On The BMJ home page I came across this advert by Eli Lilly. It invited me to “Learn how to better identify early signs of Alzheimer’s Disease” and warned that “The clock is ticking”:
To “Learn More” I clicked on the link. This took me to The BMJ’s hosted content section which was “launched to give our users access to resources produced by external organisations.” The BMJ provides a contact to “corporate sales” for “external organisations” who may be interested in this opportunity to reach a general medical audience.
Eli Lilly are one of a number of “external organisations” that have taken up this offer. Others include [at the time of writing] products relating to virology, gastroenterology, dermatology, and psychiatry.
The Eli Lilly content hosted by the BMJ carries the heading “Time is Hiding Something” followed by the sub-heading “In Alzheimer’s disease (AD) biomarker tools can uncover what’s been under the surface for years”.
Clicking on a headline tag “DISEASE STATE EDUCATION” you are taken to a page that begins:
“A timely and accurate diagnosis of Alzheimer’s disease [AD] is more important than ever. This enables patients more time to consider next steps, including treatment options.”
The second headline tag VIDEOS takes you to a page of videos:
Eli Lilly provides 9 films and states clearly: “This content has been developed, organised and funded by Eli Lilly and Company. Intended for UK healthcare professionals only” followed by two references:
[1] Diagnostic biomarkers in Alzheimer’s disease. Biomark Neuropsychiatry. 2021
[2] Geneva Task Force for the Roadmap of Alzheimer’s Biomarkers. The biomarker-based diagnosis of Alzheimer’s disease — ethical and societal issues. Neurobiology Aging. 2017
In the remainder of this post I will share some screenshots from three of these films by Eli Lilly. In doing so I will explore the content that is provided for healthcare professionals in the UK.
Eli Lilly introduces this 22 minute film: “Hear from clinical experts in the ‘Following the Sunrise’ documentary”:
Eli Lilly makes clear, from the outset, that it is the sponsor of Following the Sunrise.
The film is based on three locations across the world: Arizona, Edinburgh and Japan and shares the thoughts of three clinical experts. The film uses the metaphor of sunrise bringing light across the world: each expert is filmed as the sun is rising.
The film begins at 5.08 am. The first voice is of Dr Marwan Sabbagh, geriatric neurologist and dementia specialist, Arizona:
Open Payments, an official website of the United States government, reveals that between 2021 and 2023, Dr Sabbagh received $277,124 from industry [pharmaceutical companies]. In 2023, the companies that paid Dr Sabbagh the most were EISAI and Eli Lilly.
Open Payments provides the following graph of payments made to Dr Sabbagh over recent years in comparison to the US and Specialty means:
The film then moves from Arizona to Edinburgh, again before sunrise. Here we find Dr Craig Ritchie, Professor of the Psychiatry of Ageing at the University of Edinburgh and Founder & Chief Executive of Scottish Brain Sciences:
Professor Craig Ritchie, “led a drive, funded by the Scottish Government, to set up brain health clinics across the county” and Henry Simmons, chief executive of Alzheimer Scotland, has credited Prof Ritchie for “Scotland being ahead of the game” [source The Herald].
Unlike the USA, the UK does not have sunshine legislation that makes it mandatory for healthcare workers and academics to declare payments from industry. Professor Ritchie has submitted competing financial interests to the ABPI voluntary register. For the period 2021 to 2023, Professor Ritchie was paid £64,732 by pharmaceutical companies, including Eli Lilly and EISAI.
‘Following the Sunrise’ then moves to Japan. Here, before sunrise, we meet Dr Takeshi Iwatsubo who continues to use the metaphor of bringing light to the darkness:
This film is titled: “Timely and Accurate Diagnosis of Alzheimer’s Disease: What is the potential value to patients“. Eli Lilly makes clear that this video has been “developed, organised and funded by Eli Lilly and Company” PP-AD-GB-0147, May 2024.
Professor Dame Louise Robinson chairs this meeting along with expert colleagues, Dr Ross Dunne and Dr Richard Perry.
One of the main questions asked in this film is: “What are the benefits of an early and accurate Alzhiemer’s disease diagnosis?”:
In this film there is much consideration of this question. The argument was put that there should be a “move away from dementia as a diagnosis” in favour of early diagnosis of Alzheimer’s disease using a combination of biomarkers and clinical tests.
This film is based on a symposium held at the Royal Society of Medicine on the 25 April 2024. It was chaired by Professor Alistair Burns, National Clinical Director for Dementia and Older People’s Mental Health at NHS England and NHS Improvement. He was joined by two other experts: Dr Ross Dunne and Dr Richard Perry.
Eli Lilly made clear that this symposium had been “developed, organised and funded by Eli Lilly and Company“. PP-AD-GB 0123, April 2024
This presentation focuses on the delays in diagnosing Alzheimer’s disease in the UK.
Comments:
What is striking about this promotional material is its overwhelming positivity. Having had a career in medicine for over 20 years my experience has been that such confidence and certainty is often premature.
Detailed scrutiny of the two references that Eli Lilly provides with its promotional films is not required to discover that areas of uncertainty are omitted from the films, particularly in relation to the prognostic value of the use of biomarkers for Alzheimer’s disease:
“We focus on diagnostic biomarkers which reflect underlying Alzheimer’s disease pathologic changes. This contrasts with a prognostic biomarker, which would predict clinical progression of a patient with pathologic changes of Alzheimer’s disease from cognitively normal to mild cognitive impairment or mild cognitive impairment to dementia [1]”
“Because recent studies show that beta-amyloidosis and neurodegeneration are common in individuals without cognitive impairment (Jack et al., 2014), it is plausible that the earlier the detection of prodromal Alzheimer’s disease, the lower its prognostic utility with respect to the clinical onset of Alzheimer’s disease [2]”
[1] Diagnostic biomarkers in Alzheimer’s disease. Biomark Neuropsychiatry. 2021
[2] The Biomarker-based Diagnosis of Alzheimer’s Disease – Ethical and Societal Issues. Neurobiology Aging. 2017
In the UK, Eli Lilly has been able to promote its material through a range of means, including symposia given at educational meetings [Royal Society of Medicine] and then, through BMJ Hosted Content, to a much wider healthcare audience . The involvement of a national “Dementia Tsar” adds authority to what is being presented.
This promotional material uses the metaphor of bringing light. The light that I would like to see is the presentation of risks as well as benefits of investigations and treatments.
It was the poet Dylan Thomas who once said “Light breaks where no sun shines”. In terms of patient safety it is time that marketing was removed from medical education. Only then will there be sufficient light to be open about uncertainties and the potential for harm of any proposed intervention.