Letters to the Editor - April 12, 2004

Detailer visits long on numbers, short on good information - HIV medicine academy opposes price increase for Norvir - AMNews used the wrong word in reporting liability trial verdict

Detailer visits long on numbers, short on good information

Daily an unceasing train of detail men and women rumbles through our offices. In their wake is left an abundance of sample pharmaceutical products and a quantity of gibberish styled as a scientific justification for the preference of one glittering product over another.

Lightening-fast interactions conducted across a "windowed barrier reef" or Formica countertop, leave a blur of claims and unchallenged assertions hanging in the air for the physician to contemplate (but not for too long). All the graphs strung together would undoubtedly reach to the moon, but to no higher intellect.

Absent from the quotidian detail visit is any rational discourse of data presenting an adequate expression of dependent measures, (e.g., the "Seven Criteria For Benign Prostatic Hypertrophy," or the clinical criteria by which one could reasonably sample symptoms of depression or insomnia).

Absent from the puffing concerning the value of a given product is a rational offering of data (e.g., the number of patients needed to be treated to achieve one benefit, and reporting experimental data in natural [absolute] rather than relative frequencies).

Absent from the detail is comparison data of a reliable nature presented in a comprehensive and clear manner that would permit a clinician to make rational assessments and choices of the value of the pharmaceutical product.

To the extent that medical education is a potential benefit to be achieved from drug representative visits, it is imperative that the profession forcefully express itself concerning what it demands from the industry's presentation of data.

Medical societies owe it to their members and to the members' patients to shape the manner in which pharmaceutical information is imparted to its constituents.

Medical care can only benefit by a rethinking and remounting of the traditional drug detail.

The detail has changed very little since I was awarded my first premium pen. Also, everything else in medicine has changed, and so the drug pitch must change along with the shifting tide of medical necessity, education, economics and rational drug use. Let us act within our societies to effect reasonable changes and bring useful detail to the detail.

--Scott A. Kale, MD, Chicago

HIV medicine academy opposes price increase for Norvir

Regarding "Doctors protest 400% price hike in HIV medication," (Article, March 8): Your article states that: "Abbott spokeswoman Ann Fahey-Widman said company representatives met with doctors, including members of the HIV Medicine Assn. and the American Academy of HIV Medicine; patients; and patient advocates about the matter. Afterward, the company decided to leave the drug [Norvir] pricing at the current level in most cases."

Our concern is that the above is worded so that it implies that Abbott left the price increase in place with the agreement of the academy and other parties. In fact, the academy does not agree with the price increase even with the recent steps taken by Abbott listed above.

The academy has taken a strong stand against the Norvir price increase. On Jan. 2, the academy formally responded to this matter with a strong letter to the Abbott CEO rebutting some of the company's claims, expressing academy members' extreme concern, and urging Abbott to significantly reduce the price increase. In addition, the academy has made the decision to not request funding from Abbott Laboratories for additional projects.

--Howard Grossman, MD, chair, New York/New Jersey Chapter; board chair, Public Policy Committee, American Academy of HIV Medicine Los Angeles

AMNews used the wrong word in reporting liability trial verdict

Regarding "Dr. Diakos on trial" (Article, March 22/29): Your article refers to Rose Diakos, MD, as being found "not guilty" of malpractice. This terminology is incorrect, and has negative connotations.

Physicians are not "found guilty" of malpractice. Physicians are found "liable for damages based on a preponderance of evidence." Guilt or innocence refers to criminal actions, not civil actions, and the standard of proof in criminal actions is "beyond a reasonable doubt." The distinction is an important one.

--Mark Fritze, MD, Andover, Kansas

Editor's note: AMNews regrets the error.