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.   Continue reading

Nice work if you can get it: same talk, same slides, week in, week out – at $1,500 a pop

speech purpleSince returning from Mayo Clinic and the annual WomenHeart Science & Leadership Symposium for Women with Heart Disease training, I’ve done many public presentations on the subject of heart disease – the #1 killer of women in North America. My talks are pretty well all the same. When I tell the story of my own heart attack misdiagnosis, it never changes.  When I talk about emerging research from Mayo and other experts on women’s risk factors for developing heart disease, it’s always the same list.  When I discuss surprising symptoms and signs that you might be having a heart attack – well, you get my drift.

This is a normal public speaking reality for those who have a specific message to deliver or a unique area of expertise to share.  Same talk, same slides, different audiences.

Just ask psychiatrist Dr. Manoj Waikar, adjunct professor at Stanford University, who moonlights as a public speaker for the largest American psychiatric drug maker, Eli Lilly.  Continue reading

Is your surgeon able to understand simple instructions?

I like to think that most surgeons are very brainy people. You don’t get through all those years of university, med school and residency unless you’re able to understand instructions. Yet that’s what a puzzling 29% of orthopedic surgeons were apparently unable to do, according to a conflict-of-interest study reported in the New England Journal of Medicine.

It all started when, in order to avoid facing legal action, several companies who manufacture hip and knee implants agreed in 2007 to publicly disclose about $270 million worth of cash payments they’d made to orthopedic surgeons.

This agreement was part of a U.S. Justice Department investigation in which prosecutors accused these companies of violating anti-kickback laws by paying the physicians to use their products. This concerned the researchers, who said they felt a duty to alert the public to potential conflicts of interest that may colour how doctors treat patients when docs are on the take from product manufacturers Continue reading