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Out of Order: Didnít see that coming
March 2013
by Randall Willis  |  Email the author
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Everything has side effects.  
 
Having orange juice instead of tomato juice with breakfast can give you heartburn. Driving to work instead of taking the bus can cause your car to run out of gas. Reading this commentary can induce nausea and high blood pressure, although I hope not.
 
Even selecting one movie over another at your local multiplex can have side effects.   At the risk of feeling my stomach churn, my eyes roll or my blood boil, I went to see the movie Side Effects the other week. (SPOILER ALERT) In the movie, a young woman is sent for psychiatric counseling after struggling to cope with anxiety and depression over the release of her husband from prison for insider trading. While receiving treatment, the woman is put on antidepressants, which cause her to experience a variety of side effects, including one that triggers the pivotal action on which the movie turns.
 
As I sat in the theater, I braced myself for the standard accusations of incompetence on the part of the psychiatrist, collusion between doctors and coercion or conspiracy between the doctor and the pharma reps, all in an effort to help this poor woman cope with events as they play out. And to some extent, this does happen in the movie.
 
But just as I could feel the bile form in the back of my throat, the plot line took a significant right turn and suddenly, things aren't what they seem. What looked like it was going to be a social agenda movie turns into a thrilleróand in my opinion, an exciting one.  
 
But aside from a few heart palpitations and a bit of a brain cramp from trying to stay a step ahead of the plot, I experienced another side effect from watching the movie. I gained insightóin this case, about the ubiquity of information on therapy-related side effects.
 
Contrary to media reports and blogs that decry the pharmaceutical industry and the medical profession for hiding negative information about new (and old) therapeutics, a quick Google search quickly points out just how much information is out there. In fact, often so much so that any one individual would be hard-pressed to keep even a small percentage of it in his or her brain.  
 
It's not ignorance by volition; it's ignorance by volume.
 
As a company, you want to highlight the positives of your new therapy, but the machinery is in place to ensure you do that while providing context. Many of the diatribes seem to miss the point that it does your company no good to have patients and clinicians suffer because of your product, as demonstrated time and again with class-action lawsuits that more than eat up any profits from sales.
 
(As a personal aside, the cynic and the paranoiac in me fight a constant battle over the question of how many of us are sufficiently smart to be able to pull off a conspiracy of silence on such a grand scale.)  
 
The challenge, it seems, comes down to how best to digest, distill and disseminate this information to clinicians and patients in a manner that they can understand, and more importantly, use to make clinical treatment decisions.
 
Regulatory agencies and advertising advisory councils must be made to understand that it is not simply enough to list the panoply of side effects that were noted during clinical trials or in post-marketing analysis without providing some degree of context. Otherwise, you have consumers wondering why they would take a vaccine for traveler's diarrhea when one of the side effects of the vaccine is diarrhea (look it up!).
 
Too often, the industry's hands appear to be tied when it comes to providing target markets with information, as regulatory agencies and advertising counsels argue that consumers aren't capable of digesting this information. I think we're not giving today's consumers enough credit. The age of the uninformed consumer is coming to an end, so it's important we figure out how to make sure they get the information they need to make the right decisions for themselves.  
 
You can give someone all of the component pieces of information, but without appropriate context, it can still be misinformation. It is the equivalent of telling them all of the pieces of hardware in their new do-it-yourself bookshelf, but not giving them the assembly instructions. Sure, they know the names of everything, but are they any better informed for knowing that?  
 
Rooney Mara. Channing Tatum. Jude Law. Catherine Zeta-Jones. Side Effects. If that were all you knew, would you understand what the movie is about?
 
Willis is the features editor of ddn. He has worked at both ends of the pharmaceutical industry, from basic research to marketing, and has written about biomedical science for almost two decades.        
 

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