Healthy Skepticism Library item: 3845

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

Goozner M.
Oncologists Rebel Against Amgen's Marketing Tactics
GoozNews 2006 Mar 2
http://www.gooznews.com/

Notes:

Ralph Faggotter’s Comments:

This article enlightens us on the subject of the backroom deals which pharmaceutical companies try to make with doctors to get preferential prescribing of their products.

It also touches on the subject of Direct-to-Consumer Advertising (DTCA) and how this can result in pressure on doctors to prescribe inappropriately and against their better judgement.

Full text:

Oncologists Rebel Against Amgen’s Marketing Tactics

Last spring, the nine physicians at Marin County’s California Cancer Care received an offer they wanted to refuse. Amgen, which sells Aranesp, Neupogen and Neulasta for chemotherapy-related anemia, told the oncologists that unless they purchased a quarter of its red cell stimulator from Amgen, the goliath of the biotech world would cut off their discounts on white blood cell products. After much internal grumbling, they agreed.

Six months later, Amgen’s drug representatives came back with another offer. Unless the practice purchased 65 percent of its red cell product from Amgen, the discounts on Neupogen and Neulasta – which have no competition – would be withdrawn.

This time, they rebelled. “We have an aversion to being bullied,” said Dr. Peter D. Eisenberg, a senior member of the Cancer Care team. The firm ended its research project for Amgen, cancelled an Amgen-funded training program and withdrew a pending grant application. “Maybe this kind of aggressive behavior is okay when you buy four tires instead of two tires. But when it comes to the practice of medical oncology, this is something new.”

And possibly illegal. Last October, Johnson & Johnson’s Ortho Biotech Products division, which sells Procrit to stimulate red blood cell production, filed suit in U.S. District Court in New Jersey alleging that Amgen’s Aranesp marketing practices amounted to an anti-competitive tying arrangement designed to monopolize the market for red blood cell products, which would be a violation of the nation’s antitrust laws. Although Aranesp costs more than Procrit, Amgen has seized approximately two-thirds of the $2.8 billion oncology market since launching the tying scheme, the suit alleged.

Amgen denies the charges and will vigorously contest them in court, the company said.

Marketing disputes between the two companies have a long history. In the mid-1980s, Amgen, then a struggling start-up looking to develop the original form of human recombinant erythropoietin, which is now sold as Epogen, signed away the cancer market to J&J in order to raise cash for clinical trials. Procrit and Epogen are identical.

When it turned out that the cancer market exceeded the dialysis market, which Amgen had kept for itself, the company launched a plan to develop a longer-acting version of Epo to go after J&J’s market, which had grown to include a burgeoning population of HIV/AIDS survivors. The Food and Drug Administration approved that drug –Aranesp – in 2001.

Amgen subsequently launched a massive marketing campaign that included direct-to-consumer advertising on television to promote the use of Aranesp for treating chemo-related fatigue. J&J launched its own advertising campaign. Patient demand for the drugs soared.

Yet the medical evidence supporting the increased usage was scant and often funded by Amgen itself. Amgen also seeded the literature with economic justifications for increased use of its new drug. A typical example was a recent open-label study led by economist Ernst Berndt at the Massachusetts Institute of Technology, which appeared last year in the journal PharmacoEconomics. It claimed reduced anemia from Aranesp led to increased productivity.

However, an independent study by physicians at the M.D. Anderson Cancer center in Houston that appeared in the December issue of the Journal of Palliative Medicine concluded, “Anemia is not one of the major contributors to fatigue in patients with cancer receiving palliative care.” Citing the multi-factorial nature of fatigue in cancer patients, Journal editor Charles von Gunten wrote that “these data will help physicians resist the patient and family pressure to use erythropoietin because they saw it on television . . . Erythropoietin is ineffective in relieving fatigue if anemia is not the cause. It is an expensive placebo.”

That argument resonates with many physicians. “If we were doing our jobs right, we would work up a patient’s fatigue appropriately from beginning to end,” said Eisenberg. “It’s a lot easier to send the patient down the hall to get a shot of Procrit or Aranesp and it’s a lot more profitable. I’ve read the literature that says people feel better when their hemoglobin is improved on these products. But it’s difficult for me to get my mind around. I understand differences in survival. I understand time to tumor progression. I have a harder time understanding quality of life issues and what the real impact is,” he said.

Meanwhile, many physicians who use the drugs with their Medicare patients are faced with an economic dilemma. According to Dr. James Cohen, a community cancer specialist in Los Gatos, his practice loses $209 on every dose of Neulasta unless it receives a discount from Amgen. And, “the Neulasta rebate is linked to how much Aranesp I use,” he said. “Unless I exclusively use Aranesp without Procrit I will never achieve the volume necessary for the rebate.”

This story first appeared in the Bay Area Oncology News.
Posted by gooznews at 09:19 AM
February 28, 2006