Monday, January 31, 2022

Naughty But NICE and the NHS ...

(Edited -  content added, PS x2 added)

Just taking a break from a transcription of a marketing interview with a British payer, who is doing an unofficial, informal marketing pre-launch evaluation of a new drug that is due to launch soon, to give a small vent about something which rubbed me the wrong way today.

Without giving any details about the drug, the company involved, or what this person's actual relationship is with NICE and the NHS, let me just say first that this person is, by far, the most insulting person in my 2 years of transcribing these interviews, which again, are international - BUT - done in that stereotypical British "I'll sound so polite that they won't even know I'm being insulting, Americans are too stupid" sort of way.

Now -  although I agree with him on his clear distrust for American pharmaceuticals and that the cost of new drugs by U.S. pharmaceuticals is too high, when the efficacy isn't justified - AND - I agree with him that  our  U.S. healthcare system is largely backwards in comparison -  his insults didn't seem to be limited to just American Big Pharma, but Americans in general, blanket generalizing them.

He also had no clear understanding of how it works here, and thus made a lot of assumptions - such as that there is no cost-effectiveness analysis done for new drugs at all, in America, when actually there is - it's just that it's done by private commercial payers rather than just the government, and thus more individual rebates comes into play (which he does seem to have some  rudimentary understanding of).

Additionally, I didn't agree with this (paraphrased) assumption,  after having personally transcribed at least 20 of these interviews internationally, over the last month:

"Both the KOL (key opinion leader, the expert clinician) and myself did not agree with the definition of "refractory," in these patients, so I'd suggest your company, which I'm assuming is American, adjust your definition of refractory to fall in line with our definition - and I'm quite sure that if you used the Oxford English Dictionary, it would side with us."

Oh - we have to take sides, now, British VS. American?

I don't think so, but all righty :)

The Asian-British-accented interviewer - meaning you could tell that English was not her first language, but she spoke with a British accent, with touches of an Asian accent - just rolled over it and distracted him with another question - but here's what I have to say about that ...

"Okay, for starters, A**hole - a word which we all understand the meaning of, whether or not it is included in the Oxford English Dictionary - since this interview is double-blind, you have no idea whether the company is American or not, because we do interviews for international and even multinational companies as well.  In fact, I don't even know who the manufacturer is, or from what country. 

Secondly, the Oxford English Dictionary wouldn't help us, here, because these are medical definitions that may vary according to disease state, not basic English-word definitions. 

Lastly, and most importantly, despite what the Oxford English Dictionary says, let me assure you, after having transcribed 20+ interviews for this drug, even clinicians within your own country cannot agree on its definition, because there are no published guidelines on the definition in this particular disease state, in any country. 

In fact, the disease itself relies predominantly on patient-reported data rather than data from objective measurements.

That is the entire point of this interview, which you clearly missed  - to poll expert clinicians in this field, along with payers, knowing that there are subjective interpretations of the medical definition of this word, in this particular disease state - in order to at least try to get a general consensus for what the interpretation of the word "refractory" means to them, as opposed to the literal definition, so that it can help with subgroup analysis and assigning cost based on prevalence.

Thus, you may take your pompous, presumptive, arrogant  British arse  -- mind you, since we're apparently blanket-generalizing/stereotyping into little boxes everyone from certain countries, the British being notorious for their for getting bogged down in semantics and their obsession with proper English usage and definition, to the degree that they lose entirely the bigger picture and the plot -- and get thee to the Oxford English Dictionary yourself, to look up the definitions of the words "subjective" versus "objective," so that you can now evaluate if perhaps you might have these two definitions confused for one another?  

Cheers! :) 



Thank you, that is all.  I feel better now :) lol

PS - Interestingly, after he began thinking the manufacturer might be Swiss, instead of American, he softened a bit lol.

In fact, he softened so much that the interviewer asked again, since he was feeling "kinder" if she could try for the price point testing now.

He still said no, but interesting lol.

In fact, once he thought it was a Swiss company instead, he softened so much that he actually complimented an aspect of the American system - which doesn't occur as much as he thinks it does - and is actually a feature that I think makes things worse - which is incentives or deductions for physicians for hitting or not hitting quality metrics.  

First of all, the quotas that doctors have to reach of how many patients to see in one day - which is becoming universal - sacrifices much needed quality time for patient care to quantity for the almighty income dollar. 

Another aspect - which only a few health systems have implemented, and not the majority - is to give incentives for patient improvement, when patients are notoriously noncompliant - you can never be sure that  patients have truly have taken their meds at home, like they say they are, or exercised and followed their diet the way they said, either - and whose fault is that, then, that their health condition has not improved?  It's certainly not the physician's fault, it's the patient's.

And yet the only thing this British guy liked about the American system was this new sacrificing quality of care for quantity dollars?

Treating healthcare like revenue generation isn't going to help the overall systemic problems, and it isn't something to be praised - sorry.

Now - may I just say, it's a double-blind interview - even I have no idea who the manufacturer sponsoring the marketing interview is (but I could research the studies and find out).

Also, the aspect that made him now think it was a Swiss company, instead of American, or a multinational corporation, for that matter - isn't unique to the Swiss, like he thinks  - in fact, it's new value-based agreement offering that all pharma companies are considering, and the Swiss didn't even come up with it lol.

Oh well, let's let him think that and make an ass of himself and find out the hard way that he's not the smartest detective and economist on the planet like he thinks he is ;)


PPS - So today, which is the day after this post was initially written, she's interviewing another payer from another European country, and she switched up the question.  

So the original question was something akin to "Do you agree with this definition of refractory patients?"

Now, she's switched it to, "There's not much consensus on use of the term "refractory" versus "uncontrolled" from a payer perspective;  would you agree with this definition or will you leave that up to the treating clinicians?"


Smart girl :)

Because after that, yesterday, she's now spelling out the reason for the question, apparently for idiots, who get hung up on Oxford English dictionary definitions, instead of seeing the bigger picture, that not all clinicians define "refractory" the same way in this particular disease state and patient population, despite what Oxford says  ;)

For the record, he essentially says, "I agree with this definition, as a payer, but ultimately, it's the expert opinions by our KOL clinicians on the definitions of refractory versus uncontrolled in this disease that will influence our final decision."

Smart man, too ;)

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