By: Jean Johnson for Reflux1Part Two Part One
The ‘Heartburn Across America’ Campaign: A Sure-Fire Victory
GlaxoSmithKline wasn’t shy at all in the labeling of its public relations plan; the company used an erupting volcano logo to plant the idea in the minds of consumers that heartburn could lead to major problems.
Writes the award-winning journalist Brownlee: “The company also set up the Glaxo Institute for Digestive Health, which funded research as a way to reach out to physicians. It enlisted the help of the American College of Gastroenterology, the professional organization for doctors who specialize in treating diseases of the stomach and gut. The campaign deliberately and effectively confused GERD, which is serious, and heartburn, which is not, in the minds of both patients and doctors.
“The rest, as they say, is history. Zantac sales skyrocketed, hitting $2 billion in a year at its peak, two thirds of which was for GERD. Physicians began to view Glaxo as a leader in the field of gastroenterology; consumers started worrying that their heartburn was potentially dangerous. Condition branding was soon being used by other drug makers to sell everything from high-cholesterol medications to Viagra.”
Nexium – The Not So Innocent ‘Purple Pill’
Glaxo, of course, is just one among many. By 2003 for example, AstraZeneca’s promotional claims for its proton pump inhibitor esomeprazole, or Nexium – which is marketed on the web as the ‘purple pill,’ complete with coupons – attracted the attention of Australia’s Adwatch. The watchdog group called on the drug company to cease and desist in its use of “tricks” to sell Nexium. Adwatch believed that by using unfair dosage comparisons and failing to mention strategies as simple as elevating the head of a patient’s bed, AstraZeneca was trying to dupe the public.
Specifically, Adwatch targets ads that commit sins of omission. “Nexium 40 mg. offers greater healing power than either omeprazole or lansoprazole,” states the labeling, and what only appears later on in the fine print is the startling statement that the doses of the latter drugs were less than 40 mg.
The result? Nexium roared into Australian consciousness, capturing 10 percent of what the British Medical Journal calls “the rapidly expanding market for proton pump inhibitors…The number of prescriptions for proton pump inhibitors dispensed under Australian government-funded subsidy schemes has almost tripled over the past four years, reaching 9.2 million in 2002-03.”
And Now?
Not only are trends that have been developing since the 1980s not ebbing, the ethical quagmire appears be expanding. Increasingly, physicians are being scrutinized for the many and sizable gifts they accept from drug companies, as well as for speaking engagement fees they earn for touting the benefits of various drugs that they have found beneficial in their practices.
Where this work gets particularly questionable is when physicians share their thoughts on what’s known as “off label” uses for drugs that the FDA has not approved. A recent case in point is Peter Gleason, M.D., a Maryland psychiatrist who was arrested by the FDA in July 2006 for recommending that Xyrem, a drug approved for narcolepsy, be used for depression and pain relief.
The federal attorney’s office compared Gleason to a snake oil salesman and pointed to the $100,000 in speaking fees the psychiatrist collected last year from Xyrem’s maker Jazz Pharmaceuticals for promoting off label uses of the drug in presentations to his peers. While the figure might sound excessive, the New York Times was careful to point out in its coverage of the Gleason case that it is common practice for physicians who’ve had off label success with different medicines to share this information with their colleagues in continuing education seminars and lectures that pharmaceutical companies eagerly fund.
From issues of free speech and direct-to-consumer marketing to questions related to physicians’ ability to share unusual breakthroughs within their ranks, the world of medical ethics is a confusing one. At the very least, we hope Reflux1 readers are forewarned and consequently proceed as informed consumers unafraid of asking hard questions. In this way, consumers can drive the market in directions that serve them best.
