McKinsey Advised Johnson and Johnson on Increasing Opioid Sales • Hacker News Board

Re: McKinsey Advised Johnson and Johnson on Increasing Opioid Sales

#91

Post by cwkoss » Thu, Jul 25, 2019, 10:05 PM UTC

sgt101 wrote: post #70

cwkoss wrote: post #21

Earlier quoted context omitted.

I find the argument that humans will stop studying pharmacology if they can't monopolize their results quite unconvincing. Current pharma co R&D and innovation only effectively investigates the benefits of drugs with recent patents (with enough years remaining to monetize). There is moral validity to profit-seeking investment in drug trials which find effective treatments, but the current system enables this only wit…

>I find the argument that humans will stop studying pharmacology if they can't monopolize their results quite unconvincing. agree >Current pharma co R&D and innovation only effectively investigates the benefits of drugs with recent patents (with enough years remaining to monetize). Can you elucidate the connection to your first statement - I don't see how that follows.

Defenders of drug monopolies often argue that removing the monopoly will reduce our intensive drug research spending. This may be true. However, I'd argue that the focus of this intensive drug research spending is perverted by economic incentives and overinflated because of the artificially constrained scope.

For-profit Pharma companies have a fiduciary obligation to only invest in research which they can profit from. This leads them to only invest in research in the tiny proportion of "interesting drug candidates" that can be monopolized.

Ex. - Imagine scientists find that saffron can be an effective antidepressant with few side effects. They research the active molecule and find that adding a bromine atom would make the molecule patentable, but it is slightly less effective and has more side effects. The drug company has an incentive to spend great amounts developing the less-effective patentable drug, and no incentive to research the other. Drug company has incentive to try to convince the public that their inferior molecule is actually preferable.

Now, we have a lot of data about the safety of saffron - people have included in their diets for hundreds or thousands of years. If this can be used to treat depression, it will likely have a much better safety profile than a novel molecule which has never been ingested by humans before. The therapeutic index of saffron (delta between effective dose and aversive side effect dose) is huge! Likelihood of getting it through safety trials has very high bayesian prior.

(Saffron as antidepressant is an area of recent research - all papers I've seen published by academics https://scholar.google.com/scholar?hl=en&q=saffron+antidepre..., I made up the bromine part for the example. Saffron may also be useful as anti-tumor and in ADHD treatment)

Pharma Co's may be investing intensely in researching a tiny fraction of drugs, but this fraction is less likely to contain the safest candidates and thus I don't think those dollars are being spent very effectively.

Re: McKinsey Advised Johnson and Johnson on Increasing Opioid Sales

#92

Post by refurb » Thu, Jul 25, 2019, 10:06 PM UTC

theaustinseven wrote: post #69

refurb wrote: post #60

Earlier quoted context omitted.

My counter to your comment, and my own personal experience, is that doctors are fully aware of the manufacturers conflict of interest. They know that the drug companies will present everything in the best possible light. Other things that exist to counter this bias are competitors, who will provide a different perspective and most importantly, the FDA that regulates all pharmaceutical promotion for accuracy and will…

Yeah, but this starts to break down when the pharmaceutical representatives can give laundered incentives(fancy "educational" dinners, "educational" yacht parties, etc.) to prescribe their product. In the US, pharma reps can see the prescription amounts of doctors to verify that they are actually prescribing their product(last I heard from a pharma CRM company in 2016). This seems deeply and fundamentally unethical.…

The practice of greasing the skids with lavish events ended a while back. Drug companies can't even give free pens to their doctors now.[1]

[1]http://phrma-docs.phrma.org/sites/default/files/pdf/phrma_ma...

Re: McKinsey Advised Johnson and Johnson on Increasing Opioid Sales

#93

Post by UweSchmidt » Thu, Jul 25, 2019, 10:09 PM UTC

im3w1l wrote: post #6

cwkoss wrote: post #4

The marketing of medicine in inherently unethical because it seeks to override doctors and consumers information-based evaluations, and instead make a choice based on emotional propaganda. The harm caused by any given medical advertisement is directly proportional to its effectiveness. Every pharmaceutical sales rep is an immoral cancer on our society.

Ad supporters will sometimes say that ads are meant to get the word out about a product so people know its an option. How can we prove that this is false or that the benefits are smaller than the drawbacks?

For prescription drugs this wouldn't make sense. Only a doctor is qualified and legaly allowed to prescribe a drug. They have a tough job of making difficult diagnoses, weighing pros and cons for each treatment and dealing with a human in their specific life situation.

A patient that walks into a doctor's office asking for a certain medicine they heard about on TV distorts the process. After all the patient needs to believe in the treatment and might shop around for the doctor that gives them what they want.

Learning about a product in a medical context can't really happen in an ad. A doctor would have to go to a conference or read journals to figure out the latest science on treatments, and can then go and then choose an appropriate drug. They would probably look for the one that has 20mg of X in it, regardless of brand name or hype.

Re: McKinsey Advised Johnson and Johnson on Increasing Opioid Sales

#94

Post by 1123581321 » Thu, Jul 25, 2019, 10:09 PM UTC

mikeash wrote: post #53

refurb wrote: post #23

Earlier quoted context omitted.

This may come as a shock to you, but marketing pharmaceuticals is really no different than marketing other products. It really comes down to educating consumers about your product. Doctors as decision makers are not some monolithic block of individuals who are super educated about every product on the market and every piece of data. Just developing awareness of new drugs is a huge job. I'd say less than 5% of doctors…

Marketing comes down to educating consumers about your product? Have you ever seen marketing? Any education that occurs is either accidental or legally mandated. I do agree with you that pharmaceutical marketing isn’t fundamentally different from marketing other products. Although my conclusion from that is not that pharmaceutical marketing is therefore good.

Consumers who care enough about the medicine they’re taking to request certain prescriptions want to understand them. Mass media like TV ads drives searches and visits to more detailed official material (websites, pamphlets, etc.) Without providing useful information, the manufacturer would have trouble convincing more engaged patients to switch, and similarly to other product markets, engaged customer word of mouth is vital to growth. Word of mouth is bolstered by the more familiar mass media. It’s not perfect, but it’s far from axiomatic that the communications from the entire marketing campaign are valueless. It only appears that way to TV viewers with no medicinal motivation to research the drug.

Re: McKinsey Advised Johnson and Johnson on Increasing Opioid Sales

#95

Post by Erik816 » Thu, Jul 25, 2019, 10:39 PM UTC

umvi wrote: post #83

cwkoss wrote: post #4

The marketing of medicine in inherently unethical because it seeks to override doctors and consumers information-based evaluations, and instead make a choice based on emotional propaganda. The harm caused by any given medical advertisement is directly proportional to its effectiveness. Every pharmaceutical sales rep is an immoral cancer on our society.

I think society would benefit immensely from banning the advertising of drugs. This includes both medicinal and recreational drugs. Make all drugs legal, but mandate they have boring text/information-only labels, put the more dangerous ones behind the counter in smaller quantities, and let the only thing influencing their purchase be doctor recommendations/prescriptions or personal research. It should apply evenly fr…

I think beer should be considered food, but otherwise I can get on board with this.

Re: McKinsey Advised Johnson and Johnson on Increasing Opioid Sales

#96

Post by themark » Thu, Jul 25, 2019, 10:42 PM UTC

cwkoss wrote: post #4

The marketing of medicine in inherently unethical because it seeks to override doctors and consumers information-based evaluations, and instead make a choice based on emotional propaganda. The harm caused by any given medical advertisement is directly proportional to its effectiveness. Every pharmaceutical sales rep is an immoral cancer on our society.

Always wondered how they get away with it.

Every time I hear “Ask your doctor about ____” I cringe. How is this ok?

Re: McKinsey Advised Johnson and Johnson on Increasing Opioid Sales

#97

Post by sokoloff » Thu, Jul 25, 2019, 10:43 PM UTC

umvi wrote: post #83

cwkoss wrote: post #4

The marketing of medicine in inherently unethical because it seeks to override doctors and consumers information-based evaluations, and instead make a choice based on emotional propaganda. The harm caused by any given medical advertisement is directly proportional to its effectiveness. Every pharmaceutical sales rep is an immoral cancer on our society.

I think society would benefit immensely from banning the advertising of drugs. This includes both medicinal and recreational drugs. Make all drugs legal, but mandate they have boring text/information-only labels, put the more dangerous ones behind the counter in smaller quantities, and let the only thing influencing their purchase be doctor recommendations/prescriptions or personal research. It should apply evenly fr…

I think that almost immediately ends up in a morass of private information web sites, none of which are as trustworthy as current FDA-regulated labeling.

Do you prefer Instagram "influencers" to have more control over what drugs people take than the current regulated advertising? I don't.

Re: McKinsey Advised Johnson and Johnson on Increasing Opioid Sales

#98

Post by davidivadavid » Thu, Jul 25, 2019, 10:43 PM UTC

dooglius wrote: post #17

gringoDan wrote: post #5

Earlier quoted context omitted.

To play Devil's Advocate - without pharmaceutical companies developing and marketing drugs, how do we set up an incentive structure that encourages R&D and innovation?

Why do you think advertising promotes innovation? I would see it as the other way around, why innovate when you can just invest more into advertising an inferior product?

Because consumers aren't stupid and that doesn't work, probably? Because your competitor will gladly advertise their more innovative and better product, and yours will look inferior?

Re: McKinsey Advised Johnson and Johnson on Increasing Opioid Sales

#99

Post by harperlee » Thu, Jul 25, 2019, 10:45 PM UTC

reaperducer wrote: post #68

harperlee wrote: post #58

Earlier quoted context omitted.

Overly cynical. All companies exist to provide profits to their owners. Your argument about the datapoint can also be argued for lending: credit disappears when it’s most needed. It must be completely and utterly useless, then. Or perhaps when a crisis strikes, if you want to minimize spending, you first eliminate consultant bills, instead of, idk, firing internal employees? Part of the value of a consultant is that…

Overly cynical. All companies exist to provide profits to their owners. Overly simplistic. Not all companies exist to provide profits to their owners. There are thousands of companies in the U.S. and elsewhere which exist for other reasons.

Sure, “all” is a powerful word. It was simplistic enough to support my point, which still stands though. Perhaps it is more useful to discuss the central point on debate, instead of being picky on points that are not central to the debate?

Re: McKinsey Advised Johnson and Johnson on Increasing Opioid Sales

#100

Post by gaze » Thu, Jul 25, 2019, 10:48 PM UTC

refurb wrote: post #23

cwkoss wrote: post #4

The marketing of medicine in inherently unethical because it seeks to override doctors and consumers information-based evaluations, and instead make a choice based on emotional propaganda. The harm caused by any given medical advertisement is directly proportional to its effectiveness. Every pharmaceutical sales rep is an immoral cancer on our society.

This may come as a shock to you, but marketing pharmaceuticals is really no different than marketing other products. It really comes down to educating consumers about your product. Doctors as decision makers are not some monolithic block of individuals who are super educated about every product on the market and every piece of data. Just developing awareness of new drugs is a huge job. I'd say less than 5% of doctors…

Advertising can in general involve misleading. It’s not even close to education.