The Soul of Biotech

You may have already heard that the Republican party recently announced a new motto: “The Change You Deserve.” Politics aside, some brouhaha has been made of the fact that this slogan is already in use by Wyeth’s Effexor antidepressant. High comedy, of course. In fact, Pharmalot, one of my favorite pharma blogs, wondered if Wyeth should sue the Republicans for copyright infringement. I feel such an idea is ludicrous.

Look at some of the coverage of the Republican Party / Effexor tangle-up:

• Washington Post
• NY Times
• The Daily Show

The Post article in particular includes:

• Pictures of Effexor
• Copies of Effexor’s marketing messages
• The starting dose
• Coverage of side effects

If I was the Effexor brand director, I would have been dancing when the news was announced. It resulted in some completely free DTC advertising in most major media outlets. I might have provided the reps who carry Effexor with some guidelines for reactive answers to physician questions about the news, simply to clarify that the move by the Republicans was not in concert with Wyeth, and Wyeth has no position on the issue. Other than that, I’d sit back, enjoy the free press, the new hits on my website, and the resulting bump in sales. It’s a nice treat for an off-patent medication.

I would only sue the Republicans over this in order to get it back in the papers again a couple of months from now. But even then, I’d be reluctant to potentially damage relations with either political party over something that has been fairly positive for the company (Wyeth has donated evenly to both parties, Pharmalot reports).

By the way, if there are any political parties looking for another idea, I suggest “Enough is Enough,” which is Enbrel’s DTC slogan. I think the bump in our sales would probably net me at least a new iPod.

My name is Jonathan Sheffi, and I approved this blog post.

Boy, it’s been a long time since I wrote.

I finished my training in December, and at the turn of the new year, I finally hit the road to meet my doctors and talk product. I wish I could talk specifically about the fascinating interactions I’ve had with my physicians, but I can’t for confidentiality reasons. I can at least talk a bit about the rep experience, which has been tough but rewarding.

Last week, I came up with the perfect analogy for being a new rep: It’s like being transferred to a new school. At first, you don’t know where the classrooms are. No one knows who you are, so they aren’t especially interested in talking to you. You’re nervous, so you drop your books a couple of times. Your jokes aren’t funny, but you’re nervous so you laugh at them yourself. That sort of thing.

Things get better the same way they do in high school. You make a few friends, they actually laugh at your jokes, and eventually things get better, and before you know it, other people are glad you’re there. In the meantime, you do your homework conscientiously, ask good questions, and try to get your grades up as quickly as possible.

[Of course, it also helps when your big sister (aka partner) gets straight A’s, is as popular as the prom queen, and is kind enough to point the way.]

On Friday afternoon, I formally accepted an offer to transfer into the Enbrel Derm sales force, serving in the Portland, Oregon territory. Relocation timing and details are still pending, but I’ll probably get up there by October or so.

I’m incredibly excited to learn how to sell effectively. Both my district manager and regional director have vast reservoirs of sales experience within Amgen, so I’m confident that I’ll learn a great deal from the feet of a couple of masters.

Plus, this will be an enormous personal adventure. I don’t know a single person in Portland. In fact, I’ve never set foot in Oregon in my life. And I can’t wait to find out what’s waiting for me when I get there.

(So far, people tell me: “beer,” “rain,” and “hipsters.”)

My friend Lexi sent me a link to a NYT article that discusses personalized medicine (also known as pharmacogenomics), which is an area of great interest to me. It’s what I focused on in my master’s work, and it’s an area that, given the right opportunity, I intend to start a biotech in one day.

The article describes the promise of personalized medicine reasonably well: The opportunity to select the best therapy for a patient based on his or her genetic profile. Dr. Friedman correctly notes the opportunity for improvements in patient outcomes in terms of drug efficacy and safety, with a special eye towards his own specialty of psychology. He goes astray, however, at the very end:

Aside from the potential to transform clinical psychiatric practice, these new developments will surely change the relationship between doctors and the drug industry and between the industry and the public. Direct-to-consumer advertising will become nearly irrelevant because the drugs will no longer be interchangeable, but will be prescribed based on an individual’s biological profile. Likewise, doctors will have little reason to meet with drug company representatives because they won’t be able to give doctors the single most important piece of information: which drug for which patient. For that doctors will need a genetic test, not a salesman.

I find several things wrong with this paragraph.

Although doctors may find it challenging to select the right treatment for a condition (especially depression!), the available therapies are hardly interchangeable, even today. That’s one of the most important reasons why clinical trials exist: to demonstrate clinical attributes that differentiate a given drug from other existing therapies. Also, Dr. Friedman assumes that the genetic screens will always produce extremely clear results — but what if they don’t? Or what if the screens can only point to a set of therapies — what then? Those are critical situations in which reps will be able to consult physicians on the remaining differentiating attributes.

Furthermore, reimbursement education (for both the genetic screen and for the drug itself) is also a major function of most reps. Many doctors and caregivers struggle to understand whether or not a patient can afford a therapy, especially if the patient is on Medicare. Drug companies, including Amgen and many others, often step up to help educate physicians and guide patients to the form of coverage that best allows the physician to treat in the manner they see fit. That role will become even more critical with a screen to pay for on top of the therapy.

Finally, I don’t see personalized medicine making direct-to-consumer advertising irrelevant. If anything, marketers would focus even more on getting patients into the office to get the test, thus feeding the genetic screen funnel.

What about you? What do you think genetic screening will mean for the pharmaceutical and biotech industries?