WSJ Health Blog

Social Network Theory and Physician Prescribing Behavior

March 23rd, 2011 | 1 Comment | Source: MIT Technology Rev., WSJ Health Blog

Several years ago, scientists led by Harvard’s Nicholas Christakis showed how happiness and obesity can spread through social networks. The team showed for example, that when certain people gained weight, the chances increased that others in their social network would also gain weight. Similar analyses have mapped-out the impact of social networks on influenza outbreaks and cigarette smoking.

Now, Christakis has teamed-up with Larry Miller to create MedNetworks, a company that uses the same network mapping methods to identify physicians that most strongly influence their colleagues when it comes to prescribing drugs. If their work proves successful, they will surely find plenty of drug makers who will pay for their insights.

The Boston-based start-up relies on medical claims data for its mapping studies. It claims to be able to track growth in the popularity of a new drug within professional circles. It has identified physicians within these circles that appear to influence the prescribing behavior of others, in that after they begin prescribing a newly released drug, colleagues within three degrees of separation from them begin doing the same. “We’ve shown that we can predict adoption of pharmaceuticals among doctors,” Miller said in an interview.

To support its claims, MedNetworks cites a case study on the launch of Merck’s diabetes drug Januvia in the Raleigh-Durham area. In this example, prescribers that had Januvia adopters within one degree of separation in their social network were twice as likely to prescribe the drug as those who did not have Januvia adopters in their network.

As another example, MedNetworks reports that when a generic replacement drug for Pfizer’s blockbuster Lipitor became available, prescribers discontinued Lipitor “in clusters…and social network influence accounted for about 40% of the decline.” (more…)

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Is Your Doctor Googling You?

May 13th, 2010 | No Comments | Source: WSJ Health Blog

This post originally appeared on EHRbloggers.com.

These days it’s a given that anyone you meet, from prospective employers to next Friday night’s date is probably Googling you. But how would you feel if you knew that practice extended to your psychiatrist?

detectiveIf anecdotal observations by Brian Clinton, Benjamin Silverman and David Brendel are generalizable, the behavior is common.

Writing the Harvard Review of Psychiatry, the psychiatrists say they have not carried out research on the practice, but they admit having carried out such searches themselves. They claim to have witnessed other physicians conducting patient searches and to have spoken with many colleagues who had done likewise.

“Most patients would probably be shocked that their doctor had the time or the interest to conduct a search,” Brendel told the Wall Street Journal Health Blog. “A good number of people would feel like their privacy had been breached, although a number might be happy the doctor was thinking about them outside of the 15-30 minutes they were spending together.”

In some instances, the practice can save a life, such as when a patient blogs about suicide, but in other cases, doctors appear to be motivated by “curiosity, voyeurism and habit.”

In the absence of ethical guidelines on the matter, the psychiatrists recommend that physicians think through why they are conducting a search beforehand, and consider whether the result will interfere with their relationship with that patient. They should consider asking the patient for consent.

“Some people say absolutely it should never be done; it’s a breach of privacy,” Brendel said. “But many say it should be done as a matter of routine. It’s information that is in the public domain, and it may be information that is clinically relevant.”

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Cardiac-Themed Burger Joints in Legal Dust-Up

March 25th, 2010 | No Comments | Source: WSJ Health Blog

Jon Basso, owner of the Heart Attack Grill in Chandler, Florida and proud creator of the quadruple bypass burger (see picture) is suing his counterpart, who recently started a similarly-themed establishment, the Heart Stoppers Sports Grill, in nearby Delray Beach.

QuadBypassBurgerThe Heart Attack Grill has been around for years. Heart Stoppers began serving it’s artery-clogging, stomach-expanding fare in the past few months.

Both establishments feature Hooter’s-like “nurses” as waitresses and a cardiovascular-catastrophe themed ambiance, which prompted the lawyer representing the Heart Attack Grill to plead his case thusly to the South Florida Sun Sentinel:

“Heart Attack Grill is the originator of the medically themed hamburger grill and restaurant. … It sells high-calorie food products and we have had very extensive media coverage, including numerous shows on the Travel Channel and the Food Network. In my mind, we are just as well known as McDonald’s.”

According to the WSJ Health Blog, the Heart Stoppers folks were negotiating for a Heart Attack Grill franchise before cutting and running. The Heart Stoppers theme “is completely different,” says the lawyer for the upstart. “They didn’t steal the same trademarked Single Bypass, Double Bypass burger”

And Heart Stoppers offers food for vegetarians as well, claimed Iggy Lena, the owner.

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Deac Docs Drop Dimes

April 13th, 2009 | No Comments | Source: Boston Globe, WSJ Health Blog

The chairmen of 13 clinical departments at Boston’s Beth Israel Deaconess Medical Center agreed last week to donate $350,000 to help reduce the need for staff layoffs.
 
BIDeaconess“This was a really easy decision,” Mary Ann Stevenson told the Boston Globe.

The Radiation Oncology chair added, “most of us have been longtime campaigners for the hospital. Most of us feel really strongly about where we work.”

And they’ve appealed to their physician colleagues and reports who are affiliated with the hospital to follow suit.

“We invite you to consider making as generous a contribution as possible,” the chiefs penned in a letter to 1,100 staff physicians that was obtained by the Globe. Donated funds “will support job preservation among the hospital staff (so) they can continue to provide great service to our patients.”

Beth Israel Deaconess is affiliated with Harvard Medical School. It announced last month that it faced a $20 million operating loss for the fiscal year, and planned to enact cost-reducing moves including RIFs as a consequence.

Let'sgetabailout!After that announcement, hospital CEO cum blogger extraordinaire Paul Levy began working with employees on money saving, job preserving ideas.

That let BIDMC reduce the number of layoffs from 600 to 150.

The ideas included a temporary halt in funding employees’ 401(k) and 403(b) retirement plans, suspending a planned 3% salary increase for certain employees, eliminating the annual employee barbecue and ending hospital reimbursement for staff cell phones.

In addition, Levy has cut his own pay by 10%, and that of his executive staff by 5%.

Hospitals across the country have seen patient volumes drop as the Great Economic Crisis prompts people to defer elective procedures. Inpatient volume at BIDMC is off 1% this year.

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DTC North America-Bonanza

December 29th, 2008 | 1 Comment | Source: Wall Street Journal, WSJ Health Blog

In the decade since the FDA began permitting Big Pharma to market drugs directly to consumers, the ads have become ubiquitous on TV and radio and in print media.

The industry spends $5 billion per year on DTC and no one argues the ads move mountains. For example, ads for the highly effective cholesterol-lowering statins have increased their utilization and almost certainly saved lives as a result.

But it’s galled more than a few folks that DTC ads have been equally effective promoting lifestyle drugs that line Big Pharma’s pockets without doing much to improve overall population health.

Rep. Bart Stupak (D-Mich.) for example, never did warm to the DTC concept. In May, he called out Pfizer for Lipitor ads featuring Robert Jarvik, the well-known inventor of the artificial heart because Jarvik is not a practicing physician.

So Big Pharma knew what to expect from Stupak when PhRMA, its trade group announced last week it was tightening its own guidelines governing DTC practices.

The new “voluntary guiding principles” include halting the practice of using actors to role-play physicians on DTC ads, requiring that celebrities cease claiming they use drugs unless they actually do, and ceasing the promotion of drugs for indications not approved by the FDA.

The guidelines also limit ads with adult-oriented DTC content (that would be Viagra and congeners) to programs that normally draw adult audiences.

Stupak offered lukewarm praise and quickly added that the guidelines don’t go far enough.

He wants Big Pharma to wait 2 years after drugs are marketed before releasing ads DTC to assure all drug effects are fully understood.  He also wants the FDA’s toll-free number to appear on DTC ads to facilitate reporting of side effects.

Industry spokespeople indicated they’d be happy to review the issue in a few years if critics remained unsatisfied. There’s no chance the issue remains quiet that long.

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Skin in the Game

December 24th, 2008 | No Comments | Source: JAMA, WSJ Health Blog

In 1960, 13% of US adults were obese. Now it’s 31% and it’s looking like obesity might surpass cigarette smoking as the numero uno preventable cause of premature death.

How can we get people to get serious about losing weight?

Kevin Volpp and colleagues at the University of Pennsylvania thought why not try financial incentives and you know what? They worked like a charm.

The scientists randomized 57 obese healthy male volunteers aged 30-70 years to either of 2 incentive programs or a control group. The goal was to lose 16 pounds in 16 weeks.

In both incentive schemes, participants had to pay to play and could only win if they met weight loss targets during the study. The first involved a cash lottery. In the second, players doubled their money straight-up if they met the targets.

In both schemes, the payout came out to about the same, $300 per qualifying player. The control group received educational materials and monthly weigh-ins.

At the end of 16 weeks, only 10% of the controls achieved the weight loss target. Fully half those in each incentive group made it and the difference was significant.  The findings were not impacted by age, income or initial BMI.

At 7 months, scientists found that the weight of control group participants had returned to pre-study values. Weight of participants in the incentive groups was significantly below baseline levels, although they had packed on some pounds since the study ended.  

And almost no one in the incentive groups was lost to follow-up!

Scientists will want to study the long-term benefits of incentive programs, determine whether the findings can be generalized to women and assess program cost-effectiveness but yea, we know how get their attention all right!

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Tough Sledding for Merck

October 24th, 2008 | No Comments | Source: Wall Street Journal, WSJ Health Blog

After reporting a 28% decrease in Q3 net income, pharmaceutical giant Merck & Co. announced it will cut 7,200 jobs over the next 3 years. This amounts to 12% of its workforce and it comes on top of 10,400 job cuts the company has made during the last 3 years.

Merck said workforce reductions will coincide with the shuttering of research facilities in Seattle, Italy and Japan. Executive positions will be reduced by 25%. 40% of the reductions will involve US-based employees.

CEO Richard Clark indicated the moves were part of the company’s plans to reengineer its R & D, manufacturing and sales processes. “New business models have to be put in place for our industry to survive,” he told the Wall Street Journal.

Merck’s Q3 sales dropped 2% to $5.9 billion. The company attributed the fall to decreased revenue from three key drugs: Gardasil, a cervical cancer vaccine, Vytorin, a cholesterol-lowering drug whose effectiveness has been questioned, and Fosamax a bone mineralization drug that faces generic competition in the US. Merck also cited the economic downturn as a cause of its troubles. The Great Economic Crisis of 2008 has triggered a nearly unprecedented drop in US health care consumption.

Merck did report sales growth for its diabetes drugs, Januvia and Janumet. Sales of the former increased 250% to $379 million. Sales of the latter increased 500% to $101 million.

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Lilly’s $1.4 Billion Zyprexa Hit

October 23rd, 2008 | 1 Comment | Source: Forbes, WSJ Health Blog

Eli Lilly and Company has announced it is nearing a settlement with the US Attorney’s Office regarding unsavory marketing and promotional practices for Zyprexa, its antipsychotic blockbuster. As a consequence, Lilly will take a $1.4 billion charge, or $1.29 per share in Q3 2008.

Lilly stands accused of promoting the drug for psychotic symptoms in the setting of dementia even though the FDA did not approve the drug for this purpose.

As part of the settlement, Lilly announced it will incorporate a compliance program to assure its marketing and promotional practices comply with all laws and regulations.

“We now have a heightened sense of responsibility to all our stakeholders to intensify efforts to resolve these issues,” said Robert A. Armitage, Lilly’s general counsel.

Lilly’s move is an attempt to preempt a long, complex legal battle. Medicaid Fraud Control Units in 30 states had begun coordinating with the US Court while pursuing their own investigations of the matter.

Since its introduction in 1996, Zyprexa has been prescribed for 26 million people around the world. Q2 sales exceeded $1.1 billion, nearly a third of Lilly’s total revenue. Zyprexa sales dropped in 2008 as competitive drugs entered the market and concerns about weight gain and diabetes risk have surfaced.

Last month Pizaazz reported that Zyprexa is also commonly used off-label for psychosis in children, although its efficacy has been questioned and serious side effects have been reported in this group.

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Foxes Agree to Study the Henhouse

October 17th, 2008 | No Comments | Source: Wall Street Journal, WSJ Health Blog

Four stent makers and 4 drug companies have agreed to fund a $100 million study to determine how long vigorous but risky anti-platelet therapy should be continued in patients who receive stents following balloon angioplasty.

Anti-platelet therapy with aspirin and Plavix helps prevent blood clot formation around the stent (pictured), an event which can be serious, even fatal. The downside of anti-platelet therapy is an increased risk of bleeding and stroke. 

In patients receiving stents, physicians typically prescribe aggressive anti-platelet therapy for about one year, but many patients have developed clots after that time. The study will randomize patients to receive one year versus 2 ½ years of aggressive anti-platelet therapy.

The global market for stents, particularly the more profitable drug-eluting variety, has diminished to about $5 billion per year primarily due to concerns about blood clots and bleeding from anti-platelet therapy.

Four of the study’s funding companies are stent-makers: Johnson & Johnson, Boston Scientific Corp. Abbott Laboratories, Inc. and Medtronic, Inc.

The other four are drug companies. They include Sanofi-Aventis and Bristol-Meyers Squibb, which co-market Plavix, and Eli Lilly & Co. and Daiichi Sankyo, which co-developed prasugrel, a Plavix competitor that is edging toward FDA approval.

Plavix by the way, is the world’s second largest selling drug with $5.9 billion in annual sales. It has patent protection until November, 2011. It is anticipated that the current study will take 4 years to complete.

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Paying Doctors to use Quit Lines

October 17th, 2008 | No Comments | Source: Archives Int. Medicine, WSJ Health Blog

Physicians know the dangers of smoking, but they don’t have time to counsel patients. Toll free tobacco quit lines are a proven, cost-effective alternative, but physicians rarely refer patients to such services.

A study published in this week’s Archives of Internal Medicine has shown that paying physicians to refer cigarette-smoking patients to quit lines increases their referral rates by 250%.

The study was a randomized trial of a program offering physicians $5,000 for 50 referrals to a quit line vs. usual care (no pay for performance). Only patients who intended to quit within 30 days were eligible for referral. Physicians in the incentive program referred 11.4% of eligible smokers while those in the usual care cohort referred 4.2%.

The marginal cost per quit line enrollee was $300, a pittance given that in the US, tobacco use causes 440,000 premature deaths and $75 billion in extra medical costs per year.

The study’s authors commented that health plan collaboration was essential to program success. It streamlined referrals and allowed physicians to refer patients regardless of their insurer. Thus physicians could target all smokers rather than just those from certain health plans.

(more…)

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