Epocrates: Having Your Cake and Eating It Too

Duff Wilson in the New York Times did a nice job of shining a spotlight on a phenomenon that has lurked for too long in the shadows:
http://www.nytimes.com/2011/07/29/business/the-epocrates-app-provides-drug-information-and-drug-ads.html?_r=1&hp

Epocrates, an increasingly popular information service for physicians, has been scoring big with its free smartphone app that allows physicians to pull up drug prescribing infomation in the midst of a patient visit. Here's what one of my colleagues in family medicine says about this service:

"Dr. Robert M. Schiller, chairman of family medicine at Beth Israel Medical Center in New York, said he often uses Epocrates to look up drugs and advises medical students to use it, too.

“I have it on my iPhone,” he said. “It’s great for the convenience, being in a room with a patient and checking a medication. But the biggest problem is that it’s supported by the pharmaceutical industry.”

Drug companies, Dr. Schiller said, sponsor information that favors them. “To extent that this is a product that will influence physician prescribing behavior because it’s so efficient and useful, it really needs to have minimal bias,” he said. “And how do you assure that?”

Ah yes-- how do you assure that? Here's the dilemma-- as a seasoned physician educator notes, this type of service fills a real need, and yet there's the downside of commercial bias. So just how good a job is Epocrates doing in balancing those objectives?

Well, on the one hand, Epocrates acknowledges at least the marketing value of not being beholden to industry: “The credibility of our brand is dependent in large part on the medical community’s continued perception of us as independent from our health care industry clients, particularly pharmaceutical companies,” the company said in a securities filing this year.
... “Our first commitment is the value to the physician,” Rosemary A. Crane, president and chief executive of Epocrates, said in an interview.

So that's what they say to the docs. What do they say to the drug firms that buy their ads?

"Epocrates says drug makers get $3 in increased sales from every dollar spent on DocAlerts. The claim comes from comparing prescription records of doctors who see DocAlerts with those who do not, company officials said. But they declined to share the research, saying it was paid for by drug companies and was confidential. ... Pfizer, the world’s largest drug maker, has certainly found the marketing channel to be an effective way to reach doctors. “The beauty of the work we do with Epocrates is that we literally put ourselves in the palm of their hand,” said Dr. Freda Lewis Hall, chief medical officer at Pfizer."

By the way, what was Epocrates' CEO Rosemary A. Crane's last job before she took over the firm? Oh yes--she worked for 26 years as a Pharma executive (Johnson & Johnson, Bristol-Myers Squibb).

Docs love Epocrates because its smartphone app is free. What else is available? "UpToDate, from Wolters Kluwer Health, has a Web-based disease reference guide that, it emphasizes, does not accept money from pharmaceutical companies. But UpToDate costs $395 to $495 a year, and its first iPhone app just became available on Monday."

There you have it. The drug companies have recently been cutting back on their drug rep sales force, both to reduce costs as fewer brand name blockbusters remain on the market, but also because they see a greater marketing advantage in Internet and electronic approaches to practitioners--like Epocrates. Epocrates seems to be talking out of both sides of its mouth when it comes to who it works for--the docs or the drug industry. Which side is winning? Well, who's paying the piper?

How long are we in medicine going to keep thinking we can get goodies for free and yet we won't be biased and that the real goal is education, not marketing? And just who's in the palm of whose hand?