Sunday, January 29, 2006

Ever seen a drug rep sales pitch?

Some excerpts from 2 (two!) Fed Ex letters I received from Valeant Pharmaceuticals:

As a recognized leader in Palliative Care you have been specially selected to particpate in a Consultant Forum. The to understand the current perceptions towards Cannabinoids and their potential...

Now I thought that was nice that they complemented me. Made me feel good. A recognized leader. Not bad for being two years out of fellowship. Hmmm..the current perceptions towards Cannabinoids. More on that in a bit.

Consultant Forum particiapants will be provided a consulting honrarium of $500 from Valeant Pahrmaceuticals. ...will be held at Ruth's Chris Steak House in conjunction with the AAHPM 2006 Annual Assembly.

Wow! That is a lot of money. In fact very close to the amount for the whole assembly. 3 days of educational talks and I have to pay over $500, but then I could also receive $500 for helping advocate for cannabinoids in the United States.

Well since you already know my opinion on pharmaceutical industry and honorariums, (I don't like them and vow not to take any pens or 'free lunches.') you already know I was not going. I will be going to the Grand Ol' Opry that night on my own dime though!

So I did a little digging. Valeant Pharmaceuticals is based out of Costa Mesa, CA and is the maker of Cesamet (nabilone) an anti-emetic based on the cannabinoid class. My first letter was received in early January. Five days after the FDA denied Valeant changes in labeling.

What those changes were are not clear, but Valeant is not putting Cesamet on the market until further discussions with the FDA. Well Cesamet is on the market in Canada where it controls 88% market share. The drug was originally developed by Eli Lilly, but never went to market in the US when it was apparoved for Chemo induced nausea and vomiting in 1985.

So where am I going with all this?

Nabilone itself looks like it may be an effective antiemetic per this report in BMJ in 2001 (pdf) (no declared competing interests). I have no problem advocating for more effective medications for palliative care. My problem is the way this is done. I may end up advocating for this medicine, but I do not feel like I need to get paid $500 or get a nice steak dinner for it. Why not more discussion among oncologists if they feel they have no effective tools for chemo induced N/V? Why not more presentations at conferences that are open to scrutiny by peers and without funding from the pharma?

I want everyone to understand I have nothing personal against nabilone, cannabinoids or Valeant Pharmaceuticals or the FDA. I believe this is all part of the dance of the current system and it is unfortunate it has to be this way.

I know my question at the Assembly will be: Hey you going to Ruth's Chris on Friday night?

PS: Like the name: Cesamet (Cease + Emesis OR Cease + Mets)

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