News-Record.com

Now that it actually feels like winter, the Guilford County Department of Public Health has posted some winter weather safety tips. Given our propensity in this area for ice-caused blackouts, the list is worth reviewing.

Jan. 22, 2008, marks the 35th anniversary of the Supreme Court's Roe v. Wade ruling legalizing abortion. If you would be interested in sharing your experience with abortion, pro or con, for a possible article, please e-mail me. Thanks!

Do efforts by pharmaceutical companies to market drugs to physicians and consumers sway their decision-making? Not according to recent research co-published by a visiting professor at Duke's business school. Since the news release is not online, I'll reproduce a big chunk of it here.

DURHAM, N.C. -- When it comes to giving samples and writing prescriptions, doctors are swayed by science -- not by cozy relationships between themselves and pharmaceutical marketing reps or by advertising aimed at patients, new research shows.

"Drug marketing has been portrayed like some scary movie where pharmaceutical firms are shoving drugs in our veins for the sake of profits, but that doesn't gibe with our results," said Stefan Stremersch, a visiting professor of marketing at Duke University's Fuqua School of Business and chaired professor of marketing at Erasmus University Rotterdam in the Netherlands. "Marketing can actually spur doctors and patients -- and doctors and drug reps -- to have more informative conversations about the benefits and side effects of drugs. Marketing isn't about buying off physicians."

The study by Stremersch and Sriram Venkataraman, assistant professor of marketing at the Goizueta Business School at Emory University, contradicts the widely held perception that pharmaceutical marketing, directly to patients or doctors, adversely affects public health.

Their study, "The Debate of Influencing Doctors' Decisions: Are Drug Characteristics the Missing Link?" is featured in the November 2007 edition of Management Science. The study was produced independently of the pharmaceutical industry, and may have important implications for policy makers and authorities exploring the way marketing affects drug dispensation, the researchers say.

The authors' analysis is based on an examination of data provided by a large firm specializing in pharmaceutical marketing and clinical trial reports from the National Institute for Health and Clinical Excellence. The data yield five key findings, all of which illuminate how marketing affects doctors' decision-making:

-- Marketing efforts are more successful for more effective drugs than less effective drugs.

-- Excessive marketing efforts can actually lower the distribution of less effective drugs.

-- Marketing efforts are more successful for drugs with more side effects than drugs with fewer side effects.

-- Physicians will accommodate requests more often for drugs with fewer side effects.

-- Physicians are more responsive to patient requests for more effective drugs.

"There is evidence that physicians rely on science while prescribing," Venkataraman said. "If a drug has many side effects, it's best to have a sales rep explain those side effects directly to a doctor rather than firms bypassing medical professionals with ads aimed at patients."

Stremersch and Venkataraman found that marketing to physicians or advertising-prompted requests from patients do not automatically result in more samples or prescriptions being handed out for the marketed drug. For some drugs, the opposite may be the case.

"The reason is probably physician irritation," Stremersch said.

The findings seem somewhat counterintuitive, in the sense that you'd think pharmaceutical companies wouldn't spend what they do on marketing if that marketing didn't result in additional sales. But it might be that what additional sales do result are 1) economically satisfactory to the companies and 2) not the result of any undue influence.

What do you think?

(Abstract of the journal article is here; the full text is behind a pay firewall.)

My Sunday article on dialysis patient Waymond Blackmon is online here. You can use the comments to this post to comment on the article. I've gotten a couple of e-mails on it from readers and am awaiting their permission to post excerpts.

UPDATE: Reader Glenn Millis writes: "You kept saying people last for a long time on dialysis. Some people do. Young people mainly. Other's beat the odds. But the fact is that about 40% of the people starting dialysis at age 50 are dead in 5 years and 90% are dead in 10 years. One of the things many people think is that people can just do dialysis forever. They can't. They die. They end up being too sick to receive a transplant. Not all. But especially older people."

While I can't vouch for Millis's exact figures, he's right about depressed life expectancy for dialysis patients. My article said some people have lived on dialysis for decades, and that's accurate, but I should have made clearer that many dialysis patients don't, particularly older ones.

The U.S. Renal Data System has a report online (*.pdf file) that compares overall life expectancy at various ages with life expectancy at those same ages for dialysis patients (p. 8 in the 18-page report).

The numbers are sobering. Among the general population, people in the 25-29 age group can expect to live another 51.7 years, but among dialysis patients people in that age group can expect to live an average of 12.6 years. Members of the general population in the 50-54 age group can expect to live another 26.8 years, while dialysis patients in that group have an average life expectancy of 6.2 years. (The chart also includes life expectancy for people who have received transplants. As you would expect, the life expectancies are considerably longer for those patients than for dialysis patients.)

There's an interesting experiment in civic journalism going on right now. It's called beat blogging, and it's an effort by 13 beat reporters nationwide to build social networks into their beat reporting. (The effort has a blog, and JR blogged a little about it here.) I'm not clear on all the details as to exactly how they're going about it, and they're not all going about it in exactly the same way. But as the N&R seeks to expand its community journalism, it seems like a good idea to try.

I think the approach could be particularly valuable for the paper's readers on a beat like this one, where there's a lot of specialized knowledge involved that I don't have. If you're a medical professional and want to take part, please leave a comment or e-mail me.

(To try to facilitate this process, I've started a Twitter feed.)

January is Radon Awareness Month. The element, sometimes found in the air in home basements, can cause cancer. The Guilford County Department of Public Health has more information here.

Via the Association of Health Care Journalists listserv, here's a pair of YouTube segments from a new documentary, "The AIDS Chronicles -- Here to Represent," about the effect of AIDS/HIV on the urban African American community in Atlanta. You can read more about it at filmmaker Bailey Barash's Web site.

In looking for an article just now at the Web site of the Journal of Medical Practice Management, I came across a long list of available articles, almost all of which cost $19. But I found one that costs a whopping $227, and its title is:

"Spandex is a Privilege, Not a Right! Dress Codes in the Medical Practice"

OK, I follow the link and find that it's an audioconference led by a lawyer, not a print article. And it goes into some of the legal issues involved in regulating employee attire. But still. $227 for what sounds to me like just a lick of common sense?

I published a story today on the investigation, or lack thereof, into the case in which three women developed kidney failure after getting cosmetic injections at a Greensboro establishment. This post at our Debatables blog offers you the chance to discuss the issues the story raises.

And this morning, the state released a settlement agreement with Greensboro's Friendship Care Assisted Living in which the home agreed to close by Jan. 31 and pay a $5,000 fine. The home had a history of violations; the owner's attorney says the state wasn't giving his client a fair hearing. What do you think?

I don't want to let January slip by without noting that January is Radon Action Awareness Month. Why do you care? Because radon is the second-leading cause of lung cancer, causing roughly 21,100 such deaths per year. Many of those who die have never smoked.

Radon comes from the breakdown of uranium in the soil. It can get into the air in your home through cracks in foundations and basements, and through floor drains. Particularly during winter, when doors and windows are closed, it can build to unhealthy levels in homes.

The Guilford County Department of Public Helath says that if you have not previously had your home tested for radon and are interested in testing your home, please call Sandy Ellington at 641-6704. Free radon testing kits will be distributed to interested citizens while supplies last, through the department's Environmental Health Division.

For more information about radon, you can follow this Environmental Protection Agency link.

State researchers have completed the field work on research to determine how widespread exposure is to the chemical toluene diisocyanate and whether those exposed have developed any respiratory problems. The study looked at roughly 400 adults in 10 neighborhoods around four sites where the chemical was used. One of the sites is Olympic Products (formerly Vitafoam) in Pleasant Garden.

(More information about the chemical from the Centers for Disease Control and Prevention is available here.)

Researchers asked residents questions about their respiratory health, took blood samples to check for the presence of the chemical, and took air samples to see what level of the chemical, if any, was present in the air.

They did the same with residents of demographically similar neighborhoods in the state with no known source of exposure to toluene diisocyanate.

Researchers now will review the data and expect to publish their findings in 2009.

Researchers are keeping information about survey participants strictly confidential. But if you took part and would like to talk about it, call me at 373-7088 or shoot me an e-mail. Thanks!

If the cardinal rule of medicine is "First, do no harm," what role, if any, should physicians have in state-sanctioned executions?

The New England Journal of Medicine recently hosted a round-table discussion on that topic. Although most of the Journal's online content is behind a pay firewall, they've got a transcript of that discussion out for public consumption. If you prefer, you can download the audio.

What do you think? Should physicians be involved in state executions? Can executions be carried out without them? And what's a state to do if physicians refuse to be involved?

(The Journal also has online an interesting article about the aftereffects of mild traumatic brain injury in soldiers returning from Iraq.)

As we reported today, Greensboro ranks No. 10, and Charlotte No. 7, among the worst places to live for asthma sufferers, according to an annual report released by the Asthma and Allergy Foundation of America. The survey was funded by pharmaceutical maker AstraZeneca.

We're planning a local story. If you or a loved one suffers from asthma and you'd like to share your story, please get in touch.