using public money to finance embryonic stem cell research involving the destruction of new embryos (note each word carefully); and, bash company-sponsored research.

This is actually a very encouraging article – using adult stem cells to treat heart failure, a very serious medical problem. My father-in-law died from it. But note how the bias comes out. Here’s an extract from the article; I’ll add my comments in blue:


    The new experiments all use adult stem cells harvested from blood, bone, muscle and fat ( it is worth noting that, so far, treatments with adult stem cells seem to be far more effective, and safer, than attempted treatments with the embryonic variety). Stem cells extracted from embryos may be more effective in rebuilding hearts, researchers have said (what researchers? On what basis is this speculation made?). American trials (all American trials? What about privately funded ones?) use the less controversial (and perhaps more efficacious?) adult cells because the U.S. government won’t finance research that derives stem cells from embryos (existing embryonic stem cell lines? Or new ones?).

    The human studies generated criticism from scientists (you can find a scientist, researcher, or doctor who will take a stance on anything – who is being referred to here?) who say it is premature to test stem cells in patients (even in last-ditch efforts, with consent?), and that much of the positive data is coming from company-sponsored trials (the horrors! That means that any results must be invalid).

Many folks want to portray all stem cell research as being condemned by the U.S. government, which is patently false. Often, these same people are desperate to paint a portrait of embryonic stem cells as THE panacea, which again is quite unproven. Solid reporting should make accurate distinctions between embryonic and adult stem cell research, what exactly is and is not supported by tax dollars, what is and is not being researched with private funds, and what the relative successes and failures are.

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This month marks the one-year anniversary of my blog here at Impactiviti. I thought it might be a good time to pause and explain, to my readers, what this blog is about, and why it is different from other pharma-oriented blogs that are out there.

When I started publishing the Impactiviti blog 12 months ago, there were only a handful of pharma-oriented blogs in existence. That number has easily doubled or tripled in the past year, which is a good thing! You can see the feeds from many of them at the Pharmacental portal, a site I set up a few months ago to consolidate the “blogs of pharma” for easier viewing.

The Impactiviti blog is a bit different from others, however, in that it is primarily a communications platform for my consulting business, which focuses on life sciences sales training. On this blog, I seek to provide news, resource, links, and other interesting “stuff” for a specific community – pharma training/marketing/communications. As such, I post on issues of interest with a focus on both pharma and training, and I also touch on aspects of my business offerings. This is not, strictly speaking, a pharma news and issues blog – though I don’t shy away from addressing issues, and giving regular news summaries. And, on occasion, items of personal interest that I think others will find useful.

Impactiviti also publishes a weekly e-newsletter, the Friday Collection, with links to articles of interest on this blog and elsewhere. This brief newsletter currently goes out to over 500 subscribers; the link above allows you to subscribe if you do not currently receive it (you are welcome to join in even if you’re not in sales training!).

So, if you have occasionally come across the Impactiviti blog and wonder why it doesn’t seem to be strictly news (like Pharmalot, WSJ Health blog, or Brandweek NRx), or why it’s not full of edgy comments on marketing (like John Mack’s Pharma Marketing Blog), or why it’s not a primary goal to surface whistleblowers or pass on the latest snarky gossip (like Pharmagossip or Peter Rost) – well, it’s because this blog is a hybrid. I filter through all that stuff and pass on what I believe is of most value to my readers. I try to be balanced with both the good and the bad in our industry. I seek to give insight. And, yes, I am seeking to expand my business as a consultant – I have no problems with full disclosure. So, if you didn’t know before…now you have a glimpse what we’re about here at Impactiviti!

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