Zetia & Vytorin: how Merck got patients to spend $21 billion on drugs that don’t work

How did drug giants Merck and Schering-Plough persuade patients to spend $21 billion on a cholesterol drug that doesn’t prevent heart attacks? According to a December 14th report in Forbes, the cholesterol-lowering drug Zetia works by a little-understood mode of action, and no research has shown that it prevents heart attacks at all. Physicians have been brutal in their assessment. Zetia’s rise “was the miracle of marketing, not the miracle of medicine,” says cardiologist Dr. Sanjay Kaul of Cedars-Sinai Medical Center. Cleveland Clinic cardiologist Dr. Steven Nissen adds:

“We’ve spent billions on a drug that may turn out to be a placebo.”

Yet Merck’s clever marketers have spun straw into gold. Over the last seven years, they have convinced doctors to prescribe $21 billion worth of Zetia and its sister drug, Vytorin, which combines Zetia with Merck’s old cholesterol drug Zocor. In fact, the drugs are on track to do $4 billion in combined sales this year, despite multiple studies suggesting they fail to prevent clogged arteries. Thanks to an agressive $200 million ad campaign, American sales of Zetia and Vytorin represent 16% of all cholesterol-lowering drug sales, but only a 3% share in Canada, where direct-to-consumer (“Ask your doctor”) advertising is banned.  

Merck and its partner Schering-Plough agreed in August to pay $41.5 million to settle 140-plus lawsuits lodged against the manufacturers for misleading and improper marketing of the drug and for withholding the results of a clinical trial that showed Vytorin to be less effective than other cheaper, generic statin drugs in treating arterial plaque.

Forbes also reported that last month Zetia got trounced by the B vitamin niacin in a study that used ultrasound to examine blocked arteries. Another artery study in March 2008 found that Zetia was no better than a placebo. At that time, the American College of Cardiology advised physicians to prescibe Zetia only as a “last resort”. Merck responded by insisting that the studies are flawed, and that millions of people may need Zetia or a drug like it.

Physician and cholesterol expert Dr. John LaRosa is among many doctors who have always believed that Zetia should only be used in cases where the more common cholesterol-lowering drugs, known as statins, aren’t doing enough—and that there’s no reason to take Vytorin at all. Dr. LaRosa claims:

“The marketing pushed sales far beyond their known medical utility.”

Merck also paid doctors to promote Zetia. In the five-month period in which the first negative Zetia trial data emerged last year, for example, Merck paid cardiologist Dr. Michael Davidson over $71,000, and Weill Cornell Medical College Dean Dr. Antonio Gotto received over $27,000 for “lectures and consulting” to encourage their peers to prescribe Zetia.

Since 2004, Merck has bought $741 million worth of print, television and Internet advertisements for Zetia and Vytorin. The ads boasted that Zetia uses a “different way to lower cholesterol”, and that “only Vytorin” blocks “the two sources of cholesterol.” These ads have stopped running since negative research results have been published.

Read the full report in Forbes.

See also:

7 thoughts on “Zetia & Vytorin: how Merck got patients to spend $21 billion on drugs that don’t work

  1. I will be asking my physician about my Vytorin prescription first thing tomorrow morning, along with copies of this article and links to these journal articles. Thank you for sharing this important information with us.

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    • Outraged, I’m with you.

      But I’m not expecting a favorable response from my doctor when I bring a copy of this article and other background ammunition to request an Rx change. Based on past “conversations” with him, whenever I do my homework and actually research data that impacts my own health (instead of just buying the drug rep’s sales line as he seems to do) he gets quite defensive. But my health is too important to let his hurt feelings stop me.

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  2. Carolyn – thanks for this. This is a scathing indictment of not only these drugs but also the entire process of marketing these to helpless and innocent patients.

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  3. “…In fact, the drugs are on track to do $4 billion in combined sales this year, despite multiple studies suggesting they fail to prevent clogged arteries….”

    And yet doctors are still prescribing these drugs? This shows the pervasive power Big Pharma must have on the medical profession. What’s going on here?

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  4. “Another artery study in March 2008 found that Zetia was no better than a placebo.”

    So what reason would doctors have after March 2008 to keep prescribing Zetia if it’s “no better than a placebo”? ?!?!?!

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  5. The imaging study was flawed. it looked at a patient population who had been treated with the highest doses of statins for years. The prevailing dogma in cholesterol is that “lower is better.” The abundance of data supporting that dogma shows that how you get your LDL lower doesn’t matter, it’s the very nature of lowering your LDL that matters. Now if that is wrong, then perhaps this article is correct, but if the true outcomes trial shows that, in fact, lowering with cholesterol reduces heart attacks and strokes then rants like this article are nothing more than shouting “fire” in a crowded theater.

    Remember that, just like pharma companies, top doctors and top hospitals are in business as well. Their motives shouldn’t be assumed to be benevolent. For example, let’s say a pharma company promised to do a large (and highly profitable) clinical trial with a hospital and backed out… how would those doctors speak publicly about that pharma company and its products?

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