Healthy Skepticism Library item: 16787

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: Electronic Source

Armstrong D
A Jug of Wine, a Loaf of Bread and Lipitor
The Wall Street Journal Blog 2007 Dec 20
http://blogs.wsj.com/health/2007/12/20/a-jug-of-wine-a-loaf-of-bread-and-lipitor/

Full text:

Sometimes being No. 1 is still not enough. Lipitor, already the biggest hit in pharma history, was promoted to docs by Pfizer as a remedy for people not ill enough to need it, alleges a lawsuit filed by an ex-Pfizer official, the WSJ reports.

The drug giant, according to the suit by Jesse Polansky, a former director of outcomes-management strategies for Pfizer, funded educational programs for doctors that were thinly disguised marketing pitches to get them to prescribe the cholesterol blockbuster for people whose risks of cardiovascular disease didn’t warrant Lipitor.

Among the many educational events were dinners held for doctors at some of the best restaurants in the country. And the Health Blog was there for a couple. First, you should know that both were funded by Pfizer through an unrestricted educational grant to an outfit called Convergent Health Solutions. A call to a Convergent official about the dinners wasn’t returned.

Now the reviews. In a private room at Deux Cheminees, a swank French bistro in Philadelphia, then Temple University cardiologist Helene Glassberg lectured from a prepared deck of slides as a dozen doctors and residents sipped red wine and dined on salmon and prime rib. Glassberg, who has since jumped to the University of Pennsylvania, joined in the casual vibe by sipping from a glass of wine as she delivered her lecture.

In a slide about the federal treatment guidelines for determining who should be considered for treatment with drugs like Lipitor, Glassberg indicated that chronic kidney disease was a so-called “risk equivalent.” That’s an important distinction because it places people in the highest risk category – the one which calls for placing patients on Lipitor even when they have relatively low levels of bad cholesterol.

But federal cholesterol guidelines, from a group known as the National Cholesterol Education Program, don’t list chronic kidney disease a risk equivalent. There is also some research suggesting that dialysis patients with diabetes don’t benefit from statin therapy, and one study found that such treatment actually resulted in a doubling of the risk of fatal stroke.

Glassberg said her talk was balanced and that data support the contentions made on each slide. She said Pfizer didn’t play a role in creating the slides. But they didn’t come from Glassberg either. The deck came from Convergent, the company that received the Pfizer grant. She said the slides were created by experts in the field operating independently of Pfizer.

Next dinner, this time at Grill 23 in Boston’s Back Bay district, where Harvard cardiologist Stephen Wiviott showed the same slide. The meal was so good here that several docs took the leftovers home in doggie bags.

Wiviott, in an email, said “the slide that you inquired about regarding chronic kidney disease as a risk equivalent provides a reference (see bottom of slide) to the National Kidney Foundations K/DOQI Clinical Practice Guidelines for Managing Dyslipidemias in Chronic Kidney Disease. In this guideline, the authors state that chronic kidney disease should be considered a coronary heart disease risk equivalent and that risk factors for heart disease should be managed accordingly.”

You can see the slide and judge for yourself (click on image at right). The slide’s title refers to the federal treatment standards.

Polansky’s suit says the reference to chronic kidney disease is deliberate misinformation. He says Pfizer promotes the idea that chronic kidney disease is a risk equivalent because the 20 million people in the U.S. with the condition “represent a substantial new potential market for Lipitor.” Pfizer, for its part, said it believes the case is without merit and that it doesn’t condone off-label promotion.

Health Blog Zagat Special: Tell us about the educational dinners you’ve attended. Where did you go? What did you learn? Balanced, nutritional educational fare or junk food for the medical brain?