Friday, January 6, 2012

Peddling Useless Drugs: Paying Journals to Publish

I reprint the following from my post of November 21, 2011:

I've previously mentioned the Primary Care Medical Abstracts program run by my friends Rick Bukata and Jerry Hoffman, in which subscribers receive a CD each month with commentary on 30 recently published papers from medical journals. Since both Rick and Jerry are concerned about the impact of Pharma marketing on medical science and practice, it's not uncommon for several of the papers each month to address topics of interest to this blog. The October, 2011 issue had an especially impressive bumper crop. Here are capsule summaries of some of the papers.

Who's Marketing the Heck Out of Useless Cholesterol Drugs?

Before statins came along, an older class of drugs, the fibrates, was employed in attempts to lower cholesterol. Recent research has documented thoroughly that these drugs have no place in the medical armamentarium. Yet these authors noted a 117% increase in fibrate prescriptions between 2002 and 2009. Was this because physicians all on their own decided to go back to this old class of drugs? Hardly; the data show that newer brand-name fibrates are selling much better than older generics. So it seems that creative drug marketing has resurrected a class of drugs that should have been sent to the retirement home long ago.

Jackevicius CA, Tu JV, Ross JS, et al. Use of fibrates in the United States and Canada. JAMA 305:1217-1224, March 23/30, 2011

Okay, so you might ask, just how is Pharma going about twisting docs' arms to get them to prescibe more and more of these useless drugs?

Enter Marilyn Mann, who except for the fact that she reads this blog regularly is an eminently sane person. She posted a clue to this puzzle on her blog, which is called, for some strange reason, Marilyn Mann's Blog:

Marilyn, tipped off by Dr. Harlan Krumholz at Yale, provides links to a so-called review article on fibrate drugs. The fine print at the end of the article says that Abbott Laboratories, which by the merest coincidence manufactures two fibrates, paid the publisher to print this article. The disclaimer goes on to note that Abbott did not directly pay the authors. But the lead author is "medical editor" of the journal. I rather doubt that he does this out of the goodness of his heart, so I assume that the publisher pays him. So Abbott pays the publisher and the publisher pays the author, but Abbott does not pay the author. Okay, now it's all clear.

The tried and true tricks that the article trots out for our edification (hitting the high points only) are, first, including really glitzy graphics to illustrate what fibrates do at the chemical and cellular levels (a sure tipoff of generous Pharma funding; the average medical journal, unless they are high rollers like New England Journal, simply cannot afford cute color graphics)--thereby increasing the scientific panache of the paper without really saying anything important for clinical medicine; second, stressing surrogate endpoints--in this case, how much fibrates reduce blood levels of triglycerides, without mentioning that there's no correlation between making your lab numbers look better and your living any longer; and finally, omitting the key take home message, which is that all studies of actual patient outcomes in fibrates show that they reduce the rate of some cardiovascular events, some of the time, but don't budge the mortality rate. In other words, if you don't want to die of a heart attack, but would rather die just as quickly of something else instead, take fibrates. (In fairness, this point is mentioned, though effectively buried, in the text of the article, but is completely absent from the abstract--which is the only part of the article many, if not most, busy practitioners read.)

Marilyn wants to know why any physician would bother to read such drek, and why a state chapter of the American College of Cardiology would reveal its bottom-feeding tendencies by allowing its name to be attached to such a publication. She might as well ask why 85% of US docs see drug reps and use the industry as a source of information about pharmaceuticals. You can bet that Abbott did not merely pay the journal to print the article, they also bought a ton of reprints. Those reprints are handed to docs by the reps peddling the fibrates, and the docs have no time to read the reprint (except maybe the abstract as noted), but the reps point out the pretty pictures as evidence that the sales pitch they're delivering is "scientific."

(Hat tip also to Jerry Hoffman for helpful e-mail comments.)

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