Although Company Z really does nothing to promote their Zyximab for the off-label use on nephrologist's dementia, some practising clinicians do spot the opportunity and dilute the drug themselves. A few with an academic mind actually proposed randomized control trials to compare the two medicines.
The sales manager of Company X is horrified. In fact, the sales of their Xyzimab is not as good as they expect - obviously because many suitable cases use that cheap cheap diluted version from Company Z.
An urgent meeting is hold.
"Look. We've got to stop all this." The CEO roared.
"But how ? Zyximab is obviously as effective as our product - and way less expensive." The scientific officer said, rather naively.
"Let me see. Oh, yes. Let's focus on the other side of the coin and talk about the potential risk."
"Risk of what ?"
"Risk of - let me see - causing memory loss." The CEO concluded.
"But, nephrologist's dementia causes memory loss !" The scientist could not believe his ears.
"Exactly. We can put up a few cases who are treated with Zyximab and the memory gets worse - we then blame it to the drug. Since there's no control trial as yet, no one could prove a similar risk of deterioration when treated with our product."
"Jove, that sounds courageous. Who is going to believe us ?" The marketing manager asks.
"No, the public need not to believe in us," the CEO smiled, "We shall pass the cases to those patient support groups and possibly some of our alliance in private practice - they will voice out to the media."
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My dream broke off. I was dumbfounded and soaked with sweat. All of a sudden I realized Zhuangzi (莊子) was wrong - both him and the butterfly may represent reality.
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