Taking Your Medicine

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http://campaignfortruth.com/Eclub/210104/CTM%20-%20main%20article.htm

 

 

Taking Your Medicine

From an article by Gary Hughes and Liz Minchin

The Age, 13th December 2003

Australia

 

Many of us with chronic health problems rely on advocacy groups and peak medical

bodies for independent advice and support. But just how independent is that

advice and are we being given the full picture?

 

The Age has found that many advocacy groups are becoming hooked on sponsorship

dollars from drug companies and these international corporations are, in turn,

using them to promote their products in Australia's booming $5 billion drug

market.

 

Asthma

Meet Puff the purple dragon. Last year Puff became the public face of a new

Asthma Council Awareness campaign to encourage asthmatics to better manage their

medication.

 

But Puff had an earlier existence. He began life as the registered trademark

used by the pharmaceutical giant GlaxoSmithKline to market one if its asthma

drugs, Seretide, to doctors. His colour matches the packaging for Seretide.

 

It was GlaxoSmithKline's idea for the NAC to use its symbol and give Puff a new,

much more public role encouraging asthmatics to update their medication

regimens. GlaxoSmithKline, which is the world's biggest seller of asthma

medications, also provided financial support for the television campaign to

develop an interactive internet quiz for the NAC website to check whether

someone's asthma was under control. Even if you answer, " No " to the initial

question, " Do you have asthma " and say you have no symptoms, Puff advises you

that your asthma appears to be under control, but you should visit your doctor

anyway for a medical review.

 

NAC chief executive Kristine Whorlow defends the use of a pharmaceutical logo to

spearhead a supposedly independent campaign, saying market research before the

campaign showed there was no public recognition of Puff. The board of the

council, which is the peak asthma body in Australia, also discussed potential

conflicts of interests. " When GSK was talking to us and we were talking to them

about doing another consumer campaign and they came up with the idea of using

Puff, we discussed that very thoroughly here at our board meetings and we

decided to go ahead with it, " she said. " But we only went ahead with it when we

looked at the consumer research showing that the consumers were not aware of the

dragon at all. " ….

 

It is not surprising that the NAC and GlaxoSmithKline should work so closely

together on such a campaign. GlaxoSmith Kline was the founding sponsor of the

council when it was launched more than a decade ago and remains its principal

source of funds. According to the NAC's website, other sponsors in 2002 included

the pharmaceutical companies AstraZeneca, Aventis, Boehringer

Ingelheim,Schering-Plough, Merck, Novartis and Proctor and Gamble.

 

According to MsWhorlow, up to 60 per cent of the council's annual budget of

between $800,000 and $1 million comes from the pockets of pharmaceutical

companies.

 

Diabetes

In July last year, retired swimmer, Susie O'Neill, went on television urging

Australians to visit their doctor to check their blood glucose levels (BGL).

Just before the commercial went to air, thousands of doctors were receiving

another kind of visitor: sales representatives from the drug company AlphaPharm,

bearing new " Be Well - Know Your BLG " kits from Diabetes Australia.

 

The sophisticated, multimedia campaign was run by Diabetes Australia's NSW

division, but was paid for by O'Neill's sponsor, Capilano Honey, diabetes

monitoring equipment maker, Abbott Laboratories, and AlphaPharm, which produces

a range of generic diabetes drugs and claims to be " Australia's largest provider

of oral anti-diabetic medication " .

 

AlphaPharm is a subsidiary of major international pharmaceutical company Merck,

which also sells diabetes treatments.

 

Although the sponsorships were not mentioned on the television commercial, which

only displayed Diabetes Australia's logo, they were acknowledged on other

campaign material.

 

The campaign co-ordinator and corporate relations manager at Diabetes Australia

- NSW, Bill Edmonds, says that AlphaPharm's " field force " , or sales team, played

a crucial role in the campaign's success.

 

" Basically, they tour round the country and say, 'Look, here is the latest

awareness campaign by Diabetes Australia, the 'Be Well - Know Your BGL

campaign', and they hand it either to the practice nurse or the doctor. Now at

the same time you know that the pharmaceutical company is also selling other

products. (But) we couldn't afford to get it out there as effectively and

efficiently as the 'field force'. "

 

Mr Edmonds says he does not believe that the arrangement could be misinterpreted

as an endorsement by Diabetes Australia of AlphaPharm products " because doctors

are pretty smart creatures " .

 

Part of Diabetes Australia's 12-member federation, the NSW division, is

responsible for national marketing and fund raising and has attracted a long,

varied list of corporate sponsors.

 

Under the heading, " corporate sponsorship and branding opportunities " , the NSW

website boasts its campaigns provide " excellent return on investment " and says

that the BGL campaign offers " unique branding and market expansion opportunities

for all types of businesses " .

 

Mr Edmond says good publicity is the only benefit pharmaceutical sponsors such

as AlphaPharm and Abbott get from their involvement, and that no sponsor has

ever pressured him to get more for their money. But he admits he has

" voluntarily " gone overboard " to thank the BGL campaign supporters, quoting them

in press releases and even preparing a PowerPoint presentation for AlphaPharm

sales staff this year about the effectiveness of the 2002 awareness campaign.

 

This year, Edmonds says, only AlphaPharm, Merck and Novo Nordisk have supported

the organisation, giving about $100,000, not including non-financial aid such as

visiting doctors. In the past few years, Diabetes Australia has also won support

from other diabetes drug producers, such as Aventis, Bayer, Eli Lilly,

GlaxoSmithKline, Park Davis (now part of Pfizer), Roche and Servier.

 

Compared with many consumer groups, Diabetes Australia and its NSW branch have

massive budgets, around $93 million and $8 million respectively for the past

year, although most of that money is tied up in administering the National

Diabetes Services Scheme for the Federal Government.

 

However, Diabetes Australia's executive director, Brian Conway, says that rather

than avoiding any chance of conflicting interests, they choose to accept the

funding and in-kind support because " it still helps " .

 

One such potential conflict of interest is when Diabetes Australia or its

members lobby for diabetes drugs to be added to the Pharmaceutical Benefits

Scheme (PBS).

 

For two years, the organisation pressured the Government to add Glaxo-produced

Avandia and Actos, made by Eli Lilly, to the PBS (they were finally listed in

October this year). But Mr Conway denies that both companies' past support for

diabetes research and campaigns helped win Diabetes Australia's

Lobbying support.

 

Depression

Leanne Pethick is the woman behind DepressioNet, an apparently independent

consumer website for people suffering from depression that claims to attract

more than 1 million visits every three months. And international pharmaceutical

giant, Wyeth, which markets antidepressants, is the company behind Leanne

Pethick.

 

" DepressioNet would not exists today without Wyeth, " Ms Pethick readily admits.

" Wyeth is a company I am extremely proud to be associated with. "

 

Wyeth has provided $150,000 over the past three years to keep the

Melbourne-based DepressionNet running. But the links do not stop there.

 

Ms Pethick is also on the editorial board of Wyeth's own depression website,

'Yes To Life', and is a member of DepressioNet's medical advisory board. The Yes

To Life links through DepressioNet, which is described as " an independent

resource " without disclosing that it is substantially funded by Wyeth.

 

Ms Pethick helps with training seminars for Wyeth's sales team and last year

took part in a promotional tour the pharmaceutical company organised for a

visiting US depression expert, Professor Martin Kellick.

 

Ms Pethick even thanked Wyeth on her website for the opportunity to help with

the national tour, which saw her costs paid by the company to take part in panel

discussions at meeting of doctors.

 

But what Wyeth did not tell Ms Pethick was that Professor Kellick had been at

the centre of a row in his hometown of Boston in 1999, when The Boston Globe

reported he failed to disclose more than $500,000 in consulting fees from

pharmaceutical companies at conferences and in journal articles.

 

" No, I wasn't aware of that, " Ms Pethick told The Age. " On that particular tour

no particular product was mentioned. "

 

DepressioNet's stated aim is to " significantly increase the proportion of

Australian depression sufferers who seek help and treatment. "

 

Ms Pethick, who started the website in 2000 after her own battle with

depression, agrees that encouraging more people to seek medical treatment will

expand the market for antidepressants in Australia. But she sees no conflict of

interest in accepting drug company sponsorship.

 

She also insists her website, which also received a one-off grant of $20,000

from another pharmaceutical giant and the makers of Prozac, Eli Lilly, is able

to remain independent.

 

" The money we got from Wyeth was totally unconditional and helped us and

continues to help us to provide a vital service, " she said. " Any money we get,

we disclose. "

 

When her own savings ran out in 2001, Ms Pethick deliberately approached

companies in the antidepressant market because she thought they would be more

interested in sponsorship.

 

DepressioNet is not the only non-profit organisation advocating for patients

with mental illness that receives pharmaceutical industry financial backing.

 

The peak national body, Sane Australia, the operating name of the Schizophrenia

Australia Foundation, relies on drug companies for about 25 per cent of its

annual $1 million budget.

 

Last year, Sane Australia used a grant from Novartis Pharmaceuticals, which

markets two schizophrenia drugs, to commission an Access Economics report on the

cost of schizophrenia to the community. The report found that many sufferers

were missing out on treatment and said some newer medicines could be " extremely

effective " in reducing symptoms.

 

Earlier this year, Sane used a grant from GlaxoSmithKline, which markets a

lithium-based drug for bipolar disorder, to commission a second Access Economics

report, this time on the cost of bipolar disorder to the community. The report

found that average treatment levels for sufferers was less than a quarter of

what was considered best practice.

 

Sane Australia's executive director, Barbara Hocking, said that the organisation

accepted only unrestricted educational grants from pharmaceutical companies. " We

receive grants for specific purposes. The purposes we receive them for are

driven by us. We have our own guidelines, " she said.

 

Sane deliberately targeted Novartis and GlaxoSmithKline to fund the two Access

Economics studies because they produced drugs in those markets.

 

" The reality is, you go where you feel the money is likely to come from and it

is precisely because those companies have products in that area that we felt

they would be interested in having this independent information, " Ms Hocking

said.

 

Arthritis

Two years ago, the Australian Rheumatology Association decided to get tough with

its national executive members who were involved with drug companies. To avoid

the faintest whiff of conflicting interests, the executives were told to sever

all ties to pharmaceutical companies or resign. It didn't last.

 

" It was felt that in a small organisation that is a difficult thing to sustain, "

says association secretary, Associate Professor Geoff McColl. " There was some

consideration that it may have limited the pool of individuals who might serve

on the executive. "

 

Although the executive is mainly a professional body for rheumatologists, who

specialise in diseases of the joints, muscles, and connective tissues, it also

sees itself as a patient advocate. Instead of banning relationships with drug

companies, the ARA now insists that its executive members put any conflict of

interest on the record. But those disclosure documents are available only to

other ARA members, rather than being open to public scrutiny.

 

As well as sponsoring a number of the ARA's research and educational projects,

each year, drug companies such as Pfizer, Schering-Plough. Wyeth, Abbott and

Merck pay for its annual scientific meeting. Next year's conference is being

held in Cairns.

 

Dr McColl defends the drug-funded subsidy, saying some of his colleagues could

struggle to attend if their costs shot up from around $600 to several thousand

dollars.

 

" We are grateful to our pharmaceutical colleagues, particularly as we believe,

and I don't think there's any evidence to the contrary, that it doesn't alter

our decision making, " Dr McColl says. " Now, whether it has a more global effect

on individuals' views of particular companies, that's a much more difficult

thing to quantify. "

 

Just how easily patient Advocates can be swayed by relationships with drug

companies was illustrated three years ago in a case involving Dr McColl and

Arthritis Australia.

 

In July 2000, The ABC's Media Watch exposed how a seemingly independent

advertising campaign by the then Arthritis Foundation of Australia was used to

sell the new arthritis treatment, Celebrex. The drug's co-marketers, Pfizers and

Pharmacia, gave the Foundation an unconditional grant of $250,000. The money was

spent on television and print ads telling people to " ask your doctor about

exciting new arthritis treatments " .

 

Callers to the arthritis hot line were reportedly told, " there's this new

whizzbang drug called Celebrex " and offered a phone number to find out more

information.

 

Former Arthritis Foundation director, Ian Hook, apologised, saying, " it won't

happen again " , but that didn't stop Celebrex quickly becoming one of the top

selling drugs in Australia.

 

At the time, Dr. McColl was on Pharmacia's medical advisory board and was one

the reassuring public faces of the media and marketing blitz. He now regrets

that involvement, saying he won't be part of another drug marketing campaign.

 

" I think that taught us how powerful a direct-to-customer marketing campaign can

be and I think really there should be some legislation or guidelines so that

doesn't occur (again), " he says. " I've been made aware that if you work closely

with these people your views can be subtly altered, and that that's fine as long

as everyone knows that might have happened. And it's probably better, ideally,

if you don't get involved. "

 

Dr McColl's relationship with the Pharmacia advisory board ended 18 months ago.

He now advises Schering-Plough, makers of another rheumatoid arthritis

treatment.

 

All the key decision makers at Arthritis Australia who approved the Celebrex

campaign have since left, and new president, Ita Buttrose, says she couldn't

comment on why it went ahead.

 

But she vows " As long as I am president, Arthritis Australia will not allow

itself to be a disguised front for any pharmaceutical company or accept

donations 'with strings attached' " .

 

Herpes

Click on the sponsorship link on the Australian Herpes Management Forum's

website and everything seems to be upfront: " The AHMF is sponsored by GlaxoSmith

Kline Australia and Novartis pharmaceuticals via open educational grants.

GlaxoSmith Kline is the founding sponsor of the Australian Herpes Management

Forum and the major sponsor for 2003. "

 

But there is something that visitors to the AHMF's website are not told: The

group relies entirely on Australia's main herpes drug manufacturers for its

existence, and has since it was set up in 1996.

 

Recently appointed AHMF executive director, Trish Berger, estimates that in the

past financial year, GlaxoSmithKline has given the AHMF about $120,000 or 80 per

cent of its budget. The other 20 per cent comes from Novartis.

 

There is a strong bond between the AHMF and GlaxoSmithKline, for many years the

only major manufacturer of herpes treatment in Australia.

 

Its constitution was written by Glaxo Wellcome's (now GlaxoSmithKline) Melbourne

based law firm, Deacons, and up until August this year, the forum's

administration was run by public relations firm, Edelman, hired on the

recommendation of a well known client, GlaxoSmith Kline. Most of the experts who

have sat on the AHMF board have also worked with or advised GlaxoSmith Kline and

Novartis in recent years….

 

AHMF chairman, Professor Adrian Mindel concedes that the forum has been

vulnerable to pressure from GlaxoSmith Kline and Novartis because without their

funding, " the Australian Herpes Management Forum would cease to exist

tomorrow " ….

 

" We are all professionals who are mostly academics in this area, and protecting

our own reputations and independence is also terribly important…We think it is a

quid pro quo (arrangement) and that we gain some benefit from that by promoting

the science and improving the general health of the community. They get the

benefit in terms of their drug. And I'm not sure it's possible to completely

separate the two. "

 

In contrast, Professor Mindel says the global version of the AHMF, the

International Herpes Management Forum, may be a different story. He says that

although the IHMF " produces some high quality material……whether it is completely

unbiased is questionable because of its close ties to dug companies. "

 

More than half of the current IHMF board have links to GlaxoSmithKline, such as

leading trials of its herpes drugs, or, in one case, featuring in a Glaxo

sponsored television special.

 

Novartis has since signed on as a sponsor too, and the companies influence the

International Herpes Alliance (which also relied on GSK funding to get started

in 1999) website. Its " educational " material for journalists has been written by

the " organisations (that) have made educational contributions to the

International Herpes Alliance for the promotion of herpes awareness " - in other

words, GlaxoSmithKline and Novartis.

 

COPD

World Chronic Pulmonary Disease Day was launched globally in November last year.

But the concept was born nine months earlier at London's Radisson Hotel during a

meeting between pharmaceutical company executives and medical experts.

 

The experts were members of the executive committee of an organisation called

Global Initiative for Chronic Obstructive Lung Disease, or GOLD. The

organisation was sponsored entirely by the pharmaceutical companies attending

the meeting and the airfares and the hotel expenses for the medical experts had

been provided.

 

Minutes from the meeting showed that " the committee and sponsors discussed the

development of a World COPD Day and suggested that the feasibility and

objectives… be discussed. "

 

Nine months later, World COPD Day was launched using promotional materials

prepared by GOLD with the aim of raising public awareness of the threat posed by

chronic lung diseases. In Australia this was spearheaded by the Australian Lung

Foundation, the consumer and research arm of the Thoracic Society of Australia

and New Zealand.

 

No mention was made that the pharmaceutical companies providing the money to run

GOLD were also some of the biggest players in the global respiratory medicines

market, including the world leader, GlaxoSmithKline. Nor was it obvious that the

Australian Lung Foundation's launch was also partly funded by GlaxoSmithKline

and another international heavyweight, Boehringer Ingelheim.

 

And even harder to pick was, that the company that runs GOLD was an American

Communications corporation that boasts, on its website, of helping the

pharmaceutical industry " find solutions to significant marketing and education

challenges " through such techniques as promoting brands and repositioning or

launching products.

 

Dr Larry Grouse, the chief executive of the company Medical Communications

Resources Inc, is also the co-ordinator of GOLD and listed as a member of its

executive committee.

 

" No, I wasn't actually aware of that. Thanks for pointing it out, " says William

Darbishire, the chief executive of the Australian Lung Foundation, which is

setting up a national call centre to provide advice to COPD sufferers with a $US

20,000 ($A 27,000) grant from drug giant Pfizer.

 

MCR and virtually the same set of sponsors are also behind an international

organisation called Global Initiative For Asthma, or GINA.

 

Dr Christine Jenkins is an independent Australian representative on Gold's

executive committee as well as being the head of clinical trials at Sydney

University's Woolcock Institute of Medical Research which received a $1million

endowment from GlaxoSmithKline.

 

She strongly rejects any suggestion that the pharmaceutical industry sponsors of

GOLD and GINA could influence the setting of guidelines for the types of drugs

doctors are advised to use to treat asthma or chronic lung disease.

 

" I think Gold is a very, very independent process, " says Dr Jenkins, who helped

to launch Australia's first COPD Day at a Lung Foundation media conference last

year.

 

When GOLD issued updated treatment guidelines in July, the medication,

tiotropium, marketed by Boehringer and Pfizer as Spiriva, was added to the list

recommended. The companies issued a media release quoting Dr. Larry Grouse, but

failed to mention their financial support.

 

Five months earlier, when Spiriva was launched on to the Australian market,

Pfizer and Boehringer issued a local media release through public relations

company Hill and Knowlton quoting Dr Jenkins on the dangers of COPD.

 

Dr Jenkins said tiotropium was " an excellent drug " and it should be expected

that pharmaceutical companies would use such decisions to market their products.

 

" I think the companies will use GOLD, there is no question, " said Dr Jenkins,

who has her air fares and accommodation paid for by GOLD's drug company's

sponsors when she attends executive meetings. " That's their business, to sell

dugs. "

 

Further Resources

For more information on the double-dealing of the drug and medical industries:

Health Wars by Phillip Day

Wake up to Health by Steven Ransom

Great News on Cancer by Steven Ransom

 

 

 

 

 

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