Healthy Skepticism Library item: 2187

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

Guyatt G.
Don't allow drug firms to intimidate
Straightgoods 2001 Aug 29

Abstract:

Multinational drug companies, comprising one of the world’s most powerful industries, are not playing fair.

Full text:

Dr. Anne Holbrook, a specialist in clinical pharmacology who works at St. Joseph’s and McMaster Hospitals, knows.

In 1997, Dr. Holbrook, a specialist in evaluation of prescription drugs, led a panel of experts who produced a report for the Ontario Ministry of Health. The report looked at drugs that physicians prescribe for patients with stomach ulcers and other similar problems.

Often, acid production in the stomach contributes to these problems, and doctors prescribe medications to reduce acid production. Dr. Holbrook’s report summarized the evidence about the drugs that are available to combat stomach problems related to acid production. One of the key drugs her report examined was omeprazole, a powerful medication that almost completely blocks the ability of the stomach to produce acid.

Dr. Holbrook found that omeprazole was very effective for acid-related problems. However, the research she reviewed showed that the drug was no better than two other medications that work in a very similar way.

There was, however, one important difference between omeprazole and the other medications. Omeprazole is more expensive. In fact, at the time, it was the most expensive drug provided by the Province of Ontario’s drug benefit plan.

Dr. Holbrook was very careful. She sent the draft of her report to all the drug companies that produce products for ulcer problems. In addition, she asked other experts, consumer groups, and specialist and family doctors to review her findings. One company had a big problem with the report. Astra, the makers of omeprazole, sent Dr. Holbrook an unusual response: a lawyer’s letter.

The letter told Dr. Holbrook that if she submitted her guideline to the Ministry of Health, they would sue her. Why did the giant drug company try to bully Dr. Holbrook? Omeprazole was Astra’s biggest selling drug, generating huge profits for the company. The figures are impressive: at the time Astra generated $375 million in sales, ranking third among drug firms in Canada. Omeprazole accounted for fully 70% of all of Astra’s sales!

The government of Ontario pays much of the costs of drugs for patients over 65, and those on social assistance. For omerprazole alone, the Ontario government was paying $70 million per year. If the government substituted one of the cheaper drugs for omeprazole, the company’s sales would suffer a substantial drop.

Dr. Holbrook and the panel reviewed the evidence again, and decided that her initial conclusions were correct. She consulted Ministry of Health lawyers, and in the end decided she and the panel were safe from legal action. The result, however, was that the company’s intimidation delayed publication of Dr. Holbrook’s report by 18 months.

Unfortunately, Astra’s behaviour isn’t unique. In fact, it reflects a pattern. Increasingly, drug companies are using threats of legal action to silence medical researchers producing results they don’t like.

The Canadian Coordinating Office of Health Technology Assessment or CCOHTA is a government-funded agency that examines medical technologies. In 1997, CCOHTA produced a report looking at cholesterol-lowering drugs.

In many ways, the situation was similar to the omeprazole story. CCOHTA concluded that a number of drugs in a particular class were similar. The maker of one of the most expensive of these drugs, called statins, realized that the report could reduce their sales.

The company, Bristol-Myers Squibb, used the courts to block publication of the CCOHTA report. CCOHTA could surrender, or fight the company in court.

CCOHTA fought, and won the right to publish their report. But the legal battle cost Canadian taxpayers $300,000. The company succeeded in delaying the report for 6 months, and tying up most of CCOHTA’s resources for that period.

There are other stories of pharmaceutical industry intimidation from Canada, the United States, and around the world. While the industry behaviour might seem unfair, is there any reason Canadians should be seriously concerned?

Overall, Canada has managed to control health care spending extremely well. Despite what you hear from Mike Harris and the Tory, Tony Clement, Ontario is spending no more on health care per citizen than it did in 1992. But there is one area where costs really are spiralling: spending on prescription drugs.

In 1979, drugs represented 9% of all health care spending. Today, drugs eat up over 15% of our country’s health care budget.

Some of this increased spending is well worth it. The last 20 years have seen tremendous advances in pharmaceutical treatment of many serious medical conditions, including heart diseases, asthma, and stomach disorders.

At the same time, physicians sometimes prescribe drugs that are unnecessary, and often neglect to use the least expensive, but equally effective drug. While politicians’ claims of out-of-control health spending are inaccurate, medical advances will continue, and they are expensive. Common sense dictates that we spend our health dollars in the most efficient way.

If pharmaceutical firms can intimidate and silence health researchers who have information that would lead to wiser prescribing the result will be wasteful spending. At times, industry intimidation may even contribute to prescribing practices that threaten the patient’s health.

What can be done to stop drug companies from threatening medical scientists? The pharmaceutical industry is very sensitive to their public image. They fear government regulations and practices that would threaten their profits. If public opinion turns against them, tougher government policies are more likely.

So, the best weapon against intimidation is your disapproval – or even outrage – when companies act against the public interest by intimidating health researchers and medical experts. Time will tell if the public voice is loud enough to keep doctors and researchers safe from industry threats