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Panelists shed light on drug pricing, marketing

June 4, 2009

When it comes to brand-name medications, newer products are not always better, and lifestyle changes are sometimes more effective than anything on the market, said panelists at “’Ask Your Doctor’... Medications, Marketing and Safety.” The May 14 discussion in Tang Hall at MIT was part of the “Aging Successfully” series sponsored by the Women’s League, MIT Medical, and the Age Lab.

The pharmaceutical industry is extremely profitable because of aggressive marketing and inflated prices for brand-name medications, the speakers said. Prices of brand-name medications in the U.S. have been rising by about 10 percent a year over the past five years, said William M. Kettyle, M.D., medical director at MIT Medical and panel moderator. The pharmacy in MIT Medical has held price increases for brand-name medications to 3–4 percent over the past five years, he added.

The pharmaceutical industry claims that drug pricing reflects the high costs of research, development and clinical trials for new drugs, said panelist Marcia Angell, M.D., former editor-in-chief of the New England Journal of Medicine and author of The Truth About the Drug Companies: How They Deceive Us and What to Do About It. However, many newly approved drugs are actually just repackaged or recombined drugs that are already on the market. Of the 667 FDA drug approvals from 2000–2007, only 11 percent were classified as both “new molecular entities” and more effective than other drugs on the market. Often, “they twiddle the molecules to make ‘me too’ drugs,” she said.

Consumers pay far more for brand-name medications than for generic equivalents, which by law are exactly the same, the speakers said. For example, Fosamax, a brand-name medicine for treating osteoporosis, costs 10 times what alendronate (the generic equivalent) costs—even though both are manufactured by Merck, Kettyle noted. So whenever possible, doctors and patients should opt for generics.

Medication alternatives

Pharmaceutical companies sometimes try to create patient demand for medications for conditions that don’t necessarily need medication at all. For example, shyness is often described as “social anxiety disorder” in advertisements for medications such as Paxil, Angell said. “They’re attempting to expand the market by selling the disease more than the drugs,” she said.

Even noncontroversial conditions such as high cholesterol and hypertension don’t always require medication; studies have shown that “lifestyle changes blow away the drugs” in improving these conditions, Angell said. Doctors and patients should discuss exercise, nutrition and other nonmedical treatments when appropriate, rather than writing and filling a prescription as the first treatment of choice just to save time.

Presciber bias

Doctors and other prescribers are influenced to some degree by the pharmaceutical industry, the speakers said. Drug companies market their products to physicians though medical conferences, “detailing” of product information from sales representatives, and continuing medical education, as well as more blatant measures, including gifts and meals.

Even when doctors prescribe based on ostensibly unbiased research data, that information is sometimes faulty or incomplete, Kettyle said. For example, Knoll Pharmaceuticals sponsored a 1987 study comparing the effectiveness of Synthroid, its product for treating hypothyroidism, to generic levothyroxine. But when the results showed that Synthroid was no more effective than the less expensive generic alternative, the company refused to allow publication of the study (though it was finally published in 1997), Kettyle said.

To avoid even inadvertent biases in prescribing, doctors must be vigilant about avoiding conflicts of interest—for example, not accepting free samples or gifts from drug companies, the speakers said. MIT Medical has strict rules to guard against bias, executive director Annette Jacobs said after the lecture.

“We don’t allow our clincians to accept lunches, gifts, visits from detail people, free samples, or airfare and hotel rooms for conferences, and we haven’t for years,” she said.

Better physician education

Physicians also need information that’s “independent, unbiased and noncommercial,” said panelist Leslie Jackowski, M.B.B.S., an Australian physician and visiting scholar in the Harvard University Faculty of Arts and Sciences. He endorsed “academic detailing,” whereby pharmaceutical educators talk with physicians and make specific recommendations for practice changes based on unbiased data while also taking into account the doctors’ clinical judgment and experience. One such service is the nonprofit Independent Drug Information Service, whose website at http://www.Rxfacts.org also provides basic patient information on brand-name and generic medications for some common medical conditions, Jackowski said.

Patient involvement

Patients can take an active role by making a detailed list for their providers of their current medications and dosages (including over-the-counter and alternative medicines) and when they began taking each. They can also prepare a list of their caregivers, allergies, and diagnoses and details of their insurance coverage, Kettyle said. “It will enhance the picture of what you’re taking and why; it will enhance your own memory; and it will help coordinate your care,” he said.