I was reading this month's Journal of Clinical Psychiatry and came across a dimension of the psychiatrist - pharmaceutical company dynamic that is rarely the object of analysis. I can't put the ad here because it appears to be copyrighted so I will have to describe it and you can see the graphic here. There is a picture of a man in a brown pullover sweater in the middle. His hands are pressed together and he has a concerned look as he looks toward a younger man who is slightly unkempt to his right. The younger man is staring away and making no eye contact. To the far left behind a counter is a woman wearing a white coat and protective gloves as she swirls an Erlenmeyer flask containing bluish liquid. My theory of the mind says the man in the middle is a psychiatrist, the man to his right is the patient and the woman is some kind of biomedical researcher. The copy reads:
"Your challenges are our challenges. At Alkermes, we're inspired by the challenges that psychiatrists face every day. We share your dedication to patients living with schizophrenia, depression or addiction. So when we develop new treatments, we begin with a compassionate understanding of your real world needs. We stand ready to improve the health of your patients."
I am sure that most psychiatrists can see this for what it is - advertising and would have suggested that Alkermes take a less melodramatic approach. Alkermes is relatively new to CNS pharmaceuticals but it has drugs in the pipeline for both schizophrenia and depression. Many addiction psychiatrists are used to seeing their version of long acting naltrexone called Vivitrol. I have never seen a sales representative from the company. Pharmaceutical company reps have taken a hit with the new anti-Pharma religion and they are banned from most clinics, hospitals, and academic settings in my area. The rap against them has been that they were essentially influencing physicians to prescribe their products by financial incentives in the form of gifts or in many cases personal relationships, or a combination of both. A secondary issue was that some of the Pharma associated educational activities were more or less well disguised advertising in a number of forms.
This new approach by Alkermes taps into an area with psychiatrists that I have not previously seen as an area of focus. It is basically saying to the most beleaguered physicians: "We understand what you are up against and we are on your side." Although it seems like a clumsy first attempt, the message is powerful. If you are a senior psychiatrist and have practiced as long as I have - you realize that apart from any good colleagues that you might have from time to time - there is nobody on your side. Many psychiatrists are professionally isolated and may see their colleagues at an annual meeting. Others in larger organizations are mismanaged to the point where their colleagues are seen as competition rather than resources. There is nobody on your side professionally or in your attempts to treat your patients. In fact as I have illustrated here, there are many people in your way when you try to provide care to patients. They are incentivized to get you to ration care and in many cases that comes down to providing no care.
The Alkermes approach captures at least a part of the unconscious reason for affiliating oneself with a friendly entity. My guess is whoever is behind it does have an understanding of what is going on with physicians and psychiatrists in particular. A pharmaceutical company ad will never make it explicit, but there is also an asymmetry in the relationship they are discussing. Bundling the cost into a pharmaceutical product is a much more effective way to get reimbursed than bundling cost in the form of a psychiatrist.
Even though they appear to feel our pain - they don't really have to.
George Dawson, MD, DFAPA
Supplementary 1: Breaking news from the U.S. Patent office:
Aripiprazole lauroxil: patent app 13/607,066 covers methods of treating schizophrenia, mania, bipolar disorder, anxiety or depression by administering a broad class of compounds including aripiprazole lauroxil.
ALKS 5461: patent app 13/715,198 covers composition of matter.
ALKS 3831: patent app 13/215,718 covers the attenuation of weight gain associated with olanzapine in patients with schizophrenia by administering the combination of samidorphan (formerly ALKS 33) and olanzapine.
ALKS 7106: patent app 14/169,305 covers composition of matter.
For full details read the press release from the Alkermes web site.