I want a new drug: Drugmakers promote new (but unimproved) drugs
Like the Huey Lewis and the News hit, drug-making companies want doctors to prescribe and promote their new drugs and are willing to pay handsomely to achieve that goal, even though those new drugs are far from being god’s gift to science – and despite the fact that there are older and more affordable versions of those same drugs. This is what independent, non-profit corporation ProPublica found by analyzing the federal Open Payments database. For example, the makers of the drugs Pradaxa, Xarelto and Eliquis paid almost $20 million in the last five months of 2013 to doctors and teaching hospitals for meals, promotional speeches, counseling, and educational gifts in a bid to displace Coumadin as the only alternative for patients at risk of deadly blood clots.
Drugmakers’ marketing departments do their best – or worst – to validate these new drugs. Thus, they resort to generalities such as that X drug is better, faster, easier to use and less side effects than Y. In the specific case of blood thinners Pradaxa, Xarelto and Eliquis, their makers claim that they are at least as effective as Coumadin, which in addition requires routine blood tests and patients to abstain from eating grapefruit or cranberries, among other dietary restrictions. “They may have some unique niche in the market, but they are fairly redundant with other therapies that are already available,” associate professor of medicine and public health at Yale University School of Medicine Dr. Joseph Ross said. “Many of these, you could call me-too drugs.”
Conversely, Pharmaceutical Research and Manufacturers of America’s assistant general counsel John Murphy said that pharmaceutical companies’ spending is not just a marketing ploy but a means of making sure patients have the best alternatives. “On paper, a drug may not look like it is monumentally better than another drug, but to an individual patient, it might be,” he said. Daily diabetes injection Victoza was the medication linked to the most payment to practitioners. Its manufacturer, Novo Nordisk spent over $9 million on doctor interactions associated with the drug, not including development expenses such as research payments and royalties.
According to Novo Nordisk’s chief medical officer for North America Dr. Todd Hobbs, the company’s expenditure on Victoza is a reflection of the drug’s recentness and the need to address safety concerns such as the fact that drugs in the same class as Victoza increase the risk of thyroid cancer and pancreatitis, as researchers and advocacy groups have pointed out. “We just received a huge amount of interest and questions and need for education,” he said. “You see the fruits of that in this report.” The number 2 spot went to Bristol-Myers Squibb and Pfizer’s Eliquis with almost $8 million. The companies released a statement to justify their expenditure, saying that since the drug is prescribed by different kinds of specialists “it is critical to have a speaker program that adequately provides robust education to these physicians” so doctors can understand the proper use of the drug.
The third place went to Brilinta, yet another blood thinner. This is one is manufactured by AstraZeneca, and stands in direct competition with generic drug Plavix. The company spent more on speakers and research for this drug as it is one of its “key platforms for growth.” AstraZeneca added that “physicians are also indispensable partners in our efforts to bring new medicines to patients.” And so the list goes on. In fact, 14 of the top 20 most promoted drugs were approved by the FDA as recently as 2010. Among the similar conditions that they treat are diabetes, schizophrenia and chronic obstructive pulmonary disease; this overlapping means it’s a dog-eat-dog world. “They’re fighting over the same doctors, I guarantee you,” founder of a consulting firm that advises pharmaceutical companies in Bernardsville, N.J Rhonda Greenapple Simoff said.
Unfortunately, some of the most promoted drugs have severe adverse effects that only became apparent post-approval. Others such as Copaxone, Latuda, Xarelto, Daliresp and Humira have been singled out by the FDA for faulty promotion. For example, Subsys – approved for cancer pain in 2012 – is frequently prescribed for off-label or unapproved uses. Moreover, the New York Times reported in November that some of the physicians who were paid the most to promote Subsys were in disciplinary or legal hot water. Nonetheless, the drug’s maker Insys Therapeutics told the Times its marketing was kosher.
Conspicuous by their absence from the top, on the other hand, are disease-curing, life-prolonging drugs like a new class of hepatitis C treatments or cancer drugs. Medications that are the first to treat a condition or are an improvement over previous drugs “‘sell themselves’ on the merits of their unique benefits,” according to founder and now senior adviser to Public Citizen’s Health Research Group Dr. Sidney Wolfe.