Healthy Skepticism Library item: 13365

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

Cassels A.
Prevention vs. drugs. The real Conversation on Health
Common Ground 2007 Mar
http://commonground.ca/iss/0702188/cg188_prevention.shtml

Full text:

Join me in raising a glass to toast our favourite organ: our liver. Prost!

As you all know, Health Canada has designated March as “Help Fight Liver Diseases Month,” and what better way to honour that special organ, which processes most of the chemicals and medications we consume, than to give it a shot of alcohol? Along with the alcohol you drink and most everything else you consume, including environmental chemicals and pharmaceuticals, everything eventually gets filtered by your liver.

The liver is an extremely handy organ and justly deserves deep respect. Before you take a prescription drug, you should ask yourself, “What would my liver say about this?” If your liver shakes its head and asks for another shot of Scotch instead, you might heed its inclinations. Seriously, though, damage to the liver due to prescription drugs shouldn’t be taken lightly, as this kind of injury is common and frequently deadly.

Liver failure also has another connection with March. Seven years ago this month, a new drug called rosiglitazone, or Avandia, was approved by Health Canada. This new drug for the treatment of adult onset (type-2) diabetes arrived on the scene the same week that Avandia’s sister drug, troglitazone, or Rezulin, was unceremoniously yanked from the US market.

Rezulin was touted as an exciting development for diabetics, a drug that encouraged the body’s own insulin to work more effectively. But it also poisoned some peoples’ livers. Between March of 1997 and March of 2000, when it was pulled, at least 155 patients died after taking Rezulin. The US FDA warned that the Rezulin deaths due to liver toxicity may only account for 10 percent of the liver damage inflicted on the population. At its height, 750,000 Americans were taking this drug.

In death, however, hope springs eternal. The end of Rezulin became the best kind of marketing opportunity for the drugs that replaced it: Avandia and Actos. The glitazones, as these drugs are called, were hailed in their time as the glory of American pharmaceutical ingenuity. As Rezulin was making macabre headlines for death and destruction, full page ads in the New York Times crowed about the superior safety of Avandia, even though everyone else with two cents worth of common sense was asking, “Should we really trust the new sisters of this liver-killing drug, and now withdrawn, drug?”

You often hear the pharmaceutical industry yelping about how slowly Canada approves drugs, compared to the US. We are the beaver, slow and methodical, unlike the bald eagle, which does things at lightening speed. What you don’t hear is that sometimes the beaver’s slower, web-footed bureaucracy actually saves lives. With Rezulin, we kept building dams and haggling over the price until the drug was withdrawn in the US, without ever actually being sold in Canada. America is fast, that’s for sure. I’m sure I’m not the only one who jokes that the US government could vastly improve its pharma R&D image abroad by just changing the national animal from the bald eagle to the guinea pig. I think you get my drift.

What diabetics want to know is this: Are these glitazones, these newer generation diabetes drugs Avandia and Actos, all that much better or safer than the current raft of older drugs we use to treat diabetes? The short answer is this: Better? No. Safer? Not at all. After only a year and a half on the market, Health Canada issued a warning concerning reports of congestive heart failure, pulmonary edema (swelling) and other effects linked to Avandia and Actos.

An early trial reported in the Journal of the American Medical Association, comparing Avandia against metformin, (Glucophage), an older, more standard diabetes treatment, showed little superiority with a host of troubling side effects for Avandia, such as edema, worsening cholesterol levels and weight gain.

If any type-2 diabetic were to ask their doctor to tell them the one thing they needed to do to prevent complications of diabetes, in nine times out of 10, the doc would say, “Lose some weight.” And what’s the main thing the glitazones do? They help pack on the pounds.

My simple logic tells me that if you are gaining weight because you take a drug for diabetes, you are travelling the wrong way on a one-way street in the opposite direction from solving your type-2 diabetes problem, and you need to ask if this is really a rational course of action for you.
But if you are an investor in a company selling a drug that does the weight gain thing, and you know the weight stuff is great to produce future sales of the drug, well, no bother, carry on. Cue the cash register sound. Kaching.

By the way, the drug companies aren’t the only ones to blame for creating new patients. Food manufacturers making processed foods high in corn sugars and fat also contribute to the diabetic monkey living on your back. But in terms of the known and nasty drug side effects of the glitazones, the mischievous imp in me wants to ask out loud: “Are they doing this on purpose?”
I mean, marketing a drug with an unfortunate side effect is one thing, but one that makes the main problem you’re trying to fix worse…? Please tell me it’s a coincidence.

Which brings me to olanzapine.

You can’t talk about the issue of pharmaceutically-created patients without bringing up the case of a widely-sold drug for schizophrenia and bipolar disorder: olanzapine (trade name: Zyprexa). Late last year, Eli Lilly, the drug’s maker, stood accused of concealing the drug’s hazardous effects, according to hundreds of internal company documents and management e-mails that had been given to a reporter at the New York Times.

In early January, the drug maker agreed to pay half a billion dollars to settle 18,000 lawsuits initiated by people who had taken Zyprexa, claiming it caused them to develop diabetes.

This is no small matter. In 2005, Zyprexa was the fourth most profitable drug in the world and Eli Lilly’s top seller, worth about $4 billion a year. Ironically, Lilly’s second best seller, grossing about $3 billion a year, is a group of insulins, insulin pens and drugs (including Rezulin’s second sister, Actos) all used to treat, guess what?

Diabetes…

Hmm. Dear reader, if you’re like me, with a touch of attention deficit disorder, let me reiterate the main points: Lilly’s second largest money maker is for treating people who suffer from diabetes and some of those patients became diabetics because they took the company’s largest product. I am not sure that the business world has yet heaped praise on Lilly for its brilliant business acumen, but it very well could. Imagine selling two mutually symbiotic products – one which stirs demand for the other – like marijuana and munchies or salty peanuts and beer. I bet they learn this stuff in MBA school. It’s brilliant.

BC used to have very restrictive policies on paying for these drugs. Why? Because in every case there are drugs that are a lot safer and cheaper than olanzapine or the glitazones Avandia and Actos. Now, olanzapine is the sixth most expensive drug paid for by the BC taxpayer (about $15 million per year) and the two glitazones, whose status has recently changed so they are now covered by Pharmacare, may well consume an additional $5 million per year of taxpayer dollars.

Given the controversy over drugs which we know cause diabetes, my question is will the costs of all the additional diabetes drugs, the test strips, the liver function tests, the treatments for congestive heart failure and the resultant deaths be charged back to the companies that make those drugs?

Seeing that we are in “Conversation on Health” season right now, in which British Columbians are being asked their opinions about the sustainability of publically-funded health services, let’s seriously consider where those scarce health dollars are going.

Let me propose a simple solution to covering controversial drugs at the public’s expense, in this case three drugs worth at least $20 million a year. If we know the drugs cause additional illness, let’s not make the public or private sectors pay those costs. Let’s let the drug companies pay.
Got a new drug to sell in BC? Let’s take this approach: “Sure, Lilly, you can sell your drug in BC, but be warned; we will track patients” – a very quick data linkage exercise between the MSP database and the PharmaNet database will tell us how many patients developed diabetes because of Zyprexa – “and we will cover that drug knowing that you will pay us for any and all additional care those patients will need related to the drug’s adverse effects. Is that a deal?”

Let’s face it; we’re now in the era of the environmental politician where the axiom is “The polluter must pay.” Who can argue with that? Let’s adopt that mentality in paying for healthcare. If you pollute our livers, you pay.

Simple as that.

In fact, I could drink to that.

Prost. Another toast to our livers. Long may they live and serve us well.

Alan Cassels is co-author of Selling Sickness and a drug policy researcher at the University of Victoria. He is also the founder of Media Doctor Canada (www.mediadoctor.ca), which evaluates reporting of medical treatments in Canada’s media.