The marketing of anemia drugs - a story we shouldn't forget

In an opinion piece on TheScientist.com, Daniel W. Coyne writes, “Amgen’s incomplete report on an early major trial of epoetin misled the medical community about the anemia drug’s risks and benefits—and helped make Amgen rich.”

In the book, “How We Do Harm,” Otis Brawley, MD, chief medical and scientific officer of the American Cancer Society, writes quite a bit about hemoglobin-building drugs. He discusses:

“the nasty warfare between J&J, the company that sold Procrit, and Amgen, the company that sold Aranesp.”
“the intricate financial incentives Amgen had created to induce oncologists to prescribe more Aranesp.”
“Pharmaceutical companies were promoting an untested therapy that was purported to make patients feel better and stronger when, in fact, it caused strokes and heart attacks and in some cases made tumors grow.”
“Until the FDA finally clamped down, these drugs became the single largest category of agents used in oncology.”

That book, in my opinion, may be the most powerful book about U.S. health care that I’ve ever read. Deborah Schoch of the California HealthCare Foundation’s Center for Health Reporting recently published a review of the book. She wrote:

“Brawley’s book is a page-turner, rich with dramatic anecdotes. … It has the sharp edge of an investigative piece, exposing morally questionable clinical tests, drug companies in search of the next big money-maker, doctors granting wealthy patients what it labels “irrational care.”

Comments

Greg Pawelski posted on May 16, 2012 at 11:40 am

“Dozens of other doctors agreed to ‘influence their colleagues to use Procrit’ for unapproved indications such as cancer-related fatigue. One was Dr. Von Hoff, the director at the Arizona Cancer Center. He collected advisory fees and perks from not just Ortho, but from about 30 other pharmaceutical firms, earning directors’ fees for sitting on several companies’ boards. ‘When I saw how many shares he owned in biotech and drug firms, my jaw dropped,’ McClellan later said. Many others, like Dr. Jerome Groopman of Harvard Medical School, performed J&J-funded clinical trials. He was paid to sit on Procrit’s ‘fatigue’ advisory board and was quoted often in The New York Times extolling the drug, according to public records.” – From Kathleen Sharp’s book, “Blood Feud: The Man Who Blew the Whistle on One of the Deadliest Prescription Drugs Ever.”

In 2010, Dan Von Hoff got the Karnofsky award from the American Society of Clinical Oncology (ASCO), which is sort of a lifetime achievement award for clinical research. This is a nuclear explosion for clinical oncology. I’m wondering who was involved in the Harvard side of it? Interestingly, it is the highest levels of academia who are most tainted. One in particular, Dan Von Hoff. These ivory tower docs were the culprits. Unfortunately, this will probably play out as one more cudgel to beat the more reasonable and gentle practitioners, who either largely avoided such abuse or were led down the path by the scholars, who will themselves skip out unfazed.

Thanks for bringing this back up Gary. It is a story we shouldn’t forget.

bev M.D. posted on May 21, 2012 at 1:27 pm

A cautionary tale indeed, and compelling evidence for the idea that just because an ‘if-then’ in medicine seems intuitively obvious, that doesn’t make it true. (i.e., that a higher hemoglobin is better for you).
However, it also supports something I tell my lay friends all the time – if the medical profession doesn’t want to know the answer to a question, they just don’t study it. So why did it take so long for someone to actually examine this question?