Radiology Reps - Half Dose Multihance?

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Anonymous

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Okay, I'm asking my question here in hopes getting a straightforward answer in the anonymity of the forum. I had one of your reps in my office the other day and the whole safety ACR FDA speech blah blah blah but then she said something that peaked my interest - she said that we could half dose our patients due to the relaxivity of Multihance. I talked some of my area colleagues and they have not heard of this, the radiologists are okay with what we need to do to save money. Obviously half dose would save significantly on our contrast budget.

Then I had one of your competitors show me your box sheet and it said not to use at half dose. My question to you is...is this something that you are seeing around the country or do I just have a rogue rep trying to sway me to your product? A no BS answer is appreciated.
 






1/2 dose is popular in my area, the radiologists are concerned because it is not the approved dose so it may open them up for added liability. The 1/2 dose message has worked well for myself and other reps.
 






1/2 dose works, many reps do not suggest because it also cuts their sales in half. However, if there is alot of competition or a good target account, 1/2 dose selling is a good option to suggest. Ask your rep for physician recommendations and they can have a physician speak directly to your radiologists. The relaxivity makes a difference! Good luck!
 






I believe Bracco was unable to get FDA to agree to half dose protocols in their package insert; not sure how much literature there is to support this regimine, but a rep should not be promoting something outside a package insert.

Unless you can find significant published support for half dose protocols, then you are at your own risk. What if something is missed on a scan and becomes part of a future lawsuit? May not be an issue, but I would be prepared for that as a worst case scenario.
 






Anonymous said:
I believe Bracco was unable to get FDA to agree to half dose protocols in their package insert; not sure how much literature there is to support this regimine, but a rep should not be promoting something outside a package insert.

Unless you can find significant published support for half dose protocols, then you are at your own risk. What if something is missed on a scan and becomes part of a future lawsuit? May not be an issue, but I would be prepared for that as a worst case scenario.
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Says the Bayer/GE/Covidian rep, crawl back into your hole and continue to watch your market share decline! Half dose is perfectly okay and many radiologists stand behind it (and the number is growing). It's about time people got a clue about the differences in relaxivity, it's just a shame it took so long for the market to begin to figure it out.
 






the effectiveness of the agent at 1/2 dose has never been clinically proven, when the agent went through the approval process they tried to get a half dose indication but failed because the results were mixed and not consistent. We can't even prove added efficacy at our standard dose vs. our competitors. We are masters at implication and what could be missed.
We lose credibility by suggesting clinical practice that is not in line with our own insert, suggesting this idea of 1/2 dose makes us look questionable in the eyes of the radiologist.
Our sales suggest that our strategy is flawed.
 






Anonymous said:
the effectiveness of the agent at 1/2 dose has never been clinically proven, when the agent went through the approval process they tried to get a half dose indication but failed because the results were mixed and not consistent. We can't even prove added efficacy at our standard dose vs. our competitors. We are masters at implication and what could be missed.
We lose credibility by suggesting clinical practice that is not in line with our own insert, suggesting this idea of 1/2 dose makes us look questionable in the eyes of the radiologist.
Our sales suggest that our strategy is flawed.
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Excuses, excuses. If you can't sell, step aside for those who can. Or better yet, don't bother and we'll weed you out soon enough.
 






to those bayer, covidien and ge people, just get over it, our time is now, Magnevist is dead, and Omni and Opti are the same as generics, our time is now, we have the data and the momentum. Bayer has no counter punch to our portfolio, good luck in 2011.
 






To Original Poster . . . ask TAP Pharmaceutical reps that made off label claims of Lupron, or Pfizer reps that made off label claims on Neurontin whether or not jeopardy came into play. Ask your Bracco rep to bring his/her manager on next visit to validate the 1/2 dose off label claim . . . record on video/audio the entire meeting . . . hand over video/audio to Department of Justice for violation of PDMA and collect 10% of what the government penalizes greedy Bracco rep for . . . cutting corners in healthcare is like driving on an interstate with your brake warning lamp lit . . . teach these bloodsucking vendors a lesson, and maintain quality of care.
 






Seriously, to the doctor who asked the question. Maybe the lower dose works. Unfortunately, FDA and labeling restrictions do not permit the Bracco rep to promote that use.

Find the literature that discusses the lower dose use. I'm sure your rep can get you in touch with their medical department that can provide you with that literature. He/she legally can't request it, but you can. Just takes a phone call.

Maybe you will need to do a few cases where you do both full dose and half dose studies on the same patient. Compare and see if you feel comfortable with both studies. Have your colleagues comment on them as well.

And for gosh sakes, don't listen to me. I didn't go to medical school. Make your own decision based on the evidence.
 


















Anonymous said:
to those bayer, covidien and ge people, just get over it, our time is now, Magnevist is dead, and Omni and Opti are the same as generics, our time is now, we have the data and the momentum. Bayer has no counter punch to our portfolio, good luck in 2011.
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It had better be. MultiHance has been on the market for five plus years. And during most of that time, at least one of your major competitors has been knocked on its butt.

If I don't know a time for "momentum," then the word doesn't exist.
 




































To Original Poster: Notice that until Post #10 on this blog, nobody gave a damn about your patients, they only talked about "their sales," and how breaking the FDA's law was helping them maintain or gain business . . . everything after Post #10 reads like "we still don't care about your patients, we're worried about our competitor."

My group dumped Bracco two years ago after their rep tried to make claims versus a competitor regarding NSF issues. When I pushed back on my spineless rep, his manager caved and personally told me that the representative was fired for making false claims . . .

As per Post #10, your rep is still making false claims. Dump them like I did. They'll be back at your door apologizing for making false claims, and probably offer you a handsome discount on future purchases to re-win your favor. If they do, and after reading this message board, you'll know in your what kind of company Bracco truly is . . .
 






Anonymous said:
To Original Poster: Notice that until Post #10 on this blog, nobody gave a damn about your patients, they only talked about "their sales," and how breaking the FDA's law was helping them maintain or gain business . . . everything after Post #10 reads like "we still don't care about your patients, we're worried about our competitor."

My group dumped Bracco two years ago after their rep tried to make claims versus a competitor regarding NSF issues. When I pushed back on my spineless rep, his manager caved and personally told me that the representative was fired for making false claims . . .

As per Post #10, your rep is still making false claims. Dump them like I did. They'll be back at your door apologizing for making false claims, and probably offer you a handsome discount on future purchases to re-win your favor. If they do, and after reading this message board, you'll know in your what kind of company Bracco truly is . . .
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As Poster #10, I'm not a physician nor am I currently in the business (I did work as competitor to Bracco for a number of years).

All I'm saying is that if you, as a physician, want to consider the lower dose use of MultiHance (which I remember was a possibility discussed when the product was launched, a few months before I left the industry), I (as a physician) would be using published studies, information from Bracco's medical department, and personal experience before making any such decision which could have a significant impact (positively or negatively) on my medical practice AND economic situation.

The answer may very well be that it is a risk (from both a patient and financial standpoint) that I would not want to incur.

But I wouldn't let the Bracco rep (or any sales rep for that matter) be the sole provider of information that leads me to that decision.
 






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