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[e-drug] Australia: Drug firms fund disease awareness

E-drug: Australia: Drug firms fund disease awareness

[Long message, but well worth reading! Cross-posted from Ip-
health. Thanks. BS]

Sydney Morning Herald, Saturday December 13, 2003

Drug firms fund disease awareness
By Gary Hughes and Liz Minchin

Pharmaceutical companies are pouring millions of dollars into
patient advocacy groups and medical organisations to help expand
markets for their products.

They are also using sponsorships and educational grants to fund
disease-awareness campaigns that urge people to see their
doctors. Many groups have become largely or totally reliant on
pharmaceutical industry money, prompting concerns they are open
to pressure from companies pushing their products.

An investigation by The Age newspaper has found: An awareness
campaign run by the National Asthma Council was spearheaded by
a cartoon dragon that was the registered trademark of a drug
company used to promote one individual asthma medication.

A drug company used a public relations firm to set up an expert
medical board to persuade people they needed hepatitis A and B
vaccinations. The company was not interested in raising
awareness about hepatitis C because it did not sell a vaccine for
the disease.

Treatment guidelines issued by Australian doctors for some
diseases are being modelled by those developed by international
groups entirely funded by pharmaceutical companies selling drugs
for those same diseases.

Groups funded by pharmaceutical companies are helping lobby the
federal Government to have new drugs added to the
Pharmaceutical Benefits Scheme.

The health policy officer with the Australian Consumers'
Association, Martyn Goddard, who is a former member of the
federal Pharmaceutical Benefits Advisory Committee, said
pharmaceutical companies had far too much influence over many
consumer groups.

"Drug companies find it very easy to recruit consumer groups and
they do it very cheaply," he said. "There's almost no such thing as
clean money for most consumer organisations."

The total amount of money flowing into patient groups and medical
bodies in Australia is unclear. The most recent figure available
from the industry body Medicines Australia shows that drug
companies spent between $20 million and $25 million on
philanthropic causes in 1999, which mostly covered payments to
such groups.

One medical specialist involved in an organisation totally
sponsored by drug companies described the situation as like
"dancing with the devil". 

There are no independent regulations covering drug company
sponsorship deals and grants with patient groups in Australia.

Voluntary guidelines developed by Medicines Australia are now
being independently reviewed by Swinburne University. The review
is being funded by Medicines Australia and individual drug

A South Australian general practitioner, Dr Peter Mansfield, who
runs the internationally renowned Healthy Skepticism website,
which exposes pharmaceutical marketing techniques, said the
hijacking of patient groups had become a huge problem.

"To be an advocate for people with those conditions, those
organisations ought to be free to criticise the drug companies - just
as they ought to be free to criticise doctors if we are not doing our
jobs properly," he said.

Sugar-coating the pill
Saturday December 13, 2003

Patient advocacy groups such as the National Asthma Council and
Diabetes Australia are not as independent as they seem.
Pharmaceutical companies are pouring millions of dollars into such
groups to help expand the markets for their products. The
companies also use sponsorships and educational grants to fund
disease awareness campaigns that urge people to see their
doctors. Groups funded by pharmaceutical companies are helping
lobby the Federal Government to have new drugs added to the
Pharmaceutical Benefits Scheme. These are some of the
examples uncovered in an investigation by Gary Hughes and Liz
When the international pharmaceutical giant GlaxoSmithKline
wanted to push more deeply into Australia with its hepatitis B
vaccine, it employed a technique that had already successfully
convinced much of France that there was a threat of contracting
hepatitis B.

In 1995 it used its public relations company, Hill and Knowlton, to
set up the Viral Hepatitis Prevention Board to tell the public how at
risk it was and to help lobby for government approval for universal
immunisation of children for hepatitis B. About 10 medical experts,
including Dr Tilman Ruff, who would later go to work for
GlaxoSmithKline as medical director of its vaccine division, were
recruited to make up the board.

They were paid expenses to attend board meetings organised by
Hill and Knowlton, while material on the risks of hepatitis B was
released under the board's name. "The idea basically came from
GlaxoSmithKline ... and they basically did quite a lot of the
organising, they provided the secretariat and so on for the
meetings," says the board's chairwoman, Dr Sandy Thompson. "It
always is a little bit of a difficult relationship ... because clearly they
are in the business of wanting to sell vaccine."

The campaign was a success. The Federal Government
announced $14 million in funding for hepatitis B immunisation of
pre-adolescents in 1997 and all infants by 2000.

But GlaxoSmithKline also had a vaccine against hepatitis A. So the
board began talking about the risks of that. In July last year the
board issued a 14-page booklet sponsored by GlaxoSmithKline
and prepared by Hill and Knowlton, warning child-care workers
they were at risk of catching hepatitis A if they were not
immunised. The booklet did not mention that GlaxoSmithKline
made the hepatitis A vaccine, which costs $120 for a two-dose
course. In April a member of the Viral Hepatitis Prevention Board,
Professor Graham Cooksley, chaired a symposium in Sydney
funded with a grant from GlaxoSmithKline on: "Should we move
towards universal vaccination for hepatitis A?"

Thompson says the board has now "basically gone into recess"
because members felt "we had run our course". She says the
members were keen to do something in the area of hepatitis C, but
this created a "difficult issue" with GlaxoSmithKline, because the
company did not have a vaccine it could sell.

But Thompson rejects any suggestion of a conflict of interest
surrounding her role with the board. "We need to promote
immunisation; we need to use vaccines effectively. So I didn't feel
any conflict of interest.' Stay well, and may the field force be with

In July last year an Olympic gold medallist in swimming, Susie
O'Neill, went on television urging Australians to visit their doctor to
check their blood glucose levels (BGL). Just before the commercial
went to air, thousands of doctors around the country were
receiving another kind of visitor: sales representatives from the
drug company AlphaPharm who were bearing new "Be Well -
Know Your BGL" kits from Diabetes Australia.

The sophisticated multimedia campaign was run by Diabetes
Australia's NSW division, but was paid for by an O'Neill sponsor,
Capilano Honey, diabetes-monitoring equipment maker Abbott
Laboratories and AlphaPharm, which produces a range of generic
diabetes drugs and claims to be "Australia's largest provider of oral
anti-diabetic medication".

AlphaPharm is a subsidiary of the major international
pharmaceutical company Merck, which also sells diabetes
treatments. Although the sponsorships were not mentioned on the
TV commercial, which displayed only Diabetes Australia's logo,
they were acknowledged on other campaign material.

The campaign co-ordinator and corporate relations manager at
Diabetes Australia-NSW, Bill Edmonds, says AlphaPharm's "field
force", or sales team, played a crucial role in the campaign's

"They tour around the country and say, 'Look, here is the latest
awareness campaign by Diabetes Australia, the Be Well - Know
Your BGL campaign', and they hand it to either the practice nurse
or the doctor. Now, at the same time you know that pharmaceutical
company is also selling other product.

[But] we couldn't afford to get it out there as effectively and
efficiently as it could be through the 'field force'."

Edmonds says he does not believe the arrangement could be
misinterpreted as an endorsement by Diabetes Australia of
AlphaPharm's products, "because the doctors are pretty smart
creatures ..."

Part of Diabetes Australia's 12-member federation, the NSW
division is responsible for national marketing and fundraising, and
has attracted a long, varied list of corporate sponsors. Under the
heading "corporate sponsorship and branding opportunities", the
NSW website boasts that its campaigns provide "excellent return
on investment", and says the BGL campaign offers "unique
branding and market expansion opportunities for all types of

Edmonds says good publicity is the only benefit pharmaceutical
sponsors like AlphaPharm and Abbott get from their involvement,
and no sponsor has ever pressed him to get more for its money.

This year, Edmonds says, only AlphaPharm, Merck and Novo
Nordisk have supported the organisation, giving $100,000, not
including non-financial aid such as visiting doctors.

In the past few years, Diabetes Australia has also had support
from other diabetes drug producers, such as Aventis, Bayer, Eli
Lilly, GlaxoSmithKline, Parke-Davis (now part of Pfizer), Roche and

Meet Puff the purple dragon 
Last year Puff became the public face of a new National Asthma
Council awareness campaign to encourage asthmatics to better
manage their medications.

But Puff had had an earlier existence as the registered trademark
used by the international pharmaceutical giant GlaxoSmithKline to
market one of its asthma drugs, Seretide, to doctors. His colour
matches Seretide's packaging.

It was GlaxoSmithKline's idea for the NAC to give Puff a new,
much more public role encouraging asthmatics to update their
medication regimes.

GlaxoSmithKline, the world's biggest seller of asthma medications,
also provides financial support for the television campaign and to
develop an interactive internet quiz for the NAC website to check
whether someone's asthma is under control.

The NAC's chief executive, Kristine Whorlow, defended the use of
a pharmaceutical company logo to spearhead the campaign,
saying market research before the campaign showed there was no
public recognition of Puff. The board of the council, which is the
peak asthma body in Australia, also discussed potential conflicts of

Whorlow said the Puff campaign, every word of which was vetted
by the NAC, had been especially successful in targeting children. It
is not surprising that the NAC and GlaxoSmithKline should work so
closely together. GlaxoSmithKline was the founding sponsor of the
council when it was first launched more than a decade ago and
remains its principal source of funds. According to the NAC's
website, other sponsors in 2002 included the pharmaceutical
companies AstraZeneca, Aventis, Boehringer Ingelheim,
Schering-Plough, Merck, Novartis and Proctor and Gamble.

According to Whorlow, up to 60 per cent of the council's annual
budget of between $800,000 and $1 million comes from
international pharmaceutical companies. When the council
launched a new edition of its Asthma Management Handbook last
year, GlaxoSmithKline was the sponsor. A Newspoll survey
released at the launch showing 50 per cent of asthmatics were not
taking their medications as prescribed had been provided by
GlaxoSmithKline's public relations company, Hill and Knowlton.

The strategy of targeting patient groups to increase its market has
been successful for GlaxoSmithKline. In December last year a
briefing paper prepared by Hill and Knowlton boasted
GlaxoSmithKline had become the "number one partner" in patient
groups and associations, established strong relationships with
physicians and "did the same lobbying in the clinical development
of the product" to become the market leader in selling respiratory

Whorlow accepted that pharmaceutical companies view
sponsorship as a marketing exercise. "The reality of having a
sponsorship ... is that they want an advantage out of it," she said.
"It may be general good corporate citizenship, but more often
nowadays, to be absolutely realistic about sponsorship, it is
because of increased market share."

Whorlow said the NAC and its sponsors had the common goal of
having "more people on long-term preventative medication so they
don't experience serious asthma symptoms".

The independence of the council was protected by strict guidelines,
including the retention of editorial control over publications and the
ability of NAC spokespeople to speak freely. But the guidelines
also keep secret the details of individual sponsorships, including
the amounts involved.

"We would never be associated with anything that put forward a
wrong or incorrect message," Whorlow said.

The NAC also uses World Asthma Day in May each year as a key
part of its strategy to raise community awareness. Since 1998
World Asthma Day has been co-ordinated by an organisation
called the Global Initiative for Asthma, or GINA. GINA, according to
its website, is sponsored entirely by international pharmaceutical
companies, including GlaxoSmithKline.


New sex 'ailment' could be a purple patch

Don't worry if you haven't yet heard of Hypoactive Sexual Desire
Disorder in women. You will. HSDD is a new medical disorder for
which international pharmaceutical companies are racing to
provide a range of hormone-based drugs.

The disorder is so broadly defined - symptoms include an absence
of fantasies and lack of sexual desire - and the potential profits so
enormous that pharmaceutical companies were forced to deny
allegations in the British Medical Journal earlier this year that they
had invented it to sell drugs.

One of the companies in the race for the huge HSDD profits is the
American giant Procter and Gamble. A clinical trial partly done in
Australia by the Melbourne-based Jean Hailes Foundation is cited
as key evidence for the effectiveness of a testosterone patch for
women which Procter and Gamble developed. And Procter and
Gamble funded the trial.

In October Procter and Gamble also paid for the foundation's
research director, Professor Susan Davies, to fly to San Antonio in
Texas to present the findings of the study at a meeting of the
American Society for Reproductive Medicine.

Davis, who has previously declared accepting honorariums for
lectures and consulting from drug companies Organon, Novartis
and Servier, insists she is staunchly opposed to "disease
mongering" by pharmaceutical corporations. "We shouldn't be
creating a disease out of it [but] for those who have a problem, it
shouldn't be that we shouldn't seek options."

Last year the giant Dutch pharmaceutical company Organon flew
Davis to France to take part in a meeting it sponsored to discuss
"the true impact of reduced sex drive" on menopausal women.
After the meeting Organon issued a media release saying doctors
underestimated the impact of reduced sex drive on women. It
quoted Davis as saying Organon's hormone product Livial
consistently improved sexual wellbeing in menopausal women,
unlike other hormone replacement therapies, and praising its lack
of side effects.

Davis now says the Organon-sponsored appearance in France
was, on reflection, a mistake but insists the trip to Texas was
justified because the clinical trial paid for by Proctor and Gamble
on their testosterone patches had been valid and important. "I was
clearly the best person to present this data because I was the most
knowledgeable about the data ...We shouldn't discredit really
quality research that is done by the pharmaceutical industry."

Davis was recently cleared by the Medical Practitioners Board of
Victoria after a complaint that she had failed to adequately disclose
her funding links to the pharmaceutical industry when publicly
discussing hormone replacement therapy.

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