Health Spectator

If you’re looking to see a doctor, bring lunch. That’s one of the finding in a recent article on doctors and drug-company reps published in the latest AARP Bulletin (Ties that Bind, by Barbara Basler).

We found some interesting figures there, figures that otherwise seem to go unpublicized. For example, the pharmaceutical industry’s spending on direct marketing to doctors rose 275% from 1996 to 2004 and currently stands around $7 billion. That doesn’t count prescription samples given to doctors at an annual industry cost of $18 billion. And yes, buying lunch for doctors and their staffs are one of the main rites of entry. That makes doctors no different from, say, editors or purchasing agents.

But statistics from inside the industry itself show that if a rep gets to spend just one minute with a doctor, that doctor will write prescriptions for that rep’s drug at a 16 percent higher rate. Give the rep five minutes, and prescriptions increase 52 percent. Since primary-care physicians interact on average 28 times a week with drug sales reps, we’re looking at a huge increase in drug prescriptions that is up for grabs. And none of this is necessarily good for the patient.

In fact, it’s become such a problem that states such as Pennsylvania and South Carolina
have begun hiring their own reps to go out and counteract the pharmaceutical industry’s propaganda. It is worthwhile for them to do this simply to assure better patient outcomes, since newer drugs—the ones being pushed aggressively by the industry—are also the most expensive drugs, but not necessarily the best drugs for the patient. A beneficial side effect is a reduction in the cost of drug subsidies to patients.

Pennsylvania’s “unsales” program, while costing $3 million over three years, has so far saved state programs about $572,000 a year in prescriptions for stomach-acid suppression alone.

For while doctors naively proclaim themselves not for sale, industry figures such as those already quoted indicate they are readily influenced. Just last year a poll published in the New England Journal of Medicine showed 94 percent of doctors reporting “direct ties” to the dug industry.

Alarmed by such figures, some state legislatures have begun to fight back, trying to restrict the industry’s antics, but pharmaceutical companies are aggressive in defense of what they regard as their territory.

For example, New Hampshire passed a law in 2006 prohibiting drug companies from purchasing information about doctors’ prescribing habits. The industry got the law overturned in federal court a year later. Similar laws passed by Maine and Vermont are being challenged in court.

And last year, 17 states drafted legislation to regulate gifts to doctors and require their disclosure.

Not one of those bills became law.

In the wake of our report on links between atrial fibrillation and bisphosphonate drugs such as Fosamax and Reclast, Health Spectator performed a routine follow-up investigation of the health claims and side effects of this class of drugs. We discovered that, contrary to the majority of reports we had read when researching the initial story, other complications from treatment with bisphosphonates were already known.

Specifically, a condition known as osteonecrosis of the jaw (a condition in which the bone tissue of the jaw literally dies) had previously been linked to taking Fosamax. A check of the Merck website on May 6 showed no mention of this possible complication either under side effects or dosing information. Nevertheless, we found that no less prestigious a group than the New York Academy of Science is sponsoring a conference on bisphosphonates and osteonecrosis of the jaw (ONJ) later this month. In fact, that conference is partially funded by Merck & Co., Inc, Novartis, and Procter & Gamble Pharmaceuticals, the major manufacturers of bisphosphonates.

What’s more, it turns out that the bisphosphonates have been associated with cases of osteonecrosis of the jaw since 2003. That’s when reports surfaced of bisphosphonate-associated osteonecrosis of the jaw (BON) linked to use of Zometa (zolendronic acid) and Aredia (pamidronate). Novartis manufactures pamidronate, as well as zolendronic acid under the names Zometa and Reclast. Zometa is used to treat bone loss in cancer patients and others who are undergoing a more rapid form of bone disintegration than occurs in osteoporosis. Reclast has been approved by the FDA for Paget’s disease and is being considered for treating osteoporosis.

For the most part, early reports of BON were associated with dental work, especially dental work that directly affected the jaw, such as tooth extraction. But then it became apparent that some BON episodes were spontaneous and not the result of dental intervention. The odds of suffering from BON are much greater as a result of dental intervention, so patients who are about to undergo therapy with zolendronic acid (or any bisphosphonate, for that matter) are urged to take care of any essential dental work before beginning treatment.

At this point, the possible complications of treatment with bisphosphonates are unfamiliar to many medical professionals, hence the interest in symposia such as the NYAS educational conference on ONJ and bisphosphonates.