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The COX-2 wars

Via Kevin, M.D., this juicy account of the Vioxx vs. Celebrex war reveals a profound difference of opinion on the question of how malleable doctors' prescribing habits really are.

Merck believed that doctors could be influenced, and they were willing to pay to do it. The doctors, on the other hand, all seem to be singing a different tune.

-- Dr. Roy Altman (selected by Merck to run a clinical trial involving Vioxx, to which the drug company contributed $25,000):

He also said his involvement in the trial did not affect his prescribing.
-- Dr. Robert Ettlinger (subject of a Merck memo urging that he be "kept busy" with clinical trials and describing him as "neutralized"):
The physician said in an interview that he was "absolutely shocked" that he had been singled out for attention, saying he regularly gave speeches for many drug companies. Such work never affected the drugs he prescribed, including Vioxx or Celebrex, he said.
-- Dr. Keith Feder (founder of a nonprofit foundation that accepted a $25,000 grant from Merck, which according to a Merck representative would give a "return on investment" of "51 percent share of [the] COX-2 market in 2000"):
In an interview, Dr. Feder confirmed that the foundation had received money from both Searle and Merck, but said that the grants helped support a continuing medical education program and were not intended to influence his prescribing habits and did not do so.
-- Dr. Max Hamburger (asked drug companies to subsidize retreats for a physician group during which the physicians would put together guidelines on what drugs to prescribe):
In an interview, Dr. Hamburger said that his group solicited funds from a large number of pharmaceutical companies to support its educational meetings and that payments from those drug makers did not influence the medications prescribed.
If there are physicians out there who actually admit that their prescribing habits were influenced by drug company largesse, no New York Times reporters have found any yet.


yeah right. as physicians we keep believing we're beyond the psychological forces of advertising. we're wrong.