E-drug: Call for bad adverts for MaLAM slides www (cont'd)
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Dear Dr. Mansfield,
I visited the MaLAM website and I think it is a great idea. I am
passing the URL along to people here whom I think would find it of
particular interest.
I hope in considering advertising, you will expand your focus to
include the more inclusive topic of marketing. Let me give you some
examples of what I mean -- an older one and some more recent ones.
1) Oraflex (Benoxaprofen) was an NSAID produced by Eli Lilly during
the early 1980s. Not long after its US approval, it was withdrawn from
the market following reports of serious and even fatal adverse
reactions. The events of this time included civil and criminal charges
against Lilly. It is a long and sorry story, well documented by Public
Citizen Health Research Group under Dr. Sidney Wolfe, where I worked
on this at the time as attorney for pharmeceuticals.
The marketing part of this story is as follows: Before the drug was
released, Lilly had sent press kits (not ads) to major media announcing
the new drug. This presented the drug as news, not in advertisements
(which would not have been allowed before approval) As soon as the
drug was approved, millions of arthritis sufferers asked their
physician for Oraflex, and many physicians complied. Because of such a
steeply rising demand curve, many more people were exposed to
Oraflex early on than would normally be exposed to a brand new drug.
The public health implications of for a new drug that would have been,
in earlier times, only prescribed for a limited number of people -- and
which had only been given to a much smaller population in clinical
trials -- are obvious.
In other words, the unusually high utilization rate was due not to
advertising, but to a marketing plan that included having the drug
mentioned as part of the editorial content in major magazines, TV
shows, etc. etc. As a result, many more people used the drug and were
severely affected early on than if a more conservative approach had
been taken.
(In the case of Oraflex, the problem is complicated because this drug
had demonstrated serious problems in other countries before it ever
was considered for use in the US, but that is another matter for
another time.)
All of this, by the way, is documented by Public Citizen Health
Research Group in Washington, D. C. You can reach them through their
website -- www.essential.org and then go to Public Citizen (careful, not
Public Interest Research Group!) and then to Health Research Group. I
don't think the Oraflex documents are on the website because they
were generated too long ago, but they could send them to you.
2) The second case is more recent. This is the story of Merck's
Fosimax (alendronate), a drug for osteoporosis. Prior to the approval of
Fosimax, Merck was already "helping" the Osteoporosis Foundation and
Older Womens League, etc. prepare "osteoporosis awareness" materials.
If you get the materials produced on the topic by these organizations
around 1996-1997, etc. you will see the Merck imprint and
acknowledgement of Merck.
So far so good. People need to be aware of osteoporosis. But the thing
that bothers me is that Merck was apparently coordinating this
"awareness" effort with its marketing to physicians after the drug was
approved. It was clear from the sample of docs with whom I spoke that
when I said "osteoporosis" they responded "Fosimax" almost like a
word-association drill! In other words, Merck helped to create an
enormous perceived need just in time for THEIR product's release!
I want to be fair. The materials Merck supported spoke about diet,
exercise, etc. etc. But the bottom line was to see your doctor (who had
something to help you)!
3) Cholesterol screening. Yes, there is a connection between serum
cholesterol and coronary heart disease, but consider what great
resources we put into cholesterol screening (where there are patented
drugs on the market for treatment) and how little attention we pay to
homocysteine screening (where unhealthy levels can be treated by
non-patentable vitamins). Do you see a pattern here?
It goes beyond advertising. Advertising is just part of marketing.
While it is imnportant to sensitize health care professionals to
advertising, I think we need to become aware of the many other forms
drug marketing -- both to professionals and to consumers -- may take!
Oh yes, for a nice collection of outrageous benzodiazepene ads from
the 70's you could see the book I co-authoried, with Drs. Eve
Bargmann and Sidney Wolfe, Stopping Valium, Warner Books, 1982.
I wish you the best with your most welcome website!
Joan Levin
e-mail: jdlevin@interaccess.com
P.S. I don't know what is going to happen with the ELHILL mainframe
at NLM about which you were good enough to write. One of the most
useful strings of search statements for drug researchers:
1) subs apply, ae, to, po
2) [names of drugs]
will no longer be available. This is the search string that allows you to
enter lists of drugs, one after another, to retrieve articles on adverse
effects (drugs used for therapeutic purposes that go awry), toxicity
(drugs used in experiments, generally animal experiments to look at
toxicity) and poisoning (drugs taken for a non-therapeutic purpose).
While I applaud the services now on the internet, I think our
government has engaged in a false economy with its plans to dismantle
ELHILL, and I believe the scientific community will come to regret
allowing this to happen. I hope we can at least delay the event!
--
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