Dr. Daniel Carlat, author of The Carlat Psychiatry Blog, and coiner of the phrase “CME Laundromat” (see “Welcome to the CME Laundromat“), pointed out one way that CME (Continuing Medical Education) programs can legally do what marketing and sales cannot: make head to head comparisons between two drugs without approved clinical trial data.

Dr. Carlat will be my guest this afternoon on my LIVE Pharma Marketing Talk podcast. For more information about listening live or to the audio archive after the show, click here.

Carlat examined a CME program funded by AstraZeneca entitled. The program presented a case study about a man with bipolar disorder who was being treated unsuccessfully with Lamictal, then switched to AtraZeneca’s Seroquel, and gets better. Surprise! Here’s how Carlat describes the case (see “Biased Education: A Summer’s Cornucopia with CME, LLC“):

The second case is where things get more interesting, and where our summertime feast of CME bias really begins. This is a 30 year old man with bipolar disorder, already on lithium monotherapy, who presents with symptoms of major depression. The patient is started on Lamictal, which is TIMA’s first line recommendation for treating bipolar depression. However, unfortunately for GlaxoSmithKline (maker of Lamictal), the patient suffers unspecified “side effects” on Lamictal, and is therefore switched to AtraZeneca’s Seroquel, and gets better.

Case studies are a favorite technique used by medical education communication companies, because they are a way of spotlighting a particular product without appearing biased.

[This] case study takes place in a bizarre parallel universe in which patients have more side effects on Lamictal than on Seroquel, exactly the reverse of what we psychiatrists commonly see here on Earth. Unrealistic, perhaps, but it serves the sponsor well, telling the story of a patient who likes Seroquel. We don’t hear anything about Seroquel’s famous side effect of sedation, because that would reflect poorly on the company footing the bill.

Two interesting insights:

1. Case studies like this one do not have to be based on real-life cases, as Carlat points out. I am ashamed to admit that years ago, when I worked for a CME company doing computer-based programs sponsored by pharma companies, I developed interactive case studies by working with physicians who made up cases out of thin air — but, presumably, based on their real experience. I never documented whether or not such cases actually existed in the real world (ie, by looking at patient charts). I just took the doctor’s word for it. We paid the doctor for his case studies and, of course, told him who was paying for it.

2. This kind of “head-to-head” comparison of two drugs cannot be made by marketing or sales people UNLESS there is a specific clinical trial in which the efficacy of the two drugs are actually compared.

Recently, AstraZeneca was embarrassed by allegations that at least one sales manager instructed his sales reps to make head-to-head comparisons of 2 drugs: Arimidex and Femara (see “AZ Group of 7 Believe OIG Probe of Arimidex Marketing Is Stalled“).

Although we are talking about different drugs, we see that what AZ could not get away with via sales and marketing, it can easily do via CME. Reps cannot make the head-to-head comparisons, but they can inform their physicians that there is a CME program out there that does by handing out BRCs physicians (see this AZ Memo).

Thus, CME enters my MOM (“Marketing by Other Means”) pantheon along with public/press relations.


If you are interested in learning more about CME guidelines and regulations and the physician education practices of pharmaceutical companies, you will find this Physician Education Supplement — collection of article from Pharma Marketing News — of interest. Order it online here.