Personalized Medicine: Translating “Potential” into Reality
Cardiologists believe in personalized medicine; they just don’t practice it. What will it take to make them change? Here’s an idea: marketing.
“The best word to encapsulate cardiologists’ perception of PM is ‘potential.'”
That is how the Personalized Medicine Coalition and the American College of Cardiology summarized the attitudes of 150 cardiologists in a survey released in January.
The survey showed that PM strategies currently have at best a modest impact on the practice of cardiovascular medicine. But most agree that the impact will increase in the next five years.
Still, there seemed to be considerable frustration during a January 6 event hosted by PMC about the relatively slow uptake of personalized strategies in the CV sector. For example, ACC CEO Jack Lewin provided an overview of the survey and a compelling case for personalized medicine—but also noted the decision by ACC to recommend against pharmacogenomic testing for response toPlavix, despite evidence strong enough to persuade FDA to include that testing in labeling. (Read more here.)
Hence, it was no surprise that the final panel of the day focused heavily on what it would take to drive a change in practice.
Bruce Korf of the University of Alabama at Birmingham Department of Genetics suggested that change would come when physicians don’t have to be (or pretend to be) geneticists to use the information. No one understands how their computer works, Korf said; they just use it. The same needs to be true for pharmacogenomic treatment strategies. That’s a good point.
John Spertus from the University of Missouri focused on the limitations of education as a strategy and the power of incentives. Finding triggers—economic or otherwise—to encourage changes in prescribing behavior would be key. Another good point.
Medco VP-Scientific & Academic Affairs Russell Teagarden suggested it isn’t as hard as everyone makes it sound, pointing out that Medco has had great success encouraging use of pharmacogenomic testing associated with warfarin, working in partnership with its payor clients to call physicians to explain that such testing is available and covered. According to Teagarden, a strategy that is only used about 2% of the time normally is used 50% of the time when Medco makes a call. It isn’t that doctors are against it, he said—they just need a timely nudge. Another great point.
But still, there was, to us at least, a sense of defeat. What on earth will it take to get those doctors to do what everyone—including the doctors themselves!—agrees they should be doing?
Here’s an idea nobody raised: get pharmaceutical marketing departments into the act. If there is one strategy that has proven successful over the years in changing physician behavior, it is drug industry marketing. Sure, there are plenty of people who hate that fact, but even they don’t dispute the power and success of commercial organizations in the Rx sector.
For example: we’ve argued all along that Lilly should have taken that approach in positioningEffient against Plavix. Rather than selling the drug as generally superior and fighting to support the idea that the improved outcomes is worth a trade-off in increased bleeding—and a significant tradeoff in price, once Plavix goes off patent this year—Lilly could have focused the new brand exclusively on the Plavix non-responder segment.
Would it have worked? Hindsight is 20-20, but Effient’s third quarter US sales were just $28 million. We find it hard to believe the company couldn’t have matched that performance with less marketing costs if it had tripled the price and focused its message solely on the danger of usingPlavix in the one-third of the population who carries the marker for poor metabolism and non-response.
So, for us at least, we will take the ACC/PMC survey with a grain of salt. Cardiologists may see the potential in personalized medicine, but unless or until marketing organizations embrace it, that potential may still not translate into reality.