Monday, November 26, 2007

Effexor, Marketing, and Dr. Drug Rep

Great job by Dr. Daniel Carlat. Read his piece in the New York Times Magazine regarding his stint as Dr. Drug Rep, when he stumped for Wyeth's antidepressant Effexor for a cool $30k in one year. Not bad work if you can get it. It is a fascinating account of a common industry practice -- train doctors to give speeches to other doctors in which certain treatment is pushed hard. Overplay efficacy and downplay negative effects. Drug companies state, with a straight face, that this is "educating" physicians -- buying them fancy dinners and having one of their colleagues read company-produced marketing slides on their product.

Carlat's blog is also a great source of information.


Anonymous said...

I'm a bit puzzled by all the unconditional kudos being offered Dr. Carlat.

At the time he decided to become a drug company salesman, the things he experienced were hardly secrets. There was an existing literature on the tactics used by Big Pharma.

This did not happen in 1982- or even 1992. This was in 2002!

So, was Dr. Carlat (1) simply uninformed- or (2) was he aware of the potential issues but was blinded by dollars or (3) am I being totally unfair here?

I am so glad he has written up his experience- this is important stuff. But doesn't anyone else have the thought, "What was he thinking? Was he really this naive?????"

Just food for thought.

CL Psych said...

I agree that Big Pharma's tricks have been documented for quite some time. However, in defense of Dr. Carlat, one has to consider the culture in which physicians, including psychiatrists, are raised -- drugs are necessary and good, side effects are modest, and progress is continuous (new drugs are better than old). So I don't necessarily blame any individual doctor for being misinformed. The entire relationship between drug companies and physicians must change, starting in med school. And doctors need to learn how to interpret research findings so that they don't engage in crazily un-supported practices like doling out atypical antipsychotics by the truckload to the elderly and to badly behaved kids.

So, when any doctor breaks the mold and sounds the alarm that something is wrong, it is a sign of progress in my book.

And regarding your comment "was he really this naive?" -- it appears that naiveté is the order of the day in today's mental health treatment world, perhaps especially so among the "thought leader" crowd. And, in some instances, there is certainly a good chunk of greed thrown into the mix.

Alex Chernavsky said...

And speaking of 2002, here's an interesting column that appeared in the Wall Street Journal that year:

"Doctors Aren't Immune To Pitches by Drug Firms"

In my more pessimistic moods, I wonder if we're really making any progress. Articles like these (and even whole books) come out on a regular basis, but is anything substantial changing?

And as for naïveté, yeah, sure -- but there's also a whopping dose of hubris. Doctors think that because they're smart, and because they've undergone years of training, they are therefore immune to the subversive effects of marketing. Hah -- it is to laugh.

SAM said...

Hi! My name is Sam and I am a psychologist living, currently in Portugal.

Just wanted to tell you that I've been reading your blog and have linked it in my portuguese-language blog.

Thank you!

CL Psych said...


I likewise wonder if any progress is being made. For example, when I see the atypicals running rampant in treating, um, everything, despite a very questionable risk-benefit profile in many conditions, it does not seem to represent progress...


Many thanks for the link. I appreciate a growing readership from around the globe. I've also been picking up more psychologists as readers lately, which I take as an encouraging sign.

soulful sepulcher said...

I made the mistake of reading one of SAM's english worded blogs and got a computer virus from hell. Just an FYI.

Anonymous said...


Im a Computer Enginer, and i can tell you, that its not possible to get a virus from a webpage, specially from blogspot (which belongs to google btw), something else must have happened.
I think that probably and by coincidence you got a warning from your anti-virus while you were browsing the blog, which doesn't mean the blog was the cause, its just a coincidence.

soulful sepulcher said...

well the virus attacks have stopped since i dumped google's ad sense too.

and it wasn't from browsing a blog , it was actually from reading the comment section of the referenced blog.

thanks for the tip though.

Anonymous said...


adsense is just an advertising service from google, its just text and links, there is no way you can get a virus from it, its pretty much impossible, if you really think you got a virus from that, then call CNN , really , if people could get virus from adsense, which btw has a reach of 80% of the entire internet, and it went all this time unnoticed it would indeed be the biggest scandal of this decade

soulful sepulcher said...

dear iuri,
thank you for your primer on computer virus' and for the increased traffic from readers in Portugal on my blog meter! [including you].I love the internet.

soulful sepulcher said...

CP, sorry to have taken the comment discussion into a virus primer, as if any of us need one. I'd rather go back to bugging Carlat and Nemeroff. oops!

SAM said...

Anyways, Stephany, if you are talking about my blogs, I must say, non of them have adsenses. So, please, could you clarify me on this?
Thank you!