PM360 December 2009

Hot Topics / Healthcare Highlights

TV or Not TV
Advair had the biggest DTC budget in 2008, but it didn’t produce the most requests from patients for the drug. In discussions with their doctors, patients most often brought up side effect concerns about pneumonia, which they learned about from fair balance statements on TV. A recent study by Verilogue, a healthcare market research company, revealed that the biggest DTC budgets do not always result in the most positive pull-through or any pull-through at all. The study tracked brand requests and references to specific ads from 12,500 doctor-patient conversations in 2008 and found that DTC pull-through was only 3% and just 0.002% requested specific brands. None of the top five DTC spenders (see the table, below) were the drugs most requested by patients. Of the top five, Ambien was the most requested medication and Cymbalta was the most mentioned DTC campaign. From the reactions tracked by the study, Verilogue provided three recommendations for better DTC results:Validate patient experiences. Use DTC to help patients construct the meaning of a health condition rather than just mirroring their experiences of it. Robust discussions that referred to Cymbalta commercials mentioned depression’s effect on family members in addition to the sufferer. One tactic is going beyond TV ads by weaving the condition and treatment into the lives of TV or film characters.

Prepare physicians for the fair balance fight. Provide HCPs with tools such as brochures or narratives to help patients understand the risk-benefit scenarios. Connect meaningfully with patients. Boniva, the top referenced brand, used Sally Field, a well-known celebrity, to reach its middle-aged female audience. With this popular spokeswoman, the ad distinguished itself from others with actors portraying patients’ family members. —Andrew Matthius

The Right Dose
Every year medication errors in the U.S. result in an estimated 400,000 drug-related injuries and at least $3.5 billion in additional medical costs, according to the Institute of Medicine. The three main types of medical error are 1) prescribing, 2) dispensing, and 3) administration. A 36-month demonstration at the University of California San Francisco (UCSF) recently revealed the best way to reduce administration errors could be better training. The program resulted in an 87.7% reduction in medication administration errors, which increased accuracy to 98% at six Bay Area hospitals. The program showed similar improvements when it was expanded to nine additional hospitals for 13 months through October. The improved accuracy was attributed to better adherence to the six best practices for medication administration identified by the California Nursing Outcomes Coalition: comparing medication to medical record, keeping medication labeled until administration, checking two forms of patient identification, immediately recording administration in chart, explaining the medication to the patient, and minimizing distractions and disruptions during administration.

Each hospital’s front-line clinicians participated in on- and off-site leadership and skills training to improve in the areas
of clinical protocols, problem measurement and reporting, and administrative processes and procedures. This clinician improvement model was developed and supervised by the Integrated Nurse Leadership Program (INLP) at UCSF’s Center for the Health Professions. “Achieving higher quality with lower costs requires investing in people, not just technology and facilities,” said INLP Director Julie Kliger. “Policymakers and healthcare institutions need to recognize front-line clinicians as a tremendous but underutilized resource that can make a huge difference in patient care.” —A.M.

Fighting Addiction
More than 280 million people in North America, Japan, and Europe have an addiction or dependency on alcohol, tobacco, illicit narcotics, gambling, or prescription drugs for nonmedical use. Drugs have been a problem for millions of addicts, and drugs may soon be their solution. In the next decade, the pharmaceutical industry should be releasing a plethora of new anti-addiction drugs. Recent studies have shown addiction is a brain disorder affecting the processes responsible for motivation, decision making, pleasure seeking, inhibitory control, and the way we learn and consolidate information and experiences, according to the New York Times. The global addiction pharmacotherapeutic market is currently valued at $3.2 billion, but a new report from URCH Publishing forecasts growth of 19% by 2016. This report, titled “The World Market for Addiction Disorders, 2009–2016: Future Therapies for Substance Dependence and Impulse Control,” predicts the market will grow rapidly with over 90 drugs to treat addictions in clinical trials. Since 2005, the number of products in clinical R&D has increased by 165%. Pfizer has already had success with Chantix/Champix, which launched in 2006 and may be on track for blockbuster status in the smoking cessation market. “The drug pipeline for the addiction disorders of alcohol, cocaine, opioid, methamphetamine, phencyclidine, cannabis, and tobacco dependence is now rich with a range of novel neuroreceptor/neuropeptide modulators and antibody therapies,” said the report’s author Tim Atkinson. —A.M.

Gender Gap
While women have made strides closing the wage gap, they’re also closing in on the male lead in a less enviable arena. The once widely divergent risk for middle-aged men and women when it comes to having a heart attack is narrowing. Surveys taken from 1988 to 1994 revealed 2.5% of men ages 35 to 54 reported having a heart attack, compared with only 0.7% of same-aged women. In surveys taken between 1999 and 2004, the rate of men reporting heart attacks dropped to 2.2% while it rose to 1% for women, according to research published in the Archives of Internal Medicine. The findings also suggest that the risk of future heart disease dropped for men and worsened for women. “People didn’t think that women in that age group were at high risk for heart disease and stroke,” said the studies’ lead author Dr. Amytis Towfighi to the Los Angeles Times. “But I suspect that with growing rates of obesity, women aren't protected as much as they have been in the past.” Another problem facing women is precursors such as high blood pressure and high cholesterol not being treated as aggressively as they are in men, according to Dr. Towfighi. However, women did receive some heartening news. Another study in the Archives of Internal Medicine revealed a 52.9% reduction in the risk of death following heart attacks for women younger than 55. Men had only a 33.3% reduction. —A.M.