Friday, March 27, 2009

What's Wrong with Pharma? They Don't Listen to Their Customers

In my last blog piece, I presented a simplified overview of the appalling Pharma management practices that have resulted in no truly new psychiatric meds on the market in more than 50 years, with no replacement drugs on tap that they can even pretend to call new.

What went wrong? Lots of things. But it all boils down to this one cardinal sin: Pharma never listened to its customers.

My background as a finance/business journalist has given me considerable insight into this. Back in the late eighties, when I lived in Australia, I co-wrote a book with a prominent businessperson there, entitled "The Customer," which went to number two on the best-seller list.

It's all about organizing your business around the customer. If management isn't directly serving the customer, then they need to be serving the people serving the customer. It's amazing how entire industries get this principle wrong. Detroit, for instance, has always dictated the terms of the customer relationship. Marketing, to them, is about conditioning us into acceptance rather than finding out what we want.

Look at where Detroit is now.

Detroit, at least, pretends to listen to the customer. Pharma? Let me tell you a story:

Two years ago, I was at a book launch on the east coast. I grabbed some finger food and started up a conversation with a pharmacology expert from Bristol-Myers Squibb.

"Maybe you can enlighten me," I opened. I had been doing some research into dopamine and had pretty well concluded that stimulants and antipsychotics amounted to "dumb" dopamine meds.

We needed "smart" dopamine meds. Surely, Bristol-Myers Squibb was aware of the situation. Surely, such a drug was at least on their radar screens, if not their drawing boards.

(For background on the issue, please see For Discussion: Dopamine Cocktail.)

We actually have a smart dopamine med, the man informed me. "Aripiprozole."

Surely, he misunderstood. Nothing against Aripiprozole (Abilify), but it's been on the market for years. I was looking into the future. I realized he wasn't in a position to disclose any company trade secrets, but he could at least fill me in on some general principles, namely: Where were the next new meds going to come from?

I'm a customer. I have a right to ask.

It was if the man hadn't heard me. Once again, he started talking about aripiprozole, undoubtedly the exact same pitch he gives to psychiatrists. For years, BMS has been telling doctors that aripiprozole is a "Goldilocks" drug - not too much dopamine, not too little, just right.

Stop trying to sell me something. I'm a journalist. I've heard it all before.

Again, I tried to get the conversation back on track. Again, the man tied to shove his stupid drug down my throat. It never occurred to him to ask me why I was so interested in a "smart" dopamine med in the first place.

Were there special challenges I faced that a smart dopamine med might address? he could have asked.

Was there anything about my illness that he needed to know, that he wasn't finding out about from psychiatrists? If a "magic bullet" were to come on the market tomorrow, how would this affect my life? What impact would a safer and more effective med have on my compliance?

Believe it or not, this man could have learned a lot from me. So could BMS and their competitors. Let me assure you, no one in the entire drug industry has even bothered to ask. I'm a patient author and advocate, so if they're not interested in me then I know they are not interested in you, either.

Actually, BMS did bring a patient author on board, Andy Behrman, author of "Electroboy," but in the capacity as a spokesperson - a grateful patient - for Abilify. The arrangement worked fine until the drug pooped out and Andy went public. Then all hell broke loose. (Never piss off a writer: Andy has a tell-all book coming out.)

So what happens to companies not interested in listening to their customers? We know the answer. The evidence is there. Detroit, Wall Street, Pharma ...

"How deserted lies the city," says Lamentations, "once so full of people!"

It's tempting to say, "good riddance," but if Pharma goes down, what becomes of us?


Lizabeth said...

Pharmacy reps are scared enough of the doctors, most of them haven't had the kind of training to know what they are talking about. Talking to actual mental health patients--I don't think they are brave enough. And those that have had some training--I knew some nurses that went over the the Dark Side--have been kind of brainwashed.
After all, some of their stuff works. And sometimes the side effects take years to show up. For instance, my mother, who had breast cancer lived extra years because she was in a clinical trial for a then new drug--Tamoxifen. That is now a first line drug for breast cancer treatment in post menapausal women. But it took a while to figure out it was best for the post menapausal crowd. And they had labratory and radiology statistics to look at.
In Mental Health there are no objective statistics about the actual disease process--not yet. We have MRI scans and theories and the data base is growing, but definitly being able to say this drug will work for that--not yet.

That scares me--and it scares the drug reps too--so they repeat the company line and are afraid to talk to us. They don't want to say to our faces they have nothing guaranteed to help.

John McManamy said...

Another great comment, Lizabeth. People like you make this the best job in the world. :)