Discredited HRT drugs marketed in new versions

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Discredited HRT drugs marketed in new versions

 

By ANDRÉ PICARD

PUBLIC HEALTH REPORTER

Wednesday, October 27, 2004 - Page A23

http://www.theglobeandmail.com/servlet/ArticleNews/TPStory/LAC/20041027/HHORMONE\

27/TPHealth/

 

Now that the touted health benefits of hormone-replacement therapy for

postmenopausal women have been largely discredited, pharmaceutical

companies are promoting low-dose versions of the same drugs, according

to a new study.

 

They are doing so despite the fact that there has been no research

showing low-dose HRT is any safer, said Dr. Sumit Majumdar, an assistant

professor at the University of Alberta's division of internal medicine.

 

" There is no current evidence that the balance of harms and benefits

would be different from the higher-dose form, " he said.

 

In a paper published in today's edition of the Journal of the American

Medical Association, Dr. Majumdar showed that drugs used in

hormone-replacement therapy are among the most heavily promoted, and

that spending greatly influences prescriptions.

 

In 2002, just before a blockbuster Women's Health Initiative study that

showed the combination of progestin and estrogen increases the risk of

heart attacks, breast cancer, stroke and blood clots, pharmaceutical

companies were spending an average of more than $300-million (U.S.)

annually to promote HRT in the U.S market.

 

That spending, averaging $350 per physician, included free samples,

office-based " detailing " visits to physicians, advertising in medical

journals and direct-to-consumer marketing.

 

Dr. Majumdar is currently doing a similar study about drug promotion in

Canada. Initial results suggest average spending per Canadian physician

is even higher.

 

The drugs are sold under two principal brand names in the United States,

Prempro (a combination of progestin and estrogen) and Premarin (estrogen

only), both products of Wyeth Co.

 

In the nine months following publication of the WHI study, that

promotional spending fell sharply to $220 per physician -- a 37-per-cent

drop. During that same period, sales of HRT fell by 38 per cent.

 

Dr. Majumdar said he was particularly intrigued by the fact that

direct-to-consumer advertising of HRT dropped to zero. " The industry

tells us that the primary purpose of advertising is educating the

public. But these data suggest that education is far less important than

persuasion. "

 

He said it was " disturbing to see the correlation between promotion and

prescription, " noting that physicians have to think hard about how they

are being influenced, and what that means to patients.

 

The study found that spending on promotion of HRT is now rebounding. In

the fourth quarter of 2003, promotional spending was $55-million, up

from a low of $45-million in the first quarter of 2003, but still below

the $71-million spent in the first quarter of 2002.

 

Of the $55-million spent in the final quarter of last year,

$13.5-million went to promoting the new low-dose versions of drugs.

 

Dr. Randall Stafford, an assistant professor of medicine at the Stanford

Prevention Research Center in Stanford, Calif., and co-author of the

study, said the mixed response by the pharmaceutical companies is

intriguing.

 

" The early response reflects that the companies were cautious about

heavily promoting a product where harms appeared to exceed benefits. On

the other hand, the later resurgence in spending, particularly for a

product with unknown risks and benefits, suggests that industry

envisioned a continuing and viable market for hormone therapy. "

 

In Canada, hormone replacement therapy is sold under two brand names,

Premarin and Premplus.