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Pharmaceuticals, Marketing and Hype

"This is a locomotive that's barreling down the tracks, and you either get out of the way, get on board, or get squished,"

So says gastroenterologist Dr. James Richter about the pharmaceutical drug system. A recent article in the Boston Globe Magazine outlined how drug marketing and patent rights exhort control over the price of pharmaceutical drugs.

The article uses the development and marketing of Prilosec (the 'Purple Pill') to illustrate how health care providers and the health maintenance organizations are enchained into prescribing a 'Cadillac drug' when other 'Hyundai drugs' are available and can be as effective.

"The Costly Case of the Purple Pill".The Boston Globe Magazine November 17, 2002.

Here is a very rough sketch of the points covered.

Prilosec is the second highest grossing drug with over $4.6 Billion in worldwide sales. Launched in 1989, Prilosec's list of indications (conditions for which providers can prescribe) grows from two to eight. Prilosec is know as a PPI (Proton Pump Inhibitor) an acid-stopper used for stomach related distresses.

In 1993 the FDA allows for direct to consumer advertising to be unimpeded by a listing of side effects (provided a web address or 1-800 number was given that would provide this information). The 'Purple Pill' became ubiquitous.

A drug company can spend as much as $800 million in the research and development of new drugs. Astra-Zeneca, makes $4.2 billion; spends $2.7 billion on research and development.

Drug companies prolong the life of their patents through a series of lawsuits allowable by FDA regulations. New generations high-end drugs are introduced as 'the next big thing': Astra-Zeneca has developed Nexium to replace Prilosec as the HPP of choice.

Transitioning from a high-end drug like prilosec to a generic counterpart or other class of drug can bring upon an episode of pain or discomfort the drugs were made to abate. During this transition patients often request to remain on the high-end drug.

Health maintenance organizations and pharmaceutical benefits managers are often under cost incentives to keep a high-end drug as their primary drug for that class. HMOs and benefits managers often keep the high-end drug off their 'prior authorization' list for a fee by the drug-maker.

Neil Swidey's article comes close to delivering its promise on telling the reader "everything you need to know about the high cost of prescription medicine"

Recently the Bush Administration announced that the FDA would seek to speed up the process by which generics can be made available.

Hype in Health Reporting: Checkbook Science buys distortion of medical news. Extra September/October 2002
Diana Zuckerman. Center for Policy Research on Women and Families

Diana Zuckerman has described how medical news is shaped by pharmaceutical companies and health care industry interests. We've all seen news reports and printed articles of developments in drugs and treatments that are offered up as revolutionary breakthroughs. Such news reports are developed by a system of highly paid and well-placed public relations firms, medical ghostwriters, and speakers' bureaus.

Medical reporters covering these break-throughs sometimes never know that the 'experts', enlisted for their news pieces, are often paid by a PR firm that is paid by a sponsoring company. Zuckerman points out that few reporters ever ask about possible conflicts of interest.

Zuckerman offers three different cases wherein hype prevailed over balanced reporting. In some cases more credible research was overlooked.

--When the diet pill fen-phen was initially found to be dangerous, Wyeth-Ayerst hired Excerpta Medica Medical Communication (yes, the Excerpta Medica we know as the medical database producer, medical education company, subsidiary of Reed Elsevier) to develop counter-findings based on loose analysis. USA Today, L.A. Times, and the Boston Herald wrote about the findings presented at a medical meeting.

--Major public relations efforts succeeded in attracting attention to a 1999 study that reported on the safety of breast implants. The study was hailed by implant manufacturers and plastic surgeons and received coverage by major newspapers and networks. Recent studies by the National Cancer Institute pointing to risks in breast implants have not received as much attention.

--The recent (July 2002) clinical alert regarding hormone replacement therapy (HRT) and the risks of cancer and heart diseases was preceded by growing evidence of that risk. Librarians following the HRT issue know of the controversy swirling around it much before the clinical alert was released. (NHLBI stops trial of Estrogen Plus Progestin…) According to Zuckerman "most media covered the story as if this was enormous news that came out of nowhere". Dr. Robert Wilson was a promoter of HRT through his speaking his book "Forever Feminine". In a New York Times article earlier this year, Wilson's son admitted that his father was paid by Wyeth to promote HRT.

Javier Crespo, Conumer Health Coordinator