Monday, December 01, 2008

Can You Say H-I-P-P-A?

I just got this nice letter from Pfizer sent to my professional e-mail:
Dear Health Care Provider:

As you might know, Pfizer launched a new direct-to-consumer advertising campaign, "A LIPITOR Heart to Heart," featuring a real LIPITOR patient and encouraging patients to have a discussion with their health care provider about the importance of treating their high cholesterol. When a sample of consumers were presented with the "Heart to Heart" ad, they connected with the real life experience, found it engaging and credible, and felt motivated to speak with their physicians about their CV risk. We are considering expanding this campaign to feature several other real LIPITOR patients and would like your help in identifying potential candidates. All you have to do is click here and download "What was your wake-up call?", which is a brief instructional letter you can provide to the potential candidate(s) to help them learn how they can share their story with Pfizer.

The first ad in the LIPITOR Heart to Heart campaign featured a real LIPITOR patient, John E., who was diagnosed with high cholesterol in his forties and was not treating his condition with medication. Unfortunately, he had a heart attack last year at age 57, but that event served as a "wake-up call" to take better care of his health. Since that time, John has been treating his cholesterol with LIPITOR, along with diet and exercise.

We are asking for your help in identifying patients like John E. who you think have a story to share that would motivate other at-risk patients to talk to their own doctor about their CV risk. This patient's story could be potentially shared via TV, print, internet, or patient education. To be considered, patients should meet the following criteria:

LIPITOR patient for at least 6 months
At cholesterol goal with LIPITOR monotherapy
Age 50-65

If your patient is selected for further consideration, we will follow up with you to obtain copies of their medical records. Your patient will be asked to sign a HIPAA consent form authorizing this release.

If you would like in-office materials to help your patient have a heart to heart with you about their CV risk, please do not hesitate to contact your Pfizer representative.


Pfizer Inc

Dear Pfizer,

No doubt you've sent the above letter to lots of other well-meaning doctors. But what you must realize is that I cannot offer you my patient's name since it would completely violate their trust in me regarding divulging aspects of their healthcare to non-interested parties. It is especially troubling that you do not ask the world at large, but rather approach doctors who then risk this ethical compromise. I hope this practice will cease immediately.


Westby G. Fisher, MD
aka, Dr. Wes


Anonymous said...

They're not asking you to provide your patients' names. They're asking you to recruit patients for them by giving information to your patients about how they can be featured in an ad. Your patients' names wouldn't be given to Pfizer unless your patients decided to participate.

There's no HIPAA violation here, but I still find this ethically troubling for the same reason you do: Pfizer is hoping to profit from your patients' trust in you. At least some of them will assume their participation is important simply because their trusted doctor asked.

Jay said...


You've certainly made your point often and clearly that you feel direct to consumer marketing is evil. It's certainly easy to find examples of excess and ethical compromises.

I realize that I am in the minority as a physician, but I actually am very much in favor of direct to patient industry marketing in certain instances, particularly circumstances in which awareness is beneficial to the public (and not just to industry).

In the early days of statins, this form of marketing undoubtedly raised awareness enough to create a standard of care for aggressive lipid lowering. I have no doubt that many lives have been saved as a result of this process. I think anyone who thinks that we'd be as successful without industry efforts is a little naive.

I do, however, share your lack of enthusiasm when it comes to the current lipid marketing which is all about moving market share to high price branded meds.

The mere fact that Pfizer is asking for patient testimonials is not in and of itself unethical or illegal. If you, as a physician, believes in the cause that it being marketed, it is very reasonable to approach your patient behind closed doors to see if they are interested in sharing their story with others.

It didn't take long for me to find this story in the University of Kentucky news in which two of YOUR patients were identified as recipients of investigational devices (Medtronic Chronicle). Do you believe this to be a privacy violation???

I have used similar patient testimonials (with permission) in various media to advance a variety of causes. Everybody wins when we do this right.


Anonymous said...

This is just another example of Madison-Avenue-idiots(also known as Mad Men, as in the cable TV show) who have NO CLUE as to the law, and care less, trying to get YOU, Doc, to break the law for their benefit.
Glad to see that you not only have ETHICS but common sense - because it would only take ONE Curmudgeonly patient like myself, who doesn't WANT his medical history broadcast all over the Web and TV, to run your Malpractice premiums into Low Earth Orbit.
And neither you, nor the Medical Industry at large, need THAT again - they're already TOO DAMN HIGH!

DrWes said...

anony 12:03 -

Regarding HIPAA - fair enough. I suppose the letter of the law might not be violated here, but the problems involving doctors in this promotion are many. What role, however, does the doctor assume for rising health care costs? When we find that "John Erlenson" was (1) paid and (2) an actor for their commercial, was this disclosed on their ad? As reported in the Wall Street Journal:

"While marking a departure from the Jarvik ads, which leaned on a figure with stature in matters of the heart, Lipitor's new pitch man is not a total outsider. The talent agent -- who will be paid a union scale rate -- said he learned of the ad campaign when news of Pfizer's search for a testimonial subject crossed his desk. They were looking for a heart-attack survivor who took Lipitor, and he knew one who fit the profile."

How much will our referrals be paid if they agree to disclosure? Is this arrangement discussed in the promotional literature? What influence (payments) will the marketing types hype in the name of assuring their profits?

Jay -

Do you think it's beneficial to promote a statin that costs nearly 10 times generic for your patients? Should your patients promote this same drug to millions of other less-informed patients without disclosing this simple fact?

In the articles you point to regarding the research I helped conduct at UK, the article discusses the fact that the work was experimental. Further, my patients were not paid, nor did they incur costs, from participation in the research project. Admittedly, the benefits of the technology were uncertain at the time (it was later rejected by the FDA). While I have no problem with discussing research projects (provided they're labeled as such), I have real problem using patients for profit, pure and simple.

Jay said...


Read through my post again if you still have any doubts about my stance toward the current Lipitor campaign. I agree that Pfizer's marketing here is about protecting profits, not saving lives.

My larger point was the fact that an informed and voluntary patient "testimonial" does not necessarily constitute a privacy violation. We have use this type of marketing many times for the greater good (i.e. "poster children"). You used it to promote a research trial at UK. I've used patient testimonials in Cincinnati in similar fashion. There is nothing wrong with this. I would hold that ethical direct to consumer marketing (i.e. public health campaigns) is necessary for the promotion of good medical care.


Anonymous said...

I would be absolutely livid to learn that my doctor had used some knowledge about my health to try and sell me any product or participate in the marketing of any product. I do not see this as an ethical use of private health information in anyone's medical records. HIPAA allows the use of PHI only for direct care and those in immediate need to fulfill patient care needs. In signing HIPAA, patients are not giving permission for their PHI to be used for marketing purposes.

It is the sign of a quack for a doctor to be selling supplements, pills, or other products on the side. The conflicts of interest become really unethical very quickly.

Way to go, Dr. Wes!