The Politics of Marketing Gardasil

August 20, 2008
The Evidence Gap
Drug Makers' Push Leads to Cancer Vaccines' Rise
By ELISABETH ROSENTHAL

In two years, cervical cancer has gone from obscure killer confined mostly to poor nations to the West's disease of the moment.

Tens of millions of girls and young women have been vaccinated against the disease in the United States and Europe in the two years since two vaccines were given government approval in many countries and, often, recommended for universal use among females ages 11 to 26.

One of the vaccines, Gardasil, from Merck, is made available to the poorest girls in the country, up to age 18, at a potential cost to the United States government of more than $1 billion; proposals to mandate the vaccine for girls in middle schools have been offered in 24 states, and one will take effect in Virginia this fall. Even the normally stingy British National Health Service will start giving the other vaccine — Cervarix, from GlaxoSmithKline — to all 12-year-old girls at school this September.

The lightning-fast transition from newly minted vaccine to must-have injection in the United States and Europe represents a triumph of what the manufacturers call education and their critics call marketing. The vaccines, which offer some protection against infection from sexually transmitted viruses, are far more expensive than earlier vaccines against other diseases — Gardasil's list price is $360 for the three-dose series, and the total cost is typically $400 to nearly $1,000 with markup and office visits (and often only partially covered by health insurance).

Award-winning advertising has promoted the vaccines. Before the film "Sex and the City," some moviegoers in the United States saw ads for Gardasil. On YouTube and in advertisements on popular shows like "Law and Order," a multiethnic cast of young professionals urges girls to become "one less statistic" by getting vaccinated.

The vaccine makers have also brought attention to cervical cancer by providing money for activities by patients' and women's groups, doctors and medical experts, lobbyists and political organizations interested in the disease, sometimes in ways that skirt disclosure requirements or obscure the companies' involvement.

Even critics of the marketing efforts recognize the benefits of the vaccines. Girls who get the shots are less likely to have Pap tests with worrisome results that would lead to further treatment, saving themselves anxiety and discomfort and, in those cases, saving money. When it occurs, cervical cancer is a dreadful disease; genital warts, partly prevented by the Merck vaccine, can be a painful nuisance.

But some experts worry about the consequences of the rapid rollout of the new vaccines without more medical evidence about how best to deploy them. They say that because of the aggressive marketing, even parents of girls who are far from being sexually active may feel pressured into giving them a vaccine that is not yet needed and whose long-term impact is still unclear. Legislative efforts to require girls to have the vaccine only add to the pressure.

In the United States, hundreds of doctors have been recruited and trained to give talks about Gardasil — $4,500 for a lecture — and some have made hundreds of thousands of dollars. Politicians have been lobbied and invited to receptions urging them to legislate against a global killer. And former state officials have been recruited to lobby their former colleagues.

"There was incredible pressure from industry and politics," said Dr. Jon Abramson, a professor of pediatrics at Wake Forest University who was chairman of the committee of the Centers for Disease Control and Prevention that recommended the vaccine for all girls once they reached 11 or 12........Much more at the link



http://www.nytimes.com/2008/08/20/health/policy/20vaccine.html?fta=y&pagewanted=print

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Doctors, Marketing, and Money = Messy

Here is a item from CNN on physicians, money, marketing and ties to pharmaceutical and medical device companies. We, of course, would like to believe that all physicians are objective and only interested in our welfare. I wish it were true but sometimes........... Duncan


ATLANTA, Georgia (CNN) -- Linda Lewis says that when she had back surgery two years ago, her surgeon didn't do what was best for her health; he did was best for his bank account.
If Linda Lewis had known of her surgeon's financial ties to a device maker, she'd have sought a second opinion.

If Linda Lewis had known of her surgeon's financial ties to a device maker, she'd have sought a second opinion.

Lewis, a graduate student who lives in Sherman Oaks, California, says Dr. John Regan, a surgeon in Beverly Hills, put in an artificial disc to help relieve her lower back pain.

"He said my back would be better than ever," said Lewis, 45. "I'm thinking, 'Wow, disc replacement is the best thing since sliced bread.' "

But after the surgery, Lewis says, she ended up in debilitating pain, could walk only with the assistance of a walker and had to have a second procedure to correct the first one.

"I couldn't take enough drugs for the pain," she said. "Having that surgery was the worst decision of my life."

Lewis said she was "livid" when she later found out that Regan had financial ties to the company that makes the disc, saying she believes that those ties prompted Regan to recommend the disc over other treatment options.

In an e-mail to CNN, Regan's office manager said he "is not available for comment."

How likely is it that your doctor has a tie to a company that makes drugs or devices? Very likely, according to Dr. Robert Steinbrook, who wrote an article on doctor/industry ties this month in the New England Journal of Medicine. Video Watch more on medical marketing and doctors »

"Most physicians in the United States have financial relationships with industry, ranging from the acceptance of meals to the receipt of large sums of money for consulting, speaking, or conducting research," he wrote.

For example, two physicians made more than $8 million each from Dupuy Orthopaedics Inc., which lists the payments on its Web site.

"Consumers should absolutely know where their doctor is coming from," said Steven Findlay, a health care analyst at Consumers Union. "Doctors think they won't be influenced by these financial relationships, but the research shows that they are.".........click on the link for the rest.


Don't become a victim of medical marketing - CNN.com