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Tuesday, December 04, 2007

The Avandia scrum and the art of war and narrative control

The Executive Physician (EP) has an excellent and interesting take on several aspects of what went on ( and maybe why) in regard to the Avandia saga. I say "scrum" as in rugby because , in a way, I am reminded of a bunch of strong forces all pushing in different directions for their own ends.

Drug companies are not unique in their desire to do things for their own self interest and explain their actions in terms other than the obvious. Researchers may write articles to further their own reputations and academic careers. Federal agencies actions, as so well explicated by Thomas Sowell, can be best understood and explained by looking at the incentives and constraints they are subject to and the feedback they receive. It seems that EP gives us a view of the Avandia narrative in terms of power relationships and natural incentives a knowledge of which he attributes in part to his reading of "The Art of War" and "The Prince".

After the publication of the bomb-shell meta-analysis in the NEJM we witnessed a battle of words,data manipulation or analysis-depending on how you look at it-to determine who would control the narrative.

EP tells us that actions of the various players in the Rosi saga are natural and that "indignation is laughable".

I continue to be impressed with how much influence an article in a high impact medical journal can have. Not only has Avandia suffered a major sales slump and a relative advantage accrued to Actos but I believe that the current recently revised diabetes guidelines reflect a growing disenchantment with the glitazone family not just with Avandia. The touring Joslin Clinic traveling dinner, diabetic CME roadshow was once described by one of my ex-partners as a glitazone love-fest.I doubt if it will seem so now. The glitazone advocates no longer control the narrative.

It has not gone unnoticed how quickly the "gliptins" move on the stage. The guidelines already include one of them,sitagliptin, band name Januvia as an alternative for second line treatment ( i.e after metformin and life sype changes are unable to drive the HbA1c to under 7.)With the glitazone story still playing out you have to wonder why the movers and shakers of the diabetic treatment world are so eager to latch on to another diabetic wonder drug. Could the manufacturers of that group of medications already be scurrying to control the narrative? Duh.

1 comment:

Zagreus Ammon said...

Thanks for the shout-out. In some ways you say what I intended to say better than I said it! I like the scrum analogy for force field analysis. Accept my apologies in advance for stealing the image.