Out of Order: Didn’t see that coming

Everything has side effects.

Having orange juice instead of tomato juice with breakfastcan give you heartburn. Driving to work instead of taking the bus can causeyour car to run out of gas. Reading this commentary can induce nausea and highblood pressure, although I hope not.

Even selecting one movie over another atyour local multiplex can have side effects.

At the risk of feeling my stomach churn, my eyes roll or myblood boil, I went to see the movie SideEffects the other week. (SPOILER ALERT) In the movie, a young woman is sentfor psychiatric counseling after struggling to cope with anxiety and depressionover the release of her husband from prison for insider trading. Whilereceiving treatment, the woman is put on antidepressants, which cause her toexperience a variety of side effects, including one that triggers the pivotalaction on which the movie turns.

As I sat in the theater, I braced myself for the standardaccusations of incompetence on the part of the psychiatrist, collusion betweendoctors and coercion or conspiracy between the doctor and the pharma reps, allin an effort to help this poor woman cope with events as they play out. And tosome extent, this does happen in the movie.

But just as I could feel the bile form in the back of mythroat, the plot line took a significant right turn and suddenly, things aren'twhat they seem. What looked like it was going to be a social agenda movie turnsinto a thriller—and in my opinion, an exciting one.

But aside from a few heart palpitations and a bit of a braincramp from trying to stay a step ahead of the plot, I experienced another sideeffect from watching the movie. I gained insight—in this case, about theubiquity of information on therapy-related side effects.

Contrary to media reports and blogs that decry thepharmaceutical industry and the medical profession for hiding negativeinformation about new (and old) therapeutics, a quick Google search quicklypoints out just how much information is out there. In fact, often so much sothat any one individual would be hard-pressed to keep even a small percentageof it in his or her brain.

It's not ignorance by volition; it's ignorance by volume.

As a company, you want to highlight the positives of your newtherapy, but the machinery is in place to ensure you do that while providingcontext. Many of the diatribes seem to miss the point that it does your companyno good to have patients and clinicians suffer because of your product, asdemonstrated time and again with class-action lawsuits that more than eat upany profits from sales.

(As a personal aside, the cynic and the paranoiac in mefight a constant battle over the question of how many of us are sufficientlysmart to be able to pull off a conspiracy of silence on such a grand scale.)

The challenge, it seems, comes down to how best to digest,distill and disseminate this information to clinicians and patients in a mannerthat they can understand, and more importantly, use to make clinical treatmentdecisions.

Regulatory agencies and advertising advisory councils mustbe made to understand that it is not simply enough to list the panoply of sideeffects that were noted during clinical trials or in post-marketing analysiswithout providing some degree of context. Otherwise, you have consumerswondering why they would take a vaccine for traveler's diarrhea when one of theside effects of the vaccine is diarrhea (look it up!).

Too often, the industry's hands appear to be tied when itcomes to providing target markets with information, as regulatory agencies andadvertising counsels argue that consumers aren't capable of digesting thisinformation. I think we're not giving today's consumers enough credit. The ageof the uninformed consumer is coming to an end, so it's important we figure outhow to make sure they get the information they need to make the right decisionsfor themselves.

You can give someone all of the component pieces ofinformation, but without appropriate context, it can still be misinformation.It is the equivalent of telling them all of the pieces of hardware in their newdo-it-yourself bookshelf, but not giving them the assembly instructions. Sure,they know the names of everything, but are they any better informed for knowingthat?

Rooney Mara. Channing Tatum. Jude Law. Catherine Zeta-Jones.Side Effects. If that were all youknew, would you understand what the movie is about?

Willis is the featureseditor of ddn. He has worked at bothends of the pharmaceutical industry, from basic research to marketing, and haswritten about biomedical science for almost two decades.