Most people apparently believe that just as the latest model of a car is safer, better, etc., the latest drug to come out of the pharma lab is probably better. This illusion is, of course, created by pharma marketing which makes most money from a new and patented product.
OTOH, I don't touch a new drug or vaccine (especially if it is based on a novel technology) with a ten foot pole until it has been widely used for at least ten years. I did not take the Covid vaccine for exactly this reason.
Well given where these tests were conducted I imagine the conversation goes something like “your child has RSV which is extremely serious and deadly and their only chance is this new experimental drug now sign here before your kid dies”. Although in my experience people are happy and/or excited about using brand new medications in their pets (even when not necessary) and they love their pets like their kids so maybe people are still easily enticed by things that are shiny and new even after Covid.
Don’t think it changes the strategy of the pitch much, just the details. We’re a war torn country right now, if your kid gets RSV they will probably die because the healthcare system is overwhelmed, this will keep them from dying. Fear is the best motivator to get parents to do otherwise questionable things to their kids.
Having been in sales for several different industries, Doc, I offer you an alternative hypothesis for that rep's ignorance, or part of it, at least.
Sales representatives that truly understand the technical aspects of what they're selling, are the exception, not the rule.
Those that do know the technical details are generally solid lifetime performers, sales metrics-wise, but they are rarely the highest-grossing sales-folk.
The top producers are, by and large, those best at selling the sizzle, rather than the steak.
The reasons for this are multivariate, and the conceptual advantage is held by the occupational insider, rather than an industry insider. I'm quite sure you are aware of this, generally speaking, but this is one of those "business is business" paradigms. Marketing and sales divisions incentivize ignorance. There are good reasons for this, from a profitability perspective. The sales workforce must contain a small percentage of the learned, if only to obtain and maintain market dominance, but they are considered a liability in one sense; their metrics are comparatively weak.
Yours is a highly technical occupation and like all highly-focused technical specialists, a physician will be consumed by their specialty with little time for considerations seemingly irrelevant to the primary focus. This is evident across multiple industries and professions.
You're welcome, Doctor, and I hope it helps you in some fashion.
The name of the game is "face time" and the goal is to maximize revenue within that limited period of time. The number of buyers who are deeply interested in technical minutiae are comparatively few, and their circumspection makes them careful buyers in general. This translates to a lower per-item gross and a higher investment of a sales rep's time to hit their numbers target.
Those more perceptive and demanding buyers tend to be influential, which is why they must be captured, but sales managers seldom take that into account, which is part of the incentive feedback loop. I can give you the business case pro/con, but you don't have time for it.
When I consider the sales visit you described above, one of my first thoughts was that the rep was going to have to do what I consider to be her job, and that means at least one follow-up, and probably more. She can walk into the office of one of your less inquisitive colleagues, spend an hour and walk out with a fresh revenue stream of, say.. 50K a year (as an arbitrary number.) In your case, that 50K/one hour ratio may become 20K/four hours.
In the jargon of the occupation, that means you're not what is known as a "laydown."
I'll stop pestering you with details and just say thanks again for what you do.
A good view of sales reps is in the Netflix presentation called PAINKILLERS about how oxycontin was marketed. It is a deeply flawed film due to lots of fictionalization to make the Sackler family seem very evil but the training of the sales reps was probably realistic.
I looked up the Purdue case online and the company still has not paid out any $ for the judgment. It is tied up in appeals while Oxy is still being produced.
I haven't taken the time to look deeply into the synthetic opioid litigation, mostly because it appeared to be based on the marketing representation of something that I expect the technical specialists to have conducted due-diligence on. It isn't that I think false advertising is in any way acceptable; it's that I expect the gatekeepers to understand what they are prescribing.
That expectation is admittedly naive and probably foolish, but standards are standards, however weakly upheld.
The real scandal related to Oxycontin was not covered in PAINKILLER, Netflix production. That scandal relates to how young attractive women with limited educational background were able to convince so many physicians to prescribe Oxycontin over against common knowledge about the abuse potential of all opiates. Physicians should be educated about drug company reps and more suspicious of the efforts of Purdue reps making great efforts to expand their prescribing practice and to increase doses. This scandal has not been similarly investigated.
It's not about public health, it's all about private profits. In the last few years we've been able to view, in real time, the revolting sausage and influence factory that cranks out COVID and RSV shots. Now I question everything from the medical industrial complex.
Your points about the design of the small test are good ones and they apply to so many meds that are marketed. For instance, limit the test arm to the healthiest kids, maybe stick the sickly (is that word still acceptable?) ones in the placebo arm.
Pharma reps can make an awful lot of money and sometimes they do know something about medicine and biochemistry. But as you mention, this one's reaction to your questions makes her sound like no one else really tried to pin her down on the quality of the study. I find that so disturbing.
My sons' pediatrician was a good doctor, and yet he recommended all the shots kids got routinely in the US during the early to mid-90s. I could cry when I think how easily we rolled over for all those shots! But I give him credit: when our school board mandated Varivax for chicken pox he did say it was more about parents not wanting to have to take off work to quarantine with their kids than about any serious risk from the disease. ( I took a conscientious objection to that shot for both kids because of the fetal cells used to culture it.)
A sad state of affairs! Everything is geared to profit. Few now are “in it” for the individual/child. I know this is not set up for a spiritual point of view necessarily! But, come Jesus, come!
Really fair and detailed analysis, Adrian. As a retired pediatric pulmonologist, I embrace your perspective and will send a copy of your evaluation to a former pediatric resident who went into my field and now works for the FDA. She is full of adulation for her FDA coworkers. Like so many of our fellow physicians, she is not exposed to informed dissenting voices like yours. Thanks.
Fascinating!! I have a son who has had moderate health issues his whole life. It has been stark the doctors who think and use their judgment and the rest. My son is 22 and I’m so thankful for all his care before a lot of this, both covid and all the medical conglomerates/ obamacare. (DiGeorges)
Interestingly, he had RSV as toddler. Stressful 48 hours, but my pediatric NP cousin caught it early while we were visiting and nipped it quickly with her immediate care. Yet- He never got covid, we all did! Ha!!! I found that interesting.
May be he did--at a subclinical level. And his innate immune system at that time was strong enough to fight it off. An antibody test might have revealed it if done within about a year after the infection.
Thank you for sharing this! My feelings are similar on the outcry of covid vs RSV, not as medical provider, but as a mother of three boys who have all been hospitalized as infants with RSV. Most people didn’t even think it was that big of a deal or even knew what it was. I have tried to share about it for years on my so other parents can be aware of it and how it can get bad fast (with our first son, we had no idea what it even was. We went from him have a low grade fever to being admitted to the hospital with 66% o2 within a matter), yet I’ve never seen anyone show much concern or care. No school shut downs for the RSV outbreaks (which, I believe, kids were more likely to get at school and spread to their baby siblings - though I don’t advocate for any type of shut down). No masks (don’t support those anyways). No 24-7 coverage.
Last year, I believe (or maybe the year before?! was a really bad RSV season - I felt like I saw every baby in town being hospitalized! Yet I didn’t see much, if any, news outlets reporting on it. I remember looking at the children’s hospital bug watch here in Colorado, and being appalled at how they had skewed the covid graphs to make it look like there were more children getting it than RSV, but if you looked at the data, RSV was through the roof compared to covid.
All this to say, I have hoped for a reliable RSV medication that is safe and effective. Perhaps this will be. But reading your analysis, sounds like we aren’t quite to that point yet.
Thanks for sharing, but…I’m surprised that you thought this injection for RSV might be in any way ‘safe and effective’. There is no basis whatsoever for hoping that any meaningful ‘study’ was done, and every reason to assume the opposite. It’s good you tried to ask some questions, but why even bother? And why would we expect the sales rep to have answers, if she’s never had to do anything but sell, sell, sell. In a nutshell…when will you learn?
Try high dose Vitamin C. IV vitamin C. If pediatric patients are anything like actual kids, adults humans, or animals, you will see remarkable effectiveness coupled with virtually zero negative side effects! (Study the work of Dr. Paul Marik.)
I nearly saved a 99% dead horse with IV C, until my dratted veterinarian pushed to add a toxic drug into the bag, (and I gave in,) because her brainwashed mind couldn't believe that her toxins were dangerous and that my harmless vitamin C powerful enough alone, despite the evidence before her eyes that it was!
It's stunning how well this works for different living beings who are struggling with either infectious disease or sepsis. In fact it is so effective that FDA, CDC, NIH, NIAID, the WHO, the UN, and most governments, and virtually all hospital systems on Earth have done everything they can to destroy it. Add in the mass of toxins and immune system deregulation and degradation from "safe and effective" childhood vaccines, you have your tsunami of babies with RSV.
Answer- (from pHarma & Government & Medicine,) more toxic drugs and more toxic vaccines!
For those who survive off of human pain and suffering- BUSINESSES IS GREAT!
Thank you and your colleagues for your commitment to your patients and their families and of course thank you for your willingness to share.
I hope some with integrity survive this age.
I am pausing at —
“did I mention way more babies died in the experimental arm than the placebo arm”
How do parents agree to put babies in these barbaric experiments?
Most people apparently believe that just as the latest model of a car is safer, better, etc., the latest drug to come out of the pharma lab is probably better. This illusion is, of course, created by pharma marketing which makes most money from a new and patented product.
OTOH, I don't touch a new drug or vaccine (especially if it is based on a novel technology) with a ten foot pole until it has been widely used for at least ten years. I did not take the Covid vaccine for exactly this reason.
Well given where these tests were conducted I imagine the conversation goes something like “your child has RSV which is extremely serious and deadly and their only chance is this new experimental drug now sign here before your kid dies”. Although in my experience people are happy and/or excited about using brand new medications in their pets (even when not necessary) and they love their pets like their kids so maybe people are still easily enticed by things that are shiny and new even after Covid.
From what I understand, it was given as preventative shot, not during an active case of RSV.
Don’t think it changes the strategy of the pitch much, just the details. We’re a war torn country right now, if your kid gets RSV they will probably die because the healthcare system is overwhelmed, this will keep them from dying. Fear is the best motivator to get parents to do otherwise questionable things to their kids.
Having been in sales for several different industries, Doc, I offer you an alternative hypothesis for that rep's ignorance, or part of it, at least.
Sales representatives that truly understand the technical aspects of what they're selling, are the exception, not the rule.
Those that do know the technical details are generally solid lifetime performers, sales metrics-wise, but they are rarely the highest-grossing sales-folk.
The top producers are, by and large, those best at selling the sizzle, rather than the steak.
The reasons for this are multivariate, and the conceptual advantage is held by the occupational insider, rather than an industry insider. I'm quite sure you are aware of this, generally speaking, but this is one of those "business is business" paradigms. Marketing and sales divisions incentivize ignorance. There are good reasons for this, from a profitability perspective. The sales workforce must contain a small percentage of the learned, if only to obtain and maintain market dominance, but they are considered a liability in one sense; their metrics are comparatively weak.
Yours is a highly technical occupation and like all highly-focused technical specialists, a physician will be consumed by their specialty with little time for considerations seemingly irrelevant to the primary focus. This is evident across multiple industries and professions.
Great insight, I appreciate it!
You're welcome, Doctor, and I hope it helps you in some fashion.
The name of the game is "face time" and the goal is to maximize revenue within that limited period of time. The number of buyers who are deeply interested in technical minutiae are comparatively few, and their circumspection makes them careful buyers in general. This translates to a lower per-item gross and a higher investment of a sales rep's time to hit their numbers target.
Those more perceptive and demanding buyers tend to be influential, which is why they must be captured, but sales managers seldom take that into account, which is part of the incentive feedback loop. I can give you the business case pro/con, but you don't have time for it.
When I consider the sales visit you described above, one of my first thoughts was that the rep was going to have to do what I consider to be her job, and that means at least one follow-up, and probably more. She can walk into the office of one of your less inquisitive colleagues, spend an hour and walk out with a fresh revenue stream of, say.. 50K a year (as an arbitrary number.) In your case, that 50K/one hour ratio may become 20K/four hours.
In the jargon of the occupation, that means you're not what is known as a "laydown."
I'll stop pestering you with details and just say thanks again for what you do.
A good view of sales reps is in the Netflix presentation called PAINKILLERS about how oxycontin was marketed. It is a deeply flawed film due to lots of fictionalization to make the Sackler family seem very evil but the training of the sales reps was probably realistic.
I looked up the Purdue case online and the company still has not paid out any $ for the judgment. It is tied up in appeals while Oxy is still being produced.
I'll take a look, George, thanks.
I haven't taken the time to look deeply into the synthetic opioid litigation, mostly because it appeared to be based on the marketing representation of something that I expect the technical specialists to have conducted due-diligence on. It isn't that I think false advertising is in any way acceptable; it's that I expect the gatekeepers to understand what they are prescribing.
That expectation is admittedly naive and probably foolish, but standards are standards, however weakly upheld.
The real scandal related to Oxycontin was not covered in PAINKILLER, Netflix production. That scandal relates to how young attractive women with limited educational background were able to convince so many physicians to prescribe Oxycontin over against common knowledge about the abuse potential of all opiates. Physicians should be educated about drug company reps and more suspicious of the efforts of Purdue reps making great efforts to expand their prescribing practice and to increase doses. This scandal has not been similarly investigated.
It's not about public health, it's all about private profits. In the last few years we've been able to view, in real time, the revolting sausage and influence factory that cranks out COVID and RSV shots. Now I question everything from the medical industrial complex.
Your points about the design of the small test are good ones and they apply to so many meds that are marketed. For instance, limit the test arm to the healthiest kids, maybe stick the sickly (is that word still acceptable?) ones in the placebo arm.
Pharma reps can make an awful lot of money and sometimes they do know something about medicine and biochemistry. But as you mention, this one's reaction to your questions makes her sound like no one else really tried to pin her down on the quality of the study. I find that so disturbing.
My sons' pediatrician was a good doctor, and yet he recommended all the shots kids got routinely in the US during the early to mid-90s. I could cry when I think how easily we rolled over for all those shots! But I give him credit: when our school board mandated Varivax for chicken pox he did say it was more about parents not wanting to have to take off work to quarantine with their kids than about any serious risk from the disease. ( I took a conscientious objection to that shot for both kids because of the fetal cells used to culture it.)
A sad state of affairs! Everything is geared to profit. Few now are “in it” for the individual/child. I know this is not set up for a spiritual point of view necessarily! But, come Jesus, come!
Amen!
Really fair and detailed analysis, Adrian. As a retired pediatric pulmonologist, I embrace your perspective and will send a copy of your evaluation to a former pediatric resident who went into my field and now works for the FDA. She is full of adulation for her FDA coworkers. Like so many of our fellow physicians, she is not exposed to informed dissenting voices like yours. Thanks.
Fascinating!! I have a son who has had moderate health issues his whole life. It has been stark the doctors who think and use their judgment and the rest. My son is 22 and I’m so thankful for all his care before a lot of this, both covid and all the medical conglomerates/ obamacare. (DiGeorges)
Interestingly, he had RSV as toddler. Stressful 48 hours, but my pediatric NP cousin caught it early while we were visiting and nipped it quickly with her immediate care. Yet- He never got covid, we all did! Ha!!! I found that interesting.
"He never got Covid."
May be he did--at a subclinical level. And his innate immune system at that time was strong enough to fight it off. An antibody test might have revealed it if done within about a year after the infection.
Thank you for sharing this! My feelings are similar on the outcry of covid vs RSV, not as medical provider, but as a mother of three boys who have all been hospitalized as infants with RSV. Most people didn’t even think it was that big of a deal or even knew what it was. I have tried to share about it for years on my so other parents can be aware of it and how it can get bad fast (with our first son, we had no idea what it even was. We went from him have a low grade fever to being admitted to the hospital with 66% o2 within a matter), yet I’ve never seen anyone show much concern or care. No school shut downs for the RSV outbreaks (which, I believe, kids were more likely to get at school and spread to their baby siblings - though I don’t advocate for any type of shut down). No masks (don’t support those anyways). No 24-7 coverage.
Last year, I believe (or maybe the year before?! was a really bad RSV season - I felt like I saw every baby in town being hospitalized! Yet I didn’t see much, if any, news outlets reporting on it. I remember looking at the children’s hospital bug watch here in Colorado, and being appalled at how they had skewed the covid graphs to make it look like there were more children getting it than RSV, but if you looked at the data, RSV was through the roof compared to covid.
All this to say, I have hoped for a reliable RSV medication that is safe and effective. Perhaps this will be. But reading your analysis, sounds like we aren’t quite to that point yet.
Also, my nephew was hospitalized with RSV during 2020. Super sick.
A few weeks later, he got covid and barely had the sniffles. It was kind of crazy the difference.
I'm old enough to remember when the FDA was actually tough and not bought and paid for by Pharma.
What drug was it? If you specified the name somewhere, I missed it...
I didn’t! It’s called nirsevimab
Thanks for sharing, but…I’m surprised that you thought this injection for RSV might be in any way ‘safe and effective’. There is no basis whatsoever for hoping that any meaningful ‘study’ was done, and every reason to assume the opposite. It’s good you tried to ask some questions, but why even bother? And why would we expect the sales rep to have answers, if she’s never had to do anything but sell, sell, sell. In a nutshell…when will you learn?
Thank you, this was very helpful!
This truly is unbelievable. Bye bye western civ. We are too stupid to survive..
The corporate hospital administrators make so much money they don't want to ask questions.
Try high dose Vitamin C. IV vitamin C. If pediatric patients are anything like actual kids, adults humans, or animals, you will see remarkable effectiveness coupled with virtually zero negative side effects! (Study the work of Dr. Paul Marik.)
I nearly saved a 99% dead horse with IV C, until my dratted veterinarian pushed to add a toxic drug into the bag, (and I gave in,) because her brainwashed mind couldn't believe that her toxins were dangerous and that my harmless vitamin C powerful enough alone, despite the evidence before her eyes that it was!
It's stunning how well this works for different living beings who are struggling with either infectious disease or sepsis. In fact it is so effective that FDA, CDC, NIH, NIAID, the WHO, the UN, and most governments, and virtually all hospital systems on Earth have done everything they can to destroy it. Add in the mass of toxins and immune system deregulation and degradation from "safe and effective" childhood vaccines, you have your tsunami of babies with RSV.
Answer- (from pHarma & Government & Medicine,) more toxic drugs and more toxic vaccines!
For those who survive off of human pain and suffering- BUSINESSES IS GREAT!