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Fire-Eaters and Booze: What It Takes to Persuade Docs to Prescribe Painkillers

Cephalon (CEPH)'s knuckle-rapping from a U.K. watchdog after some of its drug sales reps took doctors barhopping in Portugal -- a trip which included fire-eaters -- shows just how cheaply doctors can be persuaded that one painkiller is better than another. Tapas and a cocktail will do the job, apparently.

The case, brought by an anonymous former Cephalon employee, will best be remembered for these quotes, found on an internal Cephalon feedback document generated to describe the success of a trip to Lisbon for a conference. The reps were promoting Effentora, a powerful painkiller:

We then took them out to the Marriott hotel until 2 am and then [a named Cephalon employee] took them clubbing until 4am!

We then went to a few bars and to a club until 3am -- a few good photos to prove it!!!

On one evening the group -- 13 doctors and three reps -- watched fire-eaters and drank at a nightspot called Bedroom. The reps believed their night out worked, one reported:
All the customers were really looked after and spoke positively about Effentora -- let's make sure they start Rxing now!
That's the gossip. The report, from the Prescription Medicines Code of Practice Authority, also contains some hard numbers about how much Cephalon's hospitality costs:
  • Flights: £188 each
  • Conference fees: £7000 each
  • Four star hotel in Lisbon: £516
  • "Subsistence" food and drinks: £51 each per meal
  • Total: ~£8000 per doctor, £104,000 overall
A close reading of the report indicates that the hospitality provided was hardly Caligula-like. Most people had just one or two drinks. Dinner was modestly priced. The difference between a bar and a "club" in the Mediterranean is often negligible. And you can see fire-eaters on the streets of many European cities on most weekends. They're free.

Rather, it's the trip and the accommodation that raises eyebrows. The docs were essentially given a free mini-vacation in Portugal, all expenses paid.

Most worryingly, one doctor on the trip appears to have become convinced that there may be a difference between Cephalon's Effentora and the rival product, Abstral, marketed by ProStrakan, according to the feedback described in the PMCPA document. As you can see from the European Medicines Authority pages on Effentora and Abstral, there is absolutely no difference between the two products. They're both made of fentanyl and come in the same strengths. The only differences are cosmetic: Effentora is placed in the cheek and Abstral is placed under the tongue. The active ingredients are mixed with slightly different inactive ingredients. That's something pain-care doctors should have known before they got on the plane.


Image by Flickr user Rob Wiss, CC.
Hat tip to Pharmalot.
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