How marketing turned Zyprexa into blockbuster
Filed under: Government, Hot Health Headline, Pharmaceuticals
Ben Wallace-Wells of Rolling Stone uses the story of the rise of Zyprexa, Eli Lilly’s blockbuster schizophrenia treatment, to look into the marketing of medication, the history of anti-psychotic drugs and the ability of the FDA to serve as an effective watchdog without the resources to conduct independent trials. The magazine also provides an interview, in which Wallace-Wells tells a little more about the reporting that went into the extensive report and the conclusions he’d drawn from his research.
Eli Lilly staked its future on Zyprexa, even though it had been shown to cause dangerous side-effects like excessive weight gain and was only approved for the treatment of schizophrenia. The total market for the treatment of schizophrenia and related illnesses sits in the tens and hundreds of millions of dollars. Through off-label prescriptions, careful manipulation of government regulation and aggressive marketing emphasizing the drug’s novelty, Lilly eventually sold more than $4 billion worth of Zyprexa annually.
“The goal for sales reps, according to Lilly’s strategy document, was to ‘expand the market of Zyprexa by redefining how primary-care physicians help reduce mood, thought and behavioral disturbances.’”
Stimulus funds study of effectiveness of treatments
Filed under: Government, Health care reform, Health policy, Hot Health Headline, Pharmaceuticals
Robert Pear reports in The New York Times that $1.1 billion of the $787 billion federal economic stimulus package will fund research into the relative effectiveness of drugs and other forms of medical treatment.
A council of federal employees will advise President Obama and Congress on the funding of studies that proponents hope will help bring down the soaring cost of health care. Advocates say the research will be used for reference purposes, and not to mandate certain treatments.
“The money will be immediately available to the Health and Human Services Department but can be spent over several years. Some money will be used for systematic reviews of published scientific studies, and some will be used for clinical trials making head-to-head comparisons of different treatments.”
Jost discusses consumer-driven health plans
In the latest installment of the Columbia Journalism Review’s “Excluded Voices” series, Trudy Lieberman, president of AHCJ’s board of directors, talks with Timothy Jost about consumer-driven health plans. Jost, a law professor at Washington and Lee University and author of “Health Care at Risk: A Critique of the Consumer-Driven Movement,” says that, while there are many specific types of consumer-driven plans, they all, at heart, shift the responsibility to pay for health care to the consumer.
Jost said the idea behind such plans was that, once they had shouldered the payment burden thanks to deductible averaging around $4,000, consumers would go to the doctor less frequently and be more cost-conscious during the visits they do make. Jost takes issue with the assertion, saying that data show that workers with consumer-driven plans are healthier simply because the healthy workers are more likely to switch to consumer-driven plans than their less-healthy counterparts.
According to Jost, consumer-driven plans may lead to cheaper insurance, but not to cheaper or more effective care.
“People in high deductible plans have a harder time getting care. They are more likely not to fill prescriptions or go to the doctor, and less likely to get the health care they need. A study by the RAND Corp. showed that consumers could not discriminate between non-essential care and necessary care, and they basically saved money by not going to the doctor.”
Furthermore, Jost says, consumers can not be relied upon to drive down health care costs by “shopping around” because they lack the information and clout to be as effective as the federal government or private insurers.
Jost says they also raise legal issues, such as whether doctors are obligated to provide information about cost as well as risks and benefits or if insurers are liable to patients or providers if they provide incorrect information in their quality rankings.
Lax oversight, complex supply chains aid outbreaks
In the wake of recent food-borne salmonella outbreaks, Justina Wang of the Rochester Democrat and Chronicle found that a combination of a complex supply chain and lax federal oversight has allowed a steady stream of dangerous pathogens to slip into the food supply.
Given the complexity of today’s food processing and distribution networks, Wang found that many health experts don’t see an end to the outbreaks.
“Absolutely it will continue to happen until big changes are made,” said Sanford Miller, former director of the FDA’s Center for Food Safety and Applied Nutrition and a senior fellow at the University of Maryland. “The food industry has just exploded over the last several decades, and unfortunately, the FDA has not been able to keep up with this.”
Pathogens can lurk in food for months and by the time someone becomes ill and is tested and diagnosed with a potentially dangerous food-borne illness, officials said, the outbreak may already be in full swing. Once the outbreak is detected, even more time passes as product recalls are put into place.
Related:
- Fatal Food: A study of illness outbreaks: Thomas Hargrove of Scripps Howard News Service wrote about food-borne illness outbreaks in a 2007 article for AHCJ. He found that some states did a good job of diagnosing and tracking down the causes of outbreaks, while other states “are virtually blind in detecting outbreaks of food illness.”
- HHS’s new social media team focuses on outbreak
Site tracks schools’ conflict-of-interest policies
AHCJ member Peggy Noonan sent a note about a useful Web site to the organization’s electronic discussion list that is worth sharing even more widely.
The AMSA PharmFree Scorecard, from the Association of American Medical Colleges, tracks the conflict-of-interest polices at medical schools:
” … evaluates conflict-of-interest policies at the 151 medical colleges and colleges of osteopathic medicine in the United States. Using letter grades to assess schools’ performance in eleven potential areas of conflict, the Scorecard offers a comprehensive look at the landscape of conflict-of-interest policies across American medical education, as well as more in-depth assessment of individual policies that govern industry interaction with medical school faculty and trainees.”
The site features an easy-to-read chart, offers a feature that lets you compares schools’ policies, includes commentary about the schools and provides relevant links. The chart evaluates schools based on polices regarding:
- gifts & meals
- consulting relationships
- industry-funded speaking relationships
- disclosure
- pharmaceutical samples
- purchasing & formularies
- site access
- on-campus education
- attendance at industry-sponsored lectures & meetings off-campus
- industry support for scholarships & funds for trainees
- medical school curriculum
- oversight mechanism
- explicit sanctions for noncompliance
Mercury may lurk in high fructose corn syrup
In the Columbia Daily Tribune, dietitian and columnist Melinda Hemmelgarn discusses a 2005 study recently published in Environmental Health in which researchers found detectable levels of mercury in nine out of 20 samples of high fructose corn syrup.
Hemmelgarn says the neurotoxin get into high fructose corn syrup when “processors use mercury-grade caustic soda to separate corn starch from the corn kernel.” Most processing plants now use mercury-free technologies, she said, but consumers have no way to distinguish between syrup made with mercury and syrup made without it.
Renee Dufault, who directed the 2005 study, said her findings were ignored by the FDA and, until this January, unpublished by scientific journals. According to Dufault, the Corn Refiners Association called the study outdated, saying that they haven’t used mercury in syrup production for years.
Dufault responds by pointing to a 2008 small-scale regional study conducted by the Institute of Agriculture and Trade Policy that tested 55 consumer products containing significant amounts of high fructose corn syrup and found mercury in almost a third of them.
Related resources:
- “The Mercury Connection,” by Tony Bartelme, Doug Pardue, The Post and Courier, Charleston, S.C., won a 2007 Award for Excellence in Health Care Journalism
- Study finds health hazards in Great Lakes; CDC blocks publication, by Sheila Kaplan, The Center for Public Integrity
- NYC-HANES finds elevated mercury levels in a quarter of NYC adults
- Enviro-Health Links - Mercury and Human Health
CDC working to uncover cause of autism
This is a guest post from Elizabeth Fernandez of the San Francisco Chronicle. Fernandez is among the first class of AHCJ-CDC Health Journalism Fellows who are spending the week studying public health issues at two Atlanta campuses of the Centers for Disease Control and Prevention.
Amid a seeming explosion nationally in rates of autism, advances are emerging in science’s understanding of the illness, but no cause has yet been found to explain the profoundly puzzling disorder, a government researcher said Thursday in Atlanta.
Multiple causes — a combination of complex genetic and environmental interactions — are likely responsible, said Catherine Rice, Ph.D., of the Centers for Disease Control and Prevention’s National Center for Birth Defects and Developmental Disabilities.
Marshall Allen, of the Las Vegas Sun, asks Catherine Rice if the prevalence of autism is increasing or just more easily diagnosed. (Photo: Christy Stretz)
Vaccines have become the focus of concern in recent years among some parents as a possible trigger, but studies generally have found no connection between the two, Rice said.
“There is a strong genetic component, but genes don’t explain everything,” she said.
Autism Spectrum Disorder is the term for a variety of developmental disorders including autism, atypical autism, Asperger’s disorder, and Rett Syndrome — Rett alone has a biologic confirming test.
An estimated 560,000 youths in the U.S. have the disorder. It’s far more prevalent among boys: three to seven boys are affected with the illness for every girl with autism.
“Our best estimate is 1 in 150 or 6-7 per 1,000 children have autism,” Rice said.
Despite a hike in rates over the past quarter-century, attributed to better assessment tools and to a broadening of the diagnostic category, researchers are “more concerned that children are being under-identified than over-identified,” Rice said. She expects a “leveling off” in rates over the next 12 years.
The disorder typically begins to unfold during the first two years of life, often noticed through a lack of interest in interacting with family. The child may engage in repetitious play behavior, may not respond to the parents’ voice “but would respond to, say, the opening of the refrigerator,” Rice said.
By age three, the disorder becomes much more evident. The median age of formal diagnosis is between 4½ and 5½.
Some children with autism have a wide range of impairments; they may have ADHD or self-injurious behaviors. Some children become overwhelmed by sounds, sights, smells. They may suffer from gastrointestinal problems, food sensitivities and sleeping disorders. Preoccupied within their “own world,” some children lack a sense of safety, and may wander into streets or other hazards.
“Children can have a lot of frustration because of their difficulty communicating,” Rice said. “It’s a lifelong disorder. We consider autism an urgent public health concern.”
Doctor suggests reforms to stop foodborne illness
Writing in the New England Journal of Medicine, Dennis G. Maki, M.D. takes a look at foodborne illness, the sources of recent outbreaks and official attempts to control the food-based spread of pathogens.
Once again, we must ask ourselves how foodborne disease can develop in 76 million residents of one of the world’s most technically advanced countries each year, causing 350,000 hospitalizations and 5000 deaths and adding $7 billion to our health care costs, despite intensive regulation of food production and distribution.
Industrial food production and importation, the American fondness for eating at restaurants and centralized distribution have helped to multiply the damage caused by any single outbreak, Maki said.
Maki suggested several possible measures to combat the spread of foodborne pathogens:
- Requiring bar codes for all commercial food so its origins and contact points can be quickly and easily traced.
- Changing the feeding practices of cattle, poultry and swine and reduce reliance on practices like anti-microbial food supplements that may promote the growth of harmful bacteria.
- Improving hygienic food-preparation practices in homes, restaurants and hospitals and giving local health departments the power and means to monitor these practices.
- Irradiating high-risk foods because “the CDC has estimated that irradiation of high-risk foods could prevent up to a million cases of bacterial foodborne disease each year in North America.”
Related:
Fatal Food: A study of illness outbreaks
Thomas Hargrove of Scripps Howard News Service wrote about foodborne illness outbreaks in a 2007 article for AHCJ. He found that some states did a good job of diagnosing and tracking down the causes of outbreaks, while other states “are virtually blind in detecting outbreaks of food illness.”
Researchers study health bloggers, form community
Last fall, a trio of researchers from the Rijeka School of Medicine in Croatia published a paper examining that peculiar class of people who may be loosely described as health bloggers. Their survey queried 197 English-language medical blogs and they included questions designed to evaluate bloggers’ Internet and blogging habits, blog characteristics, blogging motivations, and, finally, their demographics.
“Medical blogs are frequently picked up by mainstream media; thus, blogs are an important vehicle to influence medical and health policy.”
The results were published in the Journal of Medical Internet Research and found that “medical bloggers are highly educated and devoted blog writers, faithful to their sources and readers. Sharing practical knowledge and skills, as well as influencing the way other people think, were major motivations for blogging among our medical bloggers. Medical blogs are frequently picked up by mainstream media; thus, blogs are an important vehicle to influence medical and health policy.”
Two of the researchers also formed the Health Blogs Observatory, which they call an online community, and published a directory. Ed Silverman reached out to Ivor Kovic, an emergency physician, about the survey and their hopes for their observatory. Find out more about the project.
Medical economist has questions for Obama
On NiemanWatchdog.org, medical economist and scholar Rashi Fein has six questions for Obama about health care reform. Each of the questions include background behind the issues as well Fein’s opinions about each issue.
The questions deal with things like electronic medical records, access to care, the process of phasing people into universal coverage and health care costs.
Fein is professor of medical economics, emeritus, at Harvard Medical School, and co-author of The Health Care Mess; How We Got Into It and What It Will Take To Get Out.
Related:
-
Awards for Excellence in Health Care JournalismDeadline: Feb. 3
- How I did it: Falsified charts in nursing homes linked to patient care
- Access Denied: Looking at a lack of health care availability
- Transparency & medical errors: Public reporting of patient harm is a potent force
- Focus on freelancing: Tips for buying liability insurance
- Why do some patients get stuck in hospitals for weeks, months?
- Investigate health professionals and the boards that regulate them
- Presidents of AHCJ, SPJ call for more openness from Obama administration
