Healthy Skepticism Library item: 16860

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

Herper M
Zetia's Miraculous Popularity
Forbes epub2009 Nov 26
http://www.forbes.com/forbes/2009/1214/health-lipitor-merck-vytorin-zetia-miraculous-popularity.html

Abstract:

How did Merck persuade patients to spend $21 billion on a cholesterol fighter that may not prevent heart attacks?

Full text:

The evidence says Merck’s cholesterol-lowering drug Zetia should be a niche product. It works by a little-understood mode of action. No trials show that it prevents heart attacks.

Yet Merck’s clever marketers have spun straw into gold: Over the last seven years they have convinced doctors to prescribe $21 billion worth of Zetia and its sister drug, Vytorin, which combines Zetia with Merck’s old cholesterol drug Zocor. The drugs are on track to do $4 billion in combined sales this year, despite multiple studies suggesting they fail to prevent clogged arteries.

Last month Zetia got trounced by the B vitamin niacin in a study, funded by a competing drug company, that used ultrasound to examine clogged arteries. Another artery study in March 2008 found that Zetia was no better than a placebo. Merck says the imaging studies are flawed and that millions of people may need Zetia or a drug like it.

Zetia’s rise “was the miracle of marketing, not the miracle of medicine,” says cardiologist Sanjay Kaul of Cedars-Sinai Medical Center. “We’ve spent billions on a drug that may turn out to be a placebo,” says Cleveland Clinic cardiologist Steven Nissen.

The problem is endemic to American medicine: New drugs get prescribed to too many people, too fast, while evidence on whether they really help patients is collected at a tortoise’s pace. Merck took three years after launching Zetia to start a big trial to determine whether it prevents heart attacks. This study won’t finish until at least 2012.

Lipitor, Zocor and other statins block production of cholesterol in the liver. Zetia works in the intestine to absorb cholesterol from food. There’s another big difference between statins and Zetia: The former have demonstrated, in big trials, their ability to prevent heart attacks.

What explains the differing results? Chance, perhaps. But statins quell artery inflammation in ways Zetia can’t. They also raise levels of high-density lipoprotein (good cholesterol). Zetia does not, but it still has fans. “I don’t subscribe to the idea that some ways of lowering cholesterol are better than others,” says Daniel Rader of the University of Pennsylvania. He uses Zetia often.

Merck paid doctors who touted the drugs. In the five-month period in which the first negative Zetia trial data emerged in 2008, cardiologist Michael Davidson of Radiant Research got $71,150 and Weill Cornell Medical College Dean Antonio Gotto got $27,146 for lectures and consulting, according to Senator Charles Grassley. Both defended the drugs.

Since 2004 Merck has bought $741 million worth of print, television and Internet advertisements for Zetia and Vytorin, according to tns media research. The ads turned Zetia’s unproved mechanism into an advantage. They boasted that Zetia used a “different way to lower cholesterol.” Ads bragged that “only Vytorin” blocked “the two sources of cholesterol.” The ads stopped running after the drugs became controversial.

Marc Pfeffer, a cardiologist at Brigham & Women’s Hospital in Boston, points to another factor that contributed to Zetia’s rise: the often misplaced faith doctors have in improved lab test results. “When you have a lab value that reinforces your belief in a drug, you feel good about what you’re doing,” says Pfeffer. The lab test approach, he says, obscures the fact that what really matters is whether a drug prevents disease.

Cardiologist Douglas Weaver of the Henry Ford Hospital gives this advice to patients: First try Lipitor, Zocor or another statin, and crank up the dose if you have to. If your cholesterol is still high, then add a prescription version of niacin. Only if you cannot tolerate niacin’s annoying side effect (flushing) should you use Zetia or Vytorin.