The Chicago Tribune reports that sales of Viagra, Levitra and Cialis are well below Wall Street expectations. That's despite nearly $400 million spent on consumer advertising in 10 months last year.
The Tribune says some analysts believe the market has been flooded with so many free samples that sales growth has been harmed.
The Boston Globe recently reported on the ultra-aggressive marketing techniques being used by drug companies, including free trials of drugs for allergies, cholesterol, asthma, erectile dysfunction and sleeplessness.
An AMA Trustee said, "I'm really concerned that patients are being baited and hooked on free samples."
It was such freebies that sold millions on Vioxx and Celebrex. Vioxx is off the market; Celebrex is under scrutiny. Freebies continue with AstraZeneca's cholesterol drug, Crestor, despite the fact it has been linked with muscle and kidney problems. Public Citizen's Dr. Sidney Wolfe says, "The fact that someone gets it for free is not going to compensate them if they end up on kidney dialysis."
A citizen submitted the following letter to the editor of the Star Tribune.
"If Gov. Tim Pawlenty chooses to use the term 'welfare health care' to refer to such programs as MinnesotaCare and General Assistance Medical Care because they are subsidies from the government, he should at least be consistent.
During his budget proposal I did not hear him refer to his continued support for 'welfare ethanol payments' or the fact that he wants to create a fund for 'welfare stadiums.' If we are going to be calling attention to subsidies, let's call attention to all of them."
Earlier, I had urged readers to follow how states manage their health care budgets this year.
Here's what Minnesota governor Tim Pawlenty has proposed:
1. Open a metro-area casino.
2. Slash the number of low-income workers eligible for subsidized health insurance.
Now that's compassionate conservatism.
See the Star Tribune for details.
PR Week recently published an article predicting more video news releases (VNRs) on scientific medical stories in 2005.
Apparently the stink over the government paying for VNRs to promote the Medicare legislation and the No Child Left Behind effort last year weren't enough to discourage those who package fake news in this manner.
PR Week says that "most industry professionals agree that healthcare VNRs are still the most popular."
What's troubling is that there are television stations that air these VNRs as is, unedited, and without telling the audience that this information was produced by an outside source with a vested interest. In this era of entanglement of special interests in the dissemination of health and medical information, buyers and viewers better beware.
The New York Times reports on the collapse of the once-hot body-scanning business.
The story touches on these themes:
* how a medical technology bubble burst;
* the limits of direct-to-consumer advertising;
* and the folly of celebrity endorsements.
It's a story worth reading, with lessons for journalists and consumers about the real risks of sensational hype in the absence of evidence.
Journalist Merrill Goozner raises questions about Medicare's decision to expand the number of seniors who can get expensive heart-shocking devices (implantable cardioverter-defibrillators or ICDs). He points to device industry "fingerprints...all over the study" that led to the Medicare expansion of benefits -- which could mean $3 - 5 billion dollars more in taxpayer burden. But he also raises concerns about the questionable benefit found in the trials and about signs of risk from misfiring of the heart-shockers.
Goozner also questions the "quiet" news coverage of this decision. Goozner's work itself is a fine piece of journalism.
The Star Tribune reports: "UnitedHealth saw earnings rise by 46 percent in the fourth quarter to a record $739 million while earnings for the year jumped 42 percent to $2.6 billion. Full-year revenue climbed 29 percent to $37.2 billion while quarterly revenue rose 40 percent to $10.5 billion."
The Associated Press is placing a story in newspapers and on television stations all over the country today, under the headline "Mouse Experiment Offers Alzheimer's Hope."
This is not a criticism of the science but of the journalistic hype. Several paragraphs deep in the story is the caveat from the researchers: "They cautioned that while encouraging, more studies are needed to determine if similar effects might occur in people."
Sick people have told me they don't need journalists to tell them where hope resides or where it doesn't. The trail of such pre-clinical hype, and the trail of tears of the false hope it engenders, is long and painful.
Let the facts speak for themselves. Avoid the confusing coloring language that complicates our comprehension.
Minnesota has issued a report card on medical errors at 139 hospitals throughout the state. The report says that 99 serious errors occurred between July 1, 2003 and Oct. 6, 2004, including 21 preventable deaths, 13 operations on the wrong body part, and 31 instances of foreign objects being left in patients after surgery.
The Star Tribune reports: "Minnesota was the first state to adopt a list of 27 reportable events proposed by the National Quality Forum, based in Washington, D.C. Two others, New Jersey and Connecticut, have followed suit but have not released results yet. The list was inspired by a 1999 Institute of Medicine report that estimated that 44,000 to 98,000 people die each year from hospital errors."
In a letter in this week's JAMA, the CDC admits that a March 2004 study overstated by about 35,000 the number of annual obesity-related deaths in the United States. A computer error is blamed.
Since policy can be based on such estimates, it is imperative that good data be published so that good policy can be set.
The Boston Globe reminds us that last week's journal articles about the importance of C-reactive protein in controlling heart disease had an under-reported angle.
The Globe reported: "Almost overlooked in all the publicity, however, were these facts: Both studies were underwritten by drug companies that make statins, the primary medicine for reducing C-reactive protein levels. Nine of the researchers in Cleveland and Boston also received speaking or consulting fees from statin makers, while three others work directly for the company that makes the best-selling statin, Lipitor. What's more, Brigham and Women's owns a limited patent on the inexpensive blood test for CRP, meaning the hospital and Dr. Paul Ridker, lead author of the Boston study, receive royalties every time a doctor checks CRP levels. If CRP becomes the new cholesterol, Brigham and Ridker stand to make millions."
In the Globe article, Harvard's John Abramson, author of "Overdo$ed America," said: "The problem is we're looking for health in the areas that generate the most profit, not looking for profits in the areas that generate the most health."
Columnist Bob Herbert in the New York Times (registration required) writes that the Bush "administration is like an ardent lover in its zeal to shower the rich and powerful with every imaginable benefit. So tucked like a gleaming diamond in proposed legislation to curb malpractice lawsuits is a provision that would give an unconscionable degree of protection to firms responsible for drugs or medical devices that turn out to be harmful.
The provision would go beyond caps on certain damages. It would actually prohibit punitive damages in cases in which the drug or medical device had received Food and Drug Administration approval. We know the F.D.A. has failed time and again to ensure that unsafe drugs are kept off the market. To provide blanket legal protection against punitive damages in such cases is both unwarranted and dangerous."
The FDA has warned Pfizer that ads for painkillers Celebrex and Bextra misled consumers. Some ads did not disclose side effects and made unsubstantiated claims about effectiveness.
Meantime, the group called Public Citizen has opened a new version of its Web site, www.WorstPills.org.
The site offers information about hundreds of prescription drugs and warnings about 181 drugs which Public Citizen deems unsafe or ineffective.
The report that health care spending in 2003 only increased by 7.7 percent deserves more than congratulatory headlines.
For example, it should be emphasized that for the first time, health care spending grabbed more than 15 percent of the gross national product.
There were not enough news reports that included skepticism as reflected by Emory health policy professor Kenneth Thorpe in the Philadelphia Inquirer: "This is false good news. It appears to be a one-time thing. I wouldn't make too much of this."
Drug companies made a big deal of their commitment last July to post on the Web previously unpublished clinical drug trial data.
6 months later, the Boston Globe reviewed several Web sites where the results were to be posted and found unpublished data for only five drugs.
Journal of the American Medical Association associate editor Drummond Rennie called this "pathetic." The Globe further reported that one Congressman said the voluntary disclosure system is "set up like a poker game. The less information you give, the more money you are likely to make." Sidney Wolfe, director of Public Citizen's Health Research Group, called the few disclosures "thinly disguised public relations efforts"
Journalists should scrutinize their state legislatures' handling of Medicaid in 2005. Feeling squeezed by the feds, states are caught in a bind. Minnesota Public Radio quoted the state finance commissioner: "Health and human services is growing 20 percent from one biennium to the next. We don't have revenues growing at that rate. And that's a large portion of our budget. And so that's an unsustainable kind of growth in a spending program."
A Star Tribune editorial says that health care cuts made in the 2003 Minnesota state budget didn't save the state very much. Costs that came off the state budget were simply shifted onto someone else.
When is the last time you saw a story on health care cost-shifting in your local news reports?
The St. Louis Post-Dispatch has just completed a seven-part editorial series on the national health care system, titled "Health Care: A Sick System."
The daily headlines were:
* "An American Failure"
* "Your Bill Is Ready"
* "Bureaucracy and Buck-Passing"
* "Medication Nation"
* "How Other Nations Do It"
* "What Won't Work"
* "Taking the Cure"
Given the relatively sparse coverage of health policy news in the past election year, why didn't we see more of this prior to November 2, 2004?
On this date in 1985 I was between trips to Louisville, assigned by CNN to cover artificial heart experiments at a Humana hospital there. It was a media circus. Journalists were herded to a convention center miles from the hospital, fed several-times-a-day briefings by surgeons (usually optimistic), and given handout pictures or video of the experimental subjects tethered to the drive device for the Jarvik-7 heart. Much coverage was sensational, lacked context, and failed to discuss cost and policy ramifications.
1984 had just ended with more sensational coverage of a baboon heart transplant into "Baby Fae" at Loma Linda University medical center in California.
1985 would bring more pack journalism with news of President Reagan's colon cancer surgery. Hype hit fullspeed with coverage of National Cancer Institute research on interleukin-2. A central figure in both stories was Dr. Steven Rosenberg, Reagan's physician and IL-2 researcher.
I've often thought that 1984-85 was a landmark year -- a turning point -- in the coverage of medical science news. Network news, TIME and Newsweek covers, radio news, and major newspapers fed from the same trough during this feast of high-fluff, low-substance news coverage. CNN may have been the worst culprit because it repeated the stories over and over, hour after hour on both CNN and CNN Headline News. Other media caved in to the competitive pressure. One newspaper reporter told me he slept in and ordered room service and filed his Louisville artificial heart stories from his hotel room based on what he heard in CNN's live coverage of medical briefings that carried such personal details as subjects' blood chemistry and urine output.
Many of the bad journalistic habits exhibited so publicly so often in that year live on today. Remember: the Raelian cloning claims coverage was at its peak exactly two years ago.
In a new twist on the old "guns and butter" policy, the U.S. now appears on the verge of a "bad beef and higher priced drugs" policy.
Two news stories this past week beg readers to connect the dots.
One predicted that Canada may shut off Internet and mail-order sales of lower-cost prescription drugs to Americans. A Canadian pharmacy organization blames pressure by the Bush administration on the Canadian prime minister. Another Canadian pharmacy organization spokesman said he suspects the Canadian government has “quietly won U.S. trade concessions on Canadian beef and lumber in exchange for shutting down the mail-order drug industry.” (Star Tribune 12/31/04)
A headline in the same paper, same day, different section: “Canadian beef still welcome, U.S. says.”
Imports of beef stopped 19 months ago because of mad cow disease fears. This week’s U.S. announcement to stand by a decision to renew Canadian beef imports in March comes at the same time that Canada admitted it may have another case of mad cow disease.
So the U.S. may ban import of lower-cost Canadian drugs while renewing imports of Canadian beef despite continued health concerns.
Guns and butter.
Bad beef and higher-priced drugs.
What a fun year this will be to continue to track U.S. health care policy.
Andre Picard of the Toronto Globe & Mail adds to my recent "Ten troublesome trends in TV health news" with his own list of the ways to improve medical reporting in 2005.
Picard's conclusion: "Good health reporting should provide a straightforward, comprehensible summary of health issues. It has to be more than regurgitation. It needs to be balanced and provide context to information-hungry consumers.
Good health reporting should rarely be sensational, but always skeptical.
And there should be a lot more of it.
Until the media improve the quality of their work, their criticism of other players in the health system can hardly be taken seriously."
Amen.