Healthy Skepticism Library item: 1060

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: news

Elmore C.
What you need to know about pill pitchers
Palm Beach Post 2003 Apr 20

Full text:

Golfing legend Jack Nicklaus suggests you ask your doctor about the blood pressure medicine he uses. NFL coach Dan Reeves urges you to check out the cholesterol drug that worked for him. Skater Dorothy Hamill is happy to recommend an arthritis medication. And baseball star Rafael Palmeiro isn’t uncomfortable extolling the wonders of Viagra.

Sports stars are pushing pills like never before, and America is snapping them up in record numbers.

Since the government made it clear it would allow TV and radio advertising for prescription drugs in 1997, business is whirling like a Hamill Camel. Sales have been growing at more than 10 percent a year, while most of the economy has sagged. Last year, prescription drug sales soared to $400 billion worldwide, with about half of that happening in the largest market alone, the United States. Endorsements by sports figures and other celebrities — for fees not disclosed, but estimated by analysts at up to $1 million for a major campaign — helped the medicine go down in a big way.

Drug companies say athletes have helped promote greater consumer awareness of new choices.

But the Jox for Rx phenomenon could use a warning label of its own, contends Matthew Hollon, a medical school instructor at the University of Washington at Seattle.

“Nothing could be further from the truth than claims that these things are educational,” Hollon said. “You’re not hearing from a medical expert. You’re hearing from a paid celebrity. We’re doing an uncontrolled experiment on the public with the most sophisticated Madison Avenue techniques.”

With the sales boom have come questions about rising health costs compared to generic alternatives, occasional athletes who don’t actually use the product, and a whole new range of issues for sports endorsers involving side effects, deaths, lawsuits and advertising claims.

“Dorothy Hamill doesn’t tell people they have a four times higher risk of a heart attack on Vioxx,” said Sid Wolfe, a physician and director of the Health Research Group of the advocacy group Public Citizen in Washington, D.C. “Fact. Proven in a study. I’m not sure she even knows that. Sports figures get money for saying these things, but they don’t always know the facts.”

Consumers and their doctors still have to make the final choice for themselves, said Miami Heat center Alonzo Mourning. Sidelined from the NBA with a kidney ailment, he has endorsed a prescription anemia drug he uses, Procrit.

“Whether it be Dan Reeves doing it for Zocor, whether it be me endorsing Procrit, everybody’s body is going to react to the medicines differently,” Mourning said. “So you consult your physician before you even take the medicine. Don’t take prescription drugs just because an athlete takes it.”

Athletes adding to soaring costs

Still, sales figures suggest that consumers are paying plenty of attention to what famous athletes say and asking their doctors why they don’t deserve the same treatment.

No problem there from the viewpoint of the drug companies, who say athletes are in a unique position to do a lot of good. Athletes are associated with fitness and robust good health. You’re a man who doesn’t like to go to the doctor or take medicine for that heart problem? Maybe you’ll listen to Reeves. You’re a woman avoiding thoughts of arthritis because it seems like a sign of aging? Maybe you’ll think differently once you see a graceful athlete like Hamill lacing up her skates. You’re anxious in social situations and are too embarrassed to talk about it? Maybe you’ll listen to Dolphins running back Ricky Williams, who can talk movingly about how Paxil worked for him.

Hollon says there are risks to selling prescription medicines like pump sneakers, though. Unwittingly or not, he says, athletes are contributing to inflated health costs. They are promoting brand names that are often 10 or 20 times more expensive than generic drugs or over-the-counter remedies, which may be just as effective for some conditions. The largest single health-care expense for General Motors a year ago was $55 million for a heartburn pill, Prilosec, but the company believes it often was unnecessarily prescribed.

And there is this question: Should athletes without medical training be put in a position of influencing billions of dollars of decisions about a class of drugs in which the consequences can be harmful, or even fatal?

Hamill appears in commercials for the arthritis drug Vioxx, which is marketed as a pain reliever less likely to damage the lining of the stomach than aspirin and other medicines. Wolfe referred to studies at the Cleveland Clinic and the University of Pennsylvania that suggested Vioxx carried a higher risk of blood clots that could lead to heart attacks compared to older medications. Vioxx officials questioned the relevance of the studies when they came out, saying effects on mice were not conclusive about humans.

Vioxx is not the least-expensive option. At a local drug store, Vioxx cost $130.99 for 30 50-milligram capsules, compared to $15.79 for naproxen and $3.99 for Advil.

But consumers and doctors are obviously finding something they like, manufacturer Merck & Co. said.

“Dorothy does have osteoarthritis, and we believe she is a good role model for this,” Merck spokesman Chris Loder said. “We’re very pleased with her.”

Loder declined to pass along an interview request to Hamill, saying he did not know how to reach her. Attempts to contact her through other means were not successful.

Last year, Vioxx was the second biggest “growth driver” for Merck, one of the world’s three largest drug companies. Leading the charge was Zocor, the cholesterol medicine promoted by Atlanta Falcons coach Reeves.

“The Zocor people approached me after my operation in 1999, and wanted me to make a tour going around the country to help educate people that heart disease is the No. 1 killer for both men and women,” Reeves said last week in a statement provided by a Falcons spokesman. “I was not necessarily promoting the drug, but I was trying to make people aware of the ways to curtail heart disease through diet and exercise. Then the people at Zocor asked me to do ads. I agreed because it was something that I believed in.”

What’s the FDA’s involvement?

But sports figures don’t necessarily use the drugs they promote in every case. Baseball star Cal Ripken Jr. agreed to promote awareness for a Merck hypertension drug called Prinivil. The fine print in literature distributed to doctors disclosed Ripken did not have hypertension.

John Maroon, vice president of communications for Ripken Baseball, recounted: “They approached us. They did ask, ‘Do you have hypertension?’ We said no. They said ‘OK, we’ll have to put something at the bottom.’ We said, ‘OK, that’s your area.’ “

Wolfe has a problem with a situation like that.

“If the athlete has not ever used the product, or gotten results no different than aspirin, that’s misleading,” he said.

He blames regulatory agencies, including the Food and Drug Administration, for failing to remain vigilant.

“The FDA has done a miserable job of enforcing regulations they have on the books,” Wolfe said. “In 1998, they took 157 enforcement actions involving prescription drug ads. Last year the number was 27.”

An FDA spokesperson said those numbers were correct but declined further comment.

Sometimes the courts have become involved. Last year, a federal judge in Los Angeles ordered the makers of the antidepressant Williams endorses, Paxil, to stop saying the product was not habit-forming after 35 users claimed withdrawal symptoms including nausea, fever and “electric zaps.” The judge later withdrew her order after the FDA raised concerns about the court’s involvement in regulatory matters.

In another case, a jury awarded $8 million to the family of a Wyoming man who in 1998 killed his wife, daughter and granddaughter and himself after two days on Paxil. Manufacturer GlaxoSmithKline settled its appeal of the case out of court last year, according to published reports.

Williams used Paxil for “14 or 15 months” after experiencing anxiety while playing for the New Orleans Saints and found “it worked wonderfully for me.” He has agreed to promote the product. Asked in one online chat last season if he had experienced side effects, Williams said, “No, I didn’t, but I heard that you can if you don’t stop the right way.”

New York Mets catcher Mike Piazza, one of the pioneers in sports-celebrity endorsements who helped launch the allergy drug Claritin, acknowledged that prescription drugs can present some new things for athletes to think about.

“I’ve been fortunate I’ve had some wonderful endorsements and great companies,” Piazza said. “I usually research. We weigh things out. We talk about it. It’s not like I go in and say, ‘OK, fine. Where do I sign up?’ “

It is probably better for athletes to have used the product themselves, Piazza said.

“Sure, it gives it a little more credibility, you know,” he said.

As for Claritin, which became an over-the-counter product last year, Piazza said, “I know it’s worked for me. Personally, I had good results with the product. You’re not selling it as the be-all or end-all. It worked for you.”

Mourning said he worked from personal experience as well.

“If you’re going through anemia, like I’m going through anemia, maybe you don’t know that Procrit is an option,” Mourning said. “So maybe if they hear it from me, it might help them. So it’s a good thing, really.”

Nicklaus agreed to promote Altace after using the medicine to keep his blood pressure under control. He appears in advertisements with the theme, “You can do more.”

Even with the best of intentions, athletes are staking their fame and marketing power on drugs that may have unforeseen consequences, said Hollon, the University of Washington instructor.

“To a degree, they’re putting their reputation on the line,” Hollon said. “These are drugs that are moved to the market based on research studies on limited groups, not the public at large. Their advertisements are bringing millions of people to these products. What we don’t know is how this experiment is going to turn out.”