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Re: E-DRUG: Direct-to-Consumer Advertising of Prescription Medicines

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E-DRUG: Direct-to-Consumer Advertising of Prescription

In regard to direct to consumer advertising, I agree with most of the
respondents. While high quality unbiased infomation can definitely help
empower the consumer, ads just out-and-out confuse.

To help show consumers how to interpret or deconstruct a recent Bristol
Meyers Squibb ad, a Vancouver writer (Jim Boothroyd) and I have an article
coming out in the Summer edition of magazine call AdBusters - a Vancouver
magazine with international recognition whose aim it is to expose ads for
what they are and to create awareness of the power of advertising. I
believe the title of the article is "Drug Ad Hard to Swallow" and I think
this edition will be on the newsstands in a week or so. I would encourage
you to checkout some of their stuff but more importantly think about
contributing to these sorts of magazines or even writing letters to the
editors where these ads originate explaining how the infomation in the ad
should be interpreted or used.

The web site address for AdBusters is http://www.adbusters.org but I don't
think you can get access to this specific article so I have attached the
text below. Hope you fnd it interesting. Any comments would be appreciated.

THE FOLLOWING IS WHAT IS IN THE HEART ATTACK AD
As you know, drug companies are now starting to directly market
prescription drugs to the public. A recent ad depecting Darryl Sittler (a
Canadian sports icon) was printed as a full page ad from Bristol-Myers
Squibb in the Vancouver Sun stating that:

"Darryl Sittler knows about the risks of heart atacks ... so should you."

This is followed by a picture of Darryl and his family.

"Darryl lost his father to a a heart attack.
He believes in knowing your cholesterol risk.
One out of three first heart attack victims die not knowing their risk
One particular medication, with a good diet and lifestyle, can reduce the
risk of first heart attacks by 31% and second heart attacks by 62%
Call know if not for you but your family"

This is then followed by a suggestion to phone a 1-888 number. 

WHAT FOLLOWS IS ROUGHLY THE  TEXT OF OUR ARTICLE

Perhaps you've noticed that pharmaceutical companies are now pitching their
prescriptions directly to consumers. "This is the information age and more
information empowers patients to be able to have more meaningful
conversations with their doctors about cures and treatments", explains Alan
Holmer, president of the Pharmaceutical Manufacturing Association.

Really? How then to explain the ad on this page? Darryl Sittler knows about
the risks of heart attack. - so should you! This full-page plug for a
cholesterol-lowering drug called Pravachol ran in Canadian daily newspapers
last winter. At first glance, one might mistake it for a public-service
announcement. No product is named and the reader's eye is drawn to a
clip-out coupon for a free Heart Attack Prevention Line. And doesn't that
logo recall the old heart-shaped emblem of the Canadian Heart & Stroke
Foundation? Looking closer, one notices the reference to one medication
and, in the finest print, the name Bristol-Myers Squibb, the fifth largest
pharmaceutical company in the world.

Darryl lost his father to a heart attack. He believes in knowing your
cholesterol risk. One out of three first heart attack victims die not
knowing their risk.

As true Canadians know - Darryl Sittler was captain of the Toronto Maple
Leafs and scored 484 goals for the Leafs from 1970 to 1981. Sittler was
fighting fit, and probably still has a strong ticker. So if he's worried,
we  should be terrified, right?

One particular medication, with a good diet and lifestyle, can reduce the
risk of first heart attacks by 31%. But what does this mean? That if you
take this medication, eat your greens and walk to work, you're a third less
likely to have a first heart attack?

This 31% comes from a clinical study published in the New England Journal
of Medicine in 1995. The study looked at a group of 6,600 men from western
Scotland. The average age of the men was 55, all had high cholesterol and
45% were smokers. Half were given a placebo, half pravastatin, (Pravachol.)
Those who took the placebo had a 7.9% chance of a first heart attack, while
those who took the drug every day for five years had a 5.5% chance.

The difference is 2.4%, much lower than the 31% reported in the Sittler ad.
Why the disparity? The 31% comes from dividing the difference in risk
between the
placebo group and drug group, 2.4%  (7.9%-5.5%) by the risk in the placebo
group (2.4%/7.9% = 31%).

An analogy might help. Your bank announces it's slashing mortgages by 30%.
If you have a mortgage worth $1 million, a cut of 30 % means your bank has
forgiven $300,000 of your debt - good news. But if you have just $1,000
left on your mortgage, a 30% cut means you save just $300. And if you have
no mortgage, then you save nothing.

The same applies for the Sittler ad. How much you would benefit from
Pravachol depends on what your risk of heart attack is to begin with. 
If you're a 55-year-old woman with high cholesterol but no other risk
factors, your chance of a heart attack in the next five years is about 3
percent. Taking
Pravachol every day for five years may reduce your risk by 31% of 3%, or 1%
- The risk would go down from 3 down to 2% or a one in 100 chance of
benefitting from this medication. However, this drug has not been tested in
women with heart disease to even really know the answer. 

Given the benefit in the clinical study was really 2.4%, one might question
the exclamation marks in the ad. Unfortunately it is not just consumers who
are taken in: doctors, nurses and pharmacists are often confused by the
same sorts of statistics.

Free heart attack risk evaluation. Speak to a qualified nurse. Jim
Boothroyd spoke to Sheila, one of about 20 nurses answering calls for the
heart attack prevention line at Bristol-Myers Squibb. Sheila said she
wouldn't mention the medication or the study - unless the caller fell into
a high-risk category.

"Many callers are surprised that they are at risk that is why I think that
it's important to have a line such as this one," Sheila said. "We need to
promote health from awareness." But Bristol-Myers Squibb might have raised
our awareness further if it had stated: "For Scottish males with high
cholesterol, half of whom smoke, a medication which costs approximately
$4,000 for five years of therapy, with a good diet and lifestyle, can
reduce the risk of a first heart attack by just over 2%." But that kind of
copy wouldn't keep Sheila and her colleagues busy answering the phones.

James McCormack is an associate professor and chair of the clinical
division in the Faculty of Pharmaceutical Sciences at the University of
British Columbia (jmccorma@unixg.ubc.ca). Jim Boothroyd is a
Vancouver-based freelance writer.
James McCormack, Pharm.D.
Associate Professor
Clinical Division Chair
Faculty of Pharmaceutical Sciences
c/o Pharmacy Department
St. Paul's Hospital
1081 Burrard St.
Vancouver, B.C.
Canada
V6Z 1Y6
604-631-5150 Fax 604-631-5154



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