SPSP 2013 Plenary session #4: Sergio Sismondo
Tweeted from the 4th biennial conference of the Society for Philosophy of Science in Practice in Toronto, Ontario, Canada, on June 29, 2013.
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Last plenary of conference: Sergio Sismondo, “Toward a political economy of epistemic things,” starts in ~10 min #SPSP2013 #SPSP2013Toronto
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Knowledge as a quasi-substance (takes work, resources to make; requires infrastructure; moves w/ difficulty) #SPSP2013 #SPSP2013Toronto
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Political economies of knowledge (construct which might help us ask about the circumstances of production) #SPSP2013 #SPSP2013Toronto
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Very little talk in this conference about particular (local) scientific knowledge claims. Hmmm #SPSP2013 #SPSP2013Toronto
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Traditionally phil sci focused on epistemic norms; STS also thinks abt political norms of knowledge production #SPSP2013 #SPSP2013Toronto
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Production: contract research orgs (CROs) in pharmaceutical research (take 70-75% of industry’s research funding) #SPSP2013 #SPSP2013Toronto
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@docfreeride and there’s a whole raft of unexplored phil issues in contract pharma world, IMO
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40K new trials annually, 3-6 million participants recruited/yr. ~50% of trials still in N. America #SPSP2013 #SPSP2013Toronto
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Growth of sites in “cheap” places to run clinical trials #SPSP2013 #SPSP2013Toronto
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Also places that have “ready to recruit” and “treatment naive” subjects; ethical variability as another reason… #SPSP2013 #SPSP2013Toronto
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Local investment in trial resources can include ethical resources #SPSP2013 #SPSP2013Toronto
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“Can” or “should”? RT @docfreeride: Local investment in trial resources can include ethical resources #SPSP2013 #SPSP2013Toronto
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@drugmonkeyblog Apparently, actual cases where local investors are trying really hard to do it in reality.
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Another reason might be PR relations after adverse effects (can intended consumer see them easily?) #SPSP2013 #SPSP2013Toronto
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Another reason, @docfreeride, might be lax oversight, dodgy IRB and another Tuskeegee #SPSP2013Toronto
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Purposes of clinical trials: get drugs approved, “support, directly or indirectly, the marketing of our product” #SPSP2013 #SPSP2013Toronto
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(That quote from Pfizer sales document) #SPSP2013 #SPSP2013Toronto
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“Volunteers” get obvious benefits (payment, access to medical care, etc.); not like volunteer from the audience #SPSP2013 #SPSP2013Toronto
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Lots of info in this talk from pharma conferences, documents, etc. #SPSP2013 #SPSP2013Toronto
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Publication plans (to turn data, info into med journal articles); treat knowledge as resource … #SPSP2013 #SPSP2013Toronto
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… to be efficiently developed, managed, deployed. Better read/cited than articles from indy ($) researchers #SPSP2013 #SPSP2013Toronto
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Foolish to leave production of paper to researcher! Ghostwriting #SPSP2013 #SPSP2013Toronto
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Has pharma learned *nothing*? MT @docfreeride: Foolish to leave production of paper to researcher! Ghostwriting #SPSP2013 #SPSP2013Toronto
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@docfreeride @drugmonkeyblog Umm…. They do realise we can hear them, right?
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@jwoodgett @docfreeride they don’t care that we know. That’s what lobbyist money pays for
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You don’t write it, but you give us your good name on the paper! (Be the sheet on the ghost, as it were) #SPSP2013 #SPSP2013Toronto
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I’m claiming that “sheet” metaphor as my own, by the way. (See this post, which was my first published usage of it, to establish my priority claim.)
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Multiplying papers. Involve lots of people early, get 8 papers from 1 pivotal program. #SPSP2013 #SPSP2013Toronto
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Sales rep: “Field reps are dying every day for more of your work”; it’s what doctors are going to see. #SPSP2013 #SPSP2013Toronto
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Distribution & consumption: Pharma industry’s key opinion leaders (KOLs). #SPSP2013 #SPSP2013Toronto
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KOL identification & advocacy development ~3 years before drug launch. KOLs’ advocacy can be key to drug approval #SPSP2013 #SPSP2013Toronto
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Was Nemeroff mentioned?? RT @docfreeride: Distribution & consumption: Pharma industry’s key opinion leaders (KOLs). #SPSP2013Toronto
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@drugmonkeyblog Not yet. The interview subjects have identities masked. Quoted promo lit has included named sources
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If you want to read about Charles B. Nemeroff, M.D., Ph.D., here’s a place to start.
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Especially KOLs’ claims about clinical need (sometimes overrules other considerations) #SPSP2013 #SPSP2013Toronto
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KOLs: highly respected medical experts in their domain who have greater (asymmetric) effect on their peers #SPSP2013 #SPSP2013Toronto
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KOLs “people who we coopt” (says industry amongst itself) #SPSP2013 #SPSP2013Toronto
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Local KOLs: usually physicians; respected clinicians who give presentations #SPSP2013 #SPSP2013Toronto
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Track prescriptions before & after their presentations to measure investment (often better than sales rep) #SPSP2013 #SPSP2013Toronto
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Identical talks by KOL & sales rep: given by KOL, 2.5x more prescribing than given by sales rep #SPSP2013 #SPSP2013Toronto
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Local KOL given the slideset for their promotional talks. Not allowed to stray from slideset (legal reasons) #SPSP2013 #SPSP2013Toronto
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You don’t want to end up with KOL illegally promoting the drug. Stay *just* on the right side of the line #SPSP2013 #SPSP2013Toronto
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Local KOLs have sales reps rounding up their audiences, their careers are built. May give 100s of talks annually #SPSP2013 #SPSP2013Toronto
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Local KOLs sometimes go on to become researchers, when they then become research KOLs. #SPSP2013 #SPSP2013Toronto
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One such research KOL’s COIs: over a decade, a consultant for every drug that came on the market to treat bipolar #SPSP2013 #SPSP2013Toronto
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Reg. agency: “50 KOL advisory boards on same aspect of same product makes it look like you’re not seeking advice” #SPSP2013 #SPSP2013Toronto
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Are research KOLs “managed”? There are individual KOL management plans, w/desired outcomes #SPSP2013 #SPSP2013Toronto
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So … industry looks for alt language: OL engagement, managing experiences, building coalitions #SPSP2013 #SPSP2013Toronto
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So yeah, industry is managing KOLs. #SPSP2013 #SPSP2013Toronto
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@docfreeride @matthewherper Except professional KOL’s who live for the fees
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Do KOLs communicate truths? See themselves as doing education, communicating scientific/clinical truths #SPSP2013 #SPSP2013Toronto
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Education, not being a shill (is how they see themselves). Might recognize the potential, if reflective #SPSP2013 #SPSP2013Toronto
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“I believe in these products! I wouldn’t recommend them if it wasn’t true…” #SPSP2013 #SPSP2013Toronto
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Hahaah. but yeah. RT @docfreeride: “I believe in these products! I wouldn’t recommend them if it wasn’t true…” #SPSP2013 #SPSP2013Toronto
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Since pharma industry manages KOLs, and KOLs have asymettric influence on their communities … #SPSP2013 #SPSP2013Toronto
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… pharma industry has asymmetric influence on those communities #SPSP2013 #SPSP2013Toronto
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Not many forces as strong at work to counter ghost managed science #SPSP2013 #SPSP2013Toronto
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Obviously, there are some issues about epistemic power here! #SPSP2013 #SPSP2013Toronto
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Qs transferrable to less extreme examples #SPSP2013 #SPSP2013Toronto
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Problems in the distribution of knowledge? #SPSP2013 #SPSP2013Toronto
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OMG, actually big pharma monopoly game that was swag at an industry conference! #SPSP2013 #SPSP2013Toronto
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a monopoly monopoly game @docfreeride
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@SabinaLeonelli : Striking how overt and public some of these processes these are. (Ghosts we can see!) #SPSP2013 #SPSP2013Toronto
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It’s above-board enough that you can see it at a conference if you can pay the fee #SPSP2013 #SPSP2013Toronto
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… but the talk is general, almost never about particular cases (plus KOLs don’t notice selves being managed) #SPSP2013 #SPSP2013Toronto
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Ego stroking $$ = RT @docfreeride: (plus KOLs don’t notice selves being managed) #SPSP2013 #SPSP2013Toronto
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Open access to data might create some countervailing forces. Not a panacea, though #SPSP2013 #SPSP2013Toronto
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Disclosure of stuff is almost always after the fact (so drugs have half patent life w/ ghost management at work) #SPSP2013 #SPSP2013Toronto
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Infiltration of this stuff into Continuing Education, tuning Bayesian priors of clinicians #SPSP2013 #SPSP2013Toronto
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Q: isn’t it to be expected that for-profit companies will handle knowledge this way? #SPSP2013 #SPSP2013Toronto
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Q: Difference between KOL behavior and academic giving plenary talk at conference to promote his career? #SPSP2013 #SPSP2013Toronto
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General behavior might be predictable, but these particular strategies didn’t emerge until 1970s,’80s #SPSP2013 #SPSP2013Toronto
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Different kinds of regulatory structures, patterns of behavior w/in physician communities *could* change things #SPSP2013 #SPSP2013Toronto
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Difference between academic talk & KOL behavior boil down to differences in power/power asymmetry #SPSP2013 #SPSP2013Toronto
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Tracking effects of initiatives is one of the things industry does #SPSP2013 #SPSP2013Toronto
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Young surgical fellows courted as potential KOLs complain that junkets aren’t as good as the old days #SPSP2013 #SPSP2013Toronto
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Wah! RT @docfreeride: Young surgical fellows courted as potential KOLs complain that junkets aren’t as good as the old days #SPSP2013
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Regulation is to thank. (If speaker fees aren’t “fair market rate”, it counts as a gift), but … #SPSP2013 #SPSP2013Toronto
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Tighter regulations don’t do much to address the movement of pharma’s knowledge thru the system #SPSP2013 #SPSP2013Toronto
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“Corporate integrity agreements” struck by companies on verge or losing lawsuit; agreement w/gov #SPSP2013 #SPSP2013Toronto
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… and they include publication plans! #SPSP2013 #SPSP2013Toronto
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@docfreeride This is fascinating. (I used to work for a co that makes training materials for pharma sales reps so have seen some of this.)
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