Biomedical Engineering Reference
In-Depth Information
shown in Fig.
24.1
as direct or indirect linkages corresponding to promotion or
expertise based interdependencies respectively. Promotion based interdependencies
are direct linkages because they largely involve sales people employed by the com-
pany, while expertise based interdependencies mostly involve independent physi-
cians. We discuss the fi ndings related to expertise- and promotion based
interdependences in order.
Expertise based interdependencies
. Our analysis reveals that Parke Davis leveraged
expertise in several forms of interdependencies. For instance, the expertise of lead
investigators funded by Parke Davis as part of evidence-based strategy was lever-
aged by inviting them to participate in CME initiatives as part of the education
strategy. The CME initiatives by favorably pre-disposed physician scientists assured
standards of care in favor of Neurontin. A sworn testimony of an expert witness
illustrates these interdependencies:
A continuing medical education monograph … was supported by an unrestricted educa-
tional grant from Parke-Davis… [to]the author of the monograph and narrator of the
accompanying audio tape … Dr. X [name withheld], President of the International Headache
Society… (Exhibit N).
In another form of interdependency, the speaker's bureau constituted as part of
the education strategy was systematically culled to solicit physician scientists favor-
able toward Neurontin for disease advisory boards (Exhibit 69) and encouraged to
disseminate the emergent knowledge from their recently “published” research as
part of surrogate infl uence strategy (Exhibit 34). To broaden the reach of surrogate
infl uence, teleconferences were used to connect Neurontin “champions” with over
1,000 physicians and facilitate the creation of 100 “Pain CME Case Study Groups”
to promote education as part of Parke Davis efforts to increase Neurontin's off-label
use for pain. In an expert testimony, this interdependence is noted as follows:
Dr. X [name withheld] sponsored through an unrestricted educational grant discloses participa-
tion on the speakers bureau for Parke-Davis [among other affi liations], writes in a CME mono-
graph that it is important not to under dose gabapentin when managing PHN, (Exhibit P).
Parke Davis structured interdependencies between evidence and surrogate sell-
ing strategies by routinely rewarding physicians who were Neurontin champions
with privileged research grants. For instance, in a major phase IV trial, STEPS
(
S
tudy of Neurontin:
T
itration to
E
ffectiveness and
P
rofi le of
S
afety) recruited
more than 700 physicians with payments of $300 for each patient enrolled, a strat-
egy that resulted in a 20 % increase in new patients and 3 % increase in market share
(Exhibit 72). Although Parke Davis limited the number of patients that physicians
could recruit for the study to 10, it allowed leading physicians at large teaching
hospitals or centers of infl uence (who had potential to sway a large number of their
colleagues) to recruit up to 50 patients each. Grants made to these thought leaders
were to further Neurontin sales within the hospital and to use these physicians in
surrogate selling programs (Exhibit 34). For instance, a request by Dr. X [name
withheld] was approved because he was a “great Neurontin believer,” (Exhibit 85)
as noted in the following excerpt from an expert testimony:
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