Healthy Skepticism Library item: 1752

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

Robotham J.
Illness exaggerated as companies strive to sell more drugs
Sydney Morning Herald 2002 Apr 13

Full text:

A leaked proposal to promote a benign bowel condition as “a significant and discrete disease state” in order to sell more drugs has thrown new light on how prescription medicines are marketed.

The draft strategy, prepared in 2000, included the recruitment of gastroenterologists in each state to an advisory board aimed at persuading sceptical colleagues that irritable bowel syndrome was serious.

As well, it was recommended that the company, In Vivo Communications, institute a patient support program to “reap the loyalty dividend when the competitor drug kicks in”.

The drug, Lotronex, was in the end not marketed in Australia and was withdrawn from sale in the United States following reports of adverse reactions, including some deaths.

But the case – uncovered in today’s British Medical Journal in an issue devoted to “disease-mongering” – illustrates a commonplace practice, according to the paper’s Australian authors.

“Although billed as a medical education plan, the document is clearly part of the Lotronex marketing strategy,” wrote Ray Moynihan – a journalist who works for the Fairfax-published Australian Financial Review – and his co-authors Iona Heath, GP, and Newcastle medicines expert Professor David Henry.

The team obtained an early draft of the confidential document.

A director of In Vivo yesterday declined to confirm the document or discuss the issues it raised.

A GlaxoSmithKline (GSK) spokeswoman confirmed the company had sought a proposal from In Vivo on Lotronex, but said: “The ideas suggested … were never approved or adopted [and] … do not reflect those of GSK.”

Nevertheless it was “appropriate for us to support medical education about our products, and about the disease areas in which we have expertise. It is our view that responsible and appropriate prescribing is based on health professionals having sufficient information and understanding of the appropriate use of products,” the spokeswoman said.

The chairman of the Digestive Health Foundation, Sydney gastroenterologist Katie Ellard, said irritable bowel syndrome was a recognised medical condition, but only a tiny minority of patients benefitted from drug therapy.

For most, improved diet and increased exercise and fluid intake were more helpful, along with reassurance that the condition was benign.

Up to one in five people intermittently suffered from the syndrome – characterised by abdominal pain and irregular bowel habit. But most were insufficiently concerned to seek medical help, Dr Ellard said.

At present there are no drugs available in Australia for the syndrome, but a drug for women in whom the condition causes constipation is expected later this year.

Dr Ellard said it was ethically acceptable for a drug company to fund community education programs about diseases. But the industry should have no role in deciding the content of such advice.

The foundation, which is the public education arm of the Gastroenterological Society of Australia, would later this year publish revised guidelines for the management of irritable bowel.

Drug firms would be excluded from their development, but would be allowed to distribute them.

“I do feel the culture has changed. It behoves us to be very careful with our relationships with the pharmaceuticals industry,” Dr Ellard said.